Abstract
Background: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59–78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57–77] vs 74 [64–80] years, p < 0.001) and had lower driving (12 [8–16] vs 15 [11–17] cmH2O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH2O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH2O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60–1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16–2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06–1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52–0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073.
Original language | English |
---|---|
Article number | 55 |
Number of pages | 12 |
Journal | Journal of Intensive Care |
Volume | 10 |
Issue number | 1 |
DOIs | |
Publication status | Published - 1 Dec 2022 |
Keywords
- Cardiogenic pulmonary edema
- Driving pressure
- Mechanical ventilation
- Ventilator-induced lung injury
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In: Journal of Intensive Care, Vol. 10, No. 1, 55, 01.12.2022.
Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Mechanical ventilation in patients with cardiogenic pulmonary edema
T2 - a sub-analysis of the LUNG SAFE study
AU - Amado-Rodríguez, Laura
AU - Rodríguez-Garcia, Raquel
AU - Bellani, Giacomo
AU - Pham, Tài
AU - Fan, Eddy
AU - Madotto, Fabiana
AU - Laffey, John G.
AU - Albaiceta, Guillermo M.
AU - Pesenti, Antonio
AU - Brochard, Laurent
AU - Esteban, Andres
AU - Gattinoni, Luciano
AU - van Haren, Frank
AU - Larsson, Anders
AU - McAuley, Daniel F.
AU - Ranieri, Marco
AU - Rubenfeld, Gordon
AU - Taylor Thompson, B.
AU - Wrigge, Hermann
AU - Slutsky, Arthur S.
AU - Rios, Fernando
AU - Van Haren, Frank
AU - Sottiaux, Thierry
AU - Depuydt, Pieter
AU - Lora, Fredy S.
AU - Azevedo, Luciano Cesar
AU - Bugedo, Guillermo
AU - Qiu, Haibo
AU - Gonzalez, Marcos
AU - Silesky, Juan
AU - Cerny, Vladimir
AU - Nielsen, Jonas
AU - Jibaja, Manuel
AU - Wrigge, Hermann
AU - Matamis, Dimitrios
AU - Ranero, Jorge Luis
AU - Amin, Pravin
AU - Hashemian, S. M.
AU - Clarkson, Kevin
AU - Kurahashi, Kiyoyasu
AU - Villagomez, Asisclo
AU - Zeggwagh, Amine Ali
AU - Heunks, Leo M.
AU - Laake, Jon Henrik
AU - Palo, Jose Emmanuel
AU - do Vale Fernandes, Antero
AU - Sandesc, Dorel
AU - Arabi, Yaseen M.
AU - Bumbasierevic, Vesna
AU - Nin, Nicolas
AU - Lorente, Jose A.
AU - Larsson, Anders
AU - Piquilloud, Lise
AU - Abroug, Fekri
AU - McAuley, Daniel F.
AU - McNamee, Lia
AU - Hurtado, Javier
AU - Bajwa, Ed
AU - Démpaire, Gabriel
AU - Sula, Hektor
AU - Nunci, Lordian
AU - Cani, Alma
AU - Zazu, Alan
AU - Dellera, Christian
AU - Insaurralde, Carolina S.
AU - Las Lomas, Sanatorio
AU - Isidro, San
AU - Alejandro, Risso V.
AU - Daldin, Julio
AU - Vinzio, Mauricio
AU - Fernandez, Ruben O.
AU - Cardonnet, Luis P.
AU - Bettini, Lisandro R.
AU - Bisso, Mariano Carboni
AU - Osman, Emilio M.
AU - Setten, Mariano G.
AU - Lovazzano, Pablo
AU - Alvarez, Javier
AU - Villar, Veronica
AU - Pozo, Norberto C.
AU - Grubissich, Nicolas
AU - Plotnikow, Gustavo A.
AU - Vasquez, Daniela N.
AU - Ilutovich, Santiago
AU - Tiribelli, Norberto
AU - Chena, Ariel
AU - Pellegrini, Carlos A.
AU - Saenz, María G.
AU - Estenssoro, Elisa
AU - Brizuela, Matias
AU - Gianinetto, Hernan
AU - Gomez, Pablo E.
AU - Cerrato, Valeria I.
AU - Bezzi, Marco G.
AU - Borello, Silvina A.
AU - Loiacono, Flavia A.
AU - Fernandez, Adriana M.
AU - Knowles, Serena
AU - Reynolds, Claire
AU - Inskip, Deborah M.
AU - Miller, Jennene J.
AU - Kong, Jing
AU - Whitehead, Christina
AU - Bihari, Shailesh
AU - Seven, Aylin
AU - Krstevski, Amanda
AU - Rodgers, Helen J.
AU - Millar, Rebecca T.
AU - McKenna, Toni E.
AU - Bailey, Irene M.
AU - Hanlon, Gabrielle C.
AU - Aneman, Anders
AU - Lynch, Joan M.
AU - Azad, Raman
AU - Neal, John
AU - Woods, Paul W.
AU - Roberts, Brigit L.
AU - Kol, Mark R.
AU - Wong, Helen S.
AU - Riss, Katharina C.
AU - Staudinger, Thomas
AU - Wittebole, Xavier
AU - Berghe, Caroline
AU - Bulpa, Pierre A.
AU - Dive, Alain M.
AU - Verstraete, Rik
AU - Lebbinck, Herve
AU - Depuydt, Pieter
AU - Vermassen, Joris
AU - Meersseman, Philippe
AU - Ceunen, Helga
AU - Rosa, Jonas I.
AU - Beraldo, Daniel O.
AU - Piras, Claudio
AU - Rampinelli, Adenilton M.
AU - Nassar, Antonio P.
AU - Mataloun, Sergio
AU - Moock, Marcelo
AU - Thompson, Marlus M.
AU - Gonçalves, Claudio H.
AU - Antônio, Ana Carolina P.
AU - Ascoli, Aline
AU - Biondi, Rodrigo S.
AU - Fontenele, Danielle C.
AU - Nobrega, Danielle
AU - Sales, Vanessa M.
AU - BinHJAbul Wahab, Ahmad Yazid
AU - Ismail, Maizatul
AU - Shindhe, Suresh
AU - Laffey, John
AU - Beloncle, Francois
AU - Davies, Kyle G.
AU - Cirone, Rob
AU - Manoharan, Venika
AU - Ismail, Mehvish
AU - Goligher, Ewan C.
AU - Jassal, Mandeep
AU - Nishikawa, Erin
AU - Javeed, Areej
AU - Curley, Gerard
AU - Rittayamai, Nuttapol
AU - Parotto, Matteo
AU - Ferguson, Niall D.
AU - Mehta, Sangeeta
AU - Knoll, Jenny
AU - Pronovost, Antoine
AU - Canestrini, Sergio
AU - Bruhn, Alejandro R.
AU - Garcia, Patricio H.
AU - Aliaga, Felipe A.
AU - Farías, Pamela A.
AU - Yumha, Jacob S.
AU - Ortiz, Claudia A.
AU - Salas, Javier E.
AU - Saez, Alejandro A.
AU - Vega, Luis D.
AU - Labarca, Eduardo F.
AU - Martinez, Felipe T.
AU - Carreño, Nicolás G.
AU - Lora, Pilar
AU - Liu, Haitao
AU - Qiu, Haibo
AU - Liu, Ling
AU - Tang, Rui
AU - Luo, Xiaoming
AU - An, Youzhong
AU - Zhao, Huiying
AU - Gao, Yan
AU - Zhai, Zhe
AU - Ye, Zheng L.
AU - Wang, Wei
AU - Li, Wenwen
AU - Li, Qingdong
AU - Zheng, Ruiqiang
AU - Yu, Wenkui
AU - Shen, Juanhong
AU - Li, Xinyu
AU - Yu, Tao
AU - Lu, Weihua
AU - Wu, Ya Q.
AU - Huang, Xiao B.
AU - He, Zhenyang
AU - Lu, Yuanhua
AU - Han, Hui
AU - Zhang, Fan
AU - Sun, Renhua
AU - Wang, Hua X.
AU - Qin, Shu H.
AU - Zhu, Bao H.
AU - Zhao, Jun
AU - Liu, Jian
AU - Li, Bin
AU - Liu, Jing L.
AU - Zhou, Fa C.
AU - Li, Qiong J.
AU - Zhang, Xing Y.
AU - Li-Xin, Zhou
AU - Xin-Hua, Qiang
AU - Jiang, Liangyan
AU - Gao, Yuan N.
AU - Zhao, Xian Y.
AU - Li, Yuan Y.
AU - Li, Xiao L.
AU - Wang, Chunting
AU - Yao, Qingchun
AU - Yu, Rongguo
AU - Chen, Kai
AU - Shao, Huanzhang
AU - Qin, Bingyu
AU - Huang, Qing Q.
AU - Zhu, Wei H.
AU - Hang, Ai Y.
AU - Hua, Ma X.
AU - Li, Yimin
AU - Xu, Yonghao
AU - Di, Yu D.
AU - Ling, Long L.
AU - Qin, Tie H.
AU - Wang, Shou H.
AU - Qin, Junping
AU - Han, Yi
AU - Zhou, Suming
AU - Vargas, Monica P.
AU - Jimenez, Juan I.Silesky
AU - Rojas, Manuel A.González
AU - Duranteau, Jacques
AU - Nichol, Alistair
AU - Mochizuki, Katsunori
AU - Newby, Lynette
AU - McArthur, Colin
AU - LUNG SAFE Investigators
N1 - Funding Information: Supported by Centro de Investigación Biomédica en Red (CIBER)-Enfermedades respiratorias, Madrid, Spain (CB17/06/00021) and Fundación para el Fomento en Asturias de la Investigación Científica aplicada y la tecnología (FICYT, AYUD2021/52014). RRG is the recipient of a grant from Instituto de Salud Carlos III, Madrid, Spain (CM20/00083). Publisher Copyright: © 2022, The Author(s).
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59–78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57–77] vs 74 [64–80] years, p < 0.001) and had lower driving (12 [8–16] vs 15 [11–17] cmH2O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH2O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH2O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60–1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16–2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06–1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52–0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073.
AB - Background: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59–78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57–77] vs 74 [64–80] years, p < 0.001) and had lower driving (12 [8–16] vs 15 [11–17] cmH2O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH2O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH2O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60–1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16–2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06–1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52–0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073.
KW - Cardiogenic pulmonary edema
KW - Driving pressure
KW - Mechanical ventilation
KW - Ventilator-induced lung injury
UR - http://www.scopus.com/inward/record.url?scp=85144937794&partnerID=8YFLogxK
U2 - 10.1186/s40560-022-00648-x
DO - 10.1186/s40560-022-00648-x
M3 - Article
C2 - 36567347
AN - SCOPUS:85144937794
SN - 2052-0492
VL - 10
JO - Journal of Intensive Care
JF - Journal of Intensive Care
IS - 1
M1 - 55
ER -