Mechanical Ventilation in Patients With Cardiogenic Pulmonary Edema: A Sub-Analysis of the Lung Safe Study

Authors

Laura Amado-Rodríguez
Raquel Rodríguez-Garcia
Giacomo Bellani
Tài Pham
Eddy Fan
Fabiana Madotto
John G Laffey
Guillermo M Albaiceta
LUNG SAFE investigators

Publication Date

12-25-2022

Journal

Journal of Intensive Care

Abstract

BACKGROUND: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality.

METHODS: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model.

RESULTS: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH

CONCLUSIONS: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073.

Keywords

Mechanical ventilation, Cardiogenic pulmonary edema, Ventilator-induced lung injury, Driving pressure

Comments

Supplementary Materials

PMID: 36567347