Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece
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 m...
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| Veröffentlicht in: | The New England journal of medicine 2022-11, Vol.387 (20), p.1843-1854 |
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| creator | Thille, Arnaud Gacouin, Arnaud Coudroy, Rémi Ehrmann, Stephan Quenot, Jean-Pierre Nay, Mai-Anh Guitton, Christophe Contou, Damien Labro, Guylaine Reignier, Jean Pradel, Gael Beduneau, Gaëtan Dangers, Laurence Saccheri, Clement Prat, Gwénaël Lacave, Guillaume Sedillot, Nicholas Terzi, Nicolas La Combe, Béatrice Mira, Jean-Paul Romen, Antoine Azais, Marie-Ange Rouzé, Anahita Devaquet, Jérôme Delbove, Agathe Dres, Martin Bourenne, Jeremy Lautrette, Alexandre de Keizer, Joe Ragot, Stéphanie Frat, Jean-Pierre |
| description | 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 |
| doi_str_mv | 10.1056/NEJMoa2209041 |
| format | Article |
| fullrecord | <record><control><sourceid>hal</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_03984748v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>oai_HAL_hal_03984748v1</sourcerecordid><originalsourceid>FETCH-hal_primary_oai_HAL_hal_03984748v13</originalsourceid><addsrcrecordid>eNqVi82KwjAYRYOMYP1Zus_WRfRLk9Z26QyK-IdgcVs-JNpITUqSzjBvPwq-wNzNgcO5hIw5TDkk6eyw3OwtxjHkIHmHRDwRgkkJ6QeJAOKMyXkueqTv_R2e4zKPyPbUWBPQKNt69ukUhkqbGy2cxtrTHx0qenTK-9YpdmqbxrpAz8oEXWPQ1lDrKNKCHbW6qCHpXp8vNXpzQCarZfG1ZhXWZeP0A91vaVGX68WufDkQeSbnMvvm4j_tH7lSR2g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece</title><source>EZB-FREE-00999 freely available EZB journals</source><source>ProQuest Central UK/Ireland</source><source>New England Journal of Medicine</source><creator>Thille, Arnaud ; Gacouin, Arnaud ; Coudroy, Rémi ; Ehrmann, Stephan ; Quenot, Jean-Pierre ; Nay, Mai-Anh ; Guitton, Christophe ; Contou, Damien ; Labro, Guylaine ; Reignier, Jean ; Pradel, Gael ; Beduneau, Gaëtan ; Dangers, Laurence ; Saccheri, Clement ; Prat, Gwénaël ; Lacave, Guillaume ; Sedillot, Nicholas ; Terzi, Nicolas ; La Combe, Béatrice ; Mira, Jean-Paul ; Romen, Antoine ; Azais, Marie-Ange ; Rouzé, Anahita ; Devaquet, Jérôme ; Delbove, Agathe ; Dres, Martin ; Bourenne, Jeremy ; Lautrette, Alexandre ; de Keizer, Joe ; Ragot, Stéphanie ; Frat, Jean-Pierre</creator><creatorcontrib>Thille, Arnaud ; Gacouin, Arnaud ; Coudroy, Rémi ; Ehrmann, Stephan ; Quenot, Jean-Pierre ; Nay, Mai-Anh ; Guitton, Christophe ; Contou, Damien ; Labro, Guylaine ; Reignier, Jean ; Pradel, Gael ; Beduneau, Gaëtan ; Dangers, Laurence ; Saccheri, Clement ; Prat, Gwénaël ; Lacave, Guillaume ; Sedillot, Nicholas ; Terzi, Nicolas ; La Combe, Béatrice ; Mira, Jean-Paul ; Romen, Antoine ; Azais, Marie-Ange ; Rouzé, Anahita ; Devaquet, Jérôme ; Delbove, Agathe ; Dres, Martin ; Bourenne, Jeremy ; Lautrette, Alexandre ; de Keizer, Joe ; Ragot, Stéphanie ; Frat, Jean-Pierre</creatorcontrib><description>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 2 O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH 2 O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60–1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16–2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06–1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52–0.93], p = 0.015) were related to survival. 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</description><identifier>ISSN: 0028-4793</identifier><identifier>EISSN: 1533-4406</identifier><identifier>DOI: 10.1056/NEJMoa2209041</identifier><language>eng</language><publisher>Massachusetts Medical Society</publisher><subject>Life Sciences</subject><ispartof>The New England journal of medicine, 2022-11, Vol.387 (20), p.1843-1854</ispartof><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0002-7798-6715 ; 0000-0003-4336-507X ; 0000-0003-4036-6245 ; 0000-0003-4545-7461 ; 0000-0001-6221-4467 ; 0000-0003-2351-682X ; 0000-0003-4336-507X ; 0000-0003-4545-7461 ; 0000-0002-7798-6715 ; 0000-0003-4036-6245 ; 0000-0001-6221-4467 ; 0000-0003-2351-682X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://hal.science/hal-03984748$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Thille, Arnaud</creatorcontrib><creatorcontrib>Gacouin, Arnaud</creatorcontrib><creatorcontrib>Coudroy, Rémi</creatorcontrib><creatorcontrib>Ehrmann, Stephan</creatorcontrib><creatorcontrib>Quenot, Jean-Pierre</creatorcontrib><creatorcontrib>Nay, Mai-Anh</creatorcontrib><creatorcontrib>Guitton, Christophe</creatorcontrib><creatorcontrib>Contou, Damien</creatorcontrib><creatorcontrib>Labro, Guylaine</creatorcontrib><creatorcontrib>Reignier, Jean</creatorcontrib><creatorcontrib>Pradel, Gael</creatorcontrib><creatorcontrib>Beduneau, Gaëtan</creatorcontrib><creatorcontrib>Dangers, Laurence</creatorcontrib><creatorcontrib>Saccheri, Clement</creatorcontrib><creatorcontrib>Prat, Gwénaël</creatorcontrib><creatorcontrib>Lacave, Guillaume</creatorcontrib><creatorcontrib>Sedillot, Nicholas</creatorcontrib><creatorcontrib>Terzi, Nicolas</creatorcontrib><creatorcontrib>La Combe, Béatrice</creatorcontrib><creatorcontrib>Mira, Jean-Paul</creatorcontrib><creatorcontrib>Romen, Antoine</creatorcontrib><creatorcontrib>Azais, Marie-Ange</creatorcontrib><creatorcontrib>Rouzé, Anahita</creatorcontrib><creatorcontrib>Devaquet, Jérôme</creatorcontrib><creatorcontrib>Delbove, Agathe</creatorcontrib><creatorcontrib>Dres, Martin</creatorcontrib><creatorcontrib>Bourenne, Jeremy</creatorcontrib><creatorcontrib>Lautrette, Alexandre</creatorcontrib><creatorcontrib>de Keizer, Joe</creatorcontrib><creatorcontrib>Ragot, Stéphanie</creatorcontrib><creatorcontrib>Frat, Jean-Pierre</creatorcontrib><title>Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece</title><title>The New England journal of medicine</title><description>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 2 O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH 2 O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60–1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16–2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06–1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52–0.93], p = 0.015) were related to survival. 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</description><subject>Life Sciences</subject><issn>0028-4793</issn><issn>1533-4406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNqVi82KwjAYRYOMYP1Zus_WRfRLk9Z26QyK-IdgcVs-JNpITUqSzjBvPwq-wNzNgcO5hIw5TDkk6eyw3OwtxjHkIHmHRDwRgkkJ6QeJAOKMyXkueqTv_R2e4zKPyPbUWBPQKNt69ukUhkqbGy2cxtrTHx0qenTK-9YpdmqbxrpAz8oEXWPQ1lDrKNKCHbW6qCHpXp8vNXpzQCarZfG1ZhXWZeP0A91vaVGX68WufDkQeSbnMvvm4j_tH7lSR2g</recordid><startdate>20221117</startdate><enddate>20221117</enddate><creator>Thille, Arnaud</creator><creator>Gacouin, Arnaud</creator><creator>Coudroy, Rémi</creator><creator>Ehrmann, Stephan</creator><creator>Quenot, Jean-Pierre</creator><creator>Nay, Mai-Anh</creator><creator>Guitton, Christophe</creator><creator>Contou, Damien</creator><creator>Labro, Guylaine</creator><creator>Reignier, Jean</creator><creator>Pradel, Gael</creator><creator>Beduneau, Gaëtan</creator><creator>Dangers, Laurence</creator><creator>Saccheri, Clement</creator><creator>Prat, Gwénaël</creator><creator>Lacave, Guillaume</creator><creator>Sedillot, Nicholas</creator><creator>Terzi, Nicolas</creator><creator>La Combe, Béatrice</creator><creator>Mira, Jean-Paul</creator><creator>Romen, Antoine</creator><creator>Azais, Marie-Ange</creator><creator>Rouzé, Anahita</creator><creator>Devaquet, Jérôme</creator><creator>Delbove, Agathe</creator><creator>Dres, Martin</creator><creator>Bourenne, Jeremy</creator><creator>Lautrette, Alexandre</creator><creator>de Keizer, Joe</creator><creator>Ragot, Stéphanie</creator><creator>Frat, Jean-Pierre</creator><general>Massachusetts Medical Society</general><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-7798-6715</orcidid><orcidid>https://orcid.org/0000-0003-4336-507X</orcidid><orcidid>https://orcid.org/0000-0003-4036-6245</orcidid><orcidid>https://orcid.org/0000-0003-4545-7461</orcidid><orcidid>https://orcid.org/0000-0001-6221-4467</orcidid><orcidid>https://orcid.org/0000-0003-2351-682X</orcidid><orcidid>https://orcid.org/0000-0003-4336-507X</orcidid><orcidid>https://orcid.org/0000-0003-4545-7461</orcidid><orcidid>https://orcid.org/0000-0002-7798-6715</orcidid><orcidid>https://orcid.org/0000-0003-4036-6245</orcidid><orcidid>https://orcid.org/0000-0001-6221-4467</orcidid><orcidid>https://orcid.org/0000-0003-2351-682X</orcidid></search><sort><creationdate>20221117</creationdate><title>Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece</title><author>Thille, Arnaud ; Gacouin, Arnaud ; Coudroy, Rémi ; Ehrmann, Stephan ; Quenot, Jean-Pierre ; Nay, Mai-Anh ; Guitton, Christophe ; Contou, Damien ; Labro, Guylaine ; Reignier, Jean ; Pradel, Gael ; Beduneau, Gaëtan ; Dangers, Laurence ; Saccheri, Clement ; Prat, Gwénaël ; Lacave, Guillaume ; Sedillot, Nicholas ; Terzi, Nicolas ; La Combe, Béatrice ; Mira, Jean-Paul ; Romen, Antoine ; Azais, Marie-Ange ; Rouzé, Anahita ; Devaquet, Jérôme ; Delbove, Agathe ; Dres, Martin ; Bourenne, Jeremy ; Lautrette, Alexandre ; de Keizer, Joe ; Ragot, Stéphanie ; Frat, Jean-Pierre</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-hal_primary_oai_HAL_hal_03984748v13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Life Sciences</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thille, Arnaud</creatorcontrib><creatorcontrib>Gacouin, Arnaud</creatorcontrib><creatorcontrib>Coudroy, Rémi</creatorcontrib><creatorcontrib>Ehrmann, Stephan</creatorcontrib><creatorcontrib>Quenot, Jean-Pierre</creatorcontrib><creatorcontrib>Nay, Mai-Anh</creatorcontrib><creatorcontrib>Guitton, Christophe</creatorcontrib><creatorcontrib>Contou, Damien</creatorcontrib><creatorcontrib>Labro, Guylaine</creatorcontrib><creatorcontrib>Reignier, Jean</creatorcontrib><creatorcontrib>Pradel, Gael</creatorcontrib><creatorcontrib>Beduneau, Gaëtan</creatorcontrib><creatorcontrib>Dangers, Laurence</creatorcontrib><creatorcontrib>Saccheri, Clement</creatorcontrib><creatorcontrib>Prat, Gwénaël</creatorcontrib><creatorcontrib>Lacave, Guillaume</creatorcontrib><creatorcontrib>Sedillot, Nicholas</creatorcontrib><creatorcontrib>Terzi, Nicolas</creatorcontrib><creatorcontrib>La Combe, Béatrice</creatorcontrib><creatorcontrib>Mira, Jean-Paul</creatorcontrib><creatorcontrib>Romen, Antoine</creatorcontrib><creatorcontrib>Azais, Marie-Ange</creatorcontrib><creatorcontrib>Rouzé, Anahita</creatorcontrib><creatorcontrib>Devaquet, Jérôme</creatorcontrib><creatorcontrib>Delbove, Agathe</creatorcontrib><creatorcontrib>Dres, Martin</creatorcontrib><creatorcontrib>Bourenne, Jeremy</creatorcontrib><creatorcontrib>Lautrette, Alexandre</creatorcontrib><creatorcontrib>de Keizer, Joe</creatorcontrib><creatorcontrib>Ragot, Stéphanie</creatorcontrib><creatorcontrib>Frat, Jean-Pierre</creatorcontrib><collection>Hyper Article en Ligne (HAL)</collection><jtitle>The New England journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thille, Arnaud</au><au>Gacouin, Arnaud</au><au>Coudroy, Rémi</au><au>Ehrmann, Stephan</au><au>Quenot, Jean-Pierre</au><au>Nay, Mai-Anh</au><au>Guitton, Christophe</au><au>Contou, Damien</au><au>Labro, Guylaine</au><au>Reignier, Jean</au><au>Pradel, Gael</au><au>Beduneau, Gaëtan</au><au>Dangers, Laurence</au><au>Saccheri, Clement</au><au>Prat, Gwénaël</au><au>Lacave, Guillaume</au><au>Sedillot, Nicholas</au><au>Terzi, Nicolas</au><au>La Combe, Béatrice</au><au>Mira, Jean-Paul</au><au>Romen, Antoine</au><au>Azais, Marie-Ange</au><au>Rouzé, Anahita</au><au>Devaquet, Jérôme</au><au>Delbove, Agathe</au><au>Dres, Martin</au><au>Bourenne, Jeremy</au><au>Lautrette, Alexandre</au><au>de Keizer, Joe</au><au>Ragot, Stéphanie</au><au>Frat, Jean-Pierre</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece</atitle><jtitle>The New England journal of medicine</jtitle><date>2022-11-17</date><risdate>2022</risdate><volume>387</volume><issue>20</issue><spage>1843</spage><epage>1854</epage><pages>1843-1854</pages><issn>0028-4793</issn><eissn>1533-4406</eissn><abstract>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 2 O, p < 0.001), plateau (20 [15–23] vs 22 [19–26] cmH 2 O, p < 0.001) and peak (21 [17–27] vs 26 [20–32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60–1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16–2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06–1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52–0.93], p = 0.015) were related to survival. 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</abstract><pub>Massachusetts Medical Society</pub><doi>10.1056/NEJMoa2209041</doi><orcidid>https://orcid.org/0000-0002-7798-6715</orcidid><orcidid>https://orcid.org/0000-0003-4336-507X</orcidid><orcidid>https://orcid.org/0000-0003-4036-6245</orcidid><orcidid>https://orcid.org/0000-0003-4545-7461</orcidid><orcidid>https://orcid.org/0000-0001-6221-4467</orcidid><orcidid>https://orcid.org/0000-0003-2351-682X</orcidid><orcidid>https://orcid.org/0000-0003-4336-507X</orcidid><orcidid>https://orcid.org/0000-0003-4545-7461</orcidid><orcidid>https://orcid.org/0000-0002-7798-6715</orcidid><orcidid>https://orcid.org/0000-0003-4036-6245</orcidid><orcidid>https://orcid.org/0000-0001-6221-4467</orcidid><orcidid>https://orcid.org/0000-0003-2351-682X</orcidid></addata></record> |
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| subjects | Life Sciences |
| title | Spontaneous-Breathing Trials with Pressure-Support Ventilation or a T-Piece |
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