Hernández PJC, Muñoz RMR

Language: Spanish
References: 12
Page: 291-295
PDF size: 180.84 Kb.

ABSTRACT

Introduction: Efficient ventilation is essential in COVID-19 but an appropriate driving pressure (DP) and mechanical power (PM) must be applied. Objective: To evaluate the association of driving pressure and mechanical power with mortality in patients with severe-critical COVID-19. Material and methods: Observational, cross-sectional, analytical, retrospective study. Through bivariate and multivariate statistical analysis, it was determined if the DP and PM are associated with mortality, considering significant a p < 0.05. Results: 137 patients with severe-critical COVID-19, mean age 55.8 ± 16.4 years, were included. The comorbidities were arterial hypertension 85 (62%), obesity 62 (45.3%) and diabetes mellitus 50 (36.5%). Mortality was 71 (52.3%). In severe illness, the DP was 14.2 ± 5.1 cmH₂O and in critical illness it was 11.3 ± 5.0 cmH₂O (p = 0.001). The mean PM values with severe COVID-19 were 19.5 ± 19.3 J/min and in critical COVID-19 they were 29.1 ± 27.6 J/min (p = 0.026). The AUC of DP to predict mortality was 0.740 (p < 0.001) and of PM 0.569 (p = 0.171). In the multivariate analysis, the factors independently associated with mortality were age (ORa = 1.041, CI95% 1.015-1.068, p = 0.002) and DP (ORa = 1.207, CI95% 1.101-1.322, p < 0.001). Conclusion: Driving pressure is an independent and significant predictor of mortality in patients with severe-critical COVID-19.

REFERENCES

1. Fernández-Pérez GC, Oñate Miranda M, Fernández-Rodríguez P, et al. SARS-CoV-2: what it is, how it acts, and how it manifests in imaging studies [SARS-CoV-2: cómo es, cómo actúa y cómo se expresa en la imagen SARS-CoV-2: cómo es, cómo actúa y cómo se expresa en la imagen]. Radiologia. 2021;63(2):115-126. Radiologia. 2021;63(2):115-126.

2. Ortiz-Ruiz G, Cardinal-Fernández P, Dueñas-Castell CR, Garay-Fernández MA, Lara-García A, Aguirre-Rodríguez ÁP. Poder mecánico. Acta Colomb Cuid Intensivo. 2021;21(3):241-251.

3. Laffey JG, Bellani G, Pham T, et al. Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med. 2016;42(12):1865-1876.

4. Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2010;181(6):578-586.

5. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575.

6. Aoyama H, Yamada Y, Fan E. The future of driving pressure: a primary goal for mechanical ventilation? J Intensive Care. 2018;6(1):64.

7. Aoyama H, Pettenuzzo T, Aoyama K, Pinto R, Englesakis M, Fan E. Association of driving pressure with mortality among ventilated patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med. 2018;46(2):300-306.

8. Pérez-Nieto OR, Deloya-Tomás E, Lomelí-Terán JM, Pozos-Cortés KP, Monares-Zepeda E, Poblano-Morales MN. Presión de distensión (driving pressure): Principal objetivo para la protección alveolar. Neumol Cir Torax. 2018;77(3):222-227.

9. Mauad T, Duarte-Neto AN, da Silva LFF, et al. Tracking the time course of pathological patterns of lung injury in severe COVID-19. Respir Res. 2021;22(1):1-11.

10. Pérez-Abreu MR, Gómez-Tejeda JJ, Dieguez-Guach RA. Características clínico-epidemiológicas de la COVID-19. Rev Habanera Ciencias Médicas. 2020;19(2).

11. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-2168.

12. Amato MBP, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747-755.