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- Title
A lung rescue team improves survival in obesity with acute respiratory distress syndrome.
- Authors
Florio, Gaetano; Ferrari, Matteo; Bittner, Edward A.; De Santis Santiago, Roberta; Pirrone, Massimiliano; Fumagalli, Jacopo; Teggia Droghi, Maddalena; Mietto, Cristina; Pinciroli, Riccardo; Berg, Sheri; Bagchi, Aranya; Shelton, Kenneth; Kuo, Alexander; Lai, Yvonne; Sonny, Abraham; Lai, Peggy; Hibbert, Kathryn; Kwo, Jean; Pino, Richard M.; Wiener-Kronish, Jeanine
- Abstract
<bold>Background: </bold>Limited data exist regarding ventilation in patients with class III obesity [body mass index (BMI) > 40 kg/m2] and acute respiratory distress syndrome (ARDS). The aim of the present study was to determine whether an individualized titration of mechanical ventilation according to cardiopulmonary physiology reduces the mortality in patients with class III obesity and ARDS.<bold>Methods: </bold>In this retrospective study, we enrolled adults admitted to the ICU from 2012 to 2017 who had class III obesity and ARDS and received mechanical ventilation for > 48 h. Enrolled patients were divided in two cohorts: one cohort (2012-2014) had ventilator settings determined by the ARDSnet table for lower positive end-expiratory pressure/higher inspiratory fraction of oxygen (standard protocol-based cohort); the other cohort (2015-2017) had ventilator settings determined by an individualized protocol established by a lung rescue team (lung rescue team cohort). The lung rescue team used lung recruitment maneuvers, esophageal manometry, and hemodynamic monitoring.<bold>Results: </bold>The standard protocol-based cohort included 70 patients (BMI = 49 ± 9 kg/m2), and the lung rescue team cohort included 50 patients (BMI = 54 ± 13 kg/m2). Patients in the standard protocol-based cohort compared to lung rescue team cohort had almost double the risk of dying at 28 days [31% versus 16%, P = 0.012; hazard ratio (HR) 0.32; 95% confidence interval (CI95%) 0.13-0.78] and 3 months (41% versus 22%, P = 0.006; HR 0.35; CI95% 0.16-0.74), and this effect persisted at 6 months and 1 year (incidence of death unchanged 41% versus 22%, P = 0.006; HR 0.35; CI95% 0.16-0.74).<bold>Conclusion: </bold>Individualized titration of mechanical ventilation by a lung rescue team was associated with decreased mortality compared to use of an ARDSnet table.
- Subjects
OBESITY; INTENSIVE care units; LUNGS; RETROSPECTIVE studies; APACHE (Disease classification system); ADULT respiratory distress syndrome; ARTIFICIAL respiration; RESEARCH funding; BODY mass index; LONGITUDINAL method
- Publication
Critical Care, 2020, Vol 24, Issue 1, p1
- ISSN
1364-8535
- Publication type
journal article
- DOI
10.1186/s13054-019-2709-x