Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study

Alexandre Demoule; Massimo Antonelli; Peter Schellongowski; Peter Pickkers; Marcio Soares; Tine Sylvest Meyhoff; Jordi Rello; Philippe Bauer; Andry van de Louw; Virgine Lemiale; David Grimaldi; Ignacio Martin-Loeches; Martin Balik; Sangeeta Mehta; Achille Kouatchet; Andreas Barratt-Due; Miia Valkonen; Jean Reignier; Victoria Metaxa; Anne Sophie Moreau; Gaston Burghi; Djamel Mokart; Julien Mayaux; Michael Darmon; Elie Azoulay; Karin Amrein; Thomas Staundinger; Gottfried Heinz; Gürkan Sengölge; Christian Zauner; Peter Jaksch; Fabio S. Taccone; Anne Pascale Meert; Dominique Benoît; Ulysses V.A. Silva; Ana Paula Pierre de Moraes; Thiago Lishoa; Jorge Salluh; William Viana; Guilliana Moralez; Thiago Domingos Correa; Umesh Shah; Thomas Karvunidis; Balik Martin; Katerina Russinova; Anders Perner; Tine Sylvest Meyhoff; Nielsen Jonas; Ramin Brandt Bukan; Ann M. Moeller; Lene B. Nielsen; Amélie Seguin; Akli Chermak; Nicolas Terzi; Isabelle Vinatier; Florent Wallet; Kada Klouche; Laura Platon; Benjamin Gaborit; François Barbier; Frederic Pène; Antoine Rabbat; Virginie Lemiale; Martine N'Yunga; Christophe Girault; Caroline Lemaitre; Elise Artaud-Macari; F. Bruneel; Anne Sophie Moreau; Anne Kuitunen; Brian Marsh; Mater Misericordia; Aisling Mc Mahon; Gilda Cinnella; Antonella Cotoia; Ospedali Riuniti; Lucas Montini; Angélique Spoelstra de Man; Precious Pearl Landburg; Dennis Bergmans; Pleun Hemelaar; Thomas Kaufmann; Andreas Barrat-Due; Pål Klepstad; Belen Encina; Gabriel Moreno; Llorenç Socias Crespi; Emilio Rodriguez-Ruiz; Philippe Bauer; Yadav Hemang

doi:https://doi.org/10.1016/j.chest.2020.05.602

Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study

Alexandre Demoule, Massimo Antonelli, Peter Schellongowski, Peter Pickkers, Marcio Soares, Tine Sylvest Meyhoff, Jordi Rello, Philippe Bauer, Andry van de Louw, Virgine Lemiale, David Grimaldi, Ignacio Martin-Loeches, Martin Balik, Sangeeta Mehta, Achille Kouatchet, Andreas Barratt-Due, Miia Valkonen, Jean Reignier, Victoria Metaxa, Anne Sophie MoreauGaston Burghi, Djamel Mokart, Julien Mayaux, Michael Darmon, Elie Azoulay, Karin Amrein, Thomas Staundinger, Gottfried Heinz, Gürkan Sengölge, Christian Zauner, Peter Jaksch, Fabio S. Taccone, Anne Pascale Meert, Dominique Benoît, Ulysses V.A. Silva, Ana Paula Pierre de Moraes, Thiago Lishoa, Jorge Salluh, William Viana, Guilliana Moralez, Thiago Domingos Correa, Umesh Shah, Thomas Karvunidis, Balik Martin, Katerina Russinova, Anders Perner, Tine Sylvest Meyhoff, Nielsen Jonas, Ramin Brandt Bukan, Ann M. Moeller, Lene B. Nielsen, Amélie Seguin, Akli Chermak, Nicolas Terzi, Isabelle Vinatier, Florent Wallet, Kada Klouche, Laura Platon, Benjamin Gaborit, François Barbier, Frederic Pène, Antoine Rabbat, Virginie Lemiale, Martine N'Yunga, Christophe Girault, Caroline Lemaitre, Elise Artaud-Macari, F. Bruneel, Anne Sophie Moreau, Anne Kuitunen, Brian Marsh, Mater Misericordia, Aisling Mc Mahon, Gilda Cinnella, Antonella Cotoia, Ospedali Riuniti, Lucas Montini, Angélique Spoelstra de Man, Precious Pearl Landburg, Dennis Bergmans, Pleun Hemelaar, Thomas Kaufmann, Andreas Barrat-Due, Pål Klepstad, Belen Encina, Gabriel Moreno, Llorenç Socias Crespi, Emilio Rodriguez-Ruiz, Philippe Bauer, Yadav Hemang

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. Research Question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). Study Design and Methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.

Original language	English
Pages (from-to)	1947-1957
Number of pages	11
Journal	Chest
Volume	158
Issue number	5
DOIs	https://doi.org/10.1016/j.chest.2020.05.602
Publication status	Published - Nov 2020

Keywords

ARDS
acute respiratory failure
diagnosis
driving pressure
immunocompromised
outcome
plateau pressure

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https://doi.org/10.1016/j.chest.2020.05.602

Cite this

Demoule, A., Antonelli, M., Schellongowski, P., Pickkers, P., Soares, M., Meyhoff, T. S., Rello, J., Bauer, P., van de Louw, A., Lemiale, V., Grimaldi, D., Martin-Loeches, I., Balik, M., Mehta, S., Kouatchet, A., Barratt-Due, A., Valkonen, M., Reignier, J., Metaxa, V., ... Hemang, Y. (2020). Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study. Chest, 158(5), 1947-1957. https://doi.org/10.1016/j.chest.2020.05.602

@article{4c10f852fe8547afa228362c898a8ecf,

title = "Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study",

abstract = "Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. Research Question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). Study Design and Methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.",

keywords = "ARDS, acute respiratory failure, diagnosis, driving pressure, immunocompromised, outcome, plateau pressure",

author = "Alexandre Demoule and Massimo Antonelli and Peter Schellongowski and Peter Pickkers and Marcio Soares and Meyhoff, {Tine Sylvest} and Jordi Rello and Philippe Bauer and {van de Louw}, Andry and Virgine Lemiale and David Grimaldi and Ignacio Martin-Loeches and Martin Balik and Sangeeta Mehta and Achille Kouatchet and Andreas Barratt-Due and Miia Valkonen and Jean Reignier and Victoria Metaxa and Moreau, {Anne Sophie} and Gaston Burghi and Djamel Mokart and Julien Mayaux and Michael Darmon and Elie Azoulay and Karin Amrein and Thomas Staundinger and Gottfried Heinz and G{\"u}rkan Seng{\"o}lge and Christian Zauner and Peter Jaksch and Taccone, {Fabio S.} and Meert, {Anne Pascale} and Dominique Beno{\^i}t and Silva, {Ulysses V.A.} and {Pierre de Moraes}, {Ana Paula} and Thiago Lishoa and Jorge Salluh and William Viana and Guilliana Moralez and Correa, {Thiago Domingos} and Umesh Shah and Thomas Karvunidis and Balik Martin and Katerina Russinova and Anders Perner and Meyhoff, {Tine Sylvest} and Nielsen Jonas and Bukan, {Ramin Brandt} and Moeller, {Ann M.} and Nielsen, {Lene B.} and Am{\'e}lie Seguin and Akli Chermak and Nicolas Terzi and Isabelle Vinatier and Florent Wallet and Kada Klouche and Laura Platon and Benjamin Gaborit and Fran{\c c}ois Barbier and Frederic P{\`e}ne and Antoine Rabbat and Virginie Lemiale and Martine N'Yunga and Christophe Girault and Caroline Lemaitre and Elise Artaud-Macari and F. Bruneel and Moreau, {Anne Sophie} and Anne Kuitunen and Brian Marsh and Mater Misericordia and Mahon, {Aisling Mc} and Gilda Cinnella and Antonella Cotoia and Ospedali Riuniti and Lucas Montini and {Spoelstra de Man}, Ang{\'e}lique and Landburg, {Precious Pearl} and Dennis Bergmans and Pleun Hemelaar and Thomas Kaufmann and Andreas Barrat-Due and P{\aa}l Klepstad and Belen Encina and Gabriel Moreno and Crespi, {Lloren{\c c} Socias} and Emilio Rodriguez-Ruiz and Philippe Bauer and Yadav Hemang",

year = "2020",

month = nov,

doi = "https://doi.org/10.1016/j.chest.2020.05.602",

language = "English",

volume = "158",

pages = "1947--1957",

journal = "Chest",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "5",

}

Demoule, A, Antonelli, M, Schellongowski, P, Pickkers, P, Soares, M, Meyhoff, TS, Rello, J, Bauer, P, van de Louw, A, Lemiale, V, Grimaldi, D, Martin-Loeches, I, Balik, M, Mehta, S, Kouatchet, A, Barratt-Due, A, Valkonen, M, Reignier, J, Metaxa, V, Moreau, AS, Burghi, G, Mokart, D, Mayaux, J, Darmon, M, Azoulay, E, Amrein, K, Staundinger, T, Heinz, G, Sengölge, G, Zauner, C, Jaksch, P, Taccone, FS, Meert, AP, Benoît, D, Silva, UVA, Pierre de Moraes, AP, Lishoa, T, Salluh, J, Viana, W, Moralez, G, Correa, TD, Shah, U, Karvunidis, T, Martin, B, Russinova, K, Perner, A, Meyhoff, TS, Jonas, N, Bukan, RB, Moeller, AM, Nielsen, LB, Seguin, A, Chermak, A, Terzi, N, Vinatier, I, Wallet, F, Klouche, K, Platon, L, Gaborit, B, Barbier, F, Pène, F, Rabbat, A, Lemiale, V, N'Yunga, M, Girault, C, Lemaitre, C, Artaud-Macari, E, Bruneel, F, Moreau, AS, Kuitunen, A, Marsh, B, Misericordia, M, Mahon, AM, Cinnella, G, Cotoia, A, Riuniti, O, Montini, L, Spoelstra de Man, A, Landburg, PP, Bergmans, D, Hemelaar, P, Kaufmann, T, Barrat-Due, A, Klepstad, P, Encina, B, Moreno, G, Crespi, LS, Rodriguez-Ruiz, E, Bauer, P & Hemang, Y 2020, 'Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study', Chest, vol. 158, no. 5, pp. 1947-1957. https://doi.org/10.1016/j.chest.2020.05.602

TY - JOUR

T1 - Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS

T2 - A Secondary Analysis of the EFRAIM Study

AU - Demoule, Alexandre

AU - Antonelli, Massimo

AU - Schellongowski, Peter

AU - Pickkers, Peter

AU - Soares, Marcio

AU - Meyhoff, Tine Sylvest

AU - Rello, Jordi

AU - Bauer, Philippe

AU - van de Louw, Andry

AU - Lemiale, Virgine

AU - Grimaldi, David

AU - Martin-Loeches, Ignacio

AU - Balik, Martin

AU - Mehta, Sangeeta

AU - Kouatchet, Achille

AU - Barratt-Due, Andreas

AU - Valkonen, Miia

AU - Reignier, Jean

AU - Metaxa, Victoria

AU - Moreau, Anne Sophie

AU - Burghi, Gaston

AU - Mokart, Djamel

AU - Mayaux, Julien

AU - Darmon, Michael

AU - Azoulay, Elie

AU - Amrein, Karin

AU - Staundinger, Thomas

AU - Heinz, Gottfried

AU - Sengölge, Gürkan

AU - Zauner, Christian

AU - Jaksch, Peter

AU - Taccone, Fabio S.

AU - Meert, Anne Pascale

AU - Benoît, Dominique

AU - Silva, Ulysses V.A.

AU - Pierre de Moraes, Ana Paula

AU - Lishoa, Thiago

AU - Salluh, Jorge

AU - Viana, William

AU - Moralez, Guilliana

AU - Correa, Thiago Domingos

AU - Shah, Umesh

AU - Karvunidis, Thomas

AU - Martin, Balik

AU - Russinova, Katerina

AU - Perner, Anders

AU - Meyhoff, Tine Sylvest

AU - Jonas, Nielsen

AU - Bukan, Ramin Brandt

AU - Moeller, Ann M.

AU - Nielsen, Lene B.

AU - Seguin, Amélie

AU - Chermak, Akli

AU - Terzi, Nicolas

AU - Vinatier, Isabelle

AU - Wallet, Florent

AU - Klouche, Kada

AU - Platon, Laura

AU - Gaborit, Benjamin

AU - Barbier, François

AU - Pène, Frederic

AU - Rabbat, Antoine

AU - Lemiale, Virginie

AU - N'Yunga, Martine

AU - Girault, Christophe

AU - Lemaitre, Caroline

AU - Artaud-Macari, Elise

AU - Bruneel, F.

AU - Moreau, Anne Sophie

AU - Kuitunen, Anne

AU - Marsh, Brian

AU - Misericordia, Mater

AU - Mahon, Aisling Mc

AU - Cinnella, Gilda

AU - Cotoia, Antonella

AU - Riuniti, Ospedali

AU - Montini, Lucas

AU - Spoelstra de Man, Angélique

AU - Landburg, Precious Pearl

AU - Bergmans, Dennis

AU - Hemelaar, Pleun

AU - Kaufmann, Thomas

AU - Barrat-Due, Andreas

AU - Klepstad, Pål

AU - Encina, Belen

AU - Moreno, Gabriel

AU - Crespi, Llorenç Socias

AU - Rodriguez-Ruiz, Emilio

AU - Bauer, Philippe

AU - Hemang, Yadav

PY - 2020/11

Y1 - 2020/11

N2 - Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. Research Question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). Study Design and Methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.

AB - Background: In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. Research Question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). Study Design and Methods: This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. Results: Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. Interpretation: In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.

KW - ARDS

KW - acute respiratory failure

KW - diagnosis

KW - driving pressure

KW - immunocompromised

KW - outcome

KW - plateau pressure

UR - http://www.scopus.com/inward/record.url?scp=85093944484&partnerID=8YFLogxK

U2 - https://doi.org/10.1016/j.chest.2020.05.602

DO - https://doi.org/10.1016/j.chest.2020.05.602

M3 - Article

C2 - 32569634

SN - 0012-3692

VL - 158

SP - 1947

EP - 1957

JO - Chest

JF - Chest

IS - 5

ER -

Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study

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Keywords

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