TY - JOUR
T1 - Increased Driving Pressure During Assisted Ventilation for Hypoxemic Respiratory Failure Is Associated with Lower ICU Survival
T2 - The ICEBERG Study
AU - Grassi, Alice
AU - Bianchi, Isabella
AU - Teggia Droghi, Maddalena
AU - Miori, Sara
AU - Bruno, Ilaria
AU - Balzani, Eleonora
AU - Morris, Idunn S
AU - Schaedler, Dirk
AU - Becher, Tobias
AU - Valdivia Marchal, Manuel
AU - Serrano, Jose M
AU - Caritg, Oriol
AU - Roca, Oriol
AU - Costa, Eduardo
AU - Amato, Marcelo
AU - Barriga, Fernando
AU - Roldan, Rollin
AU - Boffi, Andrea
AU - Piquilloud, Lise
AU - Mitchon, Gregory J
AU - Musch, Guido
AU - Piva, Simone
AU - Bertoni, Michele
AU - Castagna, Luigi
AU - Grasselli, Giacomo
AU - Riccardo, Matteo
AU - Spadaro, Savino
AU - Nita, Ciprian
AU - McNicholas, Bairbre
AU - Sklar, Michael C
AU - Magliocca, Aurora
AU - Rezoagli, Emanuele
AU - Foti, Giuseppe
AU - Laffey, John
AU - Brochard, Laurent J
AU - Goligher, Ewan C
AU - Bellani, Giacomo
PY - 2025/6/20
Y1 - 2025/6/20
N2 - RATIONALE: Driving pressure is marker of severity and a possible target for lung protection during controlled ventilation, but its value during assisted ventilation is unknown. Inspiratory holds provide an estimate of driving pressure (quasi-static). Expiratory holds provide an estimate of the inspiratory effort, useful to estimate the transpulmonary dynamic driving pressure.OBJECTIVES: To assess the correlation between driving pressures measured during assisted ventilation and ICU outcomes.METHODS: Multicenter prospective observational study. Patients with acute hypoxemic respiratory failure were enrolled within 48 hours of triggering the ventilator. Respiratory mechanics were measured daily and the variables of interest averaged over the first three days of partial assistance. ICU outcomes were collected until day 90.MEASUREMENTS AND MAIN RESULTS: Two-hundred ninety-eight patients from 16 centers were enrolled. Tidal volume, peak airway pressure, positive-end-expiratory-pressure and inspiratory effort during the first three days of assisted ventilation did not differ between survivors and non-survivors. Quasi-static driving pressure and transpulmonary dynamic driving pressure were higher in non-survivors than in survivors (13 [11,14] vs 11 [9,13] cmH2O, p<0.001 and 19 [16,23] vs 16 [13,18] cmH2O, p<0.001, respectively), while compliance normalized to predicted body weight was lower (0.65 [0.54,0.84] vs 0.79 [0.64,0.97] ml/cmH2O/kg, p<0.001). Multivariable analysis confirmed the association with outcome. Over study days, static driving pressure significantly diverged between survivors and non-survivors.CONCLUSIONS: During assisted ventilation driving pressure and normalized compliance are associated with ICU outcome, despite some overlap. Albeit our study does not allow to estimate if driving pressure is a marker of severity, or a cause of lung injury, it highlights the potential value of monitoring and targeting it during spontaneous assisted breathing.
AB - RATIONALE: Driving pressure is marker of severity and a possible target for lung protection during controlled ventilation, but its value during assisted ventilation is unknown. Inspiratory holds provide an estimate of driving pressure (quasi-static). Expiratory holds provide an estimate of the inspiratory effort, useful to estimate the transpulmonary dynamic driving pressure.OBJECTIVES: To assess the correlation between driving pressures measured during assisted ventilation and ICU outcomes.METHODS: Multicenter prospective observational study. Patients with acute hypoxemic respiratory failure were enrolled within 48 hours of triggering the ventilator. Respiratory mechanics were measured daily and the variables of interest averaged over the first three days of partial assistance. ICU outcomes were collected until day 90.MEASUREMENTS AND MAIN RESULTS: Two-hundred ninety-eight patients from 16 centers were enrolled. Tidal volume, peak airway pressure, positive-end-expiratory-pressure and inspiratory effort during the first three days of assisted ventilation did not differ between survivors and non-survivors. Quasi-static driving pressure and transpulmonary dynamic driving pressure were higher in non-survivors than in survivors (13 [11,14] vs 11 [9,13] cmH2O, p<0.001 and 19 [16,23] vs 16 [13,18] cmH2O, p<0.001, respectively), while compliance normalized to predicted body weight was lower (0.65 [0.54,0.84] vs 0.79 [0.64,0.97] ml/cmH2O/kg, p<0.001). Multivariable analysis confirmed the association with outcome. Over study days, static driving pressure significantly diverged between survivors and non-survivors.CONCLUSIONS: During assisted ventilation driving pressure and normalized compliance are associated with ICU outcome, despite some overlap. Albeit our study does not allow to estimate if driving pressure is a marker of severity, or a cause of lung injury, it highlights the potential value of monitoring and targeting it during spontaneous assisted breathing.
U2 - 10.1164/rccm.202411-2146OC
DO - 10.1164/rccm.202411-2146OC
M3 - Article
C2 - 40540619
SN - 1073-449X
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
ER -