Driving pressure is not predictive of ARDS outcome in chest trauma patients under mechanical ventilation

Severin Ramin; Matteo Arcelli; Karim Bouchdoug; Thomas Laumon; Camille Duflos; Audrey De Jong; Samir Jaber; Xavier Capdevila; Jonathan Charbit

doi:10.1016/j.accpm.2022.101095

Driving pressure is not predictive of ARDS outcome in chest trauma patients under mechanical ventilation

Anaesth Crit Care Pain Med. 2022 Aug;41(4):101095. doi: 10.1016/j.accpm.2022.101095. Epub 2022 Apr 27.

Authors

Severin Ramin¹, Matteo Arcelli², Karim Bouchdoug³, Thomas Laumon², Camille Duflos⁴, Audrey De Jong⁵, Samir Jaber⁵, Xavier Capdevila², Jonathan Charbit²

Affiliations

¹ Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France. Electronic address: [email protected].
² Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France.
³ Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France; Department of Statistical Analysis, Montpellier, France.
⁴ Department of Statistical Analysis, Montpellier, France.
⁵ Department of Anaesthesiology and Critical Care Medicine, Saint Eloi University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France.

PMID: 35489710
DOI: 10.1016/j.accpm.2022.101095

Abstract

Background: The relationship between the driving pressure of the respiratory system (ΔPrs) under mechanical ventilation and worse outcome has never been studied specifically in chest trauma patients. The objective of the present study was to assess in cases of chest trauma the relationship between ΔPrs and severity of acute respiratory distress syndrome (ARDS) or death and length of stay.

Methods: A retrospective analysis of severe trauma patients (ISS > 15) with chest injuries admitted to the Trauma Centre from January 2010 to December 2018 was performed. Patients who received mechanical ventilation were included in our analysis. Mechanical ventilation parameters and ΔPrs were recorded during the stay in the intensive care unit. Association of ΔPrs with mortality and outcomes was specifically studied at the onset of ARDS (ΔPrs_-ARDS) by receiver operator characteristic curve analysis, Kaplan-Meier curves, and multivariate analysis.

Results: Among the 266 chest trauma patients studied, 194 (73%) developed ARDS. ΔPrs was significantly higher in the ARDS group versus in the no ARDS group (11.6 ± 2.4 cm H₂O vs. 10.9 ± 1.9 cm H₂O, p = 0.04). Among the patients with ARDS, no difference according to the duration of mechanical ventilation was found between the high ΔPrs group (ΔPrs_-ARDS > 14 cm H₂O) and the low ΔPrs group (ΔPrs_-ARDS ≤ 14 cm H₂O), (p = 0.75). ΔPrs_-ARDS was not independently associated with the duration of mechanical ventilation (hazard ratio [HR], 1.006; 95% CI, 0.95-1.07; p = 0.8) or mortality (HR, 1.07; 95% CI, 0.9-1.28; p = 0.45). High mechanical power (≥ 12 J/min) was associated with a lower time for weaning of mechanical ventilation in Kaplan-Meier curves but not in multivariate analysis (HR, 0.98; 95% CI, 0.94-1.02; p = 0.22).

Conclusion: A high ΔPrs_-ARDS was not significantly associated with an increase in mechanical ventilation duration or mortality risk in ARDS patients with chest trauma in contrast with medical patients.

Keywords: Acute respiratory distress syndrome; Intensive care unit; Lung injury; Transpulmonary pressure; Ventilator-induced lung injury.

MeSH terms

Humans
Intensive Care Units
Respiration, Artificial / adverse effects
Respiratory Distress Syndrome* / therapy
Retrospective Studies
Thoracic Injuries* / complications
Thoracic Injuries* / therapy