Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury.

Autor: Tejerina E; Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: evateje@gmail.com., Pelosi P; Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, Genoa, Italy., Muriel A; Unidad de Bioestadística Clínica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Spain., Peñuelas O; Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain., Sutherasan Y; Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand., Frutos-Vivar F; Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain., Nin N; Hospital Universitario de Montevideo, Uruguay., Davies AR; Alfred Hospital & Monash University, Melbourne, Australia., Rios F; Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina., Violi DA; Hospital HIGA Guemes, Haedo, Argentina., Raymondos K; Medizinische Hochschule Hannover, Germany., Hurtado J; Hospital de Clínicas de Montevideo, Montevideo, Uruguay., González M; Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia., Du B; Peking Union Medical College Hospital, Beijing, People's Republic of China., Amin P; Bombay Hospital Institute of Medical Sciences, Mumbai, India., Maggiore SM; Policlinico 'Agostino Gemelli', Università Cattolica Del Sacro Cuore, Roma, Italy., Thille AW; University Hospital of Poitiers, Poitiers, France., Soares MA; Hospital Universitario Sao Jose, Belo Horizonte, Brazil., Jibaja M; Hospital Eugenio Espejo, Quito, Ecuador., Villagomez AJ; Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México DF, México., Kuiper MA; Medical Center Leeuwarden (MCL), Leeuwarden, The Netherlands., Koh Y; Asan Medical Center, University of Ulsan, Seoul, Republic of Korea., Moreno RP; Hospital de Sao José, Centro Hospitalar de Lisboa Central, Lisbon, Portugal., Zeggwagh AA; Hôpital Ibn Sina, Rabat, Morocco., Matamis D; Papageorgiou Hospital, Thessaloniki, Greece., Anzueto A; South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, TX, USA., Ferguson ND; Interdepartmental Division of Critical Care Medicine, and Departments of Medicine & Physiology, University of Toronto, Canada., Esteban A; Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2017 Apr; Vol. 38, pp. 341-345. Date of Electronic Publication: 2016 Nov 18.
DOI: 10.1016/j.jcrc.2016.11.010
Abstrakt: Purpose: In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury.
Materials and Methods: We performed a secondary analysis of a prospective, observational study on mechanical ventilation.
Results: We included 986 patients mechanically ventilated due to an acute brain injury (hemorrhagic stroke, ischemic stroke or brain trauma). Incidence of ARDS in this cohort was 3%. Multivariate analysis suggested that driving pressure could be associated with the development of ARDS (odds ratio for unit increment of driving pressure 1.12; confidence interval for 95%: 1.01 to 1.23) whereas we did not observe association for tidal volume (in ml per kg of predicted body weight) or level of PEEP. ARDS was associated with an increase in mortality, longer duration of mechanical ventilation, and longer ICU length of stay.
Conclusions: In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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