A combination of oxygenation and driving pressure can provide valuable information in predicting the risk of mortality in ARDS patients

Yu-Yi Yu; Wei-Fan Ou; Jia-Jun Wu; Han-Shui Hsu; Chieh-Laing Wu; Kuang-Yao Yang; Ming-Cheng Chan

doi:10.1371/journal.pone.0295261

A combination of oxygenation and driving pressure can provide valuable information in predicting the risk of mortality in ARDS patients

PLoS One. 2023 Dec 13;18(12):e0295261. doi: 10.1371/journal.pone.0295261. eCollection 2023.

Authors

Yu-Yi Yu^{1

2}, Wei-Fan Ou³, Jia-Jun Wu^{3

4}, Han-Shui Hsu^{1

5}, Chieh-Laing Wu^{2

6}, Kuang-Yao Yang^{1

7

8}, Ming-Cheng Chan^{2

3

6}

Affiliations

¹ Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
³ Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴ Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁵ Department of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ School of Post BaccalaureateMedicine, National Chung Hsing University, Taichung, Taiwan.
⁷ Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁸ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a common life-threatening condition in critically ill patients. Itis also an important public health issue because it can cause substantial mortality and health care burden worldwide. The objective of this study was to investigate therisk factors that impact ARDS mortality in a medical center in Taiwan.

Methods: This was a single center, observational study thatretrospectively analyzed data from adults in 6 intensive care units (ICUs) at Taichung Veterans General Hospital in Taiwan from 1st October, 2018to30th September, 2019. Patients needing invasive mechanical ventilation and meeting the Berlin definition criteria were included for analysis.

Results: A total of 1,778 subjects were screened in 6 adult ICUs and 370 patients fulfilled the criteria of ARDS in the first 24 hours of the ICU admission. Among these patients, the prevalenceof ARDS was 20.8% and the overall hospital mortality rate was 42.2%. The mortality rates of mild, moderate and severe ARDS were 35.9%, 43.9% and 46.5%, respectively. In a multivariate logistic regression model, combination of driving pressure (DP) > 14cmH2O and oxygenation (P/F ratio)≤150 was an independent predictor of mortality (OR2.497, 95% CI 1.201-5.191, p = 0.014). Patients with worse oxygenation and a higher driving pressure had the highest hospital mortality rate(p<0.0001).

Conclusions: ARDS is common in ICUs and the mortality rate remains high. Combining oxygenation and respiratory mechanics may better predict the outcomes of these ARDS patients.

Copyright: © 2023 Yu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Observational Study

MeSH terms

Adult
Humans
Intensive Care Units
Lung*
Respiration, Artificial / adverse effects
Respiratory Distress Syndrome*
Risk Factors

Grants and funding

This study was supported by Taichung Veterans General Hospital (TCVGH-1104101C). The funder provided the grant for project administration, material and supplies costs, and assistant salary. The WFO, JJW, CLW, and MCC are employees of TCVGH. The funder provided partial salary for the author YYY. The funder did not have any additional role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.