Driving pressure and long-term outcomes in moderate/severe acute respiratory distress syndrome

Carlos Toufen Junior, Roberta R De Santis Santiago, Adriana S Hirota, Alysson Roncally S Carvalho, Susimeire Gomes, Marcelo Brito Passos Amato, Carlos Roberto Ribeiro Carvalho, Carlos Toufen Junior, Roberta R De Santis Santiago, Adriana S Hirota, Alysson Roncally S Carvalho, Susimeire Gomes, Marcelo Brito Passos Amato, Carlos Roberto Ribeiro Carvalho

Abstract

Background: Acute respiratory distress syndrome (ARDS) patients may present impaired in lung function and structure after hospital discharge that may be related to mechanical ventilation strategy. The aim of this study was to evaluate the association between functional and structural lung impairment, N-terminal-peptide type III procollagen (NT-PCP-III) and driving pressure during protective mechanical ventilation. It was a secondary analysis of data from randomized controlled trial that included patients with moderate/severe ARDS with at least one follow-up visit performed. We obtained serial measurements of plasma NT-PCP-III levels. Whole-lung computed tomography analysis and pulmonary function test were performed at 1 and 6 months of follow-up. A health-related quality of life survey after 6 months was also performed.

Results: Thirty-three patients were enrolled, and 21 patients survived after 6 months. In extubation day an association between driving pressure and NT-PCP-III was observed. At 1 and 6 months forced vital capacity (FVC) was negatively correlated to driving pressure (p < 0.01). At 6 months driving pressure was associated with lower FVC independently on tidal volume, plateau pressure and baseline static respiratory compliance after adjustments (r2 = 0.51, p = 0.02). There was a significant correlation between driving pressure and lung densities and nonaerated/poorly aerated lung volume after 6 months. Driving pressure was also related to general health domain of SF-36 at 6 months.

Conclusion: Even in patients ventilated with protective tidal volume, higher driving pressure is associated with worse long-term pulmonary function and structure.

Figures

Fig. 1
Fig. 1
Chart of the protocol
Fig. 2
Fig. 2
Relationship between driving pressure and forced vital capacity after 1 month (panel A) and 6 months (panel B) of acute respiratory distress syndrome
Fig. 3
Fig. 3
Mean pulmonary parenchyma density in the whole-lung CT scan in 17 ARDS patients after 6 months of follow-up split based on driving pressure median
Fig. 4
Fig. 4
Relationship between driving pressure and log10 N-terminal-peptide type III procollagen (NT-PCP-III) difference between extubation day and day 0 of acute respiratory distress syndrome
Fig. 5
Fig. 5
Changes in serum level of N-terminal peptide for type III procollagen over time in patients ventilated with driving pressure 2O 24 h after inclusion (N = 9) and patients ventilated with driving pressure ≥ 13 cmH2O 24 h after inclusion (N = 9). (NT-PCP-III = type III procollagen, 1 = day 1 after inclusion, 3 = day 3 after inclusion, 7 = level after extubation or at day 7 after inclusion)

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