• Christian Bime, Mallorie Fiero, Zhenqiang Lu, Eyal Oren, Cristine E Berry, Sairam Parthasarathy, and GarciaJoe G NJGNDivision of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson; University of Arizona Health Sciences, Tucson..
• Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson; University of Arizona Health Sciences, Tucson. Electronic address: cbime@email.arizona.edu.
• Am. J. Med. 2017 Feb 1; 130 (2): 207-213.

BackgroundIn acute respiratory distress syndrome, minimizing lung injury from repeated collapse and reopening of alveoli by applying a high positive end-expiratory pressure improves oxygenation without influencing mortality. Obesity causes alveolar atelectasis, thus suggesting that a higher positive end-expiratory pressure might be more protective among the obese. We hypothesized that the effect of applying a high positive end-expiratory pressure on mortality from acute respiratory distress syndrome would differ by obesity status.MethodsThis was a retrospective analysis of 505 patients from the Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury Trial, a multicenter randomized trial that compared a higher vs a lower positive end-expiratory pressure ventilatory strategy in acute respiratory distress syndrome. We examined the relationship between positive end-expiratory pressure strategy and 60-day mortality stratified by obesity status.ResultsAmong obese patients with acute respiratory distress syndrome, those assigned to a high positive end-expiratory pressure strategy experienced lower mortality compared with those assigned to a low strategy (18% vs 32%; P = .04). Among the nonobese, those assigned to high positive end-expiratory pressure strategy experienced similar mortality with those assigned to low strategy (34% vs 23%; P = .13). Multivariate analysis demonstrated an interaction between obesity status and the effect of positive end-expiratory pressure strategy on mortality (P <.01).ConclusionsVentilation with higher levels of positive end-expiratory pressure was associated with improved survival among the subgroup of patients with acute respiratory distress syndrome who are obese.Copyright © 2016 Elsevier Inc. All rights reserved.

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