Browsing by Author "Violi, DA"
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- Association Between Ventilatory Settings and Development of Acute Respiratory Distress Syndrome in Mechanically Ventilated Patients Due to Brain InjuryPublication . Tejerina, E; Pelosi, P; Muriel, A; Peñuelas, O; Sutherasan, Y; Frutos-Vivar, F; Nin, N; Davies, AR; Rios, F; Violi, DA; Raymondos, K; Hurtado, J; González, M; Du, B; Amin, P; Maggiore, SM; Thille, AW; Soares, MA; Jibaja, M; Villagomez, AJ; Kuiper, MA; Koh, Y; Moreno, R; Zeggwagh, AA; Matamis, D; Anzueto, A; Ferguson, ND; Esteban, APURPOSE: In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury. MATERIALS AND METHODS: We performed a secondary analysis of a prospective, observational study on mechanical ventilation. RESULTS: We included 986 patients mechanically ventilated due to an acute brain injury (hemorrhagic stroke, ischemic stroke or brain trauma). Incidence of ARDS in this cohort was 3%. Multivariate analysis suggested that driving pressure could be associated with the development of ARDS (odds ratio for unit increment of driving pressure 1.12; confidence interval for 95%: 1.01 to 1.23) whereas we did not observe association for tidal volume (in ml per kg of predicted body weight) or level of PEEP. ARDS was associated with an increase in mortality, longer duration of mechanical ventilation, and longer ICU length of stay. CONCLUSIONS: In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.
- Severe Hypercapnia and Outcome of Mechanically Ventilated Patients with Moderate or Severe Acute Respiratory Distress SyndromePublication . Nin, N; Muriel, A; Peñuelas, O; Brochard, L; Lorente, JA; Ferguson, N; Raymondos, K; Ríos, F; Violi, DA; Thille, A; González, M; Villagomez, AJ; Hurtado, J; Davies, AR; Du, B; Maggiore, SM; Soto, L; D'Empaire, G; Matamis, D; Abroug, F; Moreno, R; Soares, MA; Arabi, Y; Sandi, F; Jibaja, M; Amin, P; Koh, Y; Kuiper, MA; Bülow, HH; Zeggwagh, AA; Anzueto, A; Sznajder, J; Esteban, APURPOSE: To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). PATIENTS AND METHODS: We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. MAIN OUTCOMES: We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04-2.41; p = 0.032). CONCLUSIONS: Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS.