• Yasser Sakr, Thais Midega, Julia Antoniazzi, Jordi Solé-Violán, Philippe R Bauer, Marlies Ostermann, Tommaso Pellis, Tamas Szakmany, Kai Zacharowski, Silvio A Ñamendys-Silva, Tài Pham, Ricard Ferrer, Fabio S Taccone, Frank van Haren, Laurent Brochard, and IC-GLOSSARI investigators and the ESICM Trials group.
• Department of Anaesthesiology and Intensive Care, Uniklinikum Jena, Jena, Germany. Electronic address: yasser.sakr@med.uni-jena.de.
• J Crit Care. 2021 Dec 1; 66: 78-85.

PurposeTo investigate the possible association between ventilatory settings on the first day of invasive mechanical ventilation (IMV) and mortality in patients admitted to the intensive care unit (ICU) with severe acute respiratory infection (SARI).Materials And MethodsIn this pre-planned sub-study of a prospective, multicentre observational study, 441 patients with SARI who received controlled IMV during the ICU stay were included in the analysis.ResultsICU and hospital mortality rates were 23.1 and 28.1%, respectively. In multivariable analysis, tidal volume and respiratory rate on the first day of IMV were not associated with an increased risk of death; however, higher driving pressure (DP: odds ratio (OR) 1.05; 95% confidence interval (CI): 1.01-1.1, p = 0.011), plateau pressure (Pplat) (OR 1.08; 95% CI: 1.04-1.13, p < 0.001) and positive end-expiratory pressure (PEEP) (OR 1.13; 95% CI: 1.03-1.24, p = 0.006) were independently associated with in-hospital mortality. In subgroup analysis, in hypoxemic patients and in patients with acute respiratory distress syndrome (ARDS), higher DP, Pplat, and PEEP were associated with increased risk of in-hospital death.ConclusionsIn patients with SARI receiving IMV, higher DP, Pplat and PEEP, and not tidal volume, were associated with a higher risk of in-hospital death, especially in those with hypoxemia or ARDS.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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