Respiratory failure & ventilation
Temporal trends in respiratory parameters and their association with mortality in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: the importance of driving pressure
Authors' conclusion
Temporal trends of respiratory parameters were associated with mortality of mechanically ventilated patients with COVID-19-related ARDS. Among respiratory mechanics variables, driving pressure was the only parameter independently associated with mortality when modeled as a time-updated covariate.
Study context
- Population
- Mechanically ventilated intensive care unit (ICU) patients with COVID-19-related acute respiratory distress syndrome (ARDS)analysed
- Participants
- 585 participants
- Exposure
- Non-survivors vs survivors
- Outcome
- Association between temporal trends of respiratory parameters and ICU mortality
- Follow-up
- ICU admission (day 1) and days 3, 5, 10, 14, and 21
Methodological detailslinear mixed effects analysis, time-dependent Cox proportional hazards regression
- Linear mixed effects analysis
- Time-dependent Cox proportional hazards regression
Main finding
As reported in the abstract
Temporal trends of respiratory parameters, non-survivors vs survivors
- Higher and increased more over time
- regression coefficient (plateau pressure) 1.33; P = 0.005
- Higher and increased more over time
- regression coefficient (respiratory rate) 1.23; P = 0.01
- Higher and increased more over time
- regression coefficient (P(A-a)O2) 67.75; P < 0.001
- Higher and increased more over time
- regression coefficient (PaCO2) 4.88; P < 0.001
- Lower and decreased more over time
- regression coefficient (respiratory system compliance) −3.49; P = 0.002
- Lower and decreased more over time
- regression coefficient (PaO2/FiO2 ratio) −38.03; P < 0.001
- Higher across time
- regression coefficient (driving pressure) 1.09; P = 0.005
- All-cause ICU mortality
- 57%
Observational data: associations, not effects.
Further findings
Driving pressure (time-updated covariate) and ICU mortality
| HR (95% CI) | P value | ||
|---|---|---|---|
| Driving pressureIndependently associated | 1.04 (1.01–1.08) | P = 0.044 | |
| 0.512Hazard ratio (log scale) |
Original publication
Temporal trends in respiratory parameters and their association with mortality in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: the importance of driving pressure. Anaesth Crit Care Pain Med. Published 1 April 2026. doi:10.
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