Drive to Survive: Dynamic Driving Pressure and Survival in the Trauma Population

Résumé fourni par la source

Background Driving pressure (ΔP), the difference between peak inspiratory pressure (PIP) or plateau pressure (Pplat) and positive end-expiratory pressure (PEEP), has been proposed as a better target for avoiding ventilator-induced lung injury (VILI) in mechanically ventilated patients. This study aimed to determine if lower dynamic ΔP would correlate with reduced mortality and lower incidences of VILI. Methods A single-center retrospective analysis identified 237 trauma patients admitted in 2020 who underwent ≥48 hours of mechanical ventilation and survived ≥72 hours. The primary outcomes were 30-day hospital mortality and development of acute hypoxic VILI. Univariate and multivariate analyses assessed variables associated with 30-day mortality and VILI incidence. Results The cohort had a median age of 45 years, predominantly male (83.1%), with most admitted for blunt trauma (62.4%). The median ventilation duration was 6 days. Mortality was 20% for patients with ΔP ≤ 15 cm H 2 O and 32% for those with higher ΔP ( P = 0.04). Ventilator-induced lung injury incidence was higher in patients with ΔP ≥ 15 cm H 2 O (34% vs 19%; P = 0.01). Multivariate analysis, adjusting for age, Injury Severity Score (ISS), and presence of intracranial bleed, indicated that an average ΔP ≥ 15 cm H 2 O was associated with an increased risk of 30-day mortality (OR 2.4; 95% CI 1.2-4.8, P = 0.02) and higher VILI incidence (OR 2.2; 95% CI 1.2-4.0, P = 0.01). Conclusions Among trauma patients requiring at least 48 hours of mechanical ventilation, employing strategies to limit dynamic ΔP to less than 15 cm H 2 O may reduce 30-day mortality and the incidence of acute VILI.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.