medigraphic.com
ISSN 2448-8909 (Print)

2019, Number 2

<< Back Next >>

Med Crit 2019; 33 (2)

Driving pressure as a prognostic factor of mortality in the critical patient with obesity and acute respiratory distress syndrome

Guerrero ORK, Gómez GMN, Soriano OR, Hernández MA, González CPL

Language: Spanish
References: 19
Page: 79-83
PDF size: 253.96 Kb.


ABSTRACT

Introduction: Pulmonary distension pressure (ΔP) has been shown to be the physical variable that best correlates with survival in patients with acute respiratory distress syndrome, suggesting a protective value ‹15 cmH2O.
Objective: The purpose was to identify if the values ​​of ΔP as safety margin described are a prognostic factor of mortality, applied in obese patients with acute respiratory distress syndrome in the ICU.
Methods: Longitudinal, prospective, observational study, carried out in the Intensive Care Unit (ICU) of the Bajío National Medical Center UMAE 1, Guanajuato, from January to July 2018. 47 patients› 18 years old and BMI› 30 were admitted. with diagnosis of ARDS under invasive mechanical ventilation. The ΔP and Pplat were recorded at 24, 48 and 72 hours after admission.
Results: A significant difference was found in both ΔP and Pplat (p ‹0.05) at 24 hrs, being 14.08 ± 5 (12-20) in the group of survivors and 16.56 ± 3 (12-21) in non-survivors.
Conclusion: It was observed that maintaining ΔP and Pplat in ranges ‹15 and ‹30 respectively, in the first 24 hrs has an impact on the mortality of these patients.


REFERENCES

  1. Algaba A, Nin N, GT-IRA de la SEMICYUC. Maniobras de reclutamiento alveolar en el síndrome de distrés respiratorio agudo. Med. Intensiva. 2013;37(5):355-362.

  2. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788-800.

  3. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):2126-2136.

  4. De Lucas-Ramos P, Rodríguez González Moro JM, Rubio-Socorro Y. Obesidad y función pulmonar. Arch Bronconeumol. 2004;40 Supl 5:27-31.

  5. Espínola-Rodríguez A, Lores-Obradors L, Parellada-Esquius N, Rubio-Muñoz F, Espinosa-González N, Arellano Marcuello E. Síndrome de obesidad-hipoventilación y factores asociados. Med Clin. 2018;150(4):e7-e8.

  6. Amundson DE, Djurkovic S, Matwiyoff GN. The obesity paradox. Crit Care Clin. 2010;26(4):583-596.

  7. Ortiz C, Salas J, Ferreira L, Hermosilla JE. Protocolo de weaning rápido en pacientes obesos mórbidos con ventilación mecánica no invasiva postextubación. Rev Chil Med Intensiva. 2011;26(4):203-208.

  8. De Jong A, Chanques G, Jaber S. Mechanical ventilation in obese ICU patients: from intubation to extubation. Crit Care. 2017;21(1):63.

  9. Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest. 2006;130(3):827-833.

  10. Ashburn DD, DeAntonio A, Reed MJ. Pulmonary system and obesity. Crit Care Clin. 2010;26(4):597-602.

  11. Grieco DL, Chen L, Dres M, Brochard L. Should we use driving pressure to set tidal volume? Curr Opin Crit Care. 2017;23(1):38-44.

  12. Chiumello D, Carlesso E, Brioni M, Cressoni M. Airway driving pressure and lung stress in ARDS patients. Crit Care. 2016;20:276.

  13. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747-755.

  14. Bugedo G, Retamal J, Bruhn A. Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation? Crit Care. 2017;21(1):199.

  15. Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016;4(4):272-280.

  16. Maia LA, Samary CS, Oliveira MV, Santos CL, Huhle R, Capelozzi VL, et al. Impact of different ventilation strategies on driving pressure, mechanical power, and biological markers during open abdominal surgery in rats. Anesth Analg. 2017;125(4):1364-1374.

  17. Laffey JG, Bellani G, Pham T, Fan E, Madotto F, Bajwa EK, et al. Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med. 2016;42(12):1865-1876.

  18. De Jong A, Cossic J, Verzilli D, Monet C, Carr J, Conseil M, et al. Impact of the driving pressure on mortality in obese and non-obese ARDS patients: a retrospective study of 362 cases. Intensive Care Med. 2018;44(7):1106-1114.

  19. Villar Jesús, Martin-Rodríguez Carmen, Domínguez-Berrot Ana M. and cols. A Quantile Analysis of Plateau and Driving Pressures: Effects on Mortality in Patients With Acute Respiratory Distress Syndrome Receiving Lung-Protective Ventilation. Critical Care Medicine. 2017 (1-8).




2020     |     www.medigraphic.com