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Risk Factors for ARDS in Patients Receiving Mechanical Ventilation for > 48 h^*

^* From the Massachusetts Institute of Technology (Mr. Jia), Cambridge; Harvard-MIT Division of Health Science and Technology (Drs. Saeed and Mark), Boston; Division of Pulmonary, Critical Care and Sleep Medicine (Dr. Malhotra), Brigham and Women’s Hospital, Harvard Medical School, Boston; and Department of Anesthesia, Critical Care and Pain Medicine (Dr. Talmor), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Correspondence to: Daniel Talmor, MD, MPH, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, CC-470, Boston MA 02215; e-mail: dtalmor{at}bidmc.harvard.edu

Abstract

Background: Low tidal volume (VT) ventilation for ARDS is a well-accepted concept. However, controversy persists regarding the optimal ventilator settings for patients without ARDS receiving mechanical ventilation. This study tested the hypothesis that ventilator settings influence the development of new ARDS.

Methods: Retrospective analysis of patients from the Multi Parameter Intelligent Monitoring of Intensive Care-II project database who received mechanical ventilation for 48 h between 2001 and 2005.

Results: A total of 2,583 patients required > 48 h of ventilation. Of 789 patients who did not have ARDS at hospital admission, ARDS developed in 152 patients (19%). Univariate analysis revealed high peak inspiratory pressure (odds ratio [OR], 1.53 per SD; 95% confidence interval [CI], 1.28 to 1.84), increasing positive end-expiratory pressure (OR, 1.35 per SD; 95% CI, 1.15 to 1.58), and VT (OR, 1.36 per SD; 95% CI, 1.12 to 1.64) to be significant risk factors. Major nonventilator risk factors for ARDS included sepsis, low pH, elevated lactate, low albumin, transfusion of packed RBCs, transfusion of plasma, high net fluid balance, and low respiratory compliance. Multivariable logistic regression showed that peak pressure (OR, 1.31 per SD; 95% CI, 1.08 to 1.59), high net fluid balance (OR, 1.3 per SD; 95% CI, 1.09 to 1.56), transfusion of plasma (OR, 1.26 per SD; 95% CI, 1.07 to 1.49), sepsis (OR, 1.57; 95% CI, 1.00 to 2.45), and VT (OR, 1.29 per SD; 95% CI, 1.02 to 1.52) were significantly associated with the development of ARDS.

Conclusions: The associations between the development of ARDS and clinical interventions, including high airway pressures, high VT, positive fluid balance, and transfusion of blood products, suggests that ARDS may be a preventable complication in some cases.

Key Words: ARDS • lung injury • plateau pressure • tidal volume • transfusion • ventilator