Mean Airway Pressure as A Predictor of Mortality (Short Term) InMechanically Ventilated ARDS Patients

Abstract

Introduction: The prognostic value of mean airway pressure (MAP) in mechanically ventilated patients with acute respiratory distress syndrome (ARDS) remains inadequately explored, despite its potential as a readily available monitoring parameter. This study investigated the relationship between MAP and short-term mortality in ARDS patients. Methods & Materials: In this single-center observational cohort study, we analyzed data from 122 adult patients with ARDS requiring mechanical ventilation. We recorded demographic characteristics, ventilatory parameters, and clinical outcomes. The primary outcome was 28-day mortality. Multivariate logistic regression analysis was performed to assess the independent association between MAP and mortality, while receiver operating characteristic (ROC) curve analysis determined the optimal predictive threshold. Results: The overall 28-day mortality rate was 31.1% (38/122 patients). Non-survivors demonstrated significantly higher MAP values compared to survivors (18.9 ± 3.6 vs. 14.2 ± 3.2 cmH2O, p<0.001). ROC analysis identified an optimal MAP threshold of 16.2 cmH2O for predicting mortality (AUC 0.79, 95% CI: 0.71-0.87, sensitivity 81.6%, specificity 73.8%). In multivariate analysis, MAP remained an independent predictor of mortality (OR 1.42 per cmH2O increase, 95% CI: 1.21-1.67, p<0.001) after adjusting for age, PaO2/FiO2 ratio, and PEEP. The association between MAP and mortality was particularly strong in severe ARDS cases (P/F ratio <100). Conclusions: Mean airway pressure serves as an independent predictor of short-term mortality in mechanically ventilated ARDS patients, with values above 16.2 cmH2O associated with significantly higher mortality risk. This readily available parameter may provide clinicians with a valuable tool for risk stratification and clinical decision-making in ARDS management.