A lung rescue team improves survival in obesity with acute respiratory distress syndrome
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Published:2020-01-15
Issue:1
Volume:24
Page:
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ISSN:1364-8535
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Container-title:Critical Care
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language:en
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Short-container-title:Crit Care
Author:
Florio Gaetano, , Ferrari Matteo, Bittner Edward A., De Santis Santiago Roberta, Pirrone Massimiliano, Fumagalli Jacopo, Teggia Droghi Maddalena, Mietto Cristina, Pinciroli Riccardo, Berg Sheri, Bagchi Aranya, Shelton Kenneth, Kuo Alexander, Lai Yvonne, Sonny Abraham, Lai Peggy, Hibbert Kathryn, Kwo Jean, Pino Richard M., Wiener-Kronish Jeanine, Amato Marcelo B. P., Arora Pankaj, Kacmarek Robert M., Berra LorenzoORCID
Abstract
Abstract
Background
Limited data exist regarding ventilation in patients with class III obesity [body mass index (BMI) > 40 kg/m2] and acute respiratory distress syndrome (ARDS). The aim of the present study was to determine whether an individualized titration of mechanical ventilation according to cardiopulmonary physiology reduces the mortality in patients with class III obesity and ARDS.
Methods
In this retrospective study, we enrolled adults admitted to the ICU from 2012 to 2017 who had class III obesity and ARDS and received mechanical ventilation for > 48 h. Enrolled patients were divided in two cohorts: one cohort (2012–2014) had ventilator settings determined by the ARDSnet table for lower positive end-expiratory pressure/higher inspiratory fraction of oxygen (standard protocol-based cohort); the other cohort (2015–2017) had ventilator settings determined by an individualized protocol established by a lung rescue team (lung rescue team cohort). The lung rescue team used lung recruitment maneuvers, esophageal manometry, and hemodynamic monitoring.
Results
The standard protocol-based cohort included 70 patients (BMI = 49 ± 9 kg/m2), and the lung rescue team cohort included 50 patients (BMI = 54 ± 13 kg/m2). Patients in the standard protocol-based cohort compared to lung rescue team cohort had almost double the risk of dying at 28 days [31% versus 16%, P = 0.012; hazard ratio (HR) 0.32; 95% confidence interval (CI95%) 0.13–0.78] and 3 months (41% versus 22%, P = 0.006; HR 0.35; CI95% 0.16–0.74), and this effect persisted at 6 months and 1 year (incidence of death unchanged 41% versus 22%, P = 0.006; HR 0.35; CI95% 0.16–0.74).
Conclusion
Individualized titration of mechanical ventilation by a lung rescue team was associated with decreased mortality compared to use of an ARDSnet table.
Funder
National Institutes of Health
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference32 articles.
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