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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Acute Respiratory Distress-Syndrome | Research

Risk factors for the development of acute respiratory distress syndrome in mechanically ventilated adults in Peru: a multicenter observational study

Authors: Ena Gupta, Shakir Hossen, Matthew R. Grigsby, Phabiola Herrera, Rollin Roldan, Enrique Paz, Amador A. Jaymez, Eduardo E. Chirinos, Jose Portugal, Rocio Quispe, Roy G. Brower, William Checkley, INTENSIVOS Cohort Study

Published in: Critical Care | Issue 1/2019

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Abstract

Background

Clinical and epidemiological differences between acute respiratory distress syndrome (ARDS) that presents at the initiation of mechanical ventilation [MV] (ARDS at MV onset) and that which develops during the course of MV (ARDS after MV onset) are not well understood. We conducted an observational study in five Peruvian ICUs to characterize differences between ARDS at MV onset and after MV onset and identify risk factors for the development of ARDS after MV onset.

Methods

We consecutively enrolled critically ill patients with acute respiratory failure requiring at least 24 h of mechanical ventilation and followed them prospectively during the first 28 days and compared baseline characteristics and clinical outcomes by ARDS status.

Results

We enrolled 1657 participants on MV (mean age 60.0 years, 55% males) of whom 334 (20.2%) had ARDS at MV onset and 180 (10.9%) developed ARDS after MV onset. Average tidal volume at the initiation of MV was 8.7 mL/kg of predicted body weight (PBW) for participants with ARDS at MV onset, 8.6 mL/kg PBW for those who developed ARDS after MV onset, and 8.5 mL/kg PBW for those who never developed ARDS (p = 0.23). Overall, 90-day mortality was 56% and 55% for ARDS after MV onset and ARDS at MV onset, respectively, as compared to 46% among those who never developed ARDS (p < 0.01). Adults with ARDS had a higher body mass index (BMI) than those without ARDS (27.3 vs 26.5 kg/m2, p < 0.01). Higher peak pressure (adjusted interquartile OR = 1.51, 95% CI 1.21–1.88), higher mean airway pressure (adjusted interquartile OR = 1.41, 95% CI 1.13–1.76), and higher positive end-expiratory pressure (adjusted interquartile OR = 1.29, 95% CI 1.10–1.50) at MV onset were associated with a higher odds of developing ARDS after MV onset.

Conclusions

In this study of mechanically ventilated patients, 31% of study participants had ARDS at some point during their ICU stay. Optimal lung-protective ventilation was not used in a majority of patients. Patients with ARDS after MV onset had a similar 90-day mortality as those with ARDS at MV onset. Higher airway pressures at MV onset, higher PEEP, and higher BMI were associated with the development of ARDS after MV onset.
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Literature
1.
Task Force ARDS, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33.
2.
3.
Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685–93.CrossRefPubMed
4.
Bersten AD, Edibam C, Hunt T, Moran J, Australian, Group NZICSCT. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states. Am J Respir Crit Care Med. 2002;165(4):443–8.CrossRefPubMed
5.
Estenssoro E, Dubin A, Laffaire E, Canales H, Saenz G, Moseinco M, et al. Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med. 2002;30(11):2450–6.CrossRefPubMed
6.
Villar J, Blanco J, Anon JM, Santos-Bouza A, Blanch L, Ambros A, et al. The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med. 2011;37(12):1932–41.CrossRefPubMed
7.
Laffey JG, Madotto F, Bellani G, Pham T, Fan E, Brochard L, et al. Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study. Lancet Respir Med. 2017;5(8):627–38.CrossRefPubMed
8.
Brochard L, Roudot-Thoraval F, Roupie E, Delclaux C, Chastre J, Fernandez-Mondéjar E, et al. Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The multicenter trial group on tidal volume reduction in ARDS. Am J Respir Crit Care Med. 1998;158(6):1831–8.CrossRefPubMed
9.
Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson BT; National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Eng J Med. 2004;351(4):327–36.
10.
Mercat A, Richard JM, Vielle B, 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):646–55.CrossRefPubMed
11.
12.
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Eng J Med. 2006;354(24):2564–75.
13.
Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159–68.CrossRefPubMed
14.
National Heart, Lung, and Blood Institute ARDS Clinical Trials Network, Truwit JD, Bernard GR, Steingrub J, Matthay MA, Liu KD, Albertson TE, Brower RG, Shanholtz C, Rock P, Douglas IS, deBoisblanc BP, Hough CL, Hite RD, Thompson BT. Rosuvastatin for sepsis-associated acute respiratory distress syndrome. N Eng J Med. 2014;370(23):2191–200.
15.
Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest. 2007;131(4):954–63.CrossRefPubMed
16.
17.
18.
Tripathi S, Kaur H, Kashyap R, Dong Y, Gajic O, Murthy S. A survey on the resources and practices in pediatric critical care of resource-rich and resource-limited countries. J Intensive Care. 2015;3:40.CrossRefPubMedPubMedCentral
19.
20.
Mehta AB, Syeda SN, Wiener RS, Walkey AJ. Epidemiological trends in invasive mechanical ventilation in the United States: a population-based study. J Crit Care. 2015;30(6):1217–21.CrossRefPubMedPubMedCentral
21.
Li G, Malinchoc M, Cartin-Ceba R, Venkata CV, Kor DJ, Peters SG, et al. Eight-year trend of acute respiratory distress syndrome: a population-based study in Olmsted County, Minnesota. Am J Respir Crit Care Med. 2011;183(1):59–66.CrossRefPubMed
22.
Denney JA, Capanni F, Herrera P, Dulanto A, Roldan R, Paz E, et al. Establishment of a prospective cohort of mechanically ventilated patients in five intensive care units in Lima, Peru: protocol and organisational characteristics of participating centres. BMJ Open. 2015;5(1):e005803.CrossRefPubMedPubMedCentral
23.
Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009;37(5):1649–54.CrossRefPubMedPubMedCentral
24.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–63.
25.
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100(6):1619–36.CrossRefPubMed
26.
Zhi G, Xin W, Ying W, Guohong X, Shuying L. “Obesity paradox” in acute respiratory distress syndrome: a systematic review and meta-analysis. PLoS ONE. 2016;11(9):e0163677.
27.
Determann RM, Royakkers A, Wolthuis EK, Vlaar AP, Choi G, Paulus F, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care. 2010;14(1):R1.CrossRefPubMedPubMedCentral
28.
Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, Pasqualucci Mde O, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308(16):1651–9.CrossRefPubMed
29.
Bellani G, Laffey JG, Pham T, 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.CrossRefPubMed
30.
Summers C, Singh NR, Worpole L, Simmonds R, Babar J, Condliffe AM, et al. Incidence and recognition of acute respiratory distress syndrome in a UK intensive care unit. Thorax. 2016;71(11):1050–1.CrossRefPubMed
31.
Karthikeyan B, Kadhiravan T, Deepanjali S, Swaminathan RP. Case-mix, care processes, and outcomes in medically-ill patients receiving mechanical ventilation in a low-resource setting from southern India: a prospective clinical case series. PLoS One. 2015;10(8):e0135336.CrossRefPubMedPubMedCentral
32.
Pisani L, Algera AG, Serpa Neto A, Ahsan A, Beane A, Chittawatanarat K, et al. PRactice of VENTilation in Middle-Income Countries (PRoVENT-iMIC): rationale and protocol for a prospective international multicentre observational study in intensive care units in Asia. BMJ Open. 2018;8(4):e020841.CrossRefPubMedPubMedCentral
33.
Azevedo LC, Park M, Salluh JI, Rea-Neto A, Souza-Dantas VC, Varaschin P, et al. Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care. 2013;17(2):R63.CrossRefPubMedPubMedCentral
34.
Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries. Eur J Anaesthesiol. 2017;34(8):492–507.
35.
Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Penuelas O, Abraira V, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med. 2013;188(2):220–30.CrossRefPubMed
36.
Neto AS, Barbas CSV, Simonis FD, Artigas-Raventos A, Canet J, Determann RM, et al.; PRoVENT; PROVE Network investigators. Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study. Lancet Respir Med. 2016;4(11):882–93.
37.
Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. 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):1301–8.CrossRefPubMed
38.
Sevransky JE, Checkley W, Herrera P, Pickering BW, Barr J, Brown SM, et al. Protocols and hospital mortality in critically ill patients: the United States critical illness and injury trials group critical illness outcomes study. Crit Care Med. 2015;43(10):2076–84.CrossRefPubMedPubMedCentral
39.
Needham DM, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Sevransky JE, Dennison Himmelfarb CR, et al. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012;344:e2124.CrossRefPubMedPubMedCentral
40.
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):747–55.CrossRefPubMed
41.
Pintado MC, de Pablo R, Trascasa M, Milicua JM, Rogero S, Daguerre M, et al. Individualized PEEP setting in subjects with ARDS: a randomized controlled pilot study. Respir Care. 2013;58(9):1416–23.CrossRefPubMed
42.
Aoyama H, Pettenuzzo T, Aoyama K, Pinto R, Englesakis M, Fan E. Association of driving pressure with mortality among ventilated patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med. 2018;46(2):300–6.CrossRefPubMed
43.
Guervilly C, Forel JM, Papazian L. Respiratory rate and peak inspiratory pressure, new targets from the LUNG SAFE study analysis or physiopathological artifacts? J Thorac Dis. 2017;9(2):225–7.CrossRefPubMedPubMedCentral
44.
Rich PB, Reickert CA, Sawada S, Awad SS, Lynch WR, Johnson KJ, et al. Effect of rate and inspiratory flow on ventilator-induced lung injury. J Trauma. 2000;49(5):903–11.CrossRefPubMed
45.
Protti A, Maraffi T, Milesi M, Votta E, Santini A, Pugni P, et al. Role of strain rate in the pathogenesis of ventilator-induced lung edema. Crit Care Med. 2016;44(9):e838–45.CrossRefPubMed
46.
Brander L, Slutsky AS. Invasive mechanical ventilation. In: Albert RK, Spiro SG, Jett JR, editors. Clinical respiratory medicine. 3rd ed. Philadelpia: Mosby/Elsevier; 2008. p. 233.
47.
Bernard GR, Lucht WD, Niedermeyer ME, Snapper JR, Ogletree ML, Brigham KL. Effect of N-acetylcysteine on the pulmonary response to endotoxin in the awake sheep and upon in vitro granulocyte function. J Clin Invest. 1984;73(6):1772–84.CrossRefPubMedPubMedCentral
48.
Snapper JR, Hutchison AA, Ogletree ML, Brigham KL. Effects of cyclooxygenase inhibitors on the alterations in lung mechanics caused by endotoxemia in the unanesthetized sheep. J Clin Invest. 1983;72(1):63–76.CrossRefPubMedPubMedCentral
49.
Hutchison AA, Hinson JM Jr, Brigham KL, Snapper JR. Effect of endotoxin on airway responsiveness to aerosol histamine in sheep. J Appl Physiol Respir Environ Exerc Physiol. 1983;54(6):1463–8.PubMed
50.
Dellacà RL, Zannin E, Sancini G, Rivolta I, Leone BE, Pedotti A, et al. Changes in the mechanical properties of the respiratory system during the development of interstitial lung edema. Respir Res. 2008;9(1):51.CrossRefPubMedPubMedCentral
51.
Fuller BM, Mohr NM, Drewry AM, Carpenter CR. Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review. Crit Care. 2013;17(1):R11.CrossRefPubMedPubMedCentral
52.
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):272–80.CrossRefPubMed
53.
Loffreda S, Yang SQ, Lin HZ, Karp CL, Brengman ML, Wang DJ, et al. Leptin regulates proinflammatory immune responses. FASEB J. 1998;12(1):57–65.CrossRefPubMed
54.
Shah D, Romero F, Guo Z, Sun J, Li J, Kallen CB, et al. Obesity-induced endoplasmic reticulum stress causes lung endothelial dysfunction and promotes acute lung injury. Am J Respir Cell Mol Biol. 2017;57(2):204–15.CrossRefPubMedPubMedCentral
55.
Bajwa EK, Yu CL, Gong MN, Thompson BT, Christiani DC. Pre-B-cell colony-enhancing factor gene polymorphisms and risk of acute respiratory distress syndrome. Crit Care Med. 2007;35(5):1290–5.CrossRefPubMed
56.
Gajic O, Dabbagh O, Park PK, Adesanya A, Chang SY, Hou P, et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med. 2011;183(4):462–70.CrossRefPubMed
Metadata
Title
Risk factors for the development of acute respiratory distress syndrome in mechanically ventilated adults in Peru: a multicenter observational study
Authors
Ena Gupta
Shakir Hossen
Matthew R. Grigsby
Phabiola Herrera
Rollin Roldan
Enrique Paz
Amador A. Jaymez
Eduardo E. Chirinos
Jose Portugal
Rocio Quispe
Roy G. Brower
William Checkley
INTENSIVOS Cohort Study
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2646-8

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