A55-53 Early Driving Pressure Trajectories and the Risk of Prolonged Mechanical Ventilation in Covid-19-Related ARDS: A Multicenter Cohort Study
P -C Hsu, W -C Chen, H -t Chang, C -H Tseng, W -L Su, S -C Ku, K -C Kao, C -J Wang, C -H Wang, C -W Suk, C -K Peng, L -k Kuo, C -c Lin, W -L Liu, H -P Wu, M -H Chiu, M -C Chan, C -M Lin, C -S Lee, C Chang, H -C Chen, Y -T Chen, S -C Chang, C -M Chen, W -F Fang, K -Y YangAbstract
Rationale
Prolonged mechanical ventilation (PMV) remains a major challenge in patients with COVID-19-related acute respiratory distress syndrome (ARDS), yet the prognostic significance of early driving pressure (ΔP) trajectories is unknown. We investigated whether distinct early ΔP trajectory phenotypes are associated with the risk of PMV.
Methods
In this retrospective multicenter cohort study, adult patients with COVID-19-related ARDS requiring invasive mechanical ventilation were enrolled from 25 hospitals in Taiwan. PMV was defined as invasive mechanical ventilation for more than 21 days. Patients were classified into four ΔP trajectory phenotypes based on the mean ΔP during the first four days of ventilation (high vs. low) and its temporal trend (improving/stable vs. worsening). Multivariable logistic regression was performed adjusting for APACHE II score, baseline PaO₂/FiO₂ ratio, and mechanical power exceeding 18 J/min.
Results
A total of 469 patients were included, of whom 76.7% had moderate-to-severe ARDS. Median duration of mechanical ventilation and ICU stay were 19 and 23.1 days, respectively. Twenty-one-day mortality was 29%, and 41.6% of patients were successfully liberated from mechanical ventilation. ΔP trajectory phenotype was independently associated with PMV (overall p = 0.008). Compared with patients with persistently high and worsening ΔP, those with low mean ΔP and improving or stable trajectories had a significantly lower risk of PMV (adjusted odds ratio [OR] 0.35, 95% confidence interval [CI] 0.17-0.73). Patients with high mean ΔP but improving trajectories also had a reduced risk of PMV (adjusted OR 0.40, 95% CI 0.20-0.79). Mechanical power >18 J/min, APACHE II score, and baseline PaO₂/FiO₂ ratio were also independently associated with PMV.
Conclusion
Early driving pressure trajectories provide prognostic information beyond baseline severity of illness and oxygenation. Improvement in ΔP during the first four days of ventilation may mitigate the risk of prolonged mechanical ventilation, even among patients with an initially high ventilatory burden.
This abstract is funded by: None