PDF(Pubmed)
Abstract：
OBJECTIVE: To assess the value of the driving pressure variation rate (ΔP%) in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.
METHODS: In this case-control study, a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled. Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days. Outcome measures including driving pressure, PaO2:FiO2, and positive end-expiratory pressure, etc. were assessed every 24 h from day 0 to day 14 until successful weaning was achieved. The measurement data of non-normal distribution were presented as median (Q1, Q3), and the differences between groups were compared by Wilcoxon rank sum test. And categorical data use the Chi-square test or Fisher\'s exact test to compare. The predictive value of ΔP% in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.
RESULTS: Of the total 35 patients included in the study, 17 were successful vs. 18 failed in weaning from a ventilator after 14 days of mechanical ventilation. The cut-off values of the median ΔP% measured by Operator 1 vs. Operator 2 in the first 4 days were ≥ 4.17% and 4.55%, respectively (p < 0.001), with the area under curve of 0.804 (sensitivity of 88.2%, specificity of 64.7%) and 0.770 (sensitivity of 88.2%, specificity of 64.7%), respectively. There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group (8 (6, 13) vs. 12 (7.5, 17.3), p = 0.043). The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group (0.2‰ vs. 2.3‰, p = 0.001). There was a significant difference noted between these 2 groups in the 28-day mortality (11.8% vs. 66.7%, p = 0.003).
CONCLUSIONS: The median ΔP% in the first 4 days of mechanical ventilation showed good predictive performance in predicting the outcome of weaning from mechanical ventilation within 14 days. Further study is needed to confirm this finding.
METHODS: In this case-control study, a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled. Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days. Outcome measures including driving pressure, PaO2:FiO2, and positive end-expiratory pressure, etc. were assessed every 24 h from day 0 to day 14 until successful weaning was achieved. The measurement data of non-normal distribution were presented as median (Q1, Q3), and the differences between groups were compared by Wilcoxon rank sum test. And categorical data use the Chi-square test or Fisher\'s exact test to compare. The predictive value of ΔP% in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.
RESULTS: Of the total 35 patients included in the study, 17 were successful vs. 18 failed in weaning from a ventilator after 14 days of mechanical ventilation. The cut-off values of the median ΔP% measured by Operator 1 vs. Operator 2 in the first 4 days were ≥ 4.17% and 4.55%, respectively (p < 0.001), with the area under curve of 0.804 (sensitivity of 88.2%, specificity of 64.7%) and 0.770 (sensitivity of 88.2%, specificity of 64.7%), respectively. There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group (8 (6, 13) vs. 12 (7.5, 17.3), p = 0.043). The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group (0.2‰ vs. 2.3‰, p = 0.001). There was a significant difference noted between these 2 groups in the 28-day mortality (11.8% vs. 66.7%, p = 0.003).
CONCLUSIONS: The median ΔP% in the first 4 days of mechanical ventilation showed good predictive performance in predicting the outcome of weaning from mechanical ventilation within 14 days. Further study is needed to confirm this finding.
摘要：
目的：评估驱动压力变化率（ΔP％）在预测急性呼吸窘迫综合征患者有创机械通气撤机结局中的价值。
方法：在本病例对照研究中，在2022年1月至2022年12月期间,共纳入35例中重度急性呼吸窘迫综合征患者入住重症监护病房(ICU),并接受至少48h的有创机械通气.根据患者是否可以在14天内从呼吸机支持中取出，将患者分为成功断奶组和失败断奶组。结果措施，包括驾驶压力，PaO2：FiO2和呼气末正压，等。从第0天到第14天每24小时评估一次，直到成功断奶。非正态分布的测量数据以中位数（Q1，Q3）表示，并通过Wilcoxon秩和检验比较组间差异。分类数据使用卡方检验或Fisher精确检验进行比较。使用接收器工作特性曲线分析了ΔP％在预测呼吸机撤机结果中的预测值。
结果：在纳入研究的35名患者中，17是成功的vs.18在机械通气14天后从呼吸机撤机失败。运算符1测得的中值ΔP%的截止值与操作员2在前4天分别为≥4.17%和4.55%，分别(p<0.001)，曲线下面积为0.804(灵敏度为88.2%，特异性为64.7%)和0.770(灵敏度为88.2%，特异性为64.7%)，分别。成功断奶组和失败断奶组之间的机械通气持续时间存在显着差异（8（6，13）与12(7.5,17.3),p=0.043)。撤机成功组呼吸机相关性肺炎发生率明显低于撤机失败组(0.2‰vs.2.3‰，p=0.001)。在28天死亡率中，这两组之间存在显着差异（11.8％vs.66.7%,p=0.003)。
结论：机械通气前4天的中位数ΔP％在预测14天内从机械通气撤机的结局方面显示出良好的预测性能。需要进一步的研究来证实这一发现。
方法：在本病例对照研究中，在2022年1月至2022年12月期间,共纳入35例中重度急性呼吸窘迫综合征患者入住重症监护病房(ICU),并接受至少48h的有创机械通气.根据患者是否可以在14天内从呼吸机支持中取出，将患者分为成功断奶组和失败断奶组。结果措施，包括驾驶压力，PaO2：FiO2和呼气末正压，等。从第0天到第14天每24小时评估一次，直到成功断奶。非正态分布的测量数据以中位数（Q1，Q3）表示，并通过Wilcoxon秩和检验比较组间差异。分类数据使用卡方检验或Fisher精确检验进行比较。使用接收器工作特性曲线分析了ΔP％在预测呼吸机撤机结果中的预测值。
结果：在纳入研究的35名患者中，17是成功的vs.18在机械通气14天后从呼吸机撤机失败。运算符1测得的中值ΔP%的截止值与操作员2在前4天分别为≥4.17%和4.55%，分别(p<0.001)，曲线下面积为0.804(灵敏度为88.2%，特异性为64.7%)和0.770(灵敏度为88.2%，特异性为64.7%)，分别。成功断奶组和失败断奶组之间的机械通气持续时间存在显着差异（8（6，13）与12(7.5,17.3),p=0.043)。撤机成功组呼吸机相关性肺炎发生率明显低于撤机失败组(0.2‰vs.2.3‰，p=0.001)。在28天死亡率中，这两组之间存在显着差异（11.8％vs.66.7%,p=0.003)。
结论：机械通气前4天的中位数ΔP％在预测14天内从机械通气撤机的结局方面显示出良好的预测性能。需要进一步的研究来证实这一发现。
