This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
BACKGROUND: Prone positioning reduces mortality in patients with moderate/severe ARDS. It remains unclear which physiological parameters could guide clinicians to assess which patients are likely to benefit from prone position. This study aimed to determine the association between relative changes in physiological parameters at 24 h of prone positioning and ICU mortality in adult subjects with ARDS.
METHODS: We conducted a cohort study using the VENTILA database, including adults with ARDS receiving prone positioning. We used multivariable logistic regression to assess the association between relative changes in physiological parameters (PaO2/FIO2, dynamic driving pressure, PaCO2, and ventilatory ratio defined as [minute ventilation [mL/min] × PaCO2 [mm Hg]]/[predicted body weight × 100 [mL/min] × 37.5 [mm Hg] with ICU mortality) (primary outcome). We report adjusted odds ratios with 95% CI as measures of association.
RESULTS: We included 156 subjects of which 82 (53%) died in the ICU. A relative decline in the ventilatory ratio at 24 h was associated with lower ICU mortality (odds ratio 0.80 [95% CI 0.66–0.97], every 10% decrease). Relative changes in PaO2/FIO2 (odds ratio 0.89 [95% CI 0.77–1.03], every 25% increase), PaCO2 (odds ratio 0.97 [95% CI 0.82–1.16], every 10% decrease), and dynamic driving pressure (odds ratio 0.98 [95% CI 0.89–1.07], every 10% decrease) were not associated with ICU mortality.
CONCLUSIONS: In subjects with ARDS receiving prone positioning, a relative decline in the ventilatory ratio at 24 h was associated with lower ICU mortality.
Footnotes
- Correspondence: Eddy Fan MD, Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, 585 University Avenue, MaRS Centre 9–9013, Toronto, ON, M5G2G2, Canada. E-mail: eddy.fan{at}uhn.ca
See the Related Editorial on Page 1205
Dr Ferreyro is supported by a Vanier Canada Graduate Scholarship. Dr Fan discloses relationships with ALung Technologies, Baxter, Boehringer-Ingelheim, Fresenius Medical Care, and MC3 Cardiopulmonary. The remaining authors have disclosed no conflicts of interest.
Drs Tisminetzky and Ferreyro contributed equally to this study.
Supplementary material related to this paper is available at http://www.rcjournal.com.
- Copyright © 2022 by Daedalus Enterprises
Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.