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Impact of higher versus lower PEEP on mortality in mechanically ventilated patients with Sepsis — A multicenter, multi-cohort observational analysis
Rehn, Patrick Koos, Björn Witowski, Andrea Wappler, Frank Henzler, Dietrich Seidlitz, Silvia Maier-Hein, Lena Katzenschlager, Stephan von Garrel, Ayca Hölzl, Katharina
Rehn, Patrick
Koos, Björn
Witowski, Andrea
Wappler, Frank
Henzler, Dietrich
Seidlitz, Silvia
Maier-Hein, Lena
Katzenschlager, Stephan
von Garrel, Ayca
Hölzl, Katharina
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Author
Rehn, Patrick
Koos, Björn
Witowski, Andrea
Wappler, Frank
Henzler, Dietrich
Seidlitz, Silvia
Maier-Hein, Lena
Katzenschlager, Stephan
von Garrel, Ayca
Hölzl, Katharina
Hölle, Tobias
Full, Peter
Theobald, Vivienne
Niehaus, Benjamin
Hölzer, Hans Thomas
Vekla, Carolin
Pätzold, Ines
Thome, Selina
Bösing, Christoph
Krebs, Jörg
Decker, Sebastian
Fischer, Dania
Schmitt, Felix CF
Weigand, Markus A
Adamzik, Michael
Nowak, Hartmuth
Dietrich, Maximilian
Koos, Björn
Witowski, Andrea
Wappler, Frank
Henzler, Dietrich
Seidlitz, Silvia
Maier-Hein, Lena
Katzenschlager, Stephan
von Garrel, Ayca
Hölzl, Katharina
Hölle, Tobias
Full, Peter
Theobald, Vivienne
Niehaus, Benjamin
Hölzer, Hans Thomas
Vekla, Carolin
Pätzold, Ines
Thome, Selina
Bösing, Christoph
Krebs, Jörg
Decker, Sebastian
Fischer, Dania
Schmitt, Felix CF
Weigand, Markus A
Adamzik, Michael
Nowak, Hartmuth
Dietrich, Maximilian
Supervisor
Department
Computer Vision
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Journal article
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http://creativecommons.org/licenses/by/4.0/
Language
English
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Abstract
BACKGROUND: Optimal ventilator strategies for septic patients remain uncertain, particularly regarding positive end-expiratory pressure (PEEP). While PEEP may affect hemodynamics through changes in intrathoracic pressure, its impact on clinical outcomes in sepsis is not well understood. This multi-cohort study explores the impact of higher versus lower PEEP settings on mortality and hemodynamics in sepsis.
METHODS: We conducted a secondary analysis of 844 septic patients requiring mechanical ventilation across three cohorts (one multicentric prospective = Hyspec ICU, one monocentric prospective = SepDataNet, one monocentric retrospective = RetroSep). Patients were stratified into low PEEP groups according to the ARDSnet low PEEP table and high PEEP groups with PEEP levels above mentioned table. Primary endpoint was ICU or 30-day mortality depending on reported outcome data. Secondary endpoints included vasopressor requirement, lactate levels and fluid balance.
RESULTS: In two cohorts, higher PEEP was associated with significantly lower mortality (RetroSep: 39.4% vs. 50.4% for ICU-mortality, p = 0.008; Hyspec-ICU: 22% vs. 41.7% for 30-day mortality, p = 0.029). The difference persisted after propensity score matching in the RetroSep cohort (38.4% vs. 49.4%; p = 0.046). Hemodynamic parameters such as lactate and vasoactive-inotropic scores were similar or improved in high PEEP groups. Hyperspectral imaging showed no adverse microcirculatory effects.
CONCLUSION: In this multi-cohort analysis, higher PEEP (above ARDSnet low PEEP table) was associated with improved survival without evidence of hemodynamic deterioration. However, due to the observational nature of this analysis and possible confounders, the results should be considered hypothesis-generating and warrant confirmation in randomized trials.
Citation
P. Rehn, B. Koos, A. Witowski, F. Wappler, D. Henzler, S. Seidlitz , et al., "Impact of higher versus lower PEEP on mortality in mechanically ventilated patients with Sepsis — A multicenter, multi-cohort observational analysis," Journal of Critical Care, vol. 95, pp. 155645-155645, 2026, https://doi.org/10.1016/j.jcrc.2026.155645.
Source
Journal of Critical Care
Conference
Keywords
32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, 3 Good Health and Well Being
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Source
Publisher
Elsevier