High Positive End-Expiratory Pressure Is Associated with Improved Survival in Obese Patients with Acute Respiratory Distress Syndrome

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• 作者：Christian Bime ; MD ; MSc^a ; ^b ; ^{cbime@email.arizona.edu} ; Mallorie Fiero ; PhD^c ; Zhenqiang Lu ; PhD^b ; ^d ; Eyal Oren ; PhD ; MS^c ; Cristine E. Berry ; MD ; MHS^a ; ^b ; Sairam Parthasarathy ; MD^a ; ^b ; Joe G.N. Garcia ; MD^a ; ^b
• 关键词：Adult ; ARDS ; Mortality ; Obesity ; PEEP ; Survival
• 刊名：The American Journal of Medicine
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：130
• 期：2
• 页码：207-213
• 全文大小：508 K
• 卷排序：130

文摘

In acute respiratory distress syndrome, minimizing lung injury from repeated collapse and reopening of alveoli by applying a high positive end-expiratory pressure improves oxygenation without influencing mortality. Obesity causes alveolar atelectasis, thus suggesting that a higher positive end-expiratory pressure might be more protective among the obese. We hypothesized that the effect of applying a high positive end-expiratory pressure on mortality from acute respiratory distress syndrome would differ by obesity status.MethodsThis was a retrospective analysis of 505 patients from the Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury Trial, a multicenter randomized trial that compared a higher vs a lower positive end-expiratory pressure ventilatory strategy in acute respiratory distress syndrome. We examined the relationship between positive end-expiratory pressure strategy and 60-day mortality stratified by obesity status.ResultsAmong obese patients with acute respiratory distress syndrome, those assigned to a high positive end-expiratory pressure strategy experienced lower mortality compared with those assigned to a low strategy (18% vs 32%; P = .04). Among the nonobese, those assigned to high positive end-expiratory pressure strategy experienced similar mortality with those assigned to low strategy (34% vs 23%; P = .13). Multivariate analysis demonstrated an interaction between obesity status and the effect of positive end-expiratory pressure strategy on mortality (P <.01).ConclusionsVentilation with higher levels of positive end-expiratory pressure was associated with improved survival among the subgroup of patients with acute respiratory distress syndrome who are obese.