Influence of the Driving Pressure on Mortality in ARDS Patients with or without Abdominal Obesity: A Retrospective Cohort Study

Abstract

Objective. This study sets out to explore if the relationship between the driving pressure and hospital mortality in ARDS patients is influenced by body mass index (BMI) level or the presence of abdominal obesity. Methods. Data were extracted from an online database named “Multiparameter Intelligent Monitoring in Intensive Care III.” A total of 1556 patients were included and divided into four subgroups based on both BMI level (BMI ≥30 kg/m2 or BMI ＜30 kg/m2) and abdominal assessment. Driving pressure [i.e., the difference between plateau pressure and positive end-expiratory pressure (PEEP)] within 24 h of invasive mechanical ventilation was compared between survivors and nonsurvivors during hospitalization in each group. A logistic regression model was used for hospital mortality. Results. There were 1556 patients with mild-to-severe ARDS, 666 (42.80%) nonobese patients with nonabdominal obesity, 259 (16.65%) nonobese patients with abdominal obesity, 97 (6.23%) obese patients with nonabdominal obesity, and 534 (34.32%) obese patients with abdominal obesity. Driving pressure in nonobese patients with nonabdominal obesity was significantly lower in survivors (12.77 ± 4.53 cm H2O) than in nonsurvivors (14.26 ± 5.52 cm H2O, $p<0.01$ ). On the contrary, in the other three groups, driving pressure was not significantly different between survivors and nonsurvivors. After a logistic multivariable regression analysis, in nonobese (BMI<30 kg/m2) patients with nonabdominal obesity, the driving pressure was independently associated with increased hospital mortality (OR: 1.04, 95% CI 1.00–1.09, $p<0.05$ ) but not in the other three subgroups. Conclusion. Driving pressure is associated with increase in hospital mortality only in nonobese (BMI <30 kg/m2) patients with nonabdominal obesity.