Abstract
Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. Research Question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). Study Design and Methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
Original language | English (US) |
---|---|
Pages (from-to) | 1947-1957 |
Number of pages | 11 |
Journal | CHEST |
Volume | 158 |
Issue number | 5 |
DOIs | |
State | Published - Nov 2020 |
All Science Journal Classification (ASJC) codes
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine
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Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS : A Secondary Analysis of the EFRAIM Study. / Demoule, Alexandre; Antonelli, Massimo; Schellongowski, Peter et al.
In: CHEST, Vol. 158, No. 5, 11.2020, p. 1947-1957.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS
T2 - A Secondary Analysis of the EFRAIM Study
AU - Demoule, Alexandre
AU - Antonelli, Massimo
AU - Schellongowski, Peter
AU - Pickkers, Peter
AU - Soares, Marcio
AU - Meyhoff, Tine
AU - Rello, Jordi
AU - Bauer, Philippe R.
AU - van de Louw, Andry
AU - Lemiale, Virgine
AU - Grimaldi, David
AU - Martin-Loeches, Ignacio
AU - Balik, Martin
AU - Mehta, Sangeeta
AU - Kouatchet, Achille
AU - Barratt-Due, Andreas
AU - Valkonen, Miia
AU - Reignier, Jean
AU - Metaxa, Victoria
AU - Moreau, Anne Sophie
AU - Burghi, Gaston
AU - Mokart, Djamel
AU - Mayaux, Julien
AU - Darmon, Michael
AU - Azoulay, Elie
AU - Amrein, Karin
AU - Staundinger, Thomas
AU - Heinz, Gottfried
AU - Sengölge, Gürkan
AU - Zauner, Christian
AU - Jaksch, Peter
AU - Taccone, Fabio S.
AU - Meert, Anne Pascale
AU - Benoît, Dominique
AU - Silva, Ulysses V.A.
AU - Pierre de Moraes, Ana Paula
AU - Lishoa, Thiago
AU - Salluh, Jorge
AU - Viana, William
AU - Moralez, Guilliana
AU - Correa, Thiago Domingos
AU - Shah, Umesh
AU - Karvunidis, Thomas
AU - Martin, Balik
AU - Russinova, Katerina
AU - Perner, Anders
AU - Meyhoff, Tine Sylvest
AU - Jonas, Nielsen
AU - Bukan, Ramin Brandt
AU - Moeller, Ann M.
AU - Nielsen, Lene B.
AU - Seguin, Amélie
AU - Chermak, Akli
AU - Terzi, Nicolas
AU - Vinatier, Isabelle
AU - Wallet, Florent
AU - Klouche, Kada
AU - Platon, Laura
AU - Gaborit, Benjamin
AU - Barbier, François
AU - Pène, Frederic
AU - Rabbat, Antoine
AU - Lemiale, Virginie
AU - N'Yunga, Martine
AU - Girault, Christophe
AU - Lemaitre, Caroline
AU - Artaud-Macari, Elise
AU - Bruneel, F.
AU - Moreau, Anne Sophie
AU - Kuitunen, Anne
AU - Marsh, Brian
AU - Misericordia, Mater
AU - Mahon, Aisling Mc
AU - Cinnella, Gilda
AU - Cotoia, Antonella
AU - Riuniti, Ospedali
AU - Montini, Lucas
AU - Spoelstra de Man, Angélique
AU - Landburg, Precious Pearl
AU - Bergmans, Dennis
AU - Hemelaar, Pleun
AU - Kaufmann, Thomas
AU - Barrat-Due, Andreas
AU - Klepstad, Pål
AU - Encina, Belen
AU - Moreno, Gabriel
AU - Crespi, Llorenç Socias
AU - Rodriguez-Ruiz, Emilio
AU - Bauer, Philippe
AU - Hemang, Yadav
N1 - Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following : A. D. reports personal fees from Medtronic, Getinge, and Baxter and Hamilton; grants, personal fees, and nonfinancial support from Philips and Fisher & Paykel; grants from the French Ministry of Health; grants and personal fees from Respinor; and grants and nonfinancial support from Lungpacer, outside the submitted work. M. A. reports grants from GE; personal fees from Maquet, Chiesi , and Orion; and grants and personal fees from Estor and Intersurgical, outside the submitted work. P. S. reports personal fees from Getinge and Fisher Paykel, outside the submitted work. T. M. reports grants from Novo Nordisk Foundation and the Sofus Friis Foundation, outside the submitted work. V. L. reports nonfinancial support from Pfizer and Biomerieux France; and other from Astellas , Gilead, MSD, Baxter, and Pfrizer, outside the submitted work. I. M.-L. reports personal fees from MSD, Gilead, and Accelerate, outside the submitted work. V. M. reports personal fees from honoraria from Gilead, outside the submitted work. M. D. reports grants and personal fees from MSD, personal fees and nonfinancial support from Gilead-Kite, and personal fees from Astelas, outside the submitted work. E. A. reports personal fees and nonfinancial support from Pfizer; personal fees from Alexion , MSD, and Baxter; and grants from Ablynx , outside the submitted work. None declared (P. P., M. S., J. Rello., P. R. B., A. L., D. G., M. B., S. M., A. K., A. B.-D., M. V., J. Reignier, A.-S. M., G. B., D. M., J. M.). Funding Information: Author contributions: A. D. M. D. and E. A. take responsibility for the content of the manuscript, including the data and analysis. A. D. E. A. and M. D. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. All the authors contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: A. D. reports personal fees from Medtronic, Getinge, and Baxter and Hamilton; grants, personal fees, and nonfinancial support from Philips and Fisher & Paykel; grants from the French Ministry of Health; grants and personal fees from Respinor; and grants and nonfinancial support from Lungpacer, outside the submitted work. M. A. reports grants from GE; personal fees from Maquet, Chiesi, and Orion; and grants and personal fees from Estor and Intersurgical, outside the submitted work. P. S. reports personal fees from Getinge and Fisher Paykel, outside the submitted work. T. M. reports grants from Novo Nordisk Foundation and the Sofus Friis Foundation, outside the submitted work. V. L. reports nonfinancial support from Pfizer and Biomerieux France; and other from Astellas, Gilead, MSD, Baxter, and Pfrizer, outside the submitted work. I. M.-L. reports personal fees from MSD, Gilead, and Accelerate, outside the submitted work. V. M. reports personal fees from honoraria from Gilead, outside the submitted work. M. D. reports grants and personal fees from MSD, personal fees and nonfinancial support from Gilead-Kite, and personal fees from Astelas, outside the submitted work. E. A. reports personal fees and nonfinancial support from Pfizer; personal fees from Alexion, MSD, and Baxter; and grants from Ablynx, outside the submitted work. None declared (P. P. M. S. J. Rello. P. R. B. A. L. D. G. M. B. S. M. A. K. A. B.-D. M. V. J. Reignier, A.-S. M. G. B. D. M. J. M.). ∗EFRAIM Investigators Collaborators: This study was performed on behalf of the Caring for Critically Ill Immuno-compromised Patients Multinational Network (Nine-I). This group includes critical care specialists from 16 countries in Europe, the United States, Canada, and South America. The primary aim of this group is to improve and standardize practices in the management of critically ill immunocompromised patients. The contributors include the following: Karin Amrein, Department of Internal Medicine, Medical University of Gratz, Gratz, Austria; Peter Schellongowski and Thomas Staundinger, Department of Medicine I, Vienna, Austria; Gottfried Heinz, Department of Medicine II, Vienna, Austria; Gürkan Sengölge and Christian Zauner, Department of Medicine III, Vienna, Austria; Peter Jaksch, Department of Thoracic Surgery, Vienna, Austria; Fabio S. Taccone and David Grimaldi, Hôpital Erasme, Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Anne Pascale Meert, Institut Jules Bordet, Bruxelles, Belgium; Dominique Benoît, Ghent University Hospital, Ghent, Belgium; Ulysses V. A. Silva, Hospital de Câncer de Barretos, Barretos, Brazil; Ana Paula Pierre de Moraes, Hospital de Cancer do Maranhao, Maranhao, Brazil; Thiago Lishoa, Hospital Santa Rita, Santa Casa de Misericordia, Porte Allegre, Brazil; Marcio Soares and Jorge Salluh, D'Or Institute for Research and Education, Rio De Janeiro, Brazil; William Viana, Hospital Copa d'Or, Rio De Janeiro, Brazil; Guilliana Moralez, Hospital GetulioVargas, Rio De Janeiro, Brazil; Thiago Domingos Correa, Hospital Israelita Albert Einstein, São Paulo, Brazil; Sangeeta Mehta and Umesh Shah, University of Toronto, Toronto, ON, Canada; Thomas Karvunidis, University Hospital in Pilsen, Pilsen, Czech Republic; Balik Martin and Katerina Russinova, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic; Anders Perner, Tine Sylvest Meyhoff, and Nielsen Jonas, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Ramin Brandt Bukan and Ann M. Moeller, Herlev University Hospital, Herlev, Denmark; Lene B. Nielsen, Odense University Hospital, University of South Denmark, Odense, Denmark; and Intensive Care Department, University of Southern Denmark, Sønderborg, Denmark; Achille Kouatchet, Centre hopsitalier Régional, Angers, France; Amélie Seguin, CHU de Caen, Caen, France; Akli Chermak, Centre Hospitalier Sud Essonne, Etempes, France; Nicolas Terzi, CHU Grenoble Alpes, Université Grenoble-Alpes, Grenoble, France; Isabelle Vinatier, Centre Hospitalier de Vendée, La Roche sur Yon, France; Anne-Sophie Moreau, CHU Lille, School of Medicine, University of Lille, Lille, France; Florent Wallet, Centre Hospitalier Lyon-Sud, Lyon, France; Djamel Mokart, Insitut Paoli Calmette, Marseille, France; Kada Klouche, Laura Platon, CHU de Montpellier, Montpellier, France; Benjamin Gaborit, Hôtel Dieu, Nantes, France; François Barbier, La Source Hospital, Orléans, France; Frederic Pène, Hôpital Cochin, Paris, France; Antoine Rabbat, Hôpital Cochin, Paris, France; Alexandre Demoule and Julien Mayaux, Pitié-Salpêtrière, Paris, France; Elie Azoulay and Virginie Lemiale, Hôpital Saint-Louis, Paris, France; Martine N'Yunga, Centre Hospitalier Victor Provo, Roubaix, France; Christophe Girault, Caroline Lemaitre, and Elise Artaud-Macari, Rouen University Hospital, Rouen, France; Michael Darmon, CHU de Saint-Etienne, Saint Etienne, France; F. Bruneel, Hôpital André Mignot, Versailles, France; Anne Sophie Moreau, Institut Gustave Roussy, Villejuif, France; Miia Valkonen, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Anne Kuitunen, Tampere University Hospital, Tampere, Finland; Brian Marsh, Mater Misericordia, Dublin, Ireland; Ignacio Martin-Loeches and Aisling Mc Mahon, Saint-James Hospital, Trinity College, Dublin, Ireland; Gilda Cinnella and Antonella Cotoia, Ospedali Riuniti, Foggia, Italy; Massimo Antonelli and Lucas Montini, Policlinica Gemelli, Roma, Italy; Angélique Spoelstra de Man, University Medical Center, Amsterdam, The Netherlands; Precious Pearl Landburg, University Medical Center, Groningen, The Netherlands; Dennis Bergmans, University Medical Center, Maastricht, The Netherlands; Peter Pickkers, Pleun Hemelaar, and Thomas Kaufmann, Radboud University Medical Center, Nijmegen, The Netherlands; Andreas Barrat-Due, Oslo University Hospital, Oslo, Norway; Pål Klepstad, St. Olavs Hospital, Trondheim, Norway; Jordi Rello and Belen Encina, Universitat Autonòma de Barcelona, Barcelona, Spain; Gabriel Moreno, Bellvitge, Barcelona, Spain; Llorenç Socias Crespi, Hospital Son Llatzer, Palma, Spain; Emilio Rodriguez-Ruiz, Complexo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain; Victoria Metaxa, King's College Hospital, London, England; Gaston Burghi, Hospital Maciel, Montevideo, Uruguay; Andry Van De Louw, Pennsylvania State University, Hershey, PA; and Philippe Bauer, Yadav Hemang, Mayo Clinic, Rochester, MN. Additional information: The e-Figures and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study. Publisher Copyright: © 2020 American College of Chest Physicians
PY - 2020/11
Y1 - 2020/11
N2 - Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. Research Question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). Study Design and Methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
AB - Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. Research Question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). Study Design and Methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
UR - http://www.scopus.com/inward/record.url?scp=85093944484&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85093944484&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2020.05.602
DO - 10.1016/j.chest.2020.05.602
M3 - Article
C2 - 32569634
AN - SCOPUS:85093944484
VL - 158
SP - 1947
EP - 1957
JO - Diseases of the chest
JF - Diseases of the chest
SN - 0012-3692
IS - 5
ER -