MODIFICATION BY PRE-EXISTING COMORBIDITIESOF THE EFFECT OF ADHERENCE TO A LUNG-PROTECTIVE MECHANICAL VENTILATION STRATEGY IN A COHORT OF PATIENTS WITH THE ACUTE RESPIRATORY DISTRESS SYNDROME

acute respiratory distress syndrome;ventilation;Clinical Investigation

Simmons, DellNeedham, Dale M. ;

Johns Hopkins University

关键词: acute respiratory distress syndrome;    ventilation;    Clinical Investigation;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39250/4-18%20Simmons%20final%20with%20footnotes.pages?sequence=4&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Statement of the problem:Literature suggests that the incidence of and outcomes following Acute Respiratory Distress Syndrome (ARDS) vary with the presence of certain chronic comorbidities, possibly due to alterations in the innate immune system.We sought to determine whether the association of lung-protective ventilation (LPV), defined by tidal volumes ≤6.5 ml/ kg predicted body weight and plateau pressures ≤30 cm H2O, with ICU survival was modified by the presence of certain comorbidities.Methods:Multi-variable, time-varying Cox regression analysis of a multisite, prospective cohort study of 485 patients with baseline assessment of seven comorbidities potentially associated with ARDS progression.Analyses included adjustment for twice-daily assessment of tidal volume and other respiratory variables and daily assessment of other mortality predictors.Effect modification between the effect of LPV and each of seven comorbidities was assessed by a statistical interaction term.Results:The prevalence of comorbidities was as follows:119 (25%) had excess alcohol use histories, 112 (23%) diabetes, 69 (14%) HIV disease, 51 (11%) injection drug use within past 30 days, 48 (9.9%) moderate or severe liver disease, 42 (8.7%) hematologic malignancy history, and 36 (7.4%) rheumatologic disease.The adjusted hazard ratio (HR) for mortality for each 12-hour period of LPV-ventilation was 0.96 (95% CI:0.93-1.00; p=0.041).Only hematologic malignancy demonstrated a significant interaction (p=0.039 for interaction) with LPV, with HRs for each 12-hour period with LPV in patients with vs. without this comorbidity of 1.03 (95% CI 0.94-1.12) and 0.96 (95% CI 0.93-1.00), respectively.Conclusions:There was limited support for the hypothesis that LPV’s protective effect may be modified by the presence or absence of certain comorbidities present before ARDS onset.Of seven comorbidities tested only a history of hematologic malignancy demonstrated a significant interaction with the effect of LPV adherence, with LPV having no protective effect in patients with this comorbidity.