Driving pressure is not associated with hospital mortality in patients without ARDS.
CCCF ePoster library. Schmidt M. Oct 31, 2016; 155978; ORAL
Dr. Marcello Schmidt
Dr. Marcello Schmidt
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Topic: Retrospective or Prospective Cohort Study

Driving pressure is not associated with hospital mortality in patients without ARDS.

Schmidt, Marcello1; Amaral, Andre1,2; Fan, Eddy1,3; Rubenfeld, Gordon1,2
1Interdepartamental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; 2Sunnybrook Health Sciences Centre, Toronto, Canada; 3Toronto General Hospital, Toronto, Canada


Introduction: Driving pressure is associated with mortality in patients with Acute Respiratory Distress Syndrome (ARDS) and to pulmonary complications in patients undergoing general anesthesia. Whether driving pressure is associated with outcomes of ventilated patients without ARDS is unknown.
Objectives: To determine the independent association between driving pressure and mortality in mechanically ventilated patients without ARDS.
Methods: Retrospective cohort of 1,021 adult patients mechanically ventilated for 48 hours or more. The primary outcome was hospital mortality. Secondary outcomes were ICU and 6-month mortality. We assessed the independent association between driving pressure and outcomes using multivariate logistic regression.
Results: Our primary outcome was hospital mortality. The presence of ARDS was determined using the minimum daily PaO2:FiO2 (PF) ratio and an automated text search of chest X-ray reports. First, we tested our model in patients with ARDS and found an independent association between hospital mortality and driving pressure (OR=1.07; 95% CI 1.03-1.11). In patients without ARDS driving pressure was not independently associated with hospital mortality (OR=0.97; 95% CI 0.91-1.03).
Conclusion: In this cohort of mechanically ventilated patients driving pressure was independently associated with mortality in patients with ARDS, but not in patients without it. Possible reasons for the lack of association between driving pressure and mortality in non-ARDS patients include lack of association between compliance and mortality in these patients, a large number of patients having spontaneous breathing efforts and tidal recruitment due to low PEEP used in the vast majority of non-ARDS patients.


1.            Fothergill J. Observations on a Case Published in the Last Volume of the Medical Essays, &c. of Recovering a Man Dead in Appearance, by Distending the Lungs with Air. Printed at Edinburgh, 1744; by John Fothergill, Licent. Coll. Med. Lond. Phil Trans 1744;43:275–281.
2.            Macklin MT, Macklin CC. Malignant interstitial emphysemia of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions. Medicine 1944;23:281–358.
3.            Webb HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure. Am Rev Respir Dis 1974;110:556–565.
4.            Muscedere JG, Mullen JB, Gan K, Slutsky AS. Tidal ventilation at low airway pressures can augment lung injury. Am J Resp Crit Care Med 1994;149:1327–1334.
5.            Tremblay L, Valenza F, Ribeiro SP, Li J. Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. 1997;at .
6.            Slutsky AS, Tremblay LN. Multiple System Organ Failure. Am J Resp Crit Care Med 2012;157:1721–1725.
7.            Lassen HCA. A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency. Lancet 1953;1:37–41.
8.            Amato MB, Amato MBP, Barbas CS, Barbas CSV, Medeiros DM, Medeiros DM, Magaldi RB, Magaldi RB, Schettino GP, Schettino GP, Lorenzi-Filho G, Lorenzi-Filho G, Kairalla RA, Kairalla RA, Deheinzelin D, Deheinzelin D, Munoz C, Munoz C, Oliveira R, Oliveira R, Takagaki TY, Takagaki TY, Carvalho CR, Carvalho CRR. Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome. N Engl J Med 1998;338:347–354.
9.            The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;342:1301–1308.
10.         Determann RM, Royakkers A, Wolthuis EK, Vlaar AP, Choi G, Paulus F, Hofstra J-J, de Graaff MJ, Korevaar JC, Schultz MJ. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care 2010;14:R1.
11.         Wolthuis EK, Choi G, Dessing MC, Bresser P, Lutter R, Dzoljic M, van der Poll T, Vroom MB, Hollmann M, Schultz MJ. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology 2008;108:46–54.
12.         Pinheiro de Oliveira R, Hetzel M, Anjos Silva dos M, Dallegrave D, Friedman G. Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease. Crit Care 2010;14:R39.
13.         Chaney MA, Nikolov MP, Blakeman BP, Bakhos M. Protective ventilation attenuates postoperative pulmonary dysfunction in patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2000;14:514–518.
14.         Koner O, Celebi S, Balci H, Cetin G, Karaoglu K, Cakar N. Effects of protective and conventional mechanical ventilation on pulmonary function and systemic cytokine release after cardiopulmonary bypass. Intensive Care Med 2004;30:620–626.
15.         Futier E, Constantin JM, Paugam-Burtz C. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. … England Journal of … 2013;369:1861–1863.
16.         Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, Davies AR, Hand LE, Zhou Q, Thabane L, Austin P, Lapinsky S, Baxter A, Russell J, Skrobik Y, Ronco JJ, Stewart TE, Lung Open Ventilation Study Investigators. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2008;299:637–645.
17.         Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, Tallarini F, Cozzi P, Cressoni M, Colombo A, Marini JJ, Gattinoni L. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Resp Crit Care Med 2008;178:346–355.
18.         Talmor D, Sarge T, Malhotra A, O'Donnell CR, Ritz R, Lisbon A, Novack V, Loring SH. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 2008;359:2095–2104.
19.         Chiumello D, Cressoni M, Carlesso E, Caspani ML, Marino A, Gallazzi E, Caironi P, Lazzerini M, Moerer O, Quintel M, Gattinoni L. Bedside selection of positive end-expiratory pressure in mild, moderate, and severe acute respiratory distress syndrome. Crit Care Med 2014;42:252–264.
20.         Gattinoni L, Pesenti A. The concept of 'baby lung'. Intensive Care Med 2005;31:776–784.
21.         Amato MBP, Meade MO, Meade MO, Slutsky AS, Slutsky AS, Brochard L, Brochard L, Costa ELV, Schoenfeld DA, Schoenfeld DA, Stewart TE, Stewart TE, Briel M, Talmor D, Talmor D, Mercat A, Richard J-CM, Carvalho CRR, Brower RG, Brower RG. Driving Pressure and Survival in the Acute Respiratory Distress Syndrome. N Engl J Med 2015;372:747–755.
22.         Neto AS, Hemmes SNT, Barbas CSV, Beiderlinden M, Fernandez-Bustamante A, Futier E, Gajic O, El-Tahan MR, Ghamdi Al AA, Günay E, Jaber S, Kokulu S, Kozian A, Licker M, Lin W-Q, Maslow AD, Memtsoudis SG, Miranda DR, Moine P, Ng T, Paparella D, Ranieri VM, Scavonetto F, Schilling T, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. The Lancet Respiratory Medicine 2016;0:272–280.
23.         Saeed M, Villarroel M, Reisner AT, Clifford G, Lehman L-W, Moody G, Heldt T, Kyaw TH, Moody B, Mark RG. Multiparameter Intelligent Monitoring in Intensive Care II: A public-access intensive care unit database*. Crit Care Med 2011;39:952–960.
24.         Herasevich V, Yilmaz M, Khan H, Hubmayr RD, Gajic O. Validation of an electronic surveillance system for acute lung injury. Intensive Care Med 2009;35:1018–1023.
25.         Naggara O, Raymond J, Guilbert F, Altman DG. The problem of subgroup analyses: an example from a trial on ruptured intracranial aneurysms. AJNR Am J Neuroradiol 2011;32:633–636.
26.         Fletcher J. Subgroup analyses: how to avoid being misled. BMJ 2007;335:96–97.
27.         Vandenbroucke JP, Elm von E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, for the STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLOS Med 2007;4:e297.
28.         Rubenfeld GD, Caldwell E, Granton J, Hudson LD, Matthay MA. Interobserver variability in applying a radiographic definition for ARDS. Chest 1999;116:1347–1353.
29.         Elm von E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370:1453–1457.
30.         Loring SH, Malhotra A. Driving pressure and respiratory mechanics in ARDS. N Engl J Med 2015;372:776–777.
31.         Serpa Neto A, Cardoso SO, Manetta JA, Pereira VGM, Espósito DC, Pasqualucci M de OP, Damasceno MCT, Schultz MJ. Association Between Use of Lung-Protective Ventilation With Lower Tidal Volumes and Clinical Outcomes Among Patients Without Acute Respiratory Distress Syndrome. JAMA 2012;308:1651.
32.         Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone Position in Acute Respiratory Distress Syndrome. Rationale, Indications, and Limits. Am J Resp Crit Care Med 2013;188:1286–1293.
33.         Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 1988;137:1159–1164.
34.         Akoumianaki E, Lyazidi A, Rey N, Matamis D, Perez-Martinez N, Giraud R, Mancebo J, Brochard L, Marie Richard J-C. Mechanical ventilation-induced reverse-triggered breaths: a frequently unrecognized form of neuromechanical coupling. Chest 2013;143:927–938.
35.         Benson K, Hartz AJ. A Comparison of Observational Studies and Randomized, Controlled Trials. New England Journal of Medicine 2000;342:1878–1886.
36.         Concato J, Shah N, Horwitz RI. Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs. New England Journal of Medicine 2000;342:1887–1892.
37.         Wang R, Lagakos SW, Ware JH, Hunter DJ, Drazen JM. Statistics in Medicine — Reporting of Subgroup Analyses in Clinical Trials. New England Journal of Medicine 2007;357:2189–2194.
38.         Slutsky AS. Improving outcomes in critically ill patients: the seduction of physiology. JAMA 2009;302:2030–2032.

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