Ventilation with low tidal volume is recommended for patients with acute lung injury. Current guidelines suggest limiting plateau pressure (Pplat) to < 30 cm H2O for septic patients needing mechanical ventilation. The aim of this study was to determine whether Pplat within the first 24 h of ICU admission is predictive of outcome and whether Pplat < 30 cm H2O is associated with lower mortality rates.
METHODS:
This study was a retrospective analysis of prospectively acquired clinical data from an ICU of a tertiary referral hospital in central Taiwan. Subjects were included if they were admitted due to sepsis and respiratory failure requiring mechanical ventilation from April 2008 to November 2009.
RESULTS:
There were 220 subjects (188 males, 32 females) with a median age of 76 y and a mean Acute Physiology and Chronic Health Evaluation II score of 25.0 ± 6.5. Pneumonia was the major cause of sepsis (85.5%). The hospital mortality rate was 39.1%. Pplat was higher throughout the first 24 h of ICU admission in nonsurvivors. Higher Pplat was associated with higher mortality rates regardless of acute lung injury. In multivariate regression analysis, Pplat > 25 cm H2O at 24 h after admission was an independent risk factor for mortality (adjusted odds ratio of 2.33, 95% CI 1.10–4.91, P = .03 for hospital mortality).
CONCLUSIONS:
Pplat within the first 24 h of ICU admission is predictive of outcome, with lower Pplat associated with lower mortality rates. There is no safety margin for Pplat. Limiting Pplat should be considered even at < 30 cm H2O in septic patients with acute respiratory failure.
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