Risk factors for the development of acute respiratory distress syndrome in mechanically ventilated adults in Peru: a multicenter observational study

Abstract

BackgroundClinical and epidemiological differences between acute respiratory distress syndrome (ARDS) that presents at the initiation of mechanical ventilation [MV] (ARDS at MV onset) and that which develops during the course of MV (ARDS after MV onset) are not well understood. We conducted an observational study in five Peruvian ICUs to characterize differences between ARDS at MV onset and after MV onset and identify risk factors for the development of ARDS after MV onset.MethodsWe consecutively enrolled critically ill patients with acute respiratory failure requiring at least 24 h of mechanical ventilation and followed them prospectively during the first 28 days and compared baseline characteristics and clinical outcomes by ARDS status.ResultsWe enrolled 1657 participants on MV (mean age 60.0 years, 55% males) of whom 334 (20.2%) had ARDS at MV onset and 180 (10.9%) developed ARDS after MV onset. Average tidal volume at the initiation of MV was 8.7 mL/kg of predicted body weight (PBW) for participants with ARDS at MV onset, 8.6 mL/kg PBW for those who developed ARDS after MV onset, and 8.5 mL/kg PBW for those who never developed ARDS (p = 0.23). Overall, 90-day mortality was 56% and 55% for ARDS after MV onset and ARDS at MV onset, respectively, as compared to 46% among those who never developed ARDS (p < 0.01). Adults with ARDS had a higher body mass index (BMI) than those without ARDS (27.3 vs 26.5 kg/m2, p < 0.01). Higher peak pressure (adjusted interquartile OR = 1.51, 95% CI 1.21–1.88), higher mean airway pressure (adjusted interquartile OR = 1.41, 95% CI 1.13–1.76), and higher positive end-expiratory pressure (adjusted interquartile OR = 1.29, 95% CI 1.10–1.50) at MV onset were associated with a higher odds of developing ARDS after MV onset.ConclusionsIn this study of mechanically ventilated patients, 31% of study participants had ARDS at some point during their ICU stay. Optimal lung-protective ventilation was not used in a majority of patients. Patients with ARDS after MV onset had a similar 90-day mortality as those with ARDS at MV onset. Higher airway pressures at MV onset, higher PEEP, and higher BMI were associated with the development of ARDS after MV onset.

Epidemiological Characteristics, Ventilator Management, and Clinical Outcome in Patients Receiving Invasive Ventilation in Intensive Care Units from 10 Asian Middle-Income Countries (PRoVENT-iMiC): An International, Multicenter, Prospective Study

“…7 The proportion of patients with LIPS ³ 4 who developed ARDS during follow-up, however, was less than that reported in previous studies in high-income settings (7-9%) 7,27 and also compared with a recent investigation focusing on the development of ARDS in patients in Peruvian ICUs (11%). 28 The current study confirms the poor predictive value of the LIPS for developing ARDS 7 and for pulmonary complications, however, did identify patients at increased risk of death. The higher mortality in the group with LIPS ³ 4 may be explained, at least in part by differences in age, Body mass index and comorbidities, the SOFA score on admission, and use of noninvasive ventilation before the start of invasive ventilation.…”

“…22 [18,28] 21.0 [18,25] 22 [18,28] 28 [23,36] 0.0009 < 0.0001 Pplat (cmH 2 O) † 18 [15,21] 16 [14,18] 18 [16,21] 28 [22,30] < 0.0001 < 0.0001 Driving pressure (cmH 2 O) 14 [11,18] 13 [10,17] 15 [11,18] 16 [14,20] 0.0705 0.0037 Set RR (bpm)…”

“…Before the initiation of the study, the national coordinators reviewed the case report forms (CRFs) to evaluate clarity and consistency (see Supplemental Appendix, pp. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. A concise one-off web-based survey on ICU structure and organizational aspects was performed in the participating sites, as suggested by previous literature 12 (see Supplemental Appendix,.…”

Association between procalcitonin levels and duration of mechanical ventilation in COVID-19 patients

“…Our multivariate regression analysis was adjusted for severity of disease by including the SOFA score, for predisposing characteristics by including age, BMI, diabetes mellitus, hypertension, and chronic cardiac disease, and for procalcitonin levels on admission based on our own preliminary findings and other literature [ 8 – 11 , 13 , 27 – 29 ]. Besides a procalcitonin level of >0.1 ng/ml, duration of mechanical ventilation was associated with age and BMI in our multivariate regression model.…”

Ventilation management in acute respiratory failure related to COVID-19 versus ARDS from another origin – a descriptive narrative review

“…In one study from Canada, less than half of patients received a V T ≤ 8 ml/kg PBW [ 49 ]. In one study from Peru, only a fraction of patients received ventilation with a V T of ≤ 6 ml/kg PBW [ 44 ]. In studies in patients with acute respiratory failure related to COVID-19, median V T varied from 5.8 to 7.0 ml/kg PBW––mean V T was ~7 ml/kg PBW in one study from the United Kingdom [ 51 ] ( Table 2 and Figure 2 ).…”