Potentially modifiable ventilatory factors contributing to outcome in patients with pulmonary and extrapulmonary ARDS — An individual patient data analysis
Year: 2026
Type: article
Abstract: BACKGROUND: Previous studies have identified potentially modifiable factors associated with mortality from acute respiratory stress syndrome (ARDS), however these studies did not differentiate between underlying causes of ARDS. As the etiology of ARDS may influence patient outcomes, we aimed to identify potentially modifiable factors associated with 60-day mortality from pulmonary and extrapulmonary ARDS. METHODS: Secondary pooled analysis of six observational studies studies on mechanical ventilation in patients with pulmonary and extrapulmonary ARDS. The primary endpoint was mortality at day 60 after inclusion. Exploratory outcomes included length of stay in hospital and ICU, duration of ventilation and ventilator-free days at day 28. RESULTS: Out of 7934 patients with pulmonary or extrapulmonary ARDS, 3402 (43%) did not survive. Potentially modifiable factors associated with 60-day mortality included high driving pressure (ΔP) and high respiratory rate (RR). There was an interaction between etiology of ARDS and ΔP on 60-day mortality, with ΔP showing a stronger association in pulmonary ARDS compared with extrapulmonary ARDS (p < 0.001). In a sensitivity analysis excluding COVID-19 patients, RR was no longer associated with 60-day mortality, whereas ΔP remained associated. Tidal volume was not associated with 60-day mortality in either pulmonary or extrapulmonary ARDS. No interaction was found between ARDS etiology and RR or tidal volume on 60-day mortality. CONCLUSION: High ΔP and high RR were associated with 60-day mortality in patients with pulmonary and extrapulmonary ARDS receiving mechanical ventilation, with ΔP showing a stronger association in pulmonary ARDS compared with extrapulmonary ARDS. REGISTRATION: The pooled database was registered at ClinicalTrials.gov (identifier NCT05650957).
Source: Journal of Clinical Anesthesia
Authors: Galina Dorland, Siebe G. Blok, Pien Swart, Fleur-Stefanie L.I.M. van der Ven, M.W. Hollmann, Luciano C. Azevedo, Giacomo Bellani, Michela Botta, Elisa Estenssoro, Eddy Fan, Juliana Carvalho Ferreira, John G. Laffey, Ignacio Martin-Loeches, Ana Motos, Tai Pham, Oscar Peñuelas, Antonio Pesenti, Luigi Pisani, Ary Serpa Neto, Marcus J. Schultz, Antoni Torres, Anissa M. Tsonas, Frederique Paulus, Sabrine N.T. Hemmes, David M.P. van Meenen
Institutions: Amsterdam University Medical Centers, Rode Kruis Ziekenhuis, Hospital Israelita Albert Einstein, University of Trento, Ospedale Santa Chiara, University of Toronto, Universidade de São Paulo, AC Camargo Hospital, Brazilian Research in Intensive Care Network, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ollscoil na Gaillimhe – University of Galway, University Hospital Galway, Hospital Clínic de Barcelona, St. James's Hospital, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Centro de Investigación Biomédica en Red, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Universitat de Barcelona, Université Paris-Saclay, Bicêtre Hospital, Hospital Universitario de Getafe, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mahidol University, Mahidol Oxford Tropical Medicine Research Unit, The University of Melbourne, Austin Hospital, Austin Health, Monash University, University of Oxford, Medical University of Vienna, Institució Catalana de Recerca i Estudis Avançats, Amsterdam University of Applied Sciences, The Netherlands Cancer Institute
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,090
OpenAlex ID: W7129565815