TY - JOUR T1 - Driving Pressure Is a Risk Factor for ARDS in Mechanically Ventilated Subjects Without ARDS JF - Respiratory Care SP - 1505 LP - 1513 DO - 10.4187/respcare.08587 VL - 66 IS - 10 AU - Oriol Roca AU - Oscar Peñuelas AU - Alfonso Muriel AU - Marina García-de-Acilu AU - César Laborda AU - Judit Sacanell AU - Jordi Riera AU - Konstantinos Raymondos AU - Bin Du AU - Arnaud W Thille AU - Fernando Ríos AU - Marco González AU - Lorenzo del-Sorbo AU - Maria del Carmen Marín AU - Marco Antonio Soares AU - Bruno Valle Pinheiro AU - Nicolas Nin AU - Salvatore M Maggiore AU - Andrew Bersten AU - Pravin Amin AU - Nahit Çakar AU - Gee Young Suh AU - Fekri Abroug AU - Manuel Jibaja AU - Dimitros Matamis AU - Amine Ali Zeggwagh AU - Yuda Sutherasan AU - Antonio Anzueto AU - Andrés Esteban AU - Fernando Frutos-Vivar Y1 - 2021/10/01 UR - http://rc.rcjournal.com/content/66/10/1505.abstract N2 - 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.) ER -