Increased Driving Pressure During Assisted Ventilation for Hypoxemic Respiratory Failure Is Associated with Lower ICU Survival: The ICEBERG Study
Bibliographic record
Abstract
Abstract Rationale Driving pressure (ΔP) is a marker of severity and a possible target for lung protection during controlled ventilation, but its value during assisted ventilation is unknown. Inspiratory holds provide an estimate of ΔP that is quasi-static. Expiratory holds provide an estimate of the inspiratory effort, which is useful to estimate the transpulmonary dynamic ΔP. Objectives To assess the correlation between ΔPs measured during assisted ventilation and ICU outcomes. Methods Multicenter prospective observational study. Patients with acute hypoxemic respiratory failure were enrolled within 48 hours of triggering the ventilator. Respiratory mechanics were measured daily, and the variables of interest were averaged over the first 3 days of partial assistance. ICU outcomes were collected until Day 90. Measurements and Main Results A total of 298 patients from 16 centers were enrolled. Vt, peak airway pressure, positive end-expiratory pressure, and inspiratory effort during the first 3 days of assisted ventilation did not differ between survivors and nonsurvivors. Quasi-static ΔP and transpulmonary dynamic ΔP were higher in nonsurvivors than in survivors (13 [IQR, 11–14] vs. 11 [9–13] cm H2O [P < 0.001]; and 19 [16–23] vs. 16 [13–18] cm H2O [P < 0.001], respectively), whereas compliance normalized to predicted body weight was lower (0.65 [0.54–0.84] vs. 0.79 [0.64–0.97] mL/cm H2O/kg; P < 0.001). Multivariable analysis confirmed the association with outcomes. During the study days, static ΔP significantly diverged between survivors and nonsurvivors. Conclusions During assisted ventilation, ΔP and normalized compliance are associated with ICU outcome, despite some overlap. Although our study does not allow an estimation of whether ΔP is a marker of severity or a cause of lung injury, it highlights the potential value of monitoring and targeting it during spontaneous assisted breathing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".