RATIONALE Due to effects of aging on the respiratory system, it is conceivable that the association between driving pressure and mortality depends on age. OBJECTIVE We endeavored to evaluate whether the association between driving pressure and mortality of patients with acute respiratory distress syndrome (ARDS) varies across the adult lifespan, hypothesizing that it is stronger in older, including very old (≥80 years), patients. METHODS We performed a secondary analysis of individual patient-level data from seven ARDS Network and PETAL Network randomized controlled trials ("ARDSNet cohort"). We tested our hypothesis in a second, independent, national cohort ("Hellenic cohort"). We performed both binary logistic and Cox regression analyses including the interaction term between age (as a continuous variable) and driving pressure at baseline (i.e., the day of trial enrollment) as the predictor, and 90-day mortality as the dependent variable. FINDINGS Based on data from 4567 patients with ARDS included in the ARDSNet cohort, we found that the effect of driving pressure on mortality depended on age (p=0.01 for the interaction between age as a continuous variable and driving pressure). The difference in driving pressure between survivors and non-survivors significantly changed across the adult lifespan (p<0.01). In both cohorts, a driving pressure threshold of 11 cmH2O was associated with mortality in very old patients. INTERPRETATION Data from randomized controlled trials with strict inclusion criteria suggest that the effect of driving pressure on mortality of patients with ARDS may depend on age. These results may advocate for a personalized age-dependent mechanical ventilation approach.

中文翻译：

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基线驾驶压力与非常老年 ARDS 患者死亡率之间的关联。


基本原理 由于衰老对呼吸系统的影响，可以想象驾驶压力与死亡率之间的关联取决于年龄。目的 我们努力评估急性呼吸窘迫综合征 （ARDS） 患者驾驶压力与死亡率之间的关联是否在成年后发生变化，假设它在老年患者中更强，包括非常老年 （≥80 岁） 的患者。方法 我们对来自 7 项 ARDS 网络和 PETAL 网络随机对照试验 （“ARDSNet 队列”） 的个体患者水平数据进行了二次分析。我们在第二个独立的全国队列（“希腊队列”）中检验了我们的假设。我们进行了二元 logistic 和 Cox 回归分析，包括年龄 （作为连续变量） 和基线 （即试验入组日期） 驾驶压力之间的交互项作为预测因子，以及 90 天死亡率作为因变量。结果根据 ARDSNet 队列中包括 4567 名 ARDS 患者的数据，我们发现驾驶压力对死亡率的影响取决于年龄（作为连续变量的年龄与驾驶压力之间的交互作用 p=0.01）。幸存者和非幸存者之间的驾驶压力差异在整个成人寿命中发生显著变化 （p<0.01）。在这两个队列中，11 cmH2O 的驾驶压力阈值与非常老年患者的死亡率相关。解释 来自具有严格纳入标准的随机对照试验的数据表明，驾驶压力对 ARDS 患者死亡率的影响可能取决于年龄。这些结果可能支持个体化的年龄依赖性机械通气方法。