Decreased respiratory system compliance on the sixth day of mechanical ventilation is a predictor of death in patients with established acute lung injuryReport as inadecuate




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Respiratory Research

, 12:52

First Online: 01 December 2011Received: 04 January 2011Accepted: 22 April 2011

Abstract

BackgroundMultiple studies have identified single variables or composite scores that help risk stratify patients at the time of acute lung injury ALI diagnosis. However, few studies have addressed the important question of how changes in pulmonary physiologic variables might predict mortality in patients during the subacute or chronic phases of ALI. We studied pulmonary physiologic variables, including respiratory system compliance, P-F ratio and oxygenation index, in a cohort of patients with ALI who survived more than 6 days of mechanical ventilation to see if changes in these variables were predictive of death and whether they are informative about the pathophysiology of subacute ALI.

MethodsNinety-three patients with ALI who were mechanically ventilated for more than 6 days were enrolled in this prospective cohort study. Patients were enrolled at two medical centers in the US, a county hospital and a large academic center. Bivariate analyses were used to identify pulmonary physiologic predictors of death during the first 6 days of mechanical ventilation. Predictors on day 1, day 6 and the changes between day 1 and day 6 were compared in a multivariate logistic regression model.

ResultsThe overall mortality was 35%. In multivariate analysis, the PaO2-FiO2 OR 2.09, p < 0.04 and respiratory system compliance OR 3.61, p < 0.01 were predictive of death on the 6 day of acute lung injury. In addition, a decrease in respiratory system compliance between days 1 and days 6 OR 2.14, p < 0.01 was independently associated with mortality.

ConclusionsA low respiratory system compliance on day 6 or a decrease in the respiratory system compliance between the 1 and 6 day of mechanical ventilation were associated with increased mortality in multivariate analysis of this cohort of patients with ALI. We suggest that decreased respiratory system compliance may identify a subset of patients who have persistent pulmonary edema, atelectasis or the fibroproliferative sequelae of ALI and thus are less likely to survive their hospitalization.

Electronic supplementary materialThe online version of this article doi:10.1186-1465-9921-12-52 contains supplementary material, which is available to authorized users.

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Author: Eric J Seeley - Daniel F McAuley - Mark Eisner - Michael Miletin - HanJing Zhuo - Michael A Matthay - Richard H Kallet

Source: https://link.springer.com/







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