The relationship between PEEP variability and 28-day mortality in patients with ARDS: a retrospective study from...

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Intensive Care Unit Research

Background:

• Acute Respiratory Distress Syndrome (ARDS) presents a significant challenge in intensive care, necessitating optimized mechanical ventilation strategies.
• Positive End-Expiratory Pressure (PEEP) is crucial for managing ARDS, but its optimal management, including variability, remains under investigation.
• Understanding factors influencing mortality in ARDS patients is vital for improving clinical outcomes.

Purpose of the Study:

• To investigate the association between Positive End-Expiratory Pressure (PEEP) variability and 28-day mortality in patients diagnosed with Acute Respiratory Distress Syndrome (ARDS).
• To identify potential prognostic markers for mortality risk in mechanically ventilated ARDS patients.
• To explore the dose-response relationship between PEEP variability and mortality outcomes.

Main Methods:

• Retrospective analysis of 555 ARDS patients from the MIMIC-IV database, categorized by 28-day survival status.
• Statistical analysis including chi-square tests, t-tests, Mann-Whitney U test, and binary logistic regression to identify mortality predictors.
• Restricted cubic spline (RCS) analysis to assess the nonlinear relationship between PEEP variability and 28-day mortality, with subgroup and interaction analyses based on ARDS severity.

Main Results:

• Lower PEEP variability was independently associated with higher 28-day mortality in ARDS patients (p = .003).
• A nonlinear correlation was observed, with risk plateauing at 28.9% PEEP variability, indicating a threshold effect.
• Significant association found in mild ARDS subgroup; trends consistent but not significant in moderate-to-severe ARDS subgroups. No significant interaction between PEEP variability and ARDS severity.

Conclusions:

• Reduced PEEP variability is a significant predictor of increased 28-day mortality risk in ARDS patients, with a critical threshold identified at 28.9%.
• PEEP variability demonstrates potential as a cost-effective prognostic indicator for guiding individualized PEEP titration in mechanical ventilation.
• Further prospective research is recommended to validate these findings and their clinical utility in managing ARDS.