David M P van Meenen1, Ary Serpa Neto2,3, Frederique Paulus2, Coen Merkies2, Laura R Schouten2, Lieuwe D Bos2,4, Janneke Horn2, Nicole P Juffermans2,4, Olaf L Cremer5, Tom van der Poll6,7,8, Marcus J Schultz2,4,9,10. 1. Department of Intensive Care, University of Amsterdam, Amsterdam University Medical Centers, Location "Academic Medical Center", Meibergdreeg 9, 1105 AZ, Amsterdam, The Netherlands. d.m.vanmeenen@amsterdamumc.nl. 2. Department of Intensive Care, University of Amsterdam, Amsterdam University Medical Centers, Location "Academic Medical Center", Meibergdreeg 9, 1105 AZ, Amsterdam, The Netherlands. 3. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, São Paulo, Brazil. 4. Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), University of Amsterdam, Amsterdam University Medical Centers, Location "Academic Medical Center", Meibergdreeg 9, 1105 AZ, Amsterdam, The Netherlands. 5. Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. 6. Center for Experimental and Molecular Medicine (CEMM), University of Amsterdam, Amsterdam University Medical Centers, Location "Academic Medical Center", Meibergdreeg 9, 1105 AZ, Amsterdam, The Netherlands. 7. Center for Infection and Immunity Amsterdam, University of Amsterdam, Amsterdam University Medical Centers, Location "Academic Medical Center", Meibergdreeg 9, 1105 AZ, Amsterdam, The Netherlands. 8. Division of Infectious Diseases, University of Amsterdam, Amsterdam University Medical Centers, Location "Academic Medical Center", Meibergdreeg 9, 1105 AZ, Amsterdam, The Netherlands. 9. Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, 999 Phutthamonthon Sai 4 Rd, Bangkok, Thailand. 10. Nuffield Department of Medicine, University of Oxford, Oxford, OX1 2JD, UK.
Abstract
BACKGROUND: Outcome prediction in critically ill patients under invasive ventilation remains extremely challenging. The driving pressure (ΔP) and the mechanical power of ventilation (MP) are associated with patient-centered outcomes like mortality and duration of ventilation. The objective of this study was to assess the predictive validity for mortality of the ΔP and the MP at 24 h after start of invasive ventilation. METHODS: This is a post hoc analysis of an observational study in intensive care unit patients, restricted to critically ill patients receiving invasive ventilation for at least 24 h. The two exposures of interest were the modified ΔP and the MP at 24 h after start of invasive ventilation. The primary outcome was 90-day mortality; secondary outcomes were ICU and hospital mortality. The predictive validity was measured as incremental 90-day mortality beyond that predicted by the Acute Physiology, Age and Chronic Health Evaluation (APACHE) IV score and the Simplified Acute Physiology Score (SAPS) II. RESULTS: The analysis included 839 patients with a 90-day mortality of 42%. The median modified ΔP at 24 h was 15 [interquartile range 12 to 19] cm H2O; the median MP at 24 h was 206 [interquartile range 145 to 298] 10-3 J/min/kg predicted body weight (PBW). Both parameters were associated with 90-day mortality (odds ratio (OR) for 1 cm H2O increase in the modified ΔP, 1.05 [95% confidence interval (CI) 1.03 to 1.08]; P < 0.001; OR for 100 10-3 J/min/kg PBW increase in the MP, 1.20 [95% CI 1.09 to 1.33]; P < 0.001). Area under the ROC for 90-day mortality of the modified ΔP and the MP were 0.70 [95% CI 0.66 to 0.74] and 0.69 [95% CI 0.65 to 0.73], which was neither different from that of the APACHE IV score nor that of the SAPS II. CONCLUSIONS: In adult patients under invasive ventilation, the modified ΔP and the MP at 24 h are associated with 90 day mortality. Neither the modified ΔP nor the MP at 24 h has predictive validity beyond the APACHE IV score and the SAPS II.
BACKGROUND: Outcome prediction in critically illpatients under invasive ventilation remains extremely challenging. The driving pressure (ΔP) and the mechanical power of ventilation (MP) are associated with patient-centered outcomes like mortality and duration of ventilation. The objective of this study was to assess the predictive validity for mortality of the ΔP and the MP at 24 h after start of invasive ventilation. METHODS: This is a post hoc analysis of an observational study in intensive care unit patients, restricted to critically illpatients receiving invasive ventilation for at least 24 h. The two exposures of interest were the modified ΔP and the MP at 24 h after start of invasive ventilation. The primary outcome was 90-day mortality; secondary outcomes were ICU and hospital mortality. The predictive validity was measured as incremental 90-day mortality beyond that predicted by the Acute Physiology, Age and Chronic Health Evaluation (APACHE) IV score and the Simplified Acute Physiology Score (SAPS) II. RESULTS: The analysis included 839 patients with a 90-day mortality of 42%. The median modified ΔP at 24 h was 15 [interquartile range 12 to 19] cm H2O; the median MP at 24 h was 206 [interquartile range 145 to 298] 10-3 J/min/kg predicted body weight (PBW). Both parameters were associated with 90-day mortality (odds ratio (OR) for 1 cm H2O increase in the modified ΔP, 1.05 [95% confidence interval (CI) 1.03 to 1.08]; P < 0.001; OR for 100 10-3 J/min/kg PBW increase in the MP, 1.20 [95% CI 1.09 to 1.33]; P < 0.001). Area under the ROC for 90-day mortality of the modified ΔP and the MP were 0.70 [95% CI 0.66 to 0.74] and 0.69 [95% CI 0.65 to 0.73], which was neither different from that of the APACHE IV score nor that of the SAPS II. CONCLUSIONS: In adult patients under invasive ventilation, the modified ΔP and the MP at 24 h are associated with 90 day mortality. Neither the modified ΔP nor the MP at 24 h has predictive validity beyond the APACHE IV score and the SAPS II.
Entities:
Keywords:
Driving pressure; Intensive care unit; Invasive ventilation; Mechanical power; Mechanical power of ventilation; Mortality; Predictive validity; Prognostication; Respiratory system driving pressure; ΔP
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