Christian Bime1, Mallorie Fiero2, Zhenqiang Lu3, Eyal Oren2, Cristine E Berry4, Sairam Parthasarathy4, Joe G N Garcia4. 1. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson; University of Arizona Health Sciences, Tucson. Electronic address: cbime@email.arizona.edu. 2. Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson. 3. University of Arizona Health Sciences, Tucson; BiO5 Institute - The University of Arizona, Tucson. 4. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson; University of Arizona Health Sciences, Tucson.
Abstract
BACKGROUND: In acute respiratory distress syndrome, minimizing lung injury from repeated collapse and reopening of alveoli by applying a high positive end-expiratory pressure improves oxygenation without influencing mortality. Obesity causes alveolar atelectasis, thus suggesting that a higher positive end-expiratory pressure might be more protective among the obese. We hypothesized that the effect of applying a high positive end-expiratory pressure on mortality from acute respiratory distress syndrome would differ by obesity status. METHODS: This was a retrospective analysis of 505 patients from the Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury Trial, a multicenter randomized trial that compared a higher vs a lower positive end-expiratory pressure ventilatory strategy in acute respiratory distress syndrome. We examined the relationship between positive end-expiratory pressure strategy and 60-day mortality stratified by obesity status. RESULTS: Among obese patients with acute respiratory distress syndrome, those assigned to a high positive end-expiratory pressure strategy experienced lower mortality compared with those assigned to a low strategy (18% vs 32%; P = .04). Among the nonobese, those assigned to high positive end-expiratory pressure strategy experienced similar mortality with those assigned to low strategy (34% vs 23%; P = .13). Multivariate analysis demonstrated an interaction between obesity status and the effect of positive end-expiratory pressure strategy on mortality (P <.01). CONCLUSIONS: Ventilation with higher levels of positive end-expiratory pressure was associated with improved survival among the subgroup of patients with acute respiratory distress syndrome who are obese.
RCT Entities:
BACKGROUND: In acute respiratory distress syndrome, minimizing lung injury from repeated collapse and reopening of alveoli by applying a high positive end-expiratory pressure improves oxygenation without influencing mortality. Obesity causes alveolar atelectasis, thus suggesting that a higher positive end-expiratory pressure might be more protective among the obese. We hypothesized that the effect of applying a high positive end-expiratory pressure on mortality from acute respiratory distress syndrome would differ by obesity status. METHODS: This was a retrospective analysis of 505 patients from the Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury Trial, a multicenter randomized trial that compared a higher vs a lower positive end-expiratory pressure ventilatory strategy in acute respiratory distress syndrome. We examined the relationship between positive end-expiratory pressure strategy and 60-day mortality stratified by obesity status. RESULTS: Among obesepatients with acute respiratory distress syndrome, those assigned to a high positive end-expiratory pressure strategy experienced lower mortality compared with those assigned to a low strategy (18% vs 32%; P = .04). Among the nonobese, those assigned to high positive end-expiratory pressure strategy experienced similar mortality with those assigned to low strategy (34% vs 23%; P = .13). Multivariate analysis demonstrated an interaction between obesity status and the effect of positive end-expiratory pressure strategy on mortality (P <.01). CONCLUSIONS: Ventilation with higher levels of positive end-expiratory pressure was associated with improved survival among the subgroup of patients with acute respiratory distress syndrome who are obese.
Authors: James M O'Brien; Carolyn H Welsh; Ronald H Fish; Marek Ancukiewicz; Andrew M Kramer Journal: Ann Intern Med Date: 2004-03-02 Impact factor: 25.391
Authors: James M O'Brien; Gary S Phillips; Naeem A Ali; Maria Lucarelli; Clay B Marsh; Stanley Lemeshow Journal: Crit Care Med Date: 2006-03 Impact factor: 7.598
Authors: Bradley A Maron; Mark T Gladwin; Sebastien Bonnet; Vinicio De Jesus Perez; Sarah M Perman; Paul B Yu; Fumito Ichinose Journal: J Am Heart Assoc Date: 2020-06-18 Impact factor: 5.501
Authors: Anoopindar K Bhalla; Margaret J Klein; Guillaume Emeriaud; Yolanda M Lopez-Fernandez; Natalie Napolitano; Analia Fernandez; Awni M Al-Subu; Rainer Gedeit; Steven L Shein; Ryan Nofziger; Deyin Doreen Hsing; George Briassoulis; Stavroula Ilia; Florent Baudin; Byron Enrique Piñeres-Olave; Ledys Maria Izquierdo; John C Lin; Ira M Cheifetz; Martin C J Kneyber; Lincoln Smith; Robinder G Khemani; Christopher J L Newth Journal: Crit Care Med Date: 2021-10-01 Impact factor: 9.296