title: Effectiveness of an inspiratory pressure-limited approach to mechanical ventilation in septic patients.
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(2)O 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 cmH(2)O 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(2)O 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.
authors.affiliation: Critical Care Centre, Corporación Sanitaria Universitaria Parc Tauli, Sabadell University Hospital, Universidad Autónoma de Barcelona, CIBER Enfermedades Respiratorias, Sabadell, Spain. drmartinloeches@gmail.com
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.forename: Candelaria
authors.initials: C
authors.lastname: de Haro
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Ricard
authors.initials: R
authors.lastname: Ferrer
authors.forename: Gary S
authors.initials: GS
authors.lastname: Phillips
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Levy
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000401:mortality; D015996:Survival Rate