Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France.
GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France.
Respirology. 2019 Feb;24(2):137-145. doi: 10.1111/resp.13394. Epub 2018 Sep 5.
Elevated driving pressure (ΔP) may be associated with increased risk of acute respiratory distress syndrome (ARDS) in patients admitted via the emergency department and with post-operative pulmonary complications in surgical patients. This study investigated the association of higher ΔP with the onset of ARDS in a high-risk, intensive care unit (ICU) population.
This is a secondary analysis of a prospective multicentre observational study. Data for this ancillary study were obtained from intubated adult patients with at least one ARDS risk factor upon ICU admission enrolled in a previous multicentre observational study. Patients were followed up for the development of ARDS within 7 days (primary outcome). Univariate and multivariate analyses tested the association between ΔP (measured at ICU admission (baseline) or 24 h later (day 1)) and the development of ARDS.
A total of 221 patients were included in this study, among whom 34 (15%) developed ARDS within 7 days. These patients had higher baseline ΔP than those who did not (mean ± SD: 12.5 ± 3.1 vs 9.8 ± 3.4 cm H O, respectively, P = 0.0001). The association between baseline ΔP and the risk of developing ARDS was robust to adjustment for baseline tidal volume, positive-end expiratory pressure, illness severity, serum lactate and sepsis, pneumonia, severe trauma and shock as primary ARDS risk factors (odds ratio: 1.20; 95% CI: 1.03-1.41; P = 0.02). The same results were found with day 1 ΔP.
Among at-risk ICU patients, higher ΔP may identify those who are more likely to develop ARDS.
在因急症入住急诊科的患者中，升高的驱动压（ΔP）可能与急性呼吸窘迫综合征（ARDS）风险增加相关，在接受手术的患者中，与术后肺部并发症相关。本研究旨在调查高危重症监护病房（ICU）人群中较高 ΔP 与 ARDS 发病的关系。
这是一项前瞻性多中心观察性研究的二次分析。该辅助研究的数据来自于先前一项多中心观察性研究中，入住 ICU 时至少存在一个 ARDS 危险因素的成年插管患者。患者在 ICU 入住后 7 天内（主要结局）接受 ARDS 发病的随访。单变量和多变量分析测试了 ICU 入住时（基线）或 24 小时后（第 1 天）测量的 ΔP 与 ARDS 发生之间的关系。
本研究共纳入 221 例患者，其中 34 例（15%）在 7 天内发生 ARDS。这些患者的基线 ΔP 高于未发生 ARDS 的患者（平均±标准差：12.5±3.1 比 9.8±3.4 cmH2O，P=0.0001）。基线 ΔP 与发生 ARDS 的风险之间的关系在调整基线潮气量、呼气末正压、疾病严重程度、血清乳酸和脓毒症、肺炎、严重创伤和休克作为 ARDS 主要危险因素后仍然稳健（比值比：1.20；95%置信区间：1.03-1.41；P=0.02）。第 1 天 ΔP 也得到了相同的结果。
在高危 ICU 患者中，较高的 ΔP 可能识别出更有可能发生 ARDS 的患者。
