RT Journal Article SR Electronic T1 Driving Pressure Is a Risk Factor for ARDS in Mechanically Ventilated Subjects Without ARDS JF Respiratory Care FD American Association for Respiratory Care SP 1505 OP 1513 DO 10.4187/respcare.08587 VO 66 IS 10 A1 Oriol Roca A1 Oscar Peñuelas A1 Alfonso Muriel A1 Marina García-de-Acilu A1 César Laborda A1 Judit Sacanell A1 Jordi Riera A1 Konstantinos Raymondos A1 Bin Du A1 Arnaud W Thille A1 Fernando Ríos A1 Marco González A1 Lorenzo del-Sorbo A1 Maria del Carmen Marín A1 Marco Antonio Soares A1 Bruno Valle Pinheiro A1 Nicolas Nin A1 Salvatore M Maggiore A1 Andrew Bersten A1 Pravin Amin A1 Nahit Çakar A1 Gee Young Suh A1 Fekri Abroug A1 Manuel Jibaja A1 Dimitros Matamis A1 Amine Ali Zeggwagh A1 Yuda Sutherasan A1 Antonio Anzueto A1 Andrés Esteban A1 Fernando Frutos-Vivar YR 2021 UL http://rc.rcjournal.com/content/66/10/1505.abstract AB BACKGROUND: Driving pressure (ΔP) has been described as a risk factor for mortality in patients with ARDS. However, the role of ΔP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between ΔP on the first day of mechanical ventilation with the development of ARDS.METHODS: This was a post hoc analysis of a multicenter, prospective, observational, international study that included subjects who were on mechanical ventilation for > 12 h. Our objective was to evaluate the association between ΔP on the first day of mechanical ventilation with the development of ARDS. To assess the effect of ΔP, a logistic regression analysis was performed when adjusting for other potential risk factors. Validation of the results obtained was performed by using a bootstrap method and by repeating the same analyses at day 2.RESULTS: A total of 1,575 subjects were included, of whom 65 (4.1%) developed ARDS. The ΔP was independently associated with ARDS (odds ratio [OR] 1.12, 95% CI 1.07–1.18 for each cm H2O of ΔP increase, P < .001). The same results were observed at day 2 (OR 1.14, 95% CI 1.07–1.21; P < .001) and after bootstrap validation (OR 1.13, 95% CI 1.04–1.22; P < .001). When taking the prevalence of ARDS in the lowest quartile of ΔP (≤9 cm H2O) as a reference, the subjects with ΔP > 12–15 cm H2O and those with ΔP > 15 cm H2O presented a higher probability of ARDS (OR 3.65, 95% CI 1.32–10.04 [P = .01] and OR 7.31, 95% CI, 2.89–18.50 [P < .001], respectively).CONCLUSIONS: In the subjects without ARDS, a higher level of ΔP on the first day of mechanical ventilation was associated with later development of ARDS. (ClinicalTrials.gov registration NCT02731898.)