A study published in the Journal of Intensive Care highlights the impact of mechanical ventilation in patients with cardiogenic pulmonary edema (CPE) and reports that ventilatory variables could be used as a marker of CPE severity.
We hypothesized that patients with CPE are susceptible to VILI and their outcomes sensitive to ventilatory strategies. To test this hypothesis, patients with isolated CPE included in the LUNG SAFE study [
] were selected to study the relationships between mechanical ventilation and clinical outcomes in this population.LUNG SAFE was a multicenter , prospective cohort study that enrolled 4499 patients with hypoxemic respiratory failure []. Patients aged < 16 years or not willing to participate were excluded. Only patients with respiratory failure from isolated cardiac origin were included in this sub-study.
Patients were classified using a latent mixture analysis in two mutually exclusive and exhaustive classes using peak, plateau and driving pressures, positive end-expiratory pressure , tidal volume , respiratory system compliance, PaOand respiratory rate on day 1. Differences in ICU survival and hospital mortality between these two classes were analyzed using a competing events model, with ICU discharge and death as terminal events.
To identify factors related to ICU survival, inverse probability of treatment weights were calculated for driving pressure, so that each observation is weighted by the inverse of the probability of the exposure, given the observed value of other confounders [tidal volume, PaO
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