Potentially modifiable ventilatory factors contributing to outcome in patients with pulmonary and extrapulmonary ARDS — An individual patient data analysis
Issued Date
2026-03-01
Resource Type
ISSN
09528180
eISSN
18734529
Scopus ID
2-s2.0-105030294801
Journal Title
Journal of Clinical Anesthesia
Volume
110
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Anesthesia Vol.110 (2026)
Suggested Citation
Dorland G., Blok S.G., Swart P., van der Ven F.S.L.I.M., Hollmann M.W., Azevedo L.C., Bellani G., Botta M., Estenssoro E., Fan E., Ferreira J.C., Laffey J.G., Martin-Loeches I., Motos A., Pham T., Peñuelas O., Pesenti A., Pisani L., Neto A.S., Schultz M.J., Torres A., Tsonas A.M., Paulus F., Hemmes S.N.T., van Meenen D.M.P. Potentially modifiable ventilatory factors contributing to outcome in patients with pulmonary and extrapulmonary ARDS — An individual patient data analysis. Journal of Clinical Anesthesia Vol.110 (2026). doi:10.1016/j.jclinane.2025.112120 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115278
Title
Potentially modifiable ventilatory factors contributing to outcome in patients with pulmonary and extrapulmonary ARDS — An individual patient data analysis
Author(s)
Dorland G.
Blok S.G.
Swart P.
van der Ven F.S.L.I.M.
Hollmann M.W.
Azevedo L.C.
Bellani G.
Botta M.
Estenssoro E.
Fan E.
Ferreira J.C.
Laffey J.G.
Martin-Loeches I.
Motos A.
Pham T.
Peñuelas O.
Pesenti A.
Pisani L.
Neto A.S.
Schultz M.J.
Torres A.
Tsonas A.M.
Paulus F.
Hemmes S.N.T.
van Meenen D.M.P.
Blok S.G.
Swart P.
van der Ven F.S.L.I.M.
Hollmann M.W.
Azevedo L.C.
Bellani G.
Botta M.
Estenssoro E.
Fan E.
Ferreira J.C.
Laffey J.G.
Martin-Loeches I.
Motos A.
Pham T.
Peñuelas O.
Pesenti A.
Pisani L.
Neto A.S.
Schultz M.J.
Torres A.
Tsonas A.M.
Paulus F.
Hemmes S.N.T.
van Meenen D.M.P.
Author's Affiliation
Universidade de São Paulo
Monash University
Université Paris-Saclay
Universitat de Barcelona
University of Toronto Faculty of Medicine
Amsterdam UMC - University of Amsterdam
Medizinische Universität Wien
Hospital Clínic de Barcelona
Università di Trento
University of Galway
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Institució Catalana de Recerca i Estudis Avançats
The Netherlands Cancer Institute
Nuffield Department of Medicine
Hopital de Bicetre
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
St James's Hospital
Hospital Israelita Albert Einstein
Universidad Europea de Madrid
Austin Hospital
University Hospital Galway
A.C.Camargo Cancer Center
Hospital Universitario de Getafe
Mahidol Oxford Tropical Medicine Research Unit
Ospedale S. Chiara
Hogeschool van Amsterdam, University of Applied Sciences
Department of Critical Care
Red Cross Hospital, Beverwijk
Hospital Interzonal General de Agudos de La Plata
Brazilian Research in Intensive Care Network (BRICNet)
Miulli General Regional Hospital
Monash University
Université Paris-Saclay
Universitat de Barcelona
University of Toronto Faculty of Medicine
Amsterdam UMC - University of Amsterdam
Medizinische Universität Wien
Hospital Clínic de Barcelona
Università di Trento
University of Galway
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Institució Catalana de Recerca i Estudis Avançats
The Netherlands Cancer Institute
Nuffield Department of Medicine
Hopital de Bicetre
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
St James's Hospital
Hospital Israelita Albert Einstein
Universidad Europea de Madrid
Austin Hospital
University Hospital Galway
A.C.Camargo Cancer Center
Hospital Universitario de Getafe
Mahidol Oxford Tropical Medicine Research Unit
Ospedale S. Chiara
Hogeschool van Amsterdam, University of Applied Sciences
Department of Critical Care
Red Cross Hospital, Beverwijk
Hospital Interzonal General de Agudos de La Plata
Brazilian Research in Intensive Care Network (BRICNet)
Miulli General Regional Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Background Previous studies have identified potentially modifiable factors associated with mortality from acute respiratory stress syndrome (ARDS), however these studies did not differentiate between underlying causes of ARDS. As the etiology of ARDS may influence patient outcomes, we aimed to identify potentially modifiable factors associated with 60-day mortality from pulmonary and extrapulmonary ARDS. Methods Secondary pooled analysis of six observational studies studies on mechanical ventilation in patients with pulmonary and extrapulmonary ARDS. The primary endpoint was mortality at day 60 after inclusion. Exploratory outcomes included length of stay in hospital and ICU, duration of ventilation and ventilator-free days at day 28. Results Out of 7934 patients with pulmonary or extrapulmonary ARDS, 3402 (43%) did not survive. Potentially modifiable factors associated with 60-day mortality included high driving pressure (ΔP) and high respiratory rate (RR). There was an interaction between etiology of ARDS and ΔP on 60-day mortality, with ΔP showing a stronger association in pulmonary ARDS compared with extrapulmonary ARDS ( p < 0.001). In a sensitivity analysis excluding COVID-19 patients, RR was no longer associated with 60-day mortality, whereas ΔP remained associated. Tidal volume was not associated with 60-day mortality in either pulmonary or extrapulmonary ARDS. No interaction was found between ARDS etiology and RR or tidal volume on 60-day mortality. Conclusion High ΔP and high RR were associated with 60-day mortality in patients with pulmonary and extrapulmonary ARDS receiving mechanical ventilation, with ΔP showing a stronger association in pulmonary ARDS compared with extrapulmonary ARDS. Registration The pooled database was registered at ClinicalTrials.gov (identifier NCT05650957 ).