Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Jornal Brasileiro de Pneumologia (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132021000100203 |
Resumo: | ABSTRACT Objective: To evaluate the association that protective mechanical ventilation (MV), based on VT and maximum distending pressure (MDP), has with mortality in patients at risk for ARDS. Methods: This was a prospective cohort study conducted in an ICU and including 116 patients on MV who had at least one risk factor for the development of ARDS. Ventilatory parameters were collected twice a day for seven days, and patients were divided into two groups (protective MV and nonprotective MV) based on the MDP (difference between maximum airway pressure and PEEP) or VT. The outcome measures were 28-day mortality, ICU mortality, and in-hospital mortality. The risk factors associated with the adoption of nonprotective MV were also assessed. Results: Nonprotective MV based on VT and MDP was applied in 49 (42.2%) and 38 (32.8%) of the patients, respectively. Multivariate Cox regression showed that protective MV based on MDP was associated with lower in-hospital mortality (hazard ratio = 0.37; 95% CI: 0.19-0.73) and lower ICU mortality (hazard ratio = 0.40; 95% CI: 0.19-0.85), after adjustment for age, Simplified Acute Physiology Score 3, and vasopressor use, as well as the baseline values for PaO2/FiO2 ratio, PEEP, pH, and PaCO2. These associations were not observed when nonprotective MV was based on the VT. Conclusions: The MDP seems to be a useful tool, better than VT, for adjusting MV in patients at risk for ARDS. |
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Jornal Brasileiro de Pneumologia (Online) |
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Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort studyRespiration, artificialTidal volumeRespiratory distress syndrome, adultABSTRACT Objective: To evaluate the association that protective mechanical ventilation (MV), based on VT and maximum distending pressure (MDP), has with mortality in patients at risk for ARDS. Methods: This was a prospective cohort study conducted in an ICU and including 116 patients on MV who had at least one risk factor for the development of ARDS. Ventilatory parameters were collected twice a day for seven days, and patients were divided into two groups (protective MV and nonprotective MV) based on the MDP (difference between maximum airway pressure and PEEP) or VT. The outcome measures were 28-day mortality, ICU mortality, and in-hospital mortality. The risk factors associated with the adoption of nonprotective MV were also assessed. Results: Nonprotective MV based on VT and MDP was applied in 49 (42.2%) and 38 (32.8%) of the patients, respectively. Multivariate Cox regression showed that protective MV based on MDP was associated with lower in-hospital mortality (hazard ratio = 0.37; 95% CI: 0.19-0.73) and lower ICU mortality (hazard ratio = 0.40; 95% CI: 0.19-0.85), after adjustment for age, Simplified Acute Physiology Score 3, and vasopressor use, as well as the baseline values for PaO2/FiO2 ratio, PEEP, pH, and PaCO2. These associations were not observed when nonprotective MV was based on the VT. Conclusions: The MDP seems to be a useful tool, better than VT, for adjusting MV in patients at risk for ARDS.Sociedade Brasileira de Pneumologia e Tisiologia2021-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132021000100203Jornal Brasileiro de Pneumologia v.47 n.1 2021reponame:Jornal Brasileiro de Pneumologia (Online)instname:Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)instacron:SBPT10.36416/1806-3756/e20200360info:eu-repo/semantics/openAccessBastos-Netto,CristianeReboredo,Maycon MouraVieira,Rodrigo SouzaFonseca,Lídia Maria Carneiro daCarvalho,Erich VidalHolanda,Marcelo AlcantaraPinheiro,Bruno Valleeng2021-01-05T00:00:00Zoai:scielo:S1806-37132021000100203Revistahttp://www.jornaldepneumologia.com.br/default.aspONGhttps://old.scielo.br/oai/scielo-oai.php||jbp@jbp.org.br|| jpneumo@jornaldepneumologia.com.br1806-37561806-3713opendoar:2021-01-05T00:00Jornal Brasileiro de Pneumologia (Online) - Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)false |
dc.title.none.fl_str_mv |
Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study |
title |
Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study |
spellingShingle |
Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study Bastos-Netto,Cristiane Respiration, artificial Tidal volume Respiratory distress syndrome, adult |
title_short |
Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study |
title_full |
Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study |
title_fullStr |
Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study |
title_full_unstemmed |
Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study |
title_sort |
Protective mechanical ventilation in patients with risk factors for ARDS: prospective cohort study |
author |
Bastos-Netto,Cristiane |
author_facet |
Bastos-Netto,Cristiane Reboredo,Maycon Moura Vieira,Rodrigo Souza Fonseca,Lídia Maria Carneiro da Carvalho,Erich Vidal Holanda,Marcelo Alcantara Pinheiro,Bruno Valle |
author_role |
author |
author2 |
Reboredo,Maycon Moura Vieira,Rodrigo Souza Fonseca,Lídia Maria Carneiro da Carvalho,Erich Vidal Holanda,Marcelo Alcantara Pinheiro,Bruno Valle |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Bastos-Netto,Cristiane Reboredo,Maycon Moura Vieira,Rodrigo Souza Fonseca,Lídia Maria Carneiro da Carvalho,Erich Vidal Holanda,Marcelo Alcantara Pinheiro,Bruno Valle |
dc.subject.por.fl_str_mv |
Respiration, artificial Tidal volume Respiratory distress syndrome, adult |
topic |
Respiration, artificial Tidal volume Respiratory distress syndrome, adult |
description |
ABSTRACT Objective: To evaluate the association that protective mechanical ventilation (MV), based on VT and maximum distending pressure (MDP), has with mortality in patients at risk for ARDS. Methods: This was a prospective cohort study conducted in an ICU and including 116 patients on MV who had at least one risk factor for the development of ARDS. Ventilatory parameters were collected twice a day for seven days, and patients were divided into two groups (protective MV and nonprotective MV) based on the MDP (difference between maximum airway pressure and PEEP) or VT. The outcome measures were 28-day mortality, ICU mortality, and in-hospital mortality. The risk factors associated with the adoption of nonprotective MV were also assessed. Results: Nonprotective MV based on VT and MDP was applied in 49 (42.2%) and 38 (32.8%) of the patients, respectively. Multivariate Cox regression showed that protective MV based on MDP was associated with lower in-hospital mortality (hazard ratio = 0.37; 95% CI: 0.19-0.73) and lower ICU mortality (hazard ratio = 0.40; 95% CI: 0.19-0.85), after adjustment for age, Simplified Acute Physiology Score 3, and vasopressor use, as well as the baseline values for PaO2/FiO2 ratio, PEEP, pH, and PaCO2. These associations were not observed when nonprotective MV was based on the VT. Conclusions: The MDP seems to be a useful tool, better than VT, for adjusting MV in patients at risk for ARDS. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132021000100203 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132021000100203 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.36416/1806-3756/e20200360 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Pneumologia e Tisiologia |
publisher.none.fl_str_mv |
Sociedade Brasileira de Pneumologia e Tisiologia |
dc.source.none.fl_str_mv |
Jornal Brasileiro de Pneumologia v.47 n.1 2021 reponame:Jornal Brasileiro de Pneumologia (Online) instname:Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) instacron:SBPT |
instname_str |
Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) |
instacron_str |
SBPT |
institution |
SBPT |
reponame_str |
Jornal Brasileiro de Pneumologia (Online) |
collection |
Jornal Brasileiro de Pneumologia (Online) |
repository.name.fl_str_mv |
Jornal Brasileiro de Pneumologia (Online) - Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) |
repository.mail.fl_str_mv |
||jbp@jbp.org.br|| jpneumo@jornaldepneumologia.com.br |
_version_ |
1750318347869749248 |