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The following is a summary of “Association Between Baseline Driving Pressure and Mortality in Very Old Patients with Acute Respiratory Distress Syndrome,” published in the October 2024 issue of Pulmonology by Papoutsi et al. 

Aging affects the respiratory system, suggesting that the relationship between driving pressure and mortality may vary with age.  

Researchers conducted a retrospective study to evaluate the association between driving pressure and mortality in patients with acute respiratory distress syndrome (ARDS) varied across the adult lifespan, with a stronger effect in older adults (OAs), including those aged 80 years and above.  

They used individual patient-level data from 7 ARDS Network and PETAL Network randomized controlled trials (the “ARDSNet cohort”) and tested the hypothesis in an independent national cohort (the “Hellenic cohort”). The binary logistic and cox regression analyses were performed, incorporating the interaction term between age (as a continuous variable) and baseline driving pressure (measured on the day of trial enrollment) as the predictor, with 90-day mortality as the dependent variable.  

The results showed that data from 4,567 patients with ARDS in the ARDSNet indicated that the impact of driving pressure on mortality varied with age (P = 0.01 for the interaction between age as a continuous variable and driving pressure). The difference in driving pressure between survivors and nonsurvivors was significantly different across the adult lifespan (P < 0.01). In the ARDSNet and Hellenic, a driving pressure threshold of 11 cm H₂O was linked to higher mortality.  

Investigators concluded the impact of driving pressure on mortality in patients with ARDS may vary based on age, suggesting a need for personalized mechanical ventilation strategies. 

Source: atsjournals.org/doi/10.1164/rccm.202401-0049OC