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 |
|---|---|
| Pages (from-to) | 1947-1957 |
| Number of pages | 11 |
| Journal | Chest |
| Volume | 158 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - Nov 2020 |
Keywords
- acute respiratory failure
- ARDS
- diagnosis
- driving pressure
- immunocompromised
- outcome
- plateau pressure
- DISTRESS-SYNDROME
- NEUTROPHILS
- FAILURE
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In: Chest, Vol. 158, No. 5, 11.2020, p. 1947-1957.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS 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 - EFRAIM Investigators
AU - Bergmans, Dennis
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; G?rkan Seng?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?pital Erasme, Universit? Libre de Bruxelles (ULB), Bruxelles, Belgium; Anne Pascale Meert, Institut Jules Bordet, Bruxelles, Belgium; Dominique Beno?t, Ghent University Hospital, Ghent, Belgium; Ulysses V. A. Silva, Hospital de C?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?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?nderborg, Denmark; Achille Kouatchet, Centre hopsitalier R?gional, Angers, France; Am?lie Seguin, CHU de Caen, Caen, France; Akli Chermak, Centre Hospitalier Sud Essonne, Etempes, France; Nicolas Terzi, CHU Grenoble Alpes, Universit? Grenoble-Alpes, Grenoble, France; Isabelle Vinatier, Centre Hospitalier de Vend?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?tel Dieu, Nantes, France; Fran?ois Barbier, La Source Hospital, Orl?ans, France; Frederic P?ne, H?pital Cochin, Paris, France; Antoine Rabbat, H?pital Cochin, Paris, France; Alexandre Demoule and Julien Mayaux, Piti?-Salp?tri?re, Paris, France; Elie Azoulay and Virginie Lemiale, H?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?pital Andr? 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?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?l Klepstad, St. Olavs Hospital, Trondheim, Norway; Jordi Rello and Belen Encina, Universitat Auton?ma de Barcelona, Barcelona, Spain; Gabriel Moreno, Bellvitge, Barcelona, Spain; Lloren? 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.
KW - acute respiratory failure
KW - ARDS
KW - diagnosis
KW - driving pressure
KW - immunocompromised
KW - outcome
KW - plateau pressure
KW - DISTRESS-SYNDROME
KW - NEUTROPHILS
KW - FAILURE
U2 - 10.1016/j.chest.2020.05.602
DO - 10.1016/j.chest.2020.05.602
M3 - Article
C2 - 32569634
SN - 0012-3692
VL - 158
SP - 1947
EP - 1957
JO - Chest
JF - Chest
IS - 5
ER -