Doctor of Medicine Proves High Driving Pressure as a Threat to ARDS and Increased Proinflammatory Biomarkers in ICU Patients

Doctor of Medicine Proves High Driving Pressure as a Threat to ARDS and Increased Proinflammatory Biomarkers in ICU Patients

 

Located in the Postgraduate Program Building, Fl. III Denpasar Campus Hall Room, the Doctoral Promotion exam took place with the promovendus candidate, dr. Putu Agus Surya Panji, Sp.AN., KIC., with the dissertation title "High Driving Pressure as a Risk Factor for High Levels of IL-6, IL-8, VWF, ICAM-1 and the Event of ARDS in Patients with LIPS Score > 4 with Mechanical Ventilation "In accordance with Lung Protective Ventilation in the ICU of PROF. DR. I.G.N.G. NGOERAH Hospital". (17/10/2023)

 

Acute Respiratory Distress Syndrome (ARDS) is a very complex and heterogeneous pathological process, until now very little therapeutic management has been proven to be successful in reducing mortality and morbidity, so preventing ARDS from occurring is felt to be more beneficial. Mechanical ventilation as supportive therapy in patients with respiratory failure has the potential to cause mechanical stress on the lungs. Lung Protective Ventilation (LPV) is a mechanical ventilation strategy that has so far been proven to reduce ARDS mortality, and has even been applied as a strategy to prevent the occurrence of ARDS in patients at risk. Driving pressure with a plateau pressure formulation minus PEEP is an important component of mechanical ventilation besides LPV. This study aims to prove whether exposure to high driving pressure (( 14 cmH2O) in patients with lung injury prediction score (LIPS) > 4 is a risk factor for high pro-inflammatory biomarkers and lung tissue damage (IL-6, IL-8, vWF, ICAM- 1) as well as the incidence of ARDS in research subjects.

 

This study is a prospective analytical cohort study in two groups, namely the exposure group (driving pressure (14 cmH2O) and the control group (< 14 cmH2O) in a population of patients at risk of ARDS (LIPS > 4) who were treated in the ICU of Prof. Dr. IGNG Ngoerah Hospital . The research will take place from August 2022 until the sample size is met. Blood serum is taken 24 hours after mechanical ventilation therapy for examination of IL-6, IL-8, vWF, ICAM-1. Outcomes during treatment will be recorded in the form of the incidence of ARDS and mortality rates. Analysis is carried out with SPSS 26 for descriptive, bivariate and multivariate analysis. This research is ethically sound.

 

The number of men and women was the same in both groups (p = 1,000). The median length of stay in the two groups did not differ (13.5 days vs 12.5 days, p = 0.912). Linear regression analysis revealed that IL-6 and vWF levels were significantly different in the control and exposure groups (IL-6: 96.91 ng/L vs 109.21 ng/L; vWF: 28.97 ng/L vs 36.34 ng/ L) while IL-8 and ICAM-1 levels were not significantly different between the two groups (IL-8: 226.94 ng/L vs 224.04 ng/L; p = 0.539; ICAM-1: (812.32 ng/ L vs 909.01 ng/L; p = 0.080). High driving pressure is a risk factor for ARDS with an RR of 3.5 (1.23–9.93) (p = 0.010), high IL-6 levels with a RR of 1.37 (1.12–1.68) (p = 0.001), high vWF levels with RR of 1.33 (1.05–1.69) (p = 0.014), and high ICAM-1 levels with The RR was 1.72 (1.11-2.66) (p = 0.011), but there was no difference in mortality rates (26 compared to 28 subjects; p = 0.695).IL-6, IL-8, vWF, and ICAM-1 were biomarkers that appeared in exudative phase, post-acute phase, after 24 hours there will be inflammation and accumulation of tissue damage so that biomarkers will increase. IL-8 and ICAM-1 did not increase significantly, presumably because more is released in the alveoli than the soluble form in plasma.

 

Driving pressure of more than 14 cmH2O is a risk factor for high levels of pro-inflammatory biomarkers and lung tissue damage and has a higher incidence of ARDS.

 

The exam was led by the Deputy Dean for Academic Affairs and Planning, FK Unud, Dr. Dr. I Gede Eka Wiratnaya, Sp.OT(K), with the examining team:

1. Prof. Dr. Dr. I Made Wiryana, Sp.An-KIC (Promoter)

2. Prof. Dr. Dr. Tjok Gde Agung Senapathi, Sp.An., KAR (Copromotor I)

3. Prof. Dr. Dr. Tjokorda Gde Bagus Mahadewa, M.Kes., Sp.BS (K)Spinal., FICS., FINSS (Copromotor II)

4. Prof. Dr. Dr. I Made Bakta, Sp.PD-KHOM

5. Prof. Dr. Dr. I Made Jawi, M. Kes

6. Prof. Dr. Dr. I Wayan Putu Sutirta Yasa, M.Sc

7.Dr. Dr. I Putu Pramana Suarjaya, Sp.An., M.Kes., KMN, KNA, FIPM

8.Dr. Dr. I Made Gede Widnyana, Sp.An., KAR

9.Dr. Dr. I Wayan Niryana, M.Kes., Sp.BS(K)

 

Meanwhile, academic invitations are:

1.Dr. Dr. I Made Muliartha, S.Ked., M.Kes

2.Dr. Dr. I Gusti Agung Utara Hartawan, Sp.An., MARS., S.H.

3.Dr. Dr. I Made Junior Rina Artha, Sp.JP(K)

4.Dr. Dr. I Gusti Ngurah Mahaalit Aribawa, Sp.An., KAR, FIP.

5.Dr. Dr. Dewa Ayu Mas Shintya Dewi, Sp.An

 

In this exam, Dr. Dr. Putu Agus Surya Panji, Sp.AN., KIC., was declared to have graduated as the 401st Doctoral Graduate of the Medical Science Doctoral Study Program, Faculty of Medicine, Udayana University with the title of Very Satisfactory