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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2018

Open Access 01-12-2018 | Research

Driving pressure and long-term outcomes in moderate/severe acute respiratory distress syndrome

Authors: Carlos Toufen Junior, Roberta R. De Santis Santiago, Adriana S. Hirota, Alysson Roncally S. Carvalho, Susimeire Gomes, Marcelo Brito Passos Amato, Carlos Roberto Ribeiro Carvalho

Published in: Annals of Intensive Care | Issue 1/2018

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Abstract

Background

Acute respiratory distress syndrome (ARDS) patients may present impaired in lung function and structure after hospital discharge that may be related to mechanical ventilation strategy. The aim of this study was to evaluate the association between functional and structural lung impairment, N-terminal-peptide type III procollagen (NT-PCP-III) and driving pressure during protective mechanical ventilation. It was a secondary analysis of data from randomized controlled trial that included patients with moderate/severe ARDS with at least one follow-up visit performed. We obtained serial measurements of plasma NT-PCP-III levels. Whole-lung computed tomography analysis and pulmonary function test were performed at 1 and 6 months of follow-up. A health-related quality of life survey after 6 months was also performed.

Results

Thirty-three patients were enrolled, and 21 patients survived after 6 months. In extubation day an association between driving pressure and NT-PCP-III was observed. At 1 and 6 months forced vital capacity (FVC) was negatively correlated to driving pressure (p < 0.01). At 6 months driving pressure was associated with lower FVC independently on tidal volume, plateau pressure and baseline static respiratory compliance after adjustments (r2 = 0.51, p = 0.02). There was a significant correlation between driving pressure and lung densities and nonaerated/poorly aerated lung volume after 6 months. Driving pressure was also related to general health domain of SF-36 at 6 months.

Conclusion

Even in patients ventilated with protective tidal volume, higher driving pressure is associated with worse long-term pulmonary function and structure.
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Metadata
Title
Driving pressure and long-term outcomes in moderate/severe acute respiratory distress syndrome
Authors
Carlos Toufen Junior
Roberta R. De Santis Santiago
Adriana S. Hirota
Alysson Roncally S. Carvalho
Susimeire Gomes
Marcelo Brito Passos Amato
Carlos Roberto Ribeiro Carvalho
Publication date
01-12-2018
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2018
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-018-0469-4

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