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Cited by 194Respiratory Support and MechanismsNeonatal Respiratory Health ResearchNosocomial Infections in ICU

Oxygenation Response to Positive End-Expiratory Pressure Predicts Mortality in Acute Respiratory Distress Syndrome. A Secondary Analysis of the LOVS and ExPress Trials

Goligher, Ewan C., Kavanagh, Brian P., Rubenfeld, Gordon D., Adhikari, Neill K. J., Pinto, Ruxandra, Fan, Eddy, Brochard, Laurent J., Granton, John T. +9 more·2014·American Journal of Respiratory and Critical Care Medicine
DOI 10.1164/rccm.201404-0688oc
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Abstract

Rationale: Previous trials of higher positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) failed to demonstrate mortality benefit, possibly because of differences in lung recruitability among patients with ARDS. Objectives: To determine whether the physiological response to increased PEEP is associated with mortality. Methods: In a secondary analysis of the Lung Open Ventilation Study (LOVS, n = 983), we examined the relationship between the initial response to changes in PEEP after randomization and mortality. We sought to corroborate our findings using data from a different trial of higher PEEP (ExPress, n = 749). Measurements and Main Results: The oxygenation response (change in ratio of arterial partial pressure of oxygen to fraction of inspired oxygen: P/F) after the initial change in PEEP after randomization varied widely (median, 9.5 mm Hg; interquartile range, –16 to 47) and was only weakly related to baseline P/F or the magnitude of PEEP change. Among patients in whom PEEP was increased after randomization, an increase in P/F was associated with reduced mortality (multivariable logistic regression; adjusted odds ratio, 0.80 [95% confidence interval, 0.72–0.89] per 25–mm Hg increase in P/F), particularly in patients with severe disease (baseline P/F [less-than-or-equal-to] 150 mm Hg). Changes in compliance and dead space were not associated with mortality. These findings were confirmed by a similar analysis of data from the ExPress trial. Conclusions: Patients with ARDS who respond to increased PEEP by improved oxygenation have a lower risk of death. The oxygenation response to PEEP might be used to predict whether patients will benefit from higher versus lower PEEP.

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  • A patient-level analysis of two of the randomised PEEP trials suggested that patients with ARDS who respond to increased PEEP with improved oxygenation have a lower risk of death; this association was stronger in patients with more severe ARDS (PaO2/FiO2 < 150 mmHg) compared with patients with less severe ARDS.

    “A patient-level analysis of two of the randomised PEEP trials [440, 441] suggested that patients with ARDS who respond to increased PEEP with improved oxygenation have a lower risk of death; this association was stronger in patients with more severe ARDS (PaO2/FiO2 < 150 mmHg) compared with patients with less severe ARDS [444].”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [444]

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Authors
Goligher, E. C., Kavanagh, B. P., Rubenfeld, G. D., Adhikari, N. K. J., Pinto, R., Fan, E., Brochard, L. J., Granton, J. T., Mercat, A., Marie Richard, J.-C., Chretien, J.-M., Jones, G. L., Cook, D. J., Stewart, T. E., Slutsky, A. S., Meade, M. O., & Ferguson, N. D.
Affiliations
  • Mount Sinai Hospital (CA)
  • University of Toronto (CA)
  • Sunnybrook Health Science Centre (CA)
  • St. Michael's Hospital (CA)
  • Centre Hospitalier Universitaire d'Angers (FR)
  • Département de Réanimation Médicale et Unité Propre de Recherche et de l’Enseignement Supérieur 38-30, CHU de Rouen, Rouen, France
  • Délégation à la Recherche Clinique et à l’Innovation, CHU d’Angers, Angers, France; and
  • Department of Medicine and
  • McMaster University (CA)
Corresponding author
Ferguson, Niall D.
ORCID
Venue
American Journal of Respiratory and Critical Care Medicine
Publisher
Oxford University Press (OUP)
Published
2014-07-01
Volume
190
Issue
1
Pages
70-76
ISSN
  • 1073-449X (ISSN-L)
  • 1535-4970
DOI
10.1164/rccm.201404-0688oc
OpenAlex
W2082012484
Cited by
194
References
29
Citations by year
2026: 5 · 2025: 7 · 2024: 11 · 2023: 11 · 2022: 16 · 2021: 21 · 2020: 23 · 2019: 17 · 2018: 18 · 2017: 32 · 2016: 17 · 2015: 12 · 2014: 3 · 2013: 1
FWCI
17.08
Type
journal article
Language
en
Open access
closed
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • American Journal of Respiratory and Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords
acute respiratory distress syndrome, positive end-expiratory pressure, oxygenation response, mortality prediction, lung recruitability, PaO2/FiO2 ratio, mechanical ventilation, lung compliance, dead space
MeSH terms
Female, Humans, Male, Middle Aged, Oxygen Consumption, Positive-Pressure Respiration, Prognosis, Respiratory Distress Syndrome, Severity of Illness Index, Tidal Volume, Logistic Models, Randomized Controlled Trials as Topic, Treatment Outcome, Ventilator-Induced Lung Injury

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