BackgroundIn patients with acute respiratory distress syndrome (ARDS), low tidal volume ventilation has been associated with reduced mortality. Driving pressure (tidal volume normalized to respiratory system compliance) may be an even stronger predictor of ARDS survival than tidal volume. We sought to study whether these associations hold true in acute respiratory failure patients without ARDS.MethodsThis is a retrospectively cohort analysis of mechanically ventilated adult patients admitted to ICUs from 12 hospitals over 2 years. We used natural language processing of chest radiograph reports and data from the electronic medical record to identify patients who had ARDS. We used multivariable logistic regression and generalized linear models to estimate associations between tidal volume, driving pressure, and respiratory system compliance with adjusted 30-day mortality using covariates of Acute Physiology Score (APS), Charlson Comorbidity Index (CCI), age, and PaO2/FiO2 ratio.ResultsWe studied 2641 patients; 48% had ARDS (n = 1273). Patients with ARDS had higher mean APS (25 vs. 23, p < .001) but similar CCI (4 vs. 3, p = 0.6) scores. For non-ARDS patients, tidal volume was associated with increased adjusted mortality (OR 1.18 per 1 mL/kg PBW increase in tidal volume, CI 1.04 to 1.35, p = 0.010). We observed no association between driving pressure or respiratory compliance and mortality in patients without ARDS. In ARDS patients, both ΔP (OR1.1, CI 1.06–1.14, p < 0.001) and tidal volume (OR 1.17, CI 1.04–1.31, p = 0.007) were associated with mortality.ConclusionsIn a large retrospective analysis of critically ill non-ARDS patients receiving mechanical ventilation, we found that tidal volume was associated with 30-day mortality, while driving pressure was not.

中文翻译：

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没有 ARDS 的机械通气患者的驱动压力与死亡率无关

背景在急性呼吸窘迫综合征 (ARDS) 患者中，低潮气量通气与死亡率降低相关。驱动压力（根据呼吸系统顺应性标准化的潮气量）可能比潮气量更能预测 ARDS 存活率。我们试图研究这些关联是否适用于没有 ARDS 的急性呼吸衰竭患者。方法这是一项回顾性队列分析，对来自 12 家医院的 ICU 收治的机械通气成人患者进行了 2 年以上的研究。我们使用自然语言处理胸片报告和电子病历数据来识别患有 ARDS 的患者。我们使用多变量逻辑回归和广义线性模型来估计潮气量、驱动压、使用急性生理评分 (APS)、Charlson 合并症指数 (CCI)、年龄和 PaO2/FiO2 比率的协变量，呼吸系统对调整后 30 天死亡率的依从性。结果我们研究了 2641 名患者；48% 患有急性呼吸窘迫综合征（n = 1273）。ARDS 患者的平均 APS 较高（25 对 23，p < .001）但 CCI 评分相似（4 对 3，p = 0.6）。对于非 ARDS 患者，潮气量与调整后死亡率增加相关（或潮气量每增加 1 mL/kg PBW 为 1.18，CI 1.04 至 1.35，p = 0.010）。在没有 ARDS 的患者中，我们观察到驱动压或呼吸顺应性与死亡率之间没有关联。在 ARDS 患者中，ΔP (OR1.1, CI 1.06–1.14, p < 0.001) 和潮气量 (OR 1.17, CI 1.04–1.31, p = 0.007) 均与死亡率相关。