Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study

Alexandre Demoule; Massimo Antonelli; Peter Schellongowski; Peter Pickkers; Marcio Soares; Tine Meyhoff; Jordi Rello; Philippe R. Bauer; Andry van de Louw; Virgine Lemiale; David Grimaldi; Ignacio Martin-Loeches; Martin Balik; Sangeeta Mehta; Achille Kouatchet; Andreas Barratt-Due; Miia Valkonen; Jean Reignier; Victoria Metaxa; Anne Sophie Moreau; Gaston Burghi; Djamel Mokart; Julien Mayaux; Michael Darmon; Elie Azoulay; Karin Amrein; Thomas Staundinger; Gottfried Heinz; Gürkan Sengölge; Christian Zauner; Peter Jaksch; Fabio S. Taccone; Anne Pascale Meert; Dominique Benoît; Ulysses V.A. Silva; Ana Paula Pierre de Moraes; Thiago Lishoa; Jorge Salluh; William Viana; Guilliana Moralez; Thiago Domingos Correa; Umesh Shah; Thomas Karvunidis; Balik Martin; Katerina Russinova; Anders Perner; Tine Sylvest Meyhoff; Nielsen Jonas; Ramin Brandt Bukan; Ann M. Moeller; Lene B. Nielsen; Amélie Seguin; Akli Chermak; Nicolas Terzi; Isabelle Vinatier; Florent Wallet; Kada Klouche; Laura Platon; Benjamin Gaborit; François Barbier; Frederic Pène; Antoine Rabbat; Virginie Lemiale; Martine N'Yunga; Christophe Girault; Caroline Lemaitre; Elise Artaud-Macari; F. Bruneel; Anne Sophie Moreau; Anne Kuitunen; Brian Marsh; Mater Misericordia; Aisling Mc Mahon; Gilda Cinnella; Antonella Cotoia; Ospedali Riuniti; Lucas Montini; Angélique Spoelstra de Man; Precious Pearl Landburg; Dennis Bergmans; Pleun Hemelaar; Thomas Kaufmann; Andreas Barrat-Due; Pål Klepstad; Belen Encina; Gabriel Moreno; Llorenç Socias Crespi; Emilio Rodriguez-Ruiz; Philippe Bauer; Yadav Hemang

doi:10.1016/j.chest.2020.05.602

Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study

Alexandre Demoule, Massimo Antonelli, Peter Schellongowski, Peter Pickkers, Marcio Soares, Tine Meyhoff, Jordi Rello, Philippe R. Bauer, Andry van de Louw, Virgine Lemiale, David Grimaldi, Ignacio Martin-Loeches, Martin Balik, Sangeeta Mehta, Achille Kouatchet, Andreas Barratt-Due, Miia Valkonen, Jean Reignier, Victoria Metaxa, Anne Sophie MoreauGaston Burghi, Djamel Mokart, Julien Mayaux, Michael Darmon, Elie Azoulay, Karin Amrein, Thomas Staundinger, Gottfried Heinz, Gürkan Sengölge, Christian Zauner, Peter Jaksch, Fabio S. Taccone, Anne Pascale Meert, Dominique Benoît, Ulysses V.A. Silva, Ana Paula Pierre de Moraes, Thiago Lishoa, Jorge Salluh, William Viana, Guilliana Moralez, Thiago Domingos Correa, Umesh Shah, Thomas Karvunidis, Balik Martin, Katerina Russinova, Anders Perner, Tine Sylvest Meyhoff, Nielsen Jonas, Ramin Brandt Bukan, Ann M. Moeller, Lene B. Nielsen, Amélie Seguin, Akli Chermak, Nicolas Terzi, Isabelle Vinatier, Florent Wallet, Kada Klouche, Laura Platon, Benjamin Gaborit, François Barbier, Frederic Pène, Antoine Rabbat, Virginie Lemiale, Martine N'Yunga, Christophe Girault, Caroline Lemaitre, Elise Artaud-Macari, F. Bruneel, Anne Sophie Moreau, Anne Kuitunen, Brian Marsh, Mater Misericordia, Aisling Mc Mahon, Gilda Cinnella, Antonella Cotoia, Ospedali Riuniti, Lucas Montini, Angélique Spoelstra de Man, Precious Pearl Landburg, Dennis Bergmans, Pleun Hemelaar, Thomas Kaufmann, Andreas Barrat-Due, Pål Klepstad, Belen Encina, Gabriel Moreno, Llorenç Socias Crespi, Emilio Rodriguez-Ruiz, Philippe Bauer, Yadav Hemang

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

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	https://doi.org/10.1016/j.chest.2020.05.602
State	Published - Nov 2020

All Science Journal Classification (ASJC) codes

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.chest.2020.05.602

Cite this

Demoule, A., Antonelli, M., Schellongowski, P., Pickkers, P., Soares, M., Meyhoff, T., Rello, J., Bauer, P. R., van de Louw, A., Lemiale, V., Grimaldi, D., Martin-Loeches, I., Balik, M., Mehta, S., Kouatchet, A., Barratt-Due, A., Valkonen, M., Reignier, J., Metaxa, V., ... Hemang, Y. (2020). Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study. CHEST, 158(5), 1947-1957. https://doi.org/10.1016/j.chest.2020.05.602

@article{5abefc04423a4e56b0d416c5b15801fe,

title = "Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study",

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.",

author = "Alexandre Demoule and Massimo Antonelli and Peter Schellongowski and Peter Pickkers and Marcio Soares and Tine Meyhoff and Jordi Rello and Bauer, {Philippe R.} and {van de Louw}, Andry and Virgine Lemiale and David Grimaldi and Ignacio Martin-Loeches and Martin Balik and Sangeeta Mehta and Achille Kouatchet and Andreas Barratt-Due and Miia Valkonen and Jean Reignier and Victoria Metaxa and Moreau, {Anne Sophie} and Gaston Burghi and Djamel Mokart and Julien Mayaux and Michael Darmon and Elie Azoulay and Karin Amrein and Thomas Staundinger and Gottfried Heinz and G{\"u}rkan Seng{\"o}lge and Christian Zauner and Peter Jaksch and Taccone, {Fabio S.} and Meert, {Anne Pascale} and Dominique Beno{\^i}t and Silva, {Ulysses V.A.} and {Pierre de Moraes}, {Ana Paula} and Thiago Lishoa and Jorge Salluh and William Viana and Guilliana Moralez and Correa, {Thiago Domingos} and Umesh Shah and Thomas Karvunidis and Balik Martin and Katerina Russinova and Anders Perner and Meyhoff, {Tine Sylvest} and Nielsen Jonas and Bukan, {Ramin Brandt} and Moeller, {Ann M.} and Nielsen, {Lene B.} and Am{\'e}lie Seguin and Akli Chermak and Nicolas Terzi and Isabelle Vinatier and Florent Wallet and Kada Klouche and Laura Platon and Benjamin Gaborit and Fran{\c c}ois Barbier and Frederic P{\`e}ne and Antoine Rabbat and Virginie Lemiale and Martine N'Yunga and Christophe Girault and Caroline Lemaitre and Elise Artaud-Macari and F. Bruneel and Moreau, {Anne Sophie} and Anne Kuitunen and Brian Marsh and Mater Misericordia and Mahon, {Aisling Mc} and Gilda Cinnella and Antonella Cotoia and Ospedali Riuniti and Lucas Montini and {Spoelstra de Man}, Ang{\'e}lique and Landburg, {Precious Pearl} and Dennis Bergmans and Pleun Hemelaar and Thomas Kaufmann and Andreas Barrat-Due and P{\aa}l Klepstad and Belen Encina and Gabriel Moreno and Crespi, {Lloren{\c c} Socias} and Emilio Rodriguez-Ruiz and Philippe Bauer and Yadav Hemang",

note = "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; G{\"u}rkan Seng{\"o}lge and Christian Zauner, Department of Medicine III, Vienna, Austria; Peter Jaksch, Department of Thoracic Surgery, Vienna, Austria; Fabio S. Taccone and David Grimaldi, H{\^o}pital Erasme, Universit{\'e} Libre de Bruxelles (ULB), Bruxelles, Belgium; Anne Pascale Meert, Institut Jules Bordet, Bruxelles, Belgium; Dominique Beno{\^i}t, Ghent University Hospital, Ghent, Belgium; Ulysses V. A. Silva, Hospital de C{\^a}ncer 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, S{\~a}o 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, S{\o}nderborg, Denmark; Achille Kouatchet, Centre hopsitalier R{\'e}gional, Angers, France; Am{\'e}lie Seguin, CHU de Caen, Caen, France; Akli Chermak, Centre Hospitalier Sud Essonne, Etempes, France; Nicolas Terzi, CHU Grenoble Alpes, Universit{\'e} Grenoble-Alpes, Grenoble, France; Isabelle Vinatier, Centre Hospitalier de Vend{\'e}e, 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, H{\^o}tel Dieu, Nantes, France; Fran{\c c}ois Barbier, La Source Hospital, Orl{\'e}ans, France; Frederic P{\`e}ne, H{\^o}pital Cochin, Paris, France; Antoine Rabbat, H{\^o}pital Cochin, Paris, France; Alexandre Demoule and Julien Mayaux, Piti{\'e}-Salp{\^e}tri{\`e}re, Paris, France; Elie Azoulay and Virginie Lemiale, H{\^o}pital 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, H{\^o}pital Andr{\'e} 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; Ang{\'e}lique 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; P{\aa}l Klepstad, St. Olavs Hospital, Trondheim, Norway; Jordi Rello and Belen Encina, Universitat Auton{\`o}ma de Barcelona, Barcelona, Spain; Gabriel Moreno, Bellvitge, Barcelona, Spain; Lloren{\c c} 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: {\textcopyright} 2020 American College of Chest Physicians",

year = "2020",

month = nov,

doi = "10.1016/j.chest.2020.05.602",

language = "English (US)",

volume = "158",

pages = "1947--1957",

journal = "Diseases of the chest",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "5",

}

Demoule, A, Antonelli, M, Schellongowski, P, Pickkers, P, Soares, M, Meyhoff, T, Rello, J, Bauer, PR, van de Louw, A, Lemiale, V, Grimaldi, D, Martin-Loeches, I, Balik, M, Mehta, S, Kouatchet, A, Barratt-Due, A, Valkonen, M, Reignier, J, Metaxa, V, Moreau, AS, Burghi, G, Mokart, D, Mayaux, J, Darmon, M, Azoulay, E, Amrein, K, Staundinger, T, Heinz, G, Sengölge, G, Zauner, C, Jaksch, P, Taccone, FS, Meert, AP, Benoît, D, Silva, UVA, Pierre de Moraes, AP, Lishoa, T, Salluh, J, Viana, W, Moralez, G, Correa, TD, Shah, U, Karvunidis, T, Martin, B, Russinova, K, Perner, A, Meyhoff, TS, Jonas, N, Bukan, RB, Moeller, AM, Nielsen, LB, Seguin, A, Chermak, A, Terzi, N, Vinatier, I, Wallet, F, Klouche, K, Platon, L, Gaborit, B, Barbier, F, Pène, F, Rabbat, A, Lemiale, V, N'Yunga, M, Girault, C, Lemaitre, C, Artaud-Macari, E, Bruneel, F, Moreau, AS, Kuitunen, A, Marsh, B, Misericordia, M, Mahon, AM, Cinnella, G, Cotoia, A, Riuniti, O, Montini, L, Spoelstra de Man, A, Landburg, PP, Bergmans, D, Hemelaar, P, Kaufmann, T, Barrat-Due, A, Klepstad, P, Encina, B, Moreno, G, Crespi, LS, Rodriguez-Ruiz, E, Bauer, P & Hemang, Y 2020, 'Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study', CHEST, vol. 158, no. 5, pp. 1947-1957. https://doi.org/10.1016/j.chest.2020.05.602

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 -

Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study

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