Abstract

Background

Outcome prediction in critically ill patients under invasive ventilation remains extremely challenging. The driving pressure (ΔP) and the mechanical power of ventilation (MP) are associated with patient-centered outcomes like mortality and duration of ventilation. The objective of this study was to assess the predictive validity for mortality of the ΔP and the MP at 24 h after start of invasive ventilation.

Methods

This is a post hoc analysis of an observational study in intensive care unit patients, restricted to critically ill patients receiving invasive ventilation for at least 24 h. The two exposures of interest were the modified ΔP and the MP at 24 h after start of invasive ventilation. The primary outcome was 90-day mortality; secondary outcomes were ICU and hospital mortality. The predictive validity was measured as incremental 90-day mortality beyond that predicted by the Acute Physiology, Age and Chronic Health Evaluation (APACHE) IV score and the Simplified Acute Physiology Score (SAPS) II.

Results

The analysis included 839 patients with a 90-day mortality of 42%. The median modified ΔP at 24 h was 15 [interquartile range 12 to 19] cm H2O; the median MP at 24 h was 206 [interquartile range 145 to 298] 10−3 J/min/kg predicted body weight (PBW). Both parameters were associated with 90-day mortality (odds ratio (OR) for 1 cm H2O increase in the modified ΔP, 1.05 [95% confidence interval (CI) 1.03 to 1.08]; P < 0.001; OR for 100 10−3 J/min/kg PBW increase in the MP, 1.20 [95% CI 1.09 to 1.33]; P < 0.001). Area under the ROC for 90-day mortality of the modified ΔP and the MP were 0.70 [95% CI 0.66 to 0.74] and 0.69 [95% CI 0.65 to 0.73], which was neither different from that of the APACHE IV score nor that of the SAPS II.

Conclusions

In adult patients under invasive ventilation, the modified ΔP and the MP at 24 h are associated with 90 day mortality. Neither the modified ΔP nor the MP at 24 h has predictive validity beyond the APACHE IV score and the SAPS II.

Details

Title
The predictive validity for mortality of the driving pressure and the mechanical power of ventilation
Author
van Meenen David M P 1   VIAFID ORCID Logo  ; Serpa Neto Ary 2 ; Paulus Frederique 1 ; Coen, Merkies 1 ; Schouten, Laura R 1 ; Bos Lieuwe D 3 ; Horn, Janneke 1 ; Juffermans, Nicole P 3 ; Cremer, Olaf L 4 ; van der Poll Tom 5 ; Schultz, Marcus J 6 ; de Beer Friso M; Glas, Gerie J; Hoogendijk, Arie J; van Hooijdonk Roosmarijn T; Huson, Mischa A; Scicluna Brendon; Straat Marleen; van Vught Lonneke A; Wieske Luuk; Wiewel, Maryse A; Witteveen Esther; Bonten, Marc J; Frencken, Jos F; van de Groep Kirsten; Klein Klouwenberg Peter M; Koster-Brouwer, Maria E; Ong, David S; Varkila, Meri R; Verboom, Diana M

1  University of Amsterdam, Amsterdam University Medical Centers, Department of Intensive Care, Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262) 
2  University of Amsterdam, Amsterdam University Medical Centers, Department of Intensive Care, Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262); Hospital Israelita Albert Einstein, Department of Critical Care Medicine, São Paulo, Brazil (GRID:grid.413562.7) (ISNI:0000 0001 0385 1941) 
3  University of Amsterdam, Amsterdam University Medical Centers, Department of Intensive Care, Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262); University of Amsterdam, Amsterdam University Medical Centers, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262) 
4  University Medical Center Utrecht, Department of Intensive Care Medicine, Utrecht, The Netherlands (GRID:grid.7692.a) (ISNI:0000000090126352) 
5  University of Amsterdam, Amsterdam University Medical Centers, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262); University of Amsterdam, Amsterdam University Medical Centers, Center for Infection and Immunity Amsterdam, Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262); University of Amsterdam, Amsterdam University Medical Centers, Division of Infectious Diseases, Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262) 
6  University of Amsterdam, Amsterdam University Medical Centers, Department of Intensive Care, Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262); University of Amsterdam, Amsterdam University Medical Centers, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262); Mahidol University, Mahidol–Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand (GRID:grid.10223.32) (ISNI:0000 0004 1937 0490); University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948) 
Publication year
2020
Publication date
Dec 2020
Publisher
Springer Nature B.V.
e-ISSN
2197425X
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s40635-020-00346-8
ProQuest document ID
2473334052
Copyright
© The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.