Effects of inflammatory phenotypes in acute respiratory distress syndrome on mortality and partitioning of lung and chest wall mechanics in patients in the USA and Canada: a retrospective cohort study
3 hours ago
- #Mechanical Ventilation
- #ARDS
- #Inflammatory Phenotypes
- Inflammatory phenotypes in ARDS (hyperinflammatory vs. hypoinflammatory) impact 60-day mortality, with hyperinflammatory phenotype showing higher mortality (55% vs. 29%).
- Measures of lung-protective ventilation (driving pressure, transpulmonary driving pressure) have a more pronounced effect on reducing 60-day mortality in the hypoinflammatory phenotype compared to the hyperinflammatory phenotype.
- End-expiratory transpulmonary pressure within ±2 cm H2O is protective for the hypoinflammatory phenotype but not for the hyperinflammatory phenotype.
- Excess mortality in the hyperinflammatory phenotype is mediated by extrapulmonary organ failure (46% mediation), not respiratory failure.
- The study suggests that patients with hypoinflammatory ARDS could benefit more from lung-protective ventilation strategies and are a target for future clinical trials, but ventilation strategies should not differ based on phenotype.