High Positive End-Expiratory Pressure Is Associated with Improved Survival in Obese Patients with Acute Respiratory Distress Syndrome.

TitleHigh Positive End-Expiratory Pressure Is Associated with Improved Survival in Obese Patients with Acute Respiratory Distress Syndrome.
Publication TypeJournal Article
Year of Publication2017
AuthorsBime C, Fiero M, Lu Z, Oren E, Berry CE, Parthasarathy S, Garcia JGN
JournalAm J Med
Volume130
Issue2
Pagination207-213
Date Published2017 Feb
ISSN Number1555-7162
KeywordsFemale, Humans, Male, Middle Aged, Obesity, Positive-Pressure Respiration, Respiratory Distress Syndrome, Adult, Retrospective Studies, Tidal Volume
Abstract

<p><b>BACKGROUND: </b>In acute respiratory distress syndrome, minimizing lung injury from repeated collapse and reopening of alveoli by applying a high positive end-expiratory pressure improves oxygenation without influencing mortality. Obesity causes alveolar atelectasis, thus suggesting that a higher positive end-expiratory pressure might be more protective among the obese. We hypothesized that the effect of applying a high positive end-expiratory pressure on mortality from acute respiratory distress syndrome would differ by obesity status.</p><p><b>METHODS: </b>This was a retrospective analysis of 505 patients from the Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury Trial, a multicenter randomized trial that compared a higher vs a lower positive end-expiratory pressure ventilatory strategy in acute respiratory distress syndrome. We examined the relationship between positive end-expiratory pressure strategy and 60-day mortality stratified by obesity status.</p><p><b>RESULTS: </b>Among obese patients with acute respiratory distress syndrome, those assigned to a high positive end-expiratory pressure strategy experienced lower mortality compared with those assigned to a low strategy (18% vs 32%; P = .04). Among the nonobese, those assigned to high positive end-expiratory pressure strategy experienced similar mortality with those assigned to low strategy (34% vs 23%; P = .13). Multivariate analysis demonstrated an interaction between obesity status and the effect of positive end-expiratory pressure strategy on mortality (P <.01).</p><p><b>CONCLUSIONS: </b>Ventilation with higher levels of positive end-expiratory pressure was associated with improved survival among the subgroup of patients with acute respiratory distress syndrome who are obese.</p>

DOI10.1016/j.amjmed.2016.09.029
Alternate JournalAm. J. Med.
PubMed ID27984004