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Abstract：
Background Hypophosphatemia, defined as a serum phosphate level less than 2.5 mg/dL, is a frequent finding in patients with chronic obstructive pulmonary disease (COPD) and has been speculated to negatively affect weaning outcomes. This study aimed to determine the incidence of hypophosphatemia in COPD patients requiring mechanical ventilation and evaluate the predictive role of hypophosphatemia as an indicator of successful weaning from mechanical ventilation in such patients admitted to the intensive care unit (ICU) in a tertiary care hospital in eastern India. Methodology This prospective observational study included 60 adult patients aged 18 to 75 years with acute exacerbations of COPD on mechanical ventilation in the ICU who were planned to undergo a weaning trial. Serum phosphate levels were assessed at the time of admission and before each weaning attempt. Weaning outcomes at each attempt, length of ventilator and ICU stay, and mortality were recorded. Data collection was initiated after approval of the Institutional Ethics Committee. Receiver operating curve (ROC) analysis was done to identify the cut-off value of serum phosphate which predicted successful weaning. Results Of 60 participants, hypophosphatemia on admission was present in 15 (25%) patients. Despite the correction, 13 (21.7%) patients had hypophosphatemia before the first weaning attempt. Only 22 patients out of 60 were successfully weaned off from mechanical ventilation in the first trial, accounting for a success rate of 36.7%, of whom 20 were normophosphatemic (90.9%). In the second and third weaning trials, hypophosphatemia was significantly associated with weaning failure. Overall differences in mean serum phosphate levels among those who failed to wean in each weaning trial and the successful attempt were statistically significant (p < 0.001). On ROC analysis of serum phosphate level before the first weaning trial, a cut-off value of ≥3.0 mg/dL was identified to have 86.4% sensitivity, 55.3% specificity, 52.8% positive predictive value, 87.5% negative predictive value, and 66.7% diagnostic accuracy in predicting weaning success. Five patients died, accounting for a mortality rate of 8.3%. Lower mean serum phosphate levels before the first weaning trial, higher mean age, and longer ventilator and ICU days were significantly associated with mortality among our study participants (p < 0.05). Conclusions Our findings suggest that maintaining normal serum phosphate levels is critical to successfully weaning off patients with COPD from ventilator support.
摘要：
背景低磷酸盐血症,定义为血清磷酸盐水平低于2.5mg/dL，是慢性阻塞性肺疾病（COPD）患者的常见发现，并且推测会对断奶结局产生负面影响。本研究旨在确定需要机械通气的COPD患者中低磷酸盐血症的发生率，并评估低磷酸盐血症作为此类患者成功脱离机械通气的指标的预测作用印度东部三级医院重症监护病房（ICU）。方法这项前瞻性观察性研究包括60名年龄在18至75岁之间的成人患者，他们计划在ICU接受机械通气治疗，计划接受撤机试验。在入院时和每次断奶尝试之前评估血清磷酸盐水平。每次尝试的断奶结果，呼吸机的长度和ICU停留时间，并记录死亡率。数据收集是在机构伦理委员会批准后开始的。进行受试者工作曲线（ROC）分析以确定预测成功断奶的血清磷酸盐的临界值。60名参与者的结果，15例(25%)患者入院时出现低磷酸盐血症.尽管进行了修正,13例（21.7％）患者在首次断奶前出现低磷酸盐血症。在第一次试验中，60名患者中只有22名成功脱离机械通气，成功率为36.7%，其中20人是正常磷血症（90.9%）。在第二次和第三次断奶试验中，低磷血症与断奶失败显著相关.在每个断奶试验和成功尝试断奶失败的患者中，平均血清磷酸盐水平的总体差异具有统计学意义（p<0.001）。首次断奶试验前血清磷酸盐水平的ROC分析,≥3.0mg/dL的临界值被确定为具有86.4%的灵敏度，55.3%特异性，52.8%的阳性预测值，87.5%阴性预测值，预测断奶成功的诊断准确率为66.7%。五名病人死亡,占8.3%的死亡率。第一次断奶试验前平均血清磷酸盐水平较低，较高的平均年龄，在我们的研究参与者中,较长的呼吸机和ICU天数与死亡率显著相关(p<0.05).结论我们的发现表明，维持正常的血清磷酸盐水平对于成功地使COPD患者脱离呼吸机支持至关重要。
