First tidal volume greater than 8 mL/kg is associated with increased mortality in complicated influenza infection with acute respiratory distress syndrome
Journal
Journal of the Formosan Medical Association
Journal Volume
118
Journal Issue
1P2
Pages
378-385
Date Issued
2019
Author(s)
Chan M.-C.
Chao W.-C.
Liang S.-J.
Tseng C.-H.
Yang K.-Y.
Chen W.-C.
Perng W.-C.
Kao K.-C.
Hu H.-C.
Sheu C.-C.
Chang W.-A.
Fang W.-F.
Chen Y.-M.
Slutsky A.S.
Wu C.-L.
for Taiwan Severe Influenza Research Consortium (TSIRC) Investigators
Abstract
Backgrounds: Severe influenza infection causes substantial morbidity and mortality worldwide and remains an important threat to global health. This study addressed factors related to treatment outcomes in subjects of complicated influenza infection with acute respiratory distress syndrome (ARDS) during the Taiwan epidemic in the Spring of 2016. Methods: This is a retrospective study conducted by Taiwan Severe Influenza Research Consortium (TSIRC), including eight tertiary referral medical centers. Patients with virology-proven influenza infection admitted to intensive care unit (ICU) between January and March 2016 were included for analysis. Results: We identified 263 patients with complicated influenza infection who fulfilled ARDS criteria; the mean age was 59.8 ± 14.6 (years), and 66.1% (166/263) were male. Type A influenza (77.9%, 205/263) virus was the main pathogen during this epidemic. The 30-day mortality rate was 23.2% (61/263). The mean tidal volume (V T ) in the first three days after intubation was greater than 8 mL/kg of predicted body weight (PBW). Patients whose first measured V T was >8 mL/kg PBW had an increased 30-day mortality (p = 0.04, log-rank test). In a multivariate Cox proportional hazard regression model, an increase of 1 mL/kg PBW of first V T was associated with 26.1% increase in 30-day mortality (adjusted hazard ratio 1.261, 95% confidence interval [CI] 1.072–1.484, p < 0.01). Conclusion: First tidal volume, shortly after intubation, greater than 8 mL/kg PBW is an independent risk factor for mortality in complicated influenza infection with ARDS. Timely recognition of ARDS with strict adherence to protective ventilation strategy of lowering V T may be important in reducing mortality. ? 2018
SDGs
Other Subjects
adult; adult respiratory distress syndrome; Article; artificial ventilation; body weight; clinical feature; epidemic; female; human; infectious agent; influenza; intensive care unit; intubation; major clinical study; male; mortality rate; multicenter study; non insulin dependent diabetes mellitus; patient referral; retrospective study; risk factor; Taiwan; tidal volume; adult respiratory distress syndrome; aged; clinical trial; complication; epidemiology; influenza; Kaplan Meier method; lung; middle aged; mortality; multivariate analysis; pathophysiology; positive end expiratory pressure; proportional hazards model; severity of illness index; statistics and numerical data; tidal volume; time factor; Aged; Female; Humans; Influenza, Human; Intensive Care Units; Kaplan-Meier Estimate; Lung; Male; Middle Aged; Multivariate Analysis; Positive-Pressure Respiration; Proportional Hazards Models; Respiratory Distress Syndrome, Adult; Retrospective Studies; Risk Factors; Severity of Illness Index; Taiwan; Tidal Volume; Time Factors
Publisher
Elsevier B.V.
Type
journal article