Mean Airway Pressure As a Predictor of 90-Day Mortality in Mechanically Ventilated Patients*
- 19 February 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 48 (5), 688-695
- https://doi.org/10.1097/ccm.0000000000004268
Abstract
Objectives: To determine the association between mean airway pressure and 90-day mortality in patients with acute respiratory failure requiring mechanical ventilation and to compare the predictive ability of mean airway pressure compared with inspiratory plateau pressure and driving pressure. Design: Prospective observational cohort. Setting: Five ICUs in Lima, Peru. Subjects: Adults requiring invasive mechanical ventilation via endotracheal tube for acute respiratory failure. Interventions: None. Measurements and Main Results: Of potentially eligible participants (n = 1,500), 65 (4%) were missing baseline mean airway pressure, while 352 (23.5%) were missing baseline plateau pressure and driving pressure. Ultimately, 1,429 participants were included in the analysis with an average age of 59 ± 19 years, 45% female, and a mean PaO2/FIO2 ratio of 248 ± 147 mm Hg at baseline. Overall, 90-day mortality was 50.4%. Median baseline mean airway pressure was 13 cm H2O (interquartile range, 10–16 cm H2O) in participants who died compared to a median mean airway pressure of 12 cm H2O (interquartile range, 10–14 cm H2O) in participants who survived greater than 90 days (p < 0.001). Mean airway pressure was independently associated with 90-day mortality (odds ratio, 1.38 for difference comparing the 75th to the 25th percentile for mean airway pressure; 95% CI, 1.10–1.74) after adjusting for age, sex, baseline Acute Physiology and Chronic Health Evaluation III, baseline PaO2/FIO2 (modeled with restricted cubic spline), baseline positive end-expiratory pressure, baseline tidal volume, and hospital site. In predicting 90-day mortality, baseline mean airway pressure demonstrated similar discriminative ability (adjusted area under the curve = 0.69) and calibration characteristics as baseline plateau pressure and driving pressure. Conclusions: In a multicenter prospective cohort, baseline mean airway pressure was independently associated with 90-day mortality in mechanically ventilated participants and predicts mortality similarly to plateau pressure and driving pressure. Because mean airway pressure is readily available on all mechanically ventilated patients and all ventilator modes, it is a potentially more useful predictor of mortality in acute respiratory failure.Keywords
This publication has 22 references indexed in Scilit:
- Establishment of a prospective cohort of mechanically ventilated patients in five intensive care units in Lima, Peru: protocol and organisational characteristics of participating centresBMJ Open, 2015
- The Berlin definition of ARDS: an expanded rationale, justification, and supplementary materialIntensive Care Medicine, 2012
- Acute Respiratory Distress SyndromeJAMA, 2012
- Prediction of death and prolonged mechanical ventilation in acute lung injuryCritical Care, 2007
- Tidal Volume Reduction in Patients with Acute Lung Injury When Plateau Pressures Are Not HighAmerican Journal of Respiratory and Critical Care Medicine, 2005
- Oxygenation Index Predicts Outcome in Children with Acute Hypoxemic Respiratory FailureAmerican Journal of Respiratory and Critical Care Medicine, 2005
- Pulmonary Dead-Space Fraction as a Risk Factor for Death in the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2002
- Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2000
- Mean airway pressureCritical Care Medicine, 1992
- Effect of mechanical ventilation and volume loading on left ventricular performance in premature infants with respiratory distress syndromeCritical Care Medicine, 1986