Respiratory medicine · 2025
Effects of different positive end-expiratory pressure strategies on treating overweight patients with acute respiratory distress syndrome: A retrospective study based on large intensive care unit databases.
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Zheng Xu, Zhang Tianyao, Zhan Tiexiang, Luo Liang, Xie Canmao, Jin Biao, Fu Le
Аннотация
PURPOSE: Positive end-expiratory pressure (PEEP) refers to a vital respiratory therapeutic tool for treating ARDS. Since overweight individuals face a greater risk of pulmonary complications than others, this study aims to assess whether different PEEP strategies result in differential therapeutic outcomes for ARDS patients with varying body mass index (BMI) categories.
MATERIALS AND METHODS: This study involved a retrospective analysis of adult patients diagnosed with ARDS according to the Berlin definition, sourced from the Medical Information Marketplace for Intensive Care IV database. Patients were divided into higher and lower PEEP groups. After univariate variable selection, prognostic metrics like mortality were compared between the two groups via multivariate logistic and linear regression analyses. Subsequently, patients were classified into underweight, normal, and overweight groups by BMI. The overweight group was further divided into four sub-groups by obesity degree, followed by an in-depth subgroup analysis of relevant variables.
RESULTS: A total of 3240 patients met the inclusion criteria. BMI was significantly correlated to mortality risk (P < 0.01). However, no significant differences in mortality rates or lengths of stay in ICU and hospital were observed between the higher and lower PEEP groups (P > 0.05). Notably, among patients with a BMI ≥25, those receiving a higher PEEP strategy experienced a significantly prolonged duration of mechanical ventilation (P = 0.02).
CONCLUSIONS: Higher PEEP setting strategy in ARDS patients failed to show incremental clinical benefits. Conversely, they were associated with prolonged duration of mechanical ventilation in overweight individuals.
MATERIALS AND METHODS: This study involved a retrospective analysis of adult patients diagnosed with ARDS according to the Berlin definition, sourced from the Medical Information Marketplace for Intensive Care IV database. Patients were divided into higher and lower PEEP groups. After univariate variable selection, prognostic metrics like mortality were compared between the two groups via multivariate logistic and linear regression analyses. Subsequently, patients were classified into underweight, normal, and overweight groups by BMI. The overweight group was further divided into four sub-groups by obesity degree, followed by an in-depth subgroup analysis of relevant variables.
RESULTS: A total of 3240 patients met the inclusion criteria. BMI was significantly correlated to mortality risk (P < 0.01). However, no significant differences in mortality rates or lengths of stay in ICU and hospital were observed between the higher and lower PEEP groups (P > 0.05). Notably, among patients with a BMI ≥25, those receiving a higher PEEP strategy experienced a significantly prolonged duration of mechanical ventilation (P = 0.02).
CONCLUSIONS: Higher PEEP setting strategy in ARDS patients failed to show incremental clinical benefits. Conversely, they were associated with prolonged duration of mechanical ventilation in overweight individuals.