Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
Med Intensiva (Engl Ed). 2023 Aug;47(8):445-453. doi: 10.1016/j.medine.2023.01.004. Epub 2023 Jan 30.
To compare adherence to protective mechanical ventilation (MV) parameters in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies.
Multiple prospective cohort study.
Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120).
ARDS patients under MV.
None.
Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmHO; and driving pressure ≤15cmHO), adherence to each individual component of the protective MV, and the association between protective MV and mortality.
Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmHO (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality.
Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients.
比较 COVID-19 引起的急性呼吸窘迫综合征（ARDS）患者与其他病因引起的 ARDS 患者对保护性机械通气（MV）参数的依从性。
多中心前瞻性队列研究。
两个巴西 ARDS 患者队列进行了评估。一个队列为 2020 年和 2021 年入住巴西两个重症监护病房（ICU）的 COVID-19 患者（C-ARDS，n=282），另一个队列为 2016 年入住巴西 37 个 ICU 的其他病因 ARDS 患者（NC-ARDS，n=120）。
MV 下的 ARDS 患者。
无。
保护性 MV 的依从性（潮气量≤8ml/kgPBW；平台压≤30cmH2O；驱动压≤15cmH2O）、保护性 MV 每个单独组成部分的依从性，以及保护性 MV 与死亡率之间的关系。
C-ARDS 患者对保护性 MV 的依从性高于 NC-ARDS 患者（65.8%比 50.0%，p=0.005），主要是由于对驱动压≤15cmH2O 的依从性更高（75.0%比 62.4%，p=0.02）。多变量逻辑回归显示，C-ARDS 队列与保护性 MV 的依从性独立相关。在保护性 MV 的组成部分中，只有限制驱动压与 ICU 死亡率降低独立相关。
C-ARDS 患者对保护性 MV 的更高依从性是由于对限制驱动压的更高依从性所致。此外，较低的驱动压与 ICU 死亡率降低独立相关，这表明限制驱动压的暴露可能改善这些患者的生存率。
