The effect of target transpulmonary driving pressure values on mortality in ARDS patients: A retrospective study based on the MIMIC-IV database

PMCID: PMC12176163

PMID: 40531833

DOI: 10.1371/journal.pone.0326060

Journal: PloS one

Publication Date: 2025-6-18

Authors: Liu N, Zhang Q, Wang H, Ding R, Geng X, et al.

Key Points

• Transpulmonary driving pressure >12.5 cmH2O is associated with increased mortality in ARDS patients
• Targeted TPDP management reduced ICU mortality by 32.4% (HR 0.676)
• Careful TPDP monitoring is crucial, especially for patients with high mechanical power or spontaneous breathing phenotypes

Summary

This retrospective study investigated the impact of transpulmonary driving pressure (TPDP) on mortality in Acute Respiratory Distress Syndrome (ARDS) patients using the MIMIC-IV database. Among 4,721 ARDS patients, 295 received targeted TPDP management, with 12.5 cmH2O identified as a critical threshold. Patients with TPDP >12.5 cmH2O demonstrated significantly higher 28-day, ICU, and hospital mortality rates, particularly in moderate to severe ARDS cases.

After propensity score matching, targeted TPDP management was associated with reduced ICU mortality (Hazard Ratio 0.676, 95% CI 0.511–0.894, p=0.006). Phenotypic analysis revealed that elevated TPDP was most detrimental in Phenotype-I (High Mechanical Power) and Phenotype-II (High Spontaneous Breathing), while having minimal impact on Phenotype-III (Low Tidal Volume). Notably, peak airway pressure mediated approximately 7.0% of the mortality risk associated with elevated TPDP.