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Prolonged mechanical ventilation in acute respiratory distress syndrome.
Pubmed ID: 38010051
Journal: Shock (Augusta, Ga.)
Publication Date: Nov. 16, 2023
Affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Authors: Thompson BT, Siempos II, Giannakoulis VG, Papoutsi E, Andrianopoulos I, Papathanakos G, Koulouras V
Cite As: Andrianopoulos I, Giannakoulis VG, Papoutsi E, Papathanakos G, Koulouras V, Thompson BT, Siempos II. Prolonged mechanical ventilation in acute respiratory distress syndrome. Shock 2023 Nov 16. Epub 2023 Nov 16.
Studies:
- Acute Respiratory Distress Network (ARDSNet) Studies 01 and 03 Lower versus higher tidal volume, ketoconazole treatment and lisofylline treatment (ARMA/KARMA/LARMA)
- Acute Respiratory Distress Network (ARDSNet) Studies 06 and 08 Prospective, Randomized, Multicenter Trial of Aerosolized Albuterol Versus Placebo for the Treatment of Acute Lung Injury (ALTA)
- Acute Respiratory Distress Network (ARDSNet) Studies 07, 08, 09, 11, and 12 Early Versus Delayed Enteral Feeding to Treat People with Acute Lung Injury or Acute Respiratory Distress Syndrome (EDEN)
- Acute Respiratory Distress Network (ARDSNet) Studies 10 and 12 Statins for Acutely Injured Lungs from Sepsis (SAILS)
- Acute Respiratory Distress Network (ARDSNet) Study 04 Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury (ALVEOLI)
- Acute Respiratory Distress Network (ARDSNet) Study 05 Fluid and Catheter Treatment Trial (FACTT)
Abstract
PURPOSE: Trajectory of acute respiratory distress syndrome (ARDS) spans from rapidly improving cases to cases receiving prolonged mechanical ventilation (PMV). We attempted to estimate temporal trends of prevalence and mortality of PMV and to identify risk factors associated with mortality of patients with ARDS receiving PMV. METHODS: We performed a secondary analysis of individual patient data from six randomized controlled clinical trials conducted by the ARDS Network. PMV was defined as the need for mechanical ventilation for >21 consecutive days. RESULTS: Of 4216 patients with ARDS, 646 (15.3%) received PMV. Prevalence of PMV gradually declined from 18.4% in the ARMA (published in 2000) trial to 10.9% in the SAILS (2014) trial (R2 = 0.728, p = 0.031). 90-day mortality of patients receiving PMV did not change over time (R2 = 0.271, p = 0.290) and remained as high as 36.8%. Ιn the three most recent trials, risk factors associated with mortality among the 250 patients with ARDS receiving PMV included age, malignancy, pneumonia as the cause of ARDS, coagulation dysfunction and hepatic dysfunction during the first 21 days after trial enrollment. CONCLUSION: Although prevalence of PMV among patients enrolled in ARDS Network trials gradually declined, mortality did not change. Risk factors associated with mortality were mostly non-modifiable.