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The following is a summary of “Respiratory drive heterogeneity associated with systemic inflammation and vascular permeability in acute respiratory distress syndrome,” published in the April 2024 issue of Critical Care by Baedorf-Kassis et al.

Despite similar clinical features in patients with acute respiratory distress syndrome (ARDS), respiratory drive variation remains unexplained by factors like blood gas, oxygenation, lung mechanics, and sedation levels.

Researchers conducted a retrospective study exploring how systemic inflammation and vascular permeability markers relate to respiratory drive and clinical outcomes in ARDS.

They included patients with ARDS from the multicenter EPVent-2 trial, ensuring requisite data and plasma biomarkers. Recipients of the neuromuscular blockade were excluded. The respiratory drive was measured using P _ES0.1, representing the change in esophageal pressure during the first 0.1 seconds of inspiratory effort. Plasma levels of angiopoietin-2, interleukin-6, and interleukin-8 were measured, and clinical outcomes were evaluated at 60 days.

The results showed 54.8% out of 124 patients included exhibited detectable respiratory drive (with a P_ES0.1 range of 0–5.1 cm H₂O). Angiopoietin-2 and interleukin-8, but not interleukin-6, were independently associated with respiratory drive, regardless of acid-base status, oxygenation, respiratory mechanics, and sedation depth. Sedation depth showed no significant association with P_ES0.1 in an unadjusted model or after adjusting for mechanics and chemoreceptor input. Upon inclusion of angiopoietin-2, interleukin-6, or interleukin-8 in the models, lighter sedation was significantly linked to higher P_ES0.1. Risk of death was lower with moderate drive (P_ES0.1 of 0.5–2.9 cm H₂O) compared to either lower drive (HR 1.58, 95% CI 0.82–3.05) or higher drive (2.63, 95% CI 1.21–5.70) (P=0.049).

Investigators concluded that patients with ARDS with elevated systemic inflammation and vascular permeability markers exhibited greater respiratory drive variability.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04920-4