Effectiveness of an inspiratory pressure-limited approach to mechanical ventilation in septic patients

Ignacio Martin-Loeches, Candelaria De Haro, R. Phillip Dellinger, Ricard Ferrer, Gary S. Phillips, Mitchell M. Levy, Antonio Artigas

Research output: Contribution to journalArticleResearchpeer-review

12 Citations (Scopus)

Abstract

Severe sepsis is one of the most common causes of acute lung injury (ALI) and is associated with high mortality. The aim of the study was to see whether a protective strategy based approach with a plateau pressure <30 cmH 2O was associated with lower mortality in septic patients with ALI in the Surviving Sepsis Campaign international database. A retrospective analysis of an international multicentric database of 15,022 septic patients from 165 intensive care units was used. Septic patients with ALI and mechanical ventilation (n=1,738) had more accompanying organ dysfunction and a higher mortality rate (48.3% versus 33.0%, p<0.001) than septic patients without ALI (n=13,284). In patients with ALI and mechanical ventilation, the use of inspiratory plateau pressures maintained at <30 cmH2O was associated with lower mortality by Chi-squared test (46.4% versus 55.1%, p<0.001) and by Kaplan-Meier and log-rank test (p<0.001). In a multivariable random-effects Cox regression, plateau pressure <30 cmH 2O was significantly associated with lower mortality (hazard ratio 0.84, 95% CI 0.72-0.99; p=0.038). ALI in sepsis was associated with higher mortality, especially when an inspiratory pressure-limited mechanical ventilation approach was not implemented. Copyright©ERS 2013.
Original languageEnglish
Pages (from-to)157-164
JournalEuropean Respiratory Journal
Volume41
Issue number1
DOIs
Publication statusPublished - 1 Jan 2013

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Mechanical ventilation
  • Sepsis

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