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2020, Number 4

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Med Crit 2020; 34 (4)

Impact of alveolar distention pressure on days under mechanical ventilation in patients with acute respiratory distress syndrome (SDRA)

Cardoso-Ramírez MA, González-Prado I, Martínez-Medel AG, Islas-Mejía E, Deloya-Tomás E, Pérez-Nieto OR, Zamarrón-López EI, Guerrero-Gutiérrez MA, Soriano-Orozco R

Language: Spanish
References: 30
Page: 231-237
PDF size: 235.77 Kb.


ABSTRACT

Introduction: ARDS is characterized by a heterogeneity of damage in the lung parenchyma and the association between tidal volume (Vt) and static lung compliance (Cst) can be evaluated by DP. Most studies on DP and ARDS focus on mortality, showing a lower percentage of survival while the level of DP is higher, however, it is unknown until today whether the control of DP impacts on other objectives such as decrease of days under mechanical ventilation.
Material and methods: A systematic review of medical articles in Pubmed, EMBASE and Medigraphic was carried out with key words: driving pressure and acute respiratory distress syndrome to relate DP and days free of mechanical ventilation in the main studies on ARDS, analyzing the respiratory variables reported by these publications.
Results: The relationship was found in the systematized review; that patients ventilated with ARDS and DP ‹ 15 cmH2O was associated with fewer days of mechanical ventilation with a p = 0.03, patients with ARDS and DP ‹ 15 cmH2O comparing mortality at 90 days, decreased their mortality with p ≤ 0.0001, patients without ARDS and PD ‹ 15 cm cmH2O comparing mortality at 28 days with p = 0.005, patients with ARDS and DP association of postoperative pulmonary complications and DP ‹ 15 cmH2O, DP values greater than 15 cmH2O was associated with barotrauma, postoperative pulmonary infections, with a p ≤ 0.0001 of, in survival and mortality at 90 days, correlated with a odds ratio (OR) of 0.60 in favor of DP less than 15 cmH2O and in mortality at 28 days with an OR of 0.29, in favor of DP below 15 cmH2O. Discussion: DP is associated with mortality in a directly proportional way.
Conclusion: Lower values of DP are associated with fewer days of mechanical ventilation.


REFERENCES

  1. Tonetti T, Vasques F, Rapetti F, Maiolo G, Collino F, Romitti F, et al. Driving pressure and mechanical power: new targets for VILI prevention. Ann Transl Med. 2017;5(14):286.

  2. Thompson B, Chambers R, Liu K. Acute respiratory distress syndrome. N Engl J Med. 2017;377:562-572.

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

  4. Kacmarek RM, Villar J, Sulemanji D, Montiel R, Ferrando C, Blanco J, et al. Open lung approach for the acute respiratory distress syndrome: a pilot, randomized controlled trial. Crit Care Med. 2016;44:32-42.

  5. Terragni PP, Rosboch G, Tealdi A, Corno E, Menaldo E, Davini O, et al. Tidal hyperinflation during low tidal volumen ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2007;175:160-166.

  6. Sreedhara JK, Algahtani JS. Driving pressure: clinical applications and implications in the intensive care units. Indian J Respir Care. 2018;7:62-66.

  7. Domenico LG, Lu CH, Martin, Laurent B. Should we use driving pressure to set tidal volume? Curr Opin Crit Care. 2017;23(1):38-44.

  8. 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.

  9. Yoshida T, Fujino Y, Amato MB, Kavanagh BP. Spontaneous breathing during mechanical ventilation. risks, mechanisms, and management. Am J Respir Crit Care Med. 2017;195(8):985-992.

  10. Bruhn A, Bugedo D, Riquelme F, Varas J, Retamal J, Besa C, et al. Tidal volume is a major determinat of cyclic recruitment in acute respiratory distress syndrome. Minerva Anestesil. 2011;77(4):48-26.

  11. Goligher EC, Ferguson ND, Brochard LJ. Clinical challenges in mechanical ventilation. Lancet. 2016;387:1856-1866.

  12. Marini JJ, Jaber S. Dynamic predictors of VILI risk: beyond the driving pressure. Intensive Care Med. 2016;42(10):1597-600.

  13. Simonis FD, Barbas CS, Artigas-Raventós A, Canet J, Determann RM, Anstey J, et al. Potentially modifiable respiratory variables contributing to outcome in ICU patients with ARDS: a secondary analysis of PROVENT. Ann Intensive Care. 2018;8(1):39.

  14. Pérez-Nieto OR, Deloya-Tomás E, Lomelí-Terán J, Pozos-Cortés K, Monares-Zepeda E, Poblano-Morales M. Presión de distension (driving pressure): principal objetivo para la protección alveolar. Neumol Cir Tor. 2018;77(3):222-227.

  15. Carrasco R, Villamizar G, Medel N. Ventilator-induced lung injury (VILI) in acute respiratory distress syndrome (ARDS): volutrauma and molecular effects. Open RespirMed J. 2015;9:112-119.

  16. Passos AM, Valente BC, Machado MD, Borges MR, Pinto SG, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338(6):347-354.

  17. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-1308.

  18. Cavalcanti AB, Suzumura ÉA, Laranjeira LN, Damiani LP, Guimarães LP, Romano ER, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (peep) vs low peep on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2017;318(14):1335-1345.

  19. Serpa NA, 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.

  20. 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.

  21. Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, et al. Ventilation strategy using lo tidal volumes, recruitment maneuvers, and high positive end expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299(6):637-645.

  22. Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299(6):646-655.

  23. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159-2168.

  24. Rosas K, Gutiérrez D, Cerón U. Asociación y valor predictivo del poder mecánico con los días libres de ventilación mecánica. Med Crit. 2017;31(6):320-325.

  25. Boissier F, Katsahian S, Razazi K, Thille AW, Roche-Campo F, Leon R. Prevalence and prognosis of Cor pulmonale during protective ventilation for acute respiratory distress syndrome. Intensive Care Med. 2013;39:1725-1733.

  26. Mekontso DA, Boissier F, Charron C, Bégot E, Repessé X, Legras A, et al. Acute Cor Pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors and clinical impact. Intensive CareMed. 2016;42:862-870.

  27. Brunet J, Valette X, Buklas D, Lehoux P, Verrier P, Sauneuf B, et al. Predicting survival after extra corporeal membrane oxygenation for ARDS: an external validation of RESP and PRESERVE Scores. Respir Care. 2017;62:912-919.

  28. Fuller BM, Page D, Stephens RJ, Roberts BW, Drewry AM, Ablordeppey E, et al. Pulmonary mechanics and mortality in mechanically ventilated patients without acute respiratory distress syndrome: a cohort study. Shock. 2018;49:311-316.

  29. Chiu LC, Hu HC, Hung CY, Chang CH, Tsai FC, Yang CT, et al. Dynamic driving pressure associated mortality in acute respiratory distress syndrome with extracorporeal membrane oxygenation. Ann Intensive Care. 2017;7:12.

  30. Laffey JG, Bellani G, Pham T, Fan E, Madotto F, Bajwa EK, et al. Potentially modificable factors contributing to outcome from acute respiratory distress syndrome: the lung safe study. Critical Care Intensive Care Med. 2016;42:1865-1876.




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