Improving outcomes one breath at a time: The relationship between lung protective ventilation and risk of developing acute respiratory distress syndrome in patients with sepsis 公开

Abstract

Introduction: Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection, with a mortality of 15%. One contributor to this high mortality is the development of acute respiratory distress syndrome (ARDS), an acute diffuse, inflammatory lung process that manifests as severe hypoxemic respiratory failure. While the use of lung protective ventilation (LPV), a strategy of using low tidal volume and plateau pressure during invasive mechanical ventilation (IMV), significantly reduces mortality in patients who already meet criteria for ARDS and is the standard of care, the utility of LPV in other critically ill patient populations without ARDS is unclear. We hypothesize that in patients with sepsis requiring IMV, the use of early LPV reduces the risk of developing ARDS.

Methods: This is a retrospective cohort study of adult patients with sepsis admitted to two academic hospitals requiring IMV from January 1, 2015, to December 31, 2015. We extracted data on demographics, anthropometrics, physical measurements, severity of illness, sepsis variables, ventilator parameters, and hospital course. LPV was defined as a set ventilator tidal volume <6.5 mL/kg of predicted body weight and plateau pressure ≤ 30 cmH2O during the first day of IMV.

Results: We identified 533 patients with sepsis requiring IMV. A total of 187 (35%) patients received LPV on the first day of IMV, were more often male, had a higher mean height, had a higher mean body mass index (BMI) and more often had community acquired sepsis. A total of 133 (18%) patients developed ARDS, and had a higher weight, lower BMI, and higher SOFA score. In multivariable analysis adjusted for age, sex, height, BMI, and SOFA, receipt of LPV on the first day of IMV was not associated with a decreased risk of developing ARDS (risk ratio 0.97, 95% confidence interval 0.65 – 1.46, p=0.89).

Conclusions: In this retrospective cohort of adult patients with sepsis requiring IMV, there was no significant association between receipt of LPV on the first day of IMV risk of developing ARDS.

Table of Contents

INTRODUCTION 1

BACKGROUND 3

METHODS 8

RESULTS 15

DISCUSSION 17

REFERENCES 21

TABLES / FIGURES 25

Table 1: Baseline characteristics of patients with sepsis requiring invasive mechanical ventilation according to patients who received or did not receive lung protective ventilation (LPV) on the first day of invasive mechanical ventilation in 2015 across two academic hospitals 26

Table 2: Demographics and characteristics between patients with sepsis that developed acute respiratory distress syndrome (ARDS) and did not develop ARDS in 2015 across two academic hospitals 27

Table 3: Outcomes between patients with sepsis requiring invasive mechanical ventilation (IMV) who did and did not develop acute respiratory distress syndrome (ARDS) 28

Table 4: Multivariate logistic regression estimating the risk ratios of the receipt of LPV on the first day of IMV on the development of acute respiratory distress syndrome (ARDS) 29

Table 5: Multivariate logistic regression estimating the risk ratios of the effect of lowest tidal volume on the first day of IMV on the development of acute respiratory distress syndrome (ARDS) 30

Figure 1: Patient flow diagram 31

Figure 2: Histogram of patients who ever received lung protective ventilation (LPV) and time until receipt of LPV after IMV in days 32

 Figure 3: Histogram of the entire cohort of minimum set tidal volume on the first day of invasive mechanical ventilation 33

Appendix A: CDC Adult Sepsis Surveillance Definition 34

Appendix B: Select Categorical Covariate Classifications 35

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
关键词	Acute Respiratory Distress Syndrome Lung protective ventilation Respiratory Failure Sepsis ARDS
Committee Chair / Thesis Advisor	Murphy, David J., Emory University Martin, Gregory S., Emory University Kempker, Jordan A., Emory University
Committee Members	Trammell, Aaron, Emory University Klein, Mitchel, Emory University

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