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Decreased respiratory system compliance on the sixth day of mechanical ventilation is a predictor of death in patients with established acute lung injury.

Seeley EJ, McAuley DF, Eisner M, Miletin M, Zhuo H, Matthay MA, Kallet RH - Respir. Res. (2011)

Bottom Line: Predictors on day 1, day 6 and the changes between day 1 and day 6 were compared in a multivariate logistic regression model.In addition, a decrease in respiratory system compliance between days 1 and days 6 (OR 2.14, p < 0.01) was independently associated with mortality.We suggest that decreased respiratory system compliance may identify a subset of patients who have persistent pulmonary edema, atelectasis or the fibroproliferative sequelae of ALI and thus are less likely to survive their hospitalization.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine and Anesthesia, University of California, San Francisco, CA, USA. eric.seeley@ucsf.edu

ABSTRACT

Background: Multiple studies have identified single variables or composite scores that help risk stratify patients at the time of acute lung injury (ALI) diagnosis. However, few studies have addressed the important question of how changes in pulmonary physiologic variables might predict mortality in patients during the subacute or chronic phases of ALI. We studied pulmonary physiologic variables, including respiratory system compliance, P/F ratio and oxygenation index, in a cohort of patients with ALI who survived more than 6 days of mechanical ventilation to see if changes in these variables were predictive of death and whether they are informative about the pathophysiology of subacute ALI.

Methods: Ninety-three patients with ALI who were mechanically ventilated for more than 6 days were enrolled in this prospective cohort study. Patients were enrolled at two medical centers in the US, a county hospital and a large academic center. Bivariate analyses were used to identify pulmonary physiologic predictors of death during the first 6 days of mechanical ventilation. Predictors on day 1, day 6 and the changes between day 1 and day 6 were compared in a multivariate logistic regression model.

Results: The overall mortality was 35%. In multivariate analysis, the PaO2/FiO2 (OR 2.09, p < 0.04) and respiratory system compliance (OR 3.61, p < 0.01) were predictive of death on the 6th day of acute lung injury. In addition, a decrease in respiratory system compliance between days 1 and days 6 (OR 2.14, p < 0.01) was independently associated with mortality.

Conclusions: A low respiratory system compliance on day 6 or a decrease in the respiratory system compliance between the 1st and 6th day of mechanical ventilation were associated with increased mortality in multivariate analysis of this cohort of patients with ALI. We suggest that decreased respiratory system compliance may identify a subset of patients who have persistent pulmonary edema, atelectasis or the fibroproliferative sequelae of ALI and thus are less likely to survive their hospitalization.

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Trends in measures of oxygenation, respiratory compliance and acid base balance during the first 6 days of mechanical ventilation for acute lung injury. Data are shown as mean ± SEM. The * indicates p < 0.05.
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Figure 1: Trends in measures of oxygenation, respiratory compliance and acid base balance during the first 6 days of mechanical ventilation for acute lung injury. Data are shown as mean ± SEM. The * indicates p < 0.05.

Mentions: On days two and three of ALI, none of the measured variables discriminated between survivors and non-survivors (Figure 1, Table 2). However, on days four, five and six of ALI, several measures of oxygenation, respiratory mechanics, and acid-base balance diverged, and the difference between survivors and non-survivors was statistically significant (Figure 1, Table 2). Specifically, on day 4, the , pH, and base deficit (BD), were predictors of death. On day 5, the PaO2/FiO2 was predictive of death, and by day 6, Respiratory system compliance, Pplat, PaO2/FiO2, OI, mean Paw, pH, and BD were all predictive of death in the bivariate analysis.


Decreased respiratory system compliance on the sixth day of mechanical ventilation is a predictor of death in patients with established acute lung injury.

Seeley EJ, McAuley DF, Eisner M, Miletin M, Zhuo H, Matthay MA, Kallet RH - Respir. Res. (2011)

Trends in measures of oxygenation, respiratory compliance and acid base balance during the first 6 days of mechanical ventilation for acute lung injury. Data are shown as mean ± SEM. The * indicates p < 0.05.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3105946&req=5

Figure 1: Trends in measures of oxygenation, respiratory compliance and acid base balance during the first 6 days of mechanical ventilation for acute lung injury. Data are shown as mean ± SEM. The * indicates p < 0.05.
Mentions: On days two and three of ALI, none of the measured variables discriminated between survivors and non-survivors (Figure 1, Table 2). However, on days four, five and six of ALI, several measures of oxygenation, respiratory mechanics, and acid-base balance diverged, and the difference between survivors and non-survivors was statistically significant (Figure 1, Table 2). Specifically, on day 4, the , pH, and base deficit (BD), were predictors of death. On day 5, the PaO2/FiO2 was predictive of death, and by day 6, Respiratory system compliance, Pplat, PaO2/FiO2, OI, mean Paw, pH, and BD were all predictive of death in the bivariate analysis.

Bottom Line: Predictors on day 1, day 6 and the changes between day 1 and day 6 were compared in a multivariate logistic regression model.In addition, a decrease in respiratory system compliance between days 1 and days 6 (OR 2.14, p < 0.01) was independently associated with mortality.We suggest that decreased respiratory system compliance may identify a subset of patients who have persistent pulmonary edema, atelectasis or the fibroproliferative sequelae of ALI and thus are less likely to survive their hospitalization.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine and Anesthesia, University of California, San Francisco, CA, USA. eric.seeley@ucsf.edu

ABSTRACT

Background: Multiple studies have identified single variables or composite scores that help risk stratify patients at the time of acute lung injury (ALI) diagnosis. However, few studies have addressed the important question of how changes in pulmonary physiologic variables might predict mortality in patients during the subacute or chronic phases of ALI. We studied pulmonary physiologic variables, including respiratory system compliance, P/F ratio and oxygenation index, in a cohort of patients with ALI who survived more than 6 days of mechanical ventilation to see if changes in these variables were predictive of death and whether they are informative about the pathophysiology of subacute ALI.

Methods: Ninety-three patients with ALI who were mechanically ventilated for more than 6 days were enrolled in this prospective cohort study. Patients were enrolled at two medical centers in the US, a county hospital and a large academic center. Bivariate analyses were used to identify pulmonary physiologic predictors of death during the first 6 days of mechanical ventilation. Predictors on day 1, day 6 and the changes between day 1 and day 6 were compared in a multivariate logistic regression model.

Results: The overall mortality was 35%. In multivariate analysis, the PaO2/FiO2 (OR 2.09, p < 0.04) and respiratory system compliance (OR 3.61, p < 0.01) were predictive of death on the 6th day of acute lung injury. In addition, a decrease in respiratory system compliance between days 1 and days 6 (OR 2.14, p < 0.01) was independently associated with mortality.

Conclusions: A low respiratory system compliance on day 6 or a decrease in the respiratory system compliance between the 1st and 6th day of mechanical ventilation were associated with increased mortality in multivariate analysis of this cohort of patients with ALI. We suggest that decreased respiratory system compliance may identify a subset of patients who have persistent pulmonary edema, atelectasis or the fibroproliferative sequelae of ALI and thus are less likely to survive their hospitalization.

Show MeSH
Related in: MedlinePlus