PT  - JOURNAL ARTICLE
AU  - Ignacio Martin-Loeches
AU  - Candelaria de Haro
AU  - R. Phillip Dellinger
AU  - Ricard Ferrer
AU  - Gary S. Phillips
AU  - Mitchell M. Levy
AU  - Antonio Artigas
TI  - Effectiveness of an inspiratory pressure-limited approach to mechanical ventilation in septic patients
AID  - 10.1183/09031936.00221611
DP  - 2013 Jan 01
TA  - European Respiratory Journal
PG  - 157--164
VI  - 41
IP  - 1
4099  - http://erj.ersjournals.com/content/41/1/157.short
4100  - http://erj.ersjournals.com/content/41/1/157.full
SO  - Eur Respir J2013 Jan 01; 41
AB  - Severe sepsis is one of the most common causes of acute lung injury (ALI) and is associated with high mortality. The aim of the study was to see whether a protective strategy based approach with a plateau pressure <30 cmH2O was associated with lower mortality in septic patients with ALI in the Surviving Sepsis Campaign international database. A retrospective analysis of an international multicentric database of 15,022 septic patients from 165 intensive care units was used. Septic patients with ALI and mechanical ventilation (n=1,738) had more accompanying organ dysfunction and a higher mortality rate (48.3% versus 33.0%, p<0.001) than septic patients without ALI (n=13,284). In patients with ALI and mechanical ventilation, the use of inspiratory plateau pressures maintained at <30 cmH2O was associated with lower mortality by Chi-squared test (46.4% versus 55.1%, p<0.001) and by Kaplan–Meier and log-rank test (p<0.001). In a multivariable random-effects Cox regression, plateau pressure <30 cmH2O was significantly associated with lower mortality (hazard ratio 0.84, 95% CI 0.72–0.99; p=0.038). ALI in sepsis was associated with higher mortality, especially when an inspiratory pressure-limited mechanical ventilation approach was not implemented.