Division of Critical Care, Departments of Emergency Medicine and Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Shock. 2018 Mar;49(3):311-316. doi: 10.1097/SHK.0000000000000977.
Driving pressure has been proposed as a major determinant of outcome in patients with acute respiratory distress syndrome (ARDS), but there is little data examining the association between pulmonary mechanics, including driving pressure, and outcomes in mechanically ventilated patients without ARDS.
Secondary analysis from 1,705 mechanically ventilated patients enrolled in a clinical study that examined outcomes associated with the use of early lung-protective mechanical ventilation. The primary outcome was mortality and the secondary outcome was the incidence of ARDS. Multivariable models were constructed to: define the association between pulmonary mechanics (driving pressure, plateau pressure, and compliance) and mortality; and evaluate if driving pressure contributed information beyond that provided by other pulmonary mechanics.
The mortality rate for the entire cohort was 26.0%. Compared with survivors, non-survivors had significantly higher driving pressure [15.9 (5.4) vs. 14.9 (4.4), P = 0.005] and plateau pressure [21.4 (5.7) vs. 20.4 (4.6), P = 0.001]. Driving pressure was independently associated with mortality [adjusted OR, 1.04 (1.01-1.07)]. Models related to plateau pressure also revealed an independent association with mortality, with similar effect size and interval estimates as driving pressure. There were 152 patients who progressed to ARDS (8.9%). Along with driving pressure and plateau pressure, mechanical power [adjusted OR, 1.03 (1.00-1.06)] was also independently associated with ARDS development.
In mechanically ventilated patients, driving pressure and plateau pressure are risk factors for mortality and ARDS, and provide similar information. Mechanical power is also a risk factor for ARDS.
驱动压已被提出作为急性呼吸窘迫综合征（ARDS）患者预后的主要决定因素，但很少有数据检查包括驱动压在内的肺力学与无 ARDS 的机械通气患者结局之间的关系。
对纳入一项临床研究的 1705 例机械通气患者进行二次分析，该研究检查了早期肺保护性机械通气使用相关的结局。主要结局为死亡率，次要结局为 ARDS 的发生率。构建多变量模型以：定义肺力学（驱动压、平台压和顺应性）与死亡率之间的关系；并评估驱动压是否提供了其他肺力学之外的信息。
整个队列的死亡率为 26.0%。与幸存者相比，非幸存者的驱动压显著更高[15.9（5.4）比 14.9（4.4），P=0.005]，平台压也显著更高[21.4（5.7）比 20.4（4.6），P=0.001]。驱动压与死亡率独立相关[校正比值比，1.04（1.01-1.07）]。与平台压相关的模型也揭示了与死亡率的独立关联，其效应大小和间隔估计与驱动压相似。有 152 例患者进展为 ARDS（8.9%）。除了驱动压和平台压，机械功率[校正比值比，1.03（1.00-1.06）]也与 ARDS 发展独立相关。
在机械通气患者中，驱动压和平台压是死亡率和 ARDS 的危险因素，提供了相似的信息。机械功率也是 ARDS 的危险因素。
