Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome
Abstract Background The association between bedside ventilatory parameters—specifically arterial carbon dioxide pressure (PaCO2) and ventilatory ratio (VR)—and mortality in patients with acute respiratory distress syndrome (ARDS) remains a topic of debate. Additionally, the persistence of this assoc...
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| Language: | English |
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SpringerOpen
2025-01-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-025-01427-1 |
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| author | Lianlian Jiang Hui Chen Wei Chang Qin Sun Xueyan Yuan Zongsheng Wu Jianfeng Xie Ling Liu Yi Yang |
| author_facet | Lianlian Jiang Hui Chen Wei Chang Qin Sun Xueyan Yuan Zongsheng Wu Jianfeng Xie Ling Liu Yi Yang |
| author_sort | Lianlian Jiang |
| collection | DOAJ |
| description | Abstract Background The association between bedside ventilatory parameters—specifically arterial carbon dioxide pressure (PaCO2) and ventilatory ratio (VR)—and mortality in patients with acute respiratory distress syndrome (ARDS) remains a topic of debate. Additionally, the persistence of this association over time is unclear. This study aims to investigate the relationship between 28-day mortality in ARDS patients and their longitudinal exposure to ventilatory inefficiency, as reflected by serial measurements of PaCO2 and VR. Methods We conducted a secondary analysis of four randomized controlled trials (FACTT, ALTA, EDEN, and SAILS) from the ARDS Network. All included patients were intubated and received mechanical ventilation. Patients were excluded if they underwent extracorporeal life support or were on mechanical ventilation for less than one day. The primary outcome was 28-day mortality. Bayesian joint models were employed to estimate the strength of associations over time. Results A total of 2,851 patients were included in our analysis. The overall 28-day mortality rate was 21.3%, with a median duration of invasive mechanical ventilation of 9 days (IQR: 4–28 days). After adjustment, each daily increment in PaCO2 (HR 1.008, 95% CI 0.997–1.018) was not associated with mortality, while a daily increment in VR (HR 1.548, 95% CI 1.309–1.835) was associated with increased mortality. This association persisted during the prolonged stages (Days 0–23) of mechanical ventilation. Furthermore, a significant increase in the risk of death was related to daily exposure to VR > 2 (HR 1.088 per day, 95% CI 1.034–1.147) and its cumulative effect (HR 1.085 per area, 95% CI 1.050–1.122), whereas PaCO2 was found to be insignificant. Conclusion VR, which reflects ventilatory inefficiency, should be closely monitored during invasive mechanical ventilation. Cumulative exposure to high intensities of VR may be associated with increased mortality in patients with ARDS. |
| format | Article |
| id | doaj-art-9be6bdf88a2f439d8038ca2fafbb8dcc |
| institution | Kabale University |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj-art-9be6bdf88a2f439d8038ca2fafbb8dcc2025-01-19T12:38:38ZengSpringerOpenAnnals of Intensive Care2110-58202025-01-0115111010.1186/s13613-025-01427-1Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndromeLianlian Jiang0Hui Chen1Wei Chang2Qin Sun3Xueyan Yuan4Zongsheng Wu5Jianfeng Xie6Ling Liu7Yi Yang8Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityJiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast UniversityAbstract Background The association between bedside ventilatory parameters—specifically arterial carbon dioxide pressure (PaCO2) and ventilatory ratio (VR)—and mortality in patients with acute respiratory distress syndrome (ARDS) remains a topic of debate. Additionally, the persistence of this association over time is unclear. This study aims to investigate the relationship between 28-day mortality in ARDS patients and their longitudinal exposure to ventilatory inefficiency, as reflected by serial measurements of PaCO2 and VR. Methods We conducted a secondary analysis of four randomized controlled trials (FACTT, ALTA, EDEN, and SAILS) from the ARDS Network. All included patients were intubated and received mechanical ventilation. Patients were excluded if they underwent extracorporeal life support or were on mechanical ventilation for less than one day. The primary outcome was 28-day mortality. Bayesian joint models were employed to estimate the strength of associations over time. Results A total of 2,851 patients were included in our analysis. The overall 28-day mortality rate was 21.3%, with a median duration of invasive mechanical ventilation of 9 days (IQR: 4–28 days). After adjustment, each daily increment in PaCO2 (HR 1.008, 95% CI 0.997–1.018) was not associated with mortality, while a daily increment in VR (HR 1.548, 95% CI 1.309–1.835) was associated with increased mortality. This association persisted during the prolonged stages (Days 0–23) of mechanical ventilation. Furthermore, a significant increase in the risk of death was related to daily exposure to VR > 2 (HR 1.088 per day, 95% CI 1.034–1.147) and its cumulative effect (HR 1.085 per area, 95% CI 1.050–1.122), whereas PaCO2 was found to be insignificant. Conclusion VR, which reflects ventilatory inefficiency, should be closely monitored during invasive mechanical ventilation. Cumulative exposure to high intensities of VR may be associated with increased mortality in patients with ARDS.https://doi.org/10.1186/s13613-025-01427-1Acute respiratory distress syndromeMechanical ventilationArterial carbon dioxide pressureVentilatory ratio |
| spellingShingle | Lianlian Jiang Hui Chen Wei Chang Qin Sun Xueyan Yuan Zongsheng Wu Jianfeng Xie Ling Liu Yi Yang Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome Annals of Intensive Care Acute respiratory distress syndrome Mechanical ventilation Arterial carbon dioxide pressure Ventilatory ratio |
| title | Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome |
| title_full | Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome |
| title_fullStr | Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome |
| title_full_unstemmed | Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome |
| title_short | Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome |
| title_sort | time varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome |
| topic | Acute respiratory distress syndrome Mechanical ventilation Arterial carbon dioxide pressure Ventilatory ratio |
| url | https://doi.org/10.1186/s13613-025-01427-1 |
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