First tidal volume greater than 8 mL/kg is associated with increased mortality in complicated influenza infection with acute respiratory distress syndrome

• Main Authors: Ming-Cheng Chan, Wen-Cheng Chao, Shinn-Jye Liang, Chien-Hua Tseng, Hao-Chien Wang, Ying-Chun Chien, Kuang-Yao Yang, Wei-Chih Chen, Wann-Cherng Perng, Kuo-Chin Kao, Han-Chung Hu, Chau-Chyun Sheu, Wei-An Chang, Wen-Feng Fang, Yu-Mu Chen, Arthur S. Slutsky, Chieh-Liang Wu
• Format: Article
• Language: English
• Published: Elsevier 2019-01-01
• Series: Journal of the Formosan Medical Association
• Online Access: http://www.sciencedirect.com/science/article/pii/S0929664617307362

Backgrounds: Severe influenza infection causes substantial morbidity and mortality worldwide and remains an important threat to global health. This study addressed factors related to treatment outcomes in subjects of complicated influenza infection with acute respiratory distress syndrome (ARDS) during the Taiwan epidemic in the Spring of 2016. Methods: This is a retrospective study conducted by Taiwan Severe Influenza Research Consortium (TSIRC), including eight tertiary referral medical centers. Patients with virology-proven influenza infection admitted to intensive care unit (ICU) between January and March 2016 were included for analysis. Results: We identified 263 patients with complicated influenza infection who fulfilled ARDS criteria; the mean age was 59.8 ± 14.6 (years), and 66.1% (166/263) were male. Type A influenza (77.9%, 205/263) virus was the main pathogen during this epidemic. The 30-day mortality rate was 23.2% (61/263). The mean tidal volume (VT) in the first three days after intubation was greater than 8 mL/kg of predicted body weight (PBW). Patients whose first measured VT was >8 mL/kg PBW had an increased 30-day mortality (p = 0.04, log-rank test). In a multivariate Cox proportional hazard regression model, an increase of 1 mL/kg PBW of first VT was associated with 26.1% increase in 30-day mortality (adjusted hazard ratio 1.261, 95% confidence interval [CI] 1.072–1.484, p < 0.01). Conclusion: First tidal volume, shortly after intubation, greater than 8 mL/kg PBW is an independent risk factor for mortality in complicated influenza infection with ARDS. Timely recognition of ARDS with strict adherence to protective ventilation strategy of lowering VT may be important in reducing mortality. Keywords: Influenza, Acute respiratory distress syndrome, Tidal volume