Effect of Esophageal Pressure–guided Positive End-Expiratory Pressure on Survival from Acute Respiratory Distress Syndrome: A Risk-based and Mechanistic Reanalysis of the EPVent-2 Trial

Transpulmonary pressure Positive End-Expiratory Pressure
DOI: 10.1164/rccm.202009-3539oc Publication Date: 2021-08-31T17:45:33Z
ABSTRACT
Rationale: In acute respiratory distress syndrome (ARDS), the effect of positive end-expiratory pressure (PEEP) may depend on extent to which multiorgan dysfunction contributes risk death, and precision with PEEP is titrated attenuate atelectrauma without exacerbating overdistension. Objectives: To evaluate whether lung mechanics modified treatment in EPVent-2 (Esophageal Pressure-guided Ventilation 2) trial, a multicenter trial esophageal (Pes)-guided versus empirical high moderate severe ARDS. Methods: This post hoc reanalysis evaluated for heterogeneity mortality by baseline dysfunction, determined via Acute Physiology Chronic Health Evaluation II (APACHE-II). It also transpulmonary near 0 cm H2O was associated survival. Measurements Main Results: All 200 participants were included. Treatment 60-day differed severity (P = 0.03 interaction). Pes-guided lower among patients APACHE-II less than median value (hazard ratio, 0.43; 95% confidence interval, 0.20–0.92) have had opposite higher 1.69; 0.93–3.05). Independent group or severity, lowest when titration achieved H2O. Conclusions: The survival PEEP, compared severity. closer greater more negative values. These findings warrant prospective testing future trial.
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