The Relationship Between PEEP Variability and 28-Day Mortality in Patients With ARDS: A Retrospective Study From MIMIC-IV Database

PURPOSE: This study aimed to explore the relationship between PEEP variability and 28-day mortality in patients with Acute Respiratory Distress Syndrome (ARDS). METHODS: A retrospective analysis was performed utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients with ARDS were categorized into survival and death groups based on 28-day mortality. Differences between these groups were assessed using chi-square tests, t-tests, and the Mann-Whitney U test. Binary logistic regression analysis was performed to identify factors influencing 28-day mortality in ARDS patients. The restricted cubic spline (RCS) was used to examine the dose-response relationship between PEEP variability and 28-day mortality, with subgroup analyses by ARDS severity and interaction tests for PEEP variability and ARDS severity. CONCLUSIONS: Lower PEEP variability was significantly associated with a higher 28-day mortality risk in ARDS patients, with a threshold at 28.9%. These findings highlight the potential prognostic value of PEEP variability, which may serve as a cost-effective indicator to facilitate individualized PEEP titration in mechanically ventilated ARDS patients. Further prospective studies are warranted to validate these findings.