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

Open Access 01-12-2018 | Research

Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT

Authors: Fabienne D. Simonis, Carmen S. V. Barbas, Antonio Artigas-Raventós, Jaume Canet, Rogier M. Determann, James Anstey, Goran Hedenstierna, Sabrine N. T. Hemmes, Greet Hermans, Michael Hiesmayr, Markus W. Hollmann, Samir Jaber, Ignacio Martin-Loeches, Gary H. Mills, Rupert M. Pearse, Christian Putensen, Werner Schmid, Paolo Severgnini, Roger Smith, Tanja A. Treschan, Edda M. Tschernko, Marcos F. Vidal Melo, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J. Schultz, Ary Serpa Neto, For the PRoVENT investigators, The PROVE Network investigators

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

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Abstract

Background

The majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients.

Methods

The PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality. The primary endpoint was all-cause in-hospital mortality.

Results

935 Patients were included. In-hospital mortality was 21%. Compared to patients who died, patients who survived had a lower risk of ARDS according to the ‘Lung Injury Prediction Score’ and received lower maximum airway pressure (Pmax), driving pressure (ΔP), positive end-expiratory pressure, and FiO2 levels. Tidal volume size was similar between the groups. Higher Pmax was a potentially modifiable ventilatory variable associated with in-hospital mortality in multivariable analyses. ΔP was not independently associated with in-hospital mortality, but reliable values for ΔP were available for 343 patients only. Non-modifiable factors associated with in-hospital mortality were older age, presence of immunosuppression, higher non-pulmonary sequential organ failure assessment scores, lower pulse oximetry readings, higher heart rates, and functional dependence.

Conclusions

Higher Pmax was independently associated with higher in-hospital mortality in mechanically ventilated critically ill patients under mechanical ventilatory support for reasons other than ARDS.
Trial Registration ClinicalTrials.gov (NCT01868321).
Appendix
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Metadata
Title
Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT
Authors
Fabienne D. Simonis
Carmen S. V. Barbas
Antonio Artigas-Raventós
Jaume Canet
Rogier M. Determann
James Anstey
Goran Hedenstierna
Sabrine N. T. Hemmes
Greet Hermans
Michael Hiesmayr
Markus W. Hollmann
Samir Jaber
Ignacio Martin-Loeches
Gary H. Mills
Rupert M. Pearse
Christian Putensen
Werner Schmid
Paolo Severgnini
Roger Smith
Tanja A. Treschan
Edda M. Tschernko
Marcos F. Vidal Melo
Hermann Wrigge
Marcelo Gama de Abreu
Paolo Pelosi
Marcus J. Schultz
Ary Serpa Neto
For the PRoVENT investigators
The PROVE Network investigators
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/s13613-018-0385-7

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