Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece - Archive ouverte HAL
Article Dans Une Revue New England Journal of Medicine Année : 2022

Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece

Arnaud Thille
Arnaud Gacouin
  • Fonction : Auteur
Rémi Coudroy
  • Fonction : Auteur
Stephan Ehrmann
Jean-Pierre Quenot
Mai-Anh Nay
  • Fonction : Auteur
Christophe Guitton
  • Fonction : Auteur
Damien Contou
Guylaine Labro
  • Fonction : Auteur
Jean Reignier
  • Fonction : Auteur
Gael Pradel
  • Fonction : Auteur
Gaëtan Beduneau
  • Fonction : Auteur
Laurence Dangers
  • Fonction : Auteur
Clement Saccheri
  • Fonction : Auteur
Gwénaël Prat
  • Fonction : Auteur
Guillaume Lacave
  • Fonction : Auteur
Nicholas Sedillot
  • Fonction : Auteur
Nicolas Terzi
Béatrice La Combe
  • Fonction : Auteur
Jean-Paul Mira
  • Fonction : Auteur
  • PersonId : 928244
Antoine Romen
  • Fonction : Auteur
Marie-Ange Azais
  • Fonction : Auteur
Anahita Rouzé
  • Fonction : Auteur
Jérôme Devaquet
  • Fonction : Auteur
Agathe Delbove
  • Fonction : Auteur
Jeremy Bourenne
  • Fonction : Auteur
Alexandre Lautrette
Joe de Keizer
  • Fonction : Auteur
Stéphanie Ragot
  • Fonction : Auteur
Jean-Pierre Frat
  • Fonction : Auteur

Résumé

Abstract Background Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59–78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57–77] vs 74 [64–80] years, p < 0.001) and had lower driving (12 [8–16] vs 15 [11–17] cmH 2 O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH 2 O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60–1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16–2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06–1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52–0.93], p = 0.015) were related to survival. Conclusions Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073

Dates et versions

hal-03984748 , version 1 (13-02-2023)

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Citer

Arnaud Thille, Arnaud Gacouin, Rémi Coudroy, Stephan Ehrmann, Jean-Pierre Quenot, et al.. Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece. New England Journal of Medicine, 2022, 387 (20), pp.1843-1854. ⟨10.1056/NEJMoa2209041⟩. ⟨hal-03984748⟩
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