Abstract：
BACKGROUND:Ventilation with low tidal volume is recommended for patients with acute lung injury. Current guidelines suggest limiting plateau pressure (Pplat) to < 30 cm H2O for septic patients needing mechanical ventilation. The aim of this study was to determine whether Pplat within the first 24 h of ICU admission is predictive of outcome and whether Pplat < 30 cm H2O is associated with lower mortality rates. METHODS:This study was a retrospective analysis of prospectively acquired clinical data from an ICU of a tertiary referral hospital in central Taiwan. Subjects were included if they were admitted due to sepsis and respiratory failure requiring mechanical ventilation from April 2008 to November 2009. RESULTS:There were 220 subjects (188 males, 32 females) with a median age of 76 y and a mean Acute Physiology and Chronic Health Evaluation II score of 25.0 ± 6.5. Pneumonia was the major cause of sepsis (85.5%). The hospital mortality rate was 39.1%. Pplat was higher throughout the first 24 h of ICU admission in nonsurvivors. Higher Pplat was associated with higher mortality rates regardless of acute lung injury. In multivariate regression analysis, Pplat > 25 cm H2O at 24 h after admission was an independent risk factor for mortality (adjusted odds ratio of 2.33, 95% CI 1.10-4.91, P = .03 for hospital mortality). CONCLUSIONS:Pplat within the first 24 h of ICU admission is predictive of outcome, with lower Pplat associated with lower mortality rates. There is no safety margin for Pplat. Limiting Pplat should be considered even at < 30 cm H2O in septic patients with acute respiratory failure.
journal_name
Respir Carejournal_title
Respiratory careauthors
Chan MC,Tseng JS,Chiu JT,Hsu KH,Shih SJ,Yi CY,Wu CL,Kou YRdoi
10.4187/respcare.03138subject
Has Abstractpub_date
2015-01-01 00:00:00pages
12-20issue
1eissn
0020-1324issn
1943-3654pii
respcare.03138journal_volume
60pub_type
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