Hirotada Kobayashi, Federico Angriman, Niall D Ferguson, Neill K J Adhikari
{"title":"高频振荡通气治疗急性呼吸窘迫综合征的异质性治疗效果：急性呼吸窘迫综合征振荡早期治疗（OSCILLATE）试验的事后分析》。","authors":"Hirotada Kobayashi, Federico Angriman, Niall D Ferguson, Neill K J Adhikari","doi":"10.1097/CCE.0000000000001178","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>We sought to evaluate whether different subgroups of adults with acute respiratory distress syndrome (ARDS) respond differently to high-frequency oscillatory ventilation (HFOV).</p><p><strong>Design: </strong>The Oscillation for ARDS Treated Early (OSCILLATE) trial was a randomized controlled trial of HFOV vs. conventional ventilation that found an increased risk of in-hospital mortality (primary outcome) with HFOV. In a post hoc analysis, we applied three different approaches to evaluate heterogeneity of treatment effect for in-hospital mortality: 1) subgroup analyses based on baseline Pao<sub>2</sub>:Fio<sub>2</sub> ratio and oxygenation index (OI); 2) a risk-based approach using a multivariable outcome prediction model; and 3) a clustering approach via multivariable latent class analysis. We used multivariable logistic regression models to assess for interaction.</p><p><strong>Setting: </strong>Thirty-nine ICUs, five countries.</p><p><strong>Subjects: </strong>Five hundred forty-eight adults with moderate to severe ARDS.</p><p><strong>Interventions: </strong>HFOV vs. conventional mechanical ventilation with low tidal volume and higher positive end-expiratory pressure.</p><p><strong>Measurements and main results: </strong>The effect of HFOV on in-hospital mortality was consistent across categories of Pao<sub>2</sub>:Fio<sub>2</sub> ratio (adjusted odds ratio [aOR], 2.04; 95% CI, 1.32-3.17 and aOR, 1.16; 95% CI, 0.49-2.75 for groups with Pao<sub>2</sub>:Fio<sub>2</sub> above or equal to 80, vs. below 80, respectively; interaction <i>p</i> = 0.23) and OI (aOR, 1.78; 95% CI, 0.67-4.70; aOR, 3.19; 95% CI, 1.44-7.09; aOR, 1.73; 95% CI, 0.82-3.65; and aOR, 1.33; 95% CI, 0.61-2.90 for quartiles of baseline OI, respectively; interaction <i>p</i> = 0.44). Point estimates for the effect of HFOV were consistent across risk categories (aOR, 2.44; 95% CI, 0.40-14.83; aOR, 1.69; 95% CI, 0.75-3.85; and aOR, 2.10; 95% CI, 0.59-7.54 for the lowest, moderate, and highest risk categories, respectively; interaction <i>p</i> = 0.32). Using a clustering approach, point estimates for HFOV were also consistent (cluster 1: aOR, 1.85; 95% CI, 1.15-3.00 and cluster 2: aOR, 1.75; 95% CI, 0.91-3.38; interaction <i>p</i> = 0.75).</p><p><strong>Conclusions: </strong>We did not identify heterogeneity in the effect of HFOV across different subgroups of patients with ARDS.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 11","pages":"e1178"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548902/pdf/","citationCount":"0","resultStr":"{\"title\":\"Heterogeneous Treatment Effects of High-Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome: A Post Hoc Analysis of the Oscillation for Acute Respiratory Distress Syndrome Treated Early (OSCILLATE) Trial.\",\"authors\":\"Hirotada Kobayashi, Federico Angriman, Niall D Ferguson, Neill K J Adhikari\",\"doi\":\"10.1097/CCE.0000000000001178\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>We sought to evaluate whether different subgroups of adults with acute respiratory distress syndrome (ARDS) respond differently to high-frequency oscillatory ventilation (HFOV).</p><p><strong>Design: </strong>The Oscillation for ARDS Treated Early (OSCILLATE) trial was a randomized controlled trial of HFOV vs. conventional ventilation that found an increased risk of in-hospital mortality (primary outcome) with HFOV. In a post hoc analysis, we applied three different approaches to evaluate heterogeneity of treatment effect for in-hospital mortality: 1) subgroup analyses based on baseline Pao<sub>2</sub>:Fio<sub>2</sub> ratio and oxygenation index (OI); 2) a risk-based approach using a multivariable outcome prediction model; and 3) a clustering approach via multivariable latent class analysis. We used multivariable logistic regression models to assess for interaction.</p><p><strong>Setting: </strong>Thirty-nine ICUs, five countries.</p><p><strong>Subjects: </strong>Five hundred forty-eight adults with moderate to severe ARDS.</p><p><strong>Interventions: </strong>HFOV vs. conventional mechanical ventilation with low tidal volume and higher positive end-expiratory pressure.</p><p><strong>Measurements and main results: </strong>The effect of HFOV on in-hospital mortality was consistent across categories of Pao<sub>2</sub>:Fio<sub>2</sub> ratio (adjusted odds ratio [aOR], 2.04; 95% CI, 1.32-3.17 and aOR, 1.16; 95% CI, 0.49-2.75 for groups with Pao<sub>2</sub>:Fio<sub>2</sub> above or equal to 80, vs. below 80, respectively; interaction <i>p</i> = 0.23) and OI (aOR, 1.78; 95% CI, 0.67-4.70; aOR, 3.19; 95% CI, 1.44-7.09; aOR, 1.73; 95% CI, 0.82-3.65; and aOR, 1.33; 95% CI, 0.61-2.90 for quartiles of baseline OI, respectively; interaction <i>p</i> = 0.44). Point estimates for the effect of HFOV were consistent across risk categories (aOR, 2.44; 95% CI, 0.40-14.83; aOR, 1.69; 95% CI, 0.75-3.85; and aOR, 2.10; 95% CI, 0.59-7.54 for the lowest, moderate, and highest risk categories, respectively; interaction <i>p</i> = 0.32). Using a clustering approach, point estimates for HFOV were also consistent (cluster 1: aOR, 1.85; 95% CI, 1.15-3.00 and cluster 2: aOR, 1.75; 95% CI, 0.91-3.38; interaction <i>p</i> = 0.75).</p><p><strong>Conclusions: </strong>We did not identify heterogeneity in the effect of HFOV across different subgroups of patients with ARDS.</p>\",\"PeriodicalId\":93957,\"journal\":{\"name\":\"Critical care explorations\",\"volume\":\"6 11\",\"pages\":\"e1178\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-11-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548902/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical care explorations\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/CCE.0000000000001178\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical care explorations","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/CCE.0000000000001178","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Heterogeneous Treatment Effects of High-Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome: A Post Hoc Analysis of the Oscillation for Acute Respiratory Distress Syndrome Treated Early (OSCILLATE) Trial.
Objectives: We sought to evaluate whether different subgroups of adults with acute respiratory distress syndrome (ARDS) respond differently to high-frequency oscillatory ventilation (HFOV).
Design: The Oscillation for ARDS Treated Early (OSCILLATE) trial was a randomized controlled trial of HFOV vs. conventional ventilation that found an increased risk of in-hospital mortality (primary outcome) with HFOV. In a post hoc analysis, we applied three different approaches to evaluate heterogeneity of treatment effect for in-hospital mortality: 1) subgroup analyses based on baseline Pao2:Fio2 ratio and oxygenation index (OI); 2) a risk-based approach using a multivariable outcome prediction model; and 3) a clustering approach via multivariable latent class analysis. We used multivariable logistic regression models to assess for interaction.
Setting: Thirty-nine ICUs, five countries.
Subjects: Five hundred forty-eight adults with moderate to severe ARDS.
Interventions: HFOV vs. conventional mechanical ventilation with low tidal volume and higher positive end-expiratory pressure.
Measurements and main results: The effect of HFOV on in-hospital mortality was consistent across categories of Pao2:Fio2 ratio (adjusted odds ratio [aOR], 2.04; 95% CI, 1.32-3.17 and aOR, 1.16; 95% CI, 0.49-2.75 for groups with Pao2:Fio2 above or equal to 80, vs. below 80, respectively; interaction p = 0.23) and OI (aOR, 1.78; 95% CI, 0.67-4.70; aOR, 3.19; 95% CI, 1.44-7.09; aOR, 1.73; 95% CI, 0.82-3.65; and aOR, 1.33; 95% CI, 0.61-2.90 for quartiles of baseline OI, respectively; interaction p = 0.44). Point estimates for the effect of HFOV were consistent across risk categories (aOR, 2.44; 95% CI, 0.40-14.83; aOR, 1.69; 95% CI, 0.75-3.85; and aOR, 2.10; 95% CI, 0.59-7.54 for the lowest, moderate, and highest risk categories, respectively; interaction p = 0.32). Using a clustering approach, point estimates for HFOV were also consistent (cluster 1: aOR, 1.85; 95% CI, 1.15-3.00 and cluster 2: aOR, 1.75; 95% CI, 0.91-3.38; interaction p = 0.75).
Conclusions: We did not identify heterogeneity in the effect of HFOV across different subgroups of patients with ARDS.
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