Association of respiratory drive and effort with mortality and time to discharge in patients on mechanical ventilation in Canada: a longitudinal, prospective, registry-based cohort study
Abstract
BACKGROUND
Physiological data suggest that insufficient and excessive respiratory drive and effort during mechanical ventilation might injure the lung and diaphragm, but their clinical relevance is unknown.
METHODS
In this prospective, registry-based cohort study from the Toronto Intensive Care Observational Registry, we included all adults on mechanical ventilation admitted to the medical-surgical intensive care unit (ICU) at Toronto General Hospital from June 25, 2019, to April 1, 2022. There were no exclusion criteria. We obtained daily measurements of drive (airway occlusion pressure, P0·1), effort (expiratory occlusion pressure, Pocc), lung stress during spontaneous breathing (dynamic transpulmonary driving pressure, ΔPL,dyn), and ventilator-delivered dynamic driving pressure (ΔPaw,dyn) for the first 10 days of mechanical ventilation. Daily hazards of death in ICU or discharge alive from ICU were quantified using Cox proportional hazards models adjusted for changing severity of illness over time.
FINDINGS
We included 1186 patients. 298 (25%) patients died during follow-up. P0·1 and Pocc showed a non-linear association with the hazards of death and discharge alive (p≤0·024). In patients with a ratio of arterial partial pressure of oxygen to inspired fraction of oxygen (PaO2:FiO2) of 150 mm Hg or less, both low and high levels of P0·1 and Pocc were associated with lower rate of ICU discharge; when PaO2:FiO2 was greater than 150 mm Hg, higher P0·1 and Pocc were associated…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,186 participants or records.
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