Scripties UMCG - Rijksuniversiteit Groningen
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Driving Pressures and Mortality in Intensive Care Unit Patients not Meeting the Berlin Definition for ARDS

(2017) Merkies, C.M.

Research in determining the components associated with survival in mechanically ventilated patients, has shown that driving pressure (ΔP= plateau pressure – positive end-expiratory pressure ) is strongly associated with survival in ARDS patients. The aim of this study is to determine the association between driving pressure (ΔP) and survival in mechanically ventilated patients without ARDS. We looked at several factors including; driving pressure, energy (ΔP*tidal volume*0.0000980655) and power (energy*respiratory rate)
This is a post-hoc analysis, using data from mechanically ventilated patients without ARDS included in the Molecular Diagnosis and Risk Stratification of Sepsis study (MARS). We collected data at two time-points; one hour after intubation and 24 hours after intubation. With the use of a univariate regression analysis we analyzed if potentially modifiable factors are associated with outcome.
570 patients were included in our analysis. Among potentially modifiable factors using data measured at 24 hours after intubation, we found that ; ΔP (OR:0.924, CI:0.889-0.961, p<0.001),energy (OR 5,6419E-38, CI 5,8779E-59-5,4154E-17, p<0.001) and power (OR:0.065, CI: 0.014-0.305, p= 0.001) were associated with outcome.
Data measured at one hour after intubation did not show any significant association with outcome.
In this post-hoc analysis study with data from two ICU’s, the potentially modifiable factors associated with outcome in an univariate analyses included; ΔP, energy and Power. We found that looking at 24 hours after intubation that with an increase of ΔP the survival decreases. These findings are further steps in understanding the mechanics of mechanical ventilation in patients without ARDS. But further analysis of this cohort and clinical trials are needed to implement and translate this knowledge into practical bedside usage.

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