title: Factors associated with elevated plateau pressure in patients with acute lung injury receiving lower tidal volume ventilation.
abstract: OBJECTIVE
  Lung-protective ventilation with lower tidal volume and lower plateau pressure improves mortality in patients with acute lung injury and acute respiratory distress syndrome. We sought to determine the incidence of elevated plateau pressure in acute lung injury /acute respiratory distress syndrome patients receiving lower tidal volume ventilation and to determine the factors that predict elevated plateau pressure in these patients.
  
  
  METHODS
  We used data from 1398 participants in Acute Respiratory Distress Syndrome Network trials, who received lower tidal volume ventilation (≤ 6.5mL/kg predicted body weight).
  
  
  METHODS
  We considered patients with a plateau pressure greater than 30cm H2O and/or a tidal volume less than 5.5mL/kg predicted body weight on study day 1 to have "elevated plateau pressure." We used logistic regression to identify baseline clinical variables associated with elevated plateau pressure and to develop a model to predict elevated plateau pressure using a subset of 1,188 patients. We validated the model in the 210 patients not used for model development.
  
  
  METHODS
  Medical centers participating in Acute Respiratory Distress Syndrome Network clinical trials.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 1,398 patients in our study, 288 (20.6%) had elevated plateau pressure on day 1. Severity of illness indices and demographic factors (younger age, greater body mass index, and non-white race) were independently associated with elevated plateau pressure. The multivariable logistic regression model for predicting elevated plateau pressure had an area under the receiving operator characteristic curve of 0.71 for both the developmental and the validation subsets.
  
  
  CONCLUSIONS
  acute lung injury patients receiving lower tidal volume ventilation often have a plateau pressure that exceeds Acute Respiratory Distress Syndrome Network goals. Race, body mass index, and severity of lung injury are each independently associated with elevated plateau pressure. Selecting a smaller initial tidal volume for non-white patients and patients with higher severity of illness may decrease the incidence of elevated plateau pressure. Prospective studies are needed to evaluate this approach.
authors: Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA. hallieprescott@gmail.com
authors: Hallie C
authors: HC
authors: Prescott
authors: Roy G
authors: RG
authors: Brower
authors: Colin R
authors: CR
authors: Cooke
authors: Gary
authors: G
authors: Phillips
authors: James M
authors: JM
authors: O'Brien
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000399:Air Pressure; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D015656:Respiratory Mechanics / Q000502:physiology*; D013990:Tidal Volume / Q000502:physiology*