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Updated: Aug 6, 2026
Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)
Published on: April 7, 2021
The relationship between PEEP variability and 28-day mortality in patients with ARDS: a retrospective study from
Shaona Liao1, Nie Anliu1, Shuzeng Zhang1
1First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China.
Purpose:
This study aimed to explore the relationship between PEEP variability and 28-day mortality in patients with Acute Respiratory Distress Syndrome (ARDS).
Methods:
A retrospective analysis was performed utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients with ARDS were categorized into survival and death groups based on 28-day mortality. Differences between these groups were assessed using chi-square tests, t-tests, and the Mann-Whitney U test. Binary logistic regression analysis was performed to identify factors influencing 28-day mortality in ARDS patients. The restricted cubic spline (RCS) was used to examine the dose-response relationship between PEEP variability and 28-day mortality, with subgroup analyses by ARDS severity and interaction tests for PEEP variability and ARDS severity.
Results:
Among 555 included patients, 348 were in the survival group and 207 in the death group. Binary logistic regression indicated PEEP variability was independently associated with 28-day mortality in ARDS patients. RCS analysis revealed a significant nonlinear correlation (χ2 = 8.71, df = 1, p = .003). Low PEEP variability predicted higher 28-day mortality, with the risk curve plateauing at 28.9%. Subgroup analyses revealed a significant nonlinear association in the mild ARDS subgroup (χ2=10.11, df=1, p=.002), with a comparable 28.9% threshold. The moderate-to-severe subgroup showed no significance (χ2=0.03, df=1, p=.854) but consistent trends and an identical inflection point. Interaction analysis confirmed no significant interaction between PEEP variability and ARDS severity (pfor interaction=.197).
Conclusions:
Lower PEEP variability was significantly associated with a higher 28-day mortality risk in ARDS patients, with a threshold at 28.9%. These findings highlight the potential prognostic value of PEEP variability, which may serve as a cost-effective indicator to facilitate individualized PEEP titration in mechanically ventilated ARDS patients. Further prospective studies are warranted to validate these findings.
