A lung rescue team improves survival in obesity with acute respiratory distress syndrome

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art_FLORIO_A_lung_rescue_team_improves_survival_in_obesity_2020.PDF (900.17 KB)
Citações na Scopus
40
Tipo de produção
article
Data de publicação
2020
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BMC
Autores
FLORIO, Gaetano
FERRARI, Matteo
BITTNER, Edward A.
SANTIAGO, Roberta De Santis
PIRRONE, Massimiliano
FUMAGALLI, Jacopo
DROGHI, Maddalena Teggia
MIETTO, Cristina
PINCIROLI, Riccardo
BERG, Sheri
Citação
CRITICAL CARE, v.24, n.1, article ID 4, 11p, 2020
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background Limited data exist regarding ventilation in patients with class III obesity [body mass index (BMI) > 40 kg/m(2)] 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. Methods 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. Results The standard protocol-based cohort included 70 patients (BMI = 49 +/- 9 kg/m(2)), and the lung rescue team cohort included 50 patients (BMI = 54 +/- 13 kg/m(2)). 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). Conclusion Individualized titration of mechanical ventilation by a lung rescue team was associated with decreased mortality compared to use of an ARDSnet table.
Palavras-chave
ARDS, Obesity, Mechanical ventilation, Cardiopulmonary physiology, Mortality
URI
https://observatorio.fm.usp.br/handle/OPI/35403
Referências
  1. Amato MBP, 2015, NEW ENGL J MED, V372, P747, DOI 10.1056/NEJMsa1410639
  2. Amato MBP, 1998, NEW ENGL J MED, V338, P347, DOI 10.1056/NEJM199802053380602
  3. Behazin N, 2010, J APPL PHYSIOL, V108, P212, DOI 10.1152/japplphysiol.91356.2008
  4. Beitler JR, 2019, JAMA-J AM MED ASSOC, V321, P846, DOI 10.1001/jama.2019.0555
  5. Bellani G, 2016, JAMA-J AM MED ASSOC, V315, P788, DOI 10.1001/jama.2016.0291
  6. Bluth T, 2019, JAMA-J AM MED ASSOC, V321, P2292, DOI 10.1001/jama.2019.7505
  7. Boles JM, 2007, EUR RESPIR J, V29, P1033, DOI 10.1183/09031936.00010206
  8. Brochard L, 1998, AM J RESP CRIT CARE, V158, P1831, DOI 10.1164/ajrccm.158.6.9801044
  9. Brower RG, 2004, NEW ENGL J MED, V351, P327
  10. Brower RG, 2000, NEW ENGL J MED, V342, P1301, DOI 10.1056/nejm200005043421801
  11. Cavalcanti AB, 2017, JAMA-J AM MED ASSOC, V318, P1335, DOI 10.1001/jama.2017.14171
  12. Di Angelantonio E, 2016, LANCET, V388, P776, DOI 10.1016/S0140-6736(16)30175-1
  13. El-Solh A, 2001, CHEST, V120, P1989, DOI 10.1378/chest.120.6.1989
  14. Fumagalli J, 2019, ANESTHESIOLOGY, V130, P791, DOI 10.1097/ALN.0000000000002638
  15. Fumagalli J, 2017, CRIT CARE MED, V45, P1374, DOI 10.1097/CCM.0000000000002460
  16. Gattinoni L, 2006, NEW ENGL J MED, V354, P1775, DOI 10.1056/NEJMoa052052
  17. Gattinoni L, 2005, INTENS CARE MED, V31, P776, DOI 10.1007/s00134-005-2627-z
  18. Grieco DL, 2019, ANESTHESIOLOGY, V131, P58, DOI 10.1097/ALN.0000000000002662
  19. Hales CM, 2018, JAMA-J AM MED ASSOC, V319, P1723, DOI 10.1001/jama.2018.3060
  20. HICKLING KG, 1994, CRIT CARE MED, V22, P1568, DOI 10.1097/00003246-199422100-00011
  21. HICKLING KG, 1990, INTENS CARE MED, V16, P372, DOI 10.1007/BF01735174
  22. Maiolo G, 2018, AM J RESP CRIT CARE, V197, P1586, DOI 10.1164/rccm.201709-1804OC
  23. Marshall RV, 2016, JAMA OTOLARYNGOL, V142, P772, DOI 10.1001/jamaoto.2016.1089
  24. Meade MO, 2008, JAMA-J AM MED ASSOC, V299, P637, DOI 10.1001/jama.299.6.637
  25. Mercat A, 2008, JAMA-J AM MED ASSOC, V299, P646, DOI 10.1001/jama.299.6.646
  26. Moss M, 2019, NEW ENGL J MED, V380, P1997, DOI 10.1056/NEJMoa1901686
  27. Ogden Cynthia L, 2015, NCHS Data Brief, P1
  28. Papazian L, 2010, NEW ENGL J MED, V363, P1107, DOI 10.1056/NEJMoa1005372
  29. Pirrone M, 2016, CRIT CARE MED, V44, P300, DOI 10.1097/CCM.0000000000001387
  30. Ranieri VM, 2012, JAMA-J AM MED ASSOC, V307, P2526, DOI 10.1001/jama.2012.5669
  31. Soto GJ, 2012, CRIT CARE MED, V40, P2601, DOI 10.1097/CCM.0b013e3182591ed9
  32. Spina S, 2019, RESP CARE

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/09
Artigos e Materiais de Revistas Científicas - ODS/03