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
AUTHORS (43)
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.
SUPPLEMENTAL MATERIAL
Coming soon ....
REFERENCES (22)
CITATIONS (71)
EXTERNAL LINKS
PlumX Metrics
RECOMMENDATIONS
FAIR ASSESSMENT
Coming soon ....
JUPYTER LAB
Coming soon ....