Transpulmonary Pressure Monitoring in Patients With ARDS

Abstract

Background:

There is a lack of consensus regarding the use of transpulmonary pressure (P_L) monitoring in the treatment of patients with ARDS. The purpose of this study was to evaluate if patients with a diagnosis of ARDS had better outcomes when P_L was monitored. Outcomes included the number of days on a ventilator and in the ICU, the hospital length of stay, and mortality. A comparison was made between two groups of patients with and without P_L monitoring.

Methods:

A retrospective analysis was conducted of adult patients with ARDS admitted to Santa Barbara Cottage Hospital between January 2018 and May 2021, with and without P_L monitoring. A total of 40 patients (n = 40) were included in this study: 20 patients with P_L monitoring and 20 patients without P_L monitoring.

Results:

There were significant differences in the mean of variables between the group with P_L monitoring and the group without P_L monitoring: LOS: (t ₍₃₈₎) = -2.88, P <.05); ventilator days: (t ₍₃₈₎ = -4.53, P <.001); ICU length of stay: (t ₍₃₈₎ = -3.68, P <.001). There was no significant difference in the mean ages of patients between the groups (t ₍₃₈₎ = -.306, P = .766) or between the use of P_L monitoring and mortality in this sample of patients, as identified via chi square analysis (x² (1, N = 40) = 0.900, P = .343).

Conclusions:

The results may indicate the conditional use of P_L monitoring, meaning that benefit cannot be inferred. The data indicated that P_L monitoring was more likely to be implemented on patients who were deemed ‘sicker’, who required longer lengths of stays in both the ICU and hospital, as well as more days on the ventilator.

Group and Summary Statistics for Each Group

 	PL1 = No2 = Yes	N	Mean	Std.Deviation	Std.Error Mean	Median	Range(min. - max.)
Vent Days	12	202040	9.2026.3517.77	7.1415.3614.67	1.603.43	..13.5	..57(2-59)
LOS	12	202040	21.9038.2030.05	20.1315.4319.53	4.503.45	..26.5	..83(3-86)
ICUStay	12	202040	14.1030.3022.20	10.8716.3915.99	2.433.67	..20.05	..66(2-68)
Age	12	202040	56.3557.5556.95	14.669.6212.25	3.282.15	..54.50	..60(29-91)

T-Tests Analysis

EqualVarianceAssumed	F	Sig.	t	df	Sig.(2-tailed)	MeanDifference
Vent Days	14.87	.000	-4.53	38	.000	-17.15
LOS	.55	.47	-2.87	38	.007	-16.30
ICU Stay	2.70	.11	-3.68	38	.001	-16.20
Age	3.74	.061	-.306	38	.761	-1.20