Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

Alexandre Demoule; Massimo Antonelli; Peter Schellongowski; Peter Pickkers; Marcio Soares; Tine Meyhoff; Jordi Rello; Philippe Bauer; Andry van de Louw; Virgine Lemiale; David Grimaldi; Ignacio Martin-Loeches; Martin Balik; Sangeeta Mehta; Achille Kouatchet; Andreas Barratt-Due; Miia Valkonen; Jean Reignier; Victoria Metaxa; Anne-Sophie Moreau; Gaston Burghi; Djamel Mokart; Julien Mayaux; Michael Darmon; Elie Azoulay; Karin Amrein; Peter Schellongowski; Thomas Staundinger; Gottfried Heinz; Gürkan Sengölge; Christian Zauner; Peter Jaksch; Fabio Taccone; David Grimaldi; Anne Pascale Meert; Dominique Benoît; Ulysses V.A. Silva; Ana Paula Pierre de Moraes; Thiago Lishoa; Marcio Soares; Jorge Salluh; William Viana; Guilliana Moralez; Thiago Domingos Correa; Sangeeta Mehta; Umesh Shah; Thomas Karvunidis; Balik Martin; Katerina Russinova; Anders Perner; Tine Sylvest Meyhoff; Nielsen Jonas; Ramin Brandt Bukan; Ann Moeller; Lene Nielsen; Achille Kouatchet; Amélie Seguin; Akli Chermak; Nicolas Terzi; Isabelle Vinatier; Anne-Sophie Moreau; Florent Wallet; Djamel Mokart; Kada Klouche; Laura Platon; Benjamin Gaborit; François Barbier; Frederic Pène; Antoine Rabbat; Alexandre Demoule; Julien Mayaux; Elie Azoulay; Virginie Lemiale; Martine N'Yunga; Christophe Girault; Caroline Lemaitre; Elise Artaud-Macari; Michael Darmon; F. Bruneel; Anne Sophie Moreau; Miia Valkonen; Anne Kuitunen; Brian Marsh; Mater Misericordia; Ignacio Martin-Loeches; Aisling Mc Mahon; Gilda Cinnella; Antonella Cotoia; Ospedali Riuniti; Massimo Antonelli; Lucas Montini; Angélique Spoelstra de Man; Precious Pearl Landburg; Dennis Bergmans; Peter Pickkers; Pleun Hemelaar; Thomas Kaufmann; Andreas Barrat-Due; Pål Klepstad; Jordi Rello; Belen Encina; Gabriel Moreno; Llorenç Socias Crespi; Emilio Rodriguez-Ruiz; Victoria Metaxa; Gaston Burghi; Andry van de Louw; Philippe Bauer; Yadav Hemang

doi:10.1016/j.chest.2020.05.602

Journal Articles Chest Year : 2020

Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

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Alexandre Demoule

Function : Author

Massimo Antonelli

Function : Author

Peter Schellongowski

Function : Author

Peter Pickkers

Function : Author

Marcio Soares

Function : Author

Tine Meyhoff

Function : Author

Jordi Rello

Function : Author

Philippe Bauer

Function : Author

Andry van de Louw

Function : Author

Virgine Lemiale

Function : Author

David Grimaldi

Function : Author

Ignacio Martin-Loeches

Function : Author

Martin Balik

Function : Author

Sangeeta Mehta

Function : Author

Achille Kouatchet

Function : Author

Andreas Barratt-Due

Function : Author

Miia Valkonen

Function : Author

Jean Reignier

Function : Author

Victoria Metaxa

Function : Author

Anne-Sophie Moreau

Function : Author

Gaston Burghi

Function : Author

Djamel Mokart

Function : Author

Julien Mayaux

Function : Author

Michael Darmon

Function : Author
PersonId : 910815
ORCID : 0000-0003-4198-8038
IdRef : 069528896

Elie Azoulay

Function : Author
PersonId : 1189025
ORCID : 0000-0002-8162-1508
IdRef : 066920515

Karin Amrein

Function : Author

Peter Schellongowski

Function : Author

Thomas Staundinger

Function : Author

Gottfried Heinz

Function : Author

Gürkan Sengölge

Function : Author

Christian Zauner

Function : Author

Peter Jaksch

Function : Author

Fabio Taccone

Function : Author

David Grimaldi

Function : Author

Anne Pascale Meert

Function : Author

Dominique Benoît

Function : Author

Ulysses V.A. Silva

Function : Author

Ana Paula Pierre de Moraes

Function : Author

Thiago Lishoa

Function : Author

Marcio Soares

Function : Author

Jorge Salluh

Function : Author

William Viana

Function : Author

Guilliana Moralez

Function : Author

Thiago Domingos Correa

Function : Author

Sangeeta Mehta

Function : Author

Umesh Shah

Function : Author

Thomas Karvunidis

Function : Author

Balik Martin

Function : Author

Katerina Russinova

Function : Author

Anders Perner

Function : Author

Tine Sylvest Meyhoff

Function : Author

Nielsen Jonas

Function : Author

Ramin Brandt Bukan

Function : Author

Ann Moeller

Function : Author

Lene Nielsen

Function : Author

Achille Kouatchet

Function : Author

Amélie Seguin

Function : Author

Akli Chermak

Function : Author

Nicolas Terzi

Function : Author
PersonId : 879054
ORCID : 0000-0003-4036-6245
IdRef : 120009579

Isabelle Vinatier

Function : Author

Anne-Sophie Moreau

Function : Author

Florent Wallet

Function : Author

Djamel Mokart

Function : Author

Kada Klouche

Function : Author
PersonId : 930999
ORCID : 0000-0003-1633-7700

Laura Platon

Function : Author

Benjamin Gaborit

Function : Author
PersonId : 799507
ORCID : 0000-0002-6076-9722
IdRef : 191798371

François Barbier

Function : Author

Frederic Pène

Function : Author

Antoine Rabbat

Function : Author

Alexandre Demoule

Function : Author

Julien Mayaux

Function : Author

Elie Azoulay

Function : Author

Virginie Lemiale

Function : Author

Martine N'Yunga

Function : Author

Christophe Girault

Function : Author

Caroline Lemaitre

Function : Author

Elise Artaud-Macari

Function : Author

Michael Darmon

Function : Author

F. Bruneel

Function : Author

Anne Sophie Moreau

Function : Author

Miia Valkonen

Function : Author

Anne Kuitunen

Function : Author

Brian Marsh

Function : Author

Mater Misericordia

Function : Author

Ignacio Martin-Loeches

Function : Author

Aisling Mc Mahon

Function : Author

Gilda Cinnella

Function : Author

Antonella Cotoia

Function : Author

Ospedali Riuniti

Function : Author

Massimo Antonelli

Function : Author

Lucas Montini

Function : Author

Angélique Spoelstra de Man

Function : Author

Precious Pearl Landburg

Function : Author

Dennis Bergmans

Function : Author

Peter Pickkers

Function : Author

Pleun Hemelaar

Function : Author

Thomas Kaufmann

Function : Author

Andreas Barrat-Due

Function : Author

Pål Klepstad

Function : Author

Jordi Rello

Function : Author

Belen Encina

Function : Author

Gabriel Moreno

Function : Author

Llorenç Socias Crespi

Function : Author

Emilio Rodriguez-Ruiz

Function : Author

Victoria Metaxa

Function : Author

Gaston Burghi

Function : Author

Andry van de Louw

Function : Author

Philippe Bauer

Function : Author

Yadav Hemang

Function : Author

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.

Keywords

ARDS Acute respiratory failure Diagnosis Driving pressure Immunocompromised Outcome Plateau pressure

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Life Sciences [q-bio]

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https://hal.science/hal-03614745

Submitted on : Friday, November 29, 2024-4:40:38 PM

Last modification on : Friday, November 29, 2024-4:40:39 PM

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hal-03614745 , version 1 (29-11-2024)

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Attribution - NonCommercial

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HAL Id : hal-03614745 , version 1
DOI : 10.1016/j.chest.2020.05.602
PII : S0012-3692(20)31717-7
PUBMED : 32569634
WOS : 000596845800031

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Alexandre Demoule, Massimo Antonelli, Peter Schellongowski, Peter Pickkers, Marcio Soares, et al.. Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS. Chest, 2020, 158 (5), pp.1947-1957. ⟨10.1016/j.chest.2020.05.602⟩. ⟨hal-03614745⟩

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Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

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