@article {Chanrespcare.03138, author = {Ming-Cheng Chan and Jeng-Sen Tseng and Jung-Te Chiu and Kuo-Hsuan Hsu and Sou-Jen Shih and Chi-Yuan Yi and Chieh-Liang Wu and Yu Ru Kou}, title = {Prognostic Value of Plateau Pressure Below 30 cm H2O in Septic Patients With Acute Respiratory Failure}, elocation-id = {respcare.03138}, year = {2014}, doi = {10.4187/respcare.03138}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Ventilation with low tidal volume is recommended for patients with acute lung injury. Current guidelines suggest limiting plateau pressure (Pplat) to \< 30 cm H2O for septic patients needing mechanical ventilation. The aim of this study was to determine whether Pplat within the first 24 h of ICU admission is predictive of outcome and whether Pplat \< 30 cm H2O is associated with lower mortality rates. METHODS: This study was a retrospective analysis of prospectively acquired clinical data from an ICU of a tertiary referral hospital in central Taiwan. Subjects were included if they were admitted due to sepsis and respiratory failure requiring mechanical ventilation from April 2008 to November 2009. RESULTS: There were 220 subjects (188 males, 32 females) with a median age of 76 y and a mean Acute Physiology and Chronic Health Evaluation II score of 25.0 {\textpm} 6.5. Pneumonia was the major cause of sepsis (85.5\%). The hospital mortality rate was 39.1\%. Pplat was higher throughout the first 24 h of ICU admission in nonsurvivors. Higher Pplat was associated with higher mortality rates regardless of acute lung injury. In multivariate regression analysis, Pplat \> 25 cm H2O at 24 h after admission was an independent risk factor for mortality (adjusted odds ratio of 2.33, 95\% CI 1.10 {\textendash} 4.91, P = .03 for hospital mortality). CONCLUSIONS: Pplat within the first 24 h of ICU admission is predictive of outcome, with lower Pplat associated with lower mortality rates. There is no safety margin for Pplat. Limiting Pplat should be considered even at \< 30 cm H2O in septic patients with acute respiratory failure.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/early/2014/09/23/respcare.03138}, eprint = {https://rc.rcjournal.com/content/early/2014/09/23/respcare.03138.full.pdf}, journal = {Respiratory Care} }