Prognostic Value of Plateau Pressure Below 30 cm H2O in Septic Subjects With Acute Respiratory Failure

BACKGROUND: Ventilation with low tidal volume is recommended for patients with acute lung injury. Current guidelines suggest limiting plateau pressure (P plat ) to 2 O for septic patients needing mechanical ventilation. The aim of this study was to determine whether P plat within the first 24 h of ICU admission is predictive of outcome and whether P plat 2 O is associated with lower mortality rates. METHODS: This study was a retrospective analysis of prospectively acquired clinical data from an ICU of a tertiary referral hospital in central Taiwan. Subjects were included if they were admitted due to sepsis and respiratory failure requiring mechanical ventilation from April 2008 to November 2009. RESULTS: There were 220 subjects (188 males, 32 females) with a median age of 76 y and a mean Acute Physiology and Chronic Health Evaluation II score of 25.0 ± 6.5. Pneumonia was the major cause of sepsis (85.5%). The hospital mortality rate was 39.1%. P plat was higher throughout the first 24 h of ICU admission in nonsurvivors. Higher P plat was associated with higher mortality rates regardless of acute lung injury. In multivariate regression analysis, P plat > 25 cm H 2 O at 24 h after admission was an independent risk factor for mortality (adjusted odds ratio of 2.33, 95% CI 1.10–4.91, P = .03 for hospital mortality). CONCLUSIONS: P plat within the first 24 h of ICU admission is predictive of outcome, with lower P plat associated with lower mortality rates. There is no safety margin for P plat . Limiting P plat should be considered even at 2 O in septic patients with acute respiratory failure.