Dynamic driving pressure associated mortality in acute respiratory distress syndrome with extracorporeal membrane oxygenation

Chiu, Li-Chung; Hu, Han-Chung; Hung, Chen-Yiu; Chang, Chih-Hao; Tsai, Feng-Chun; Yang, Cheng-Ta; Huang, Chung-Chi; Wu, Huang-Pin; Kao, Kuo-Chin

doi:10.1186/s13613-017-0236-y

Annals of Intensive Care

Table 1 Characteristics of survivors and nonsurvivors of severe ARDS patients with ECMO support

From: Dynamic driving pressure associated mortality in acute respiratory distress syndrome with extracorporeal membrane oxygenation

Characteristic	All patients (n = 158)	Survivors (n = 71)	Nonsurvivors (n = 87)	p value
Age (years)	50.3 ± 16.3	46.0 ± 16.5	53.8 ± 15.4	0.003
Male (gender)	108 (68.4%)	48 (67.6%)	60 (69%)	0.855
Body weight (kg)	68.5 ± 16.7	70.1 ± 17.4	67.1 ± 16.1	0.268
Body mass index (kg/m²)	25.8 ± 5.2	26.0 ± 5.8	25.6 ± 4.7	0.656
ARDS etiologies
Bacterial pneumonia	55 (34.8%)	19 (26.8%)	36 (41.4%)	0.055
Viral pneumonia	24 (15.2%)	13 (18.3%)	11(12.6%)	0.327
Nonpulmonary sepsis	21 (13.3%)	4 (5.6%)	17 (19.5%)	0.017
Pulmonary contusion	19 (12%)	13 (18.3%)	6 (6.9%)	0.028
Aspiration pneumonia	11 (7%)	8 (11.3%)	3 (3.4%)	0.066
Other causes	28 (17.7%)	14 (19.7%)	14 (16.1%)	1.0
Comorbidities
Diabetes mellitus	40 (25.3%)	23 (32.4%)	17 (19.5%)	0.065
Cerebrovascular accident	10 (6.3%)	6 (8.5%)	4 (4.6%)	0.346
Chronic heart disease^a	55 (34.8%)	23 (32.4%)	32 (36.8%)	0.565
Chronic lung disease^b	16 (10.1%)	4 (5.6%)	12 (13.8%)	0.115
Chronic liver disease^c	22 (13.9%)	6 (8.5%)	16 (18.4%)	0.073
Chronic kidney disease^d	18 (11.4%)	8 (11.3%)	10 (11.5%)	0.964
Immunocompromised^e	42 (26.6%)	11 (15.5%)	31 (35.6%)	0.004
APACHE II score	23.4 ± 7.5	21.8 ± 8.0	24.7 ± 6.9	0.014
SOFA score	10.9 ± 3.2	10.3 ± 3.1	11.4 ± 3.2	0.042
Lung injury score	3.37 ± 0.44	3.44 ± 0.43	3.32 ± 0.45	0.085
ARDS duration before ECMO (h)	28.0 (7.0–129.0)	9.8 (3.7–64.0)	54.0 (16.0–200.0)	<0.001
Pre-ECMO ventilator settings
PaO₂/FiO₂ (mmHg)	64 (52–87)	64 (53–80)	63 (52–107)	0.198
Tidal volume (ml/kg PBW)	7.7 ± 2.4	7.7 ± 2.3	7.8 ± 2.4	0.753
PEEP (cm H₂O)	12.0 ± 2.8	12.2 ± 2.5	11.8 ± 3.0	0.319
Peak inspiratory pressure (cm H₂O)	33.9 ± 6.5	33.6 ± 6.0	34.1 ± 6.8	0.645
Mean airway pressure (cm H₂O)	18.7 ± 4.4	18.4 ± 4.2	18.9 ± 4.6	0.539
Dynamic driving pressure (cm H₂O)	21.9 ± 6.2	21.1 ± 5.8	22.6 ± 6.5	0.139
Dynamic compliance (ml/cm H₂O)	22.5 ± 11.2	23.4 ± 11.6	21.7 ± 10.9	0.366
Pre-ECMO blood gas
pH	7.28 ± 0.14	7.27 ± 0.12	7.28 ± 0.15	0.842
PaCO₂ (mmHg)	52.2 ± 18.8	50.7 ± 19.6	53.5 ± 18.2	0.359
PaO₂ (mmHg)	73.3 ± 39.3	71.6 ± 39.2	74.8 ± 39.6	0.617
Saturation (%)	84.4 ± 15.9	84.7 ± 12.7	84.1 ± 18.2	0.804
Ventilator settings from day 1 to 3 on ECMO
PaO₂/FiO₂ (mmHg)	178 (131–240)	200 (146–247)	165 (124–212)	0.588
Tidal volume (ml/kg PBW)	6.0 ± 2.2	6.1 ± 2.0	6.0 ± 2.4	0.914
PEEP (cm H₂O)	12.0 ± 3.3	12.3 ± 3.2	11.7 ± 3.3	0.202
Peak inspiratory pressure (cm H₂O)	31.7 ± 5.6	30.6 ± 5.1	32.8 ± 5.9	0.018
Mean airway pressure (cm H₂O)	17.7 ± 4.0	17.4 ± 3.6	17.9 ± 4.3	0.406
Dynamic driving pressure (cm H₂O)	19.8 ± 6.3	18.3 ± 6.0	21.1 ± 6.4	0.006
Dynamic compliance (ml/cm H₂O)	19.2 ± 8.1	21.1 ± 7.7	17.4 ± 8.1	0.006
Duration of ECMO (days)	9.0 (4.8–14.6)	8.7 (5.0–13.0)	9.8 (4.7–16.1)	0.696
ECMO complications	43 (27.2%)	16 (22.5%)	27 (31.0%)	0.232

Data are presented as mean ± standard deviation, count or median (interquartile range)
APACHE Acute Physiology and Chronic Health Evaluation, ARDS acute respiratory distress syndrome, ECMO extracorporeal membrane oxygenation, FiO ₂ fraction of inspired oxygen, PaCO ₂ partial pressure of carbon dioxide in arterial blood, PaO ₂ partial pressure of oxygen in arterial blood, PBW predicted body weight, PEEP positive end-expiratory pressure, SOFA Sequential Organ Failure Assessment. Dynamic driving pressure: (peak inspiratory pressure—PEEP)
^aChronic heart disease included chronic heart failure, valvular heart disease, arrhythmia, hypertension and coronary artery disease
^bChronic lung disease included chronic obstructive pulmonary disease, interstitial lung disease, tuberculosis and bronchiectasis
^cChronic liver disease included chronic hepatitis and cirrhosis
^dChronic kidney disease included chronic renal insufficiency with creatinine level above 1.5 mg/dl
^eImmunocompromised included hematological malignancies, solid tumors, sold organ transplantation, long-term steroid or immunosuppressant use and human immunodeficiency virus infection

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