Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA.
Crit Care Med. 2013 Mar;41(3):756-64. doi: 10.1097/CCM.0b013e3182741790.
Lung-protective ventilation with lower tidal volume and lower plateau pressure improves mortality in patients with acute lung injury and acute respiratory distress syndrome. We sought to determine the incidence of elevated plateau pressure in acute lung injury /acute respiratory distress syndrome patients receiving lower tidal volume ventilation and to determine the factors that predict elevated plateau pressure in these patients.
We used data from 1398 participants in Acute Respiratory Distress Syndrome Network trials, who received lower tidal volume ventilation (≤ 6.5mL/kg predicted body weight).
We considered patients with a plateau pressure greater than 30cm H2O and/or a tidal volume less than 5.5mL/kg predicted body weight on study day 1 to have "elevated plateau pressure." We used logistic regression to identify baseline clinical variables associated with elevated plateau pressure and to develop a model to predict elevated plateau pressure using a subset of 1,188 patients. We validated the model in the 210 patients not used for model development.
Medical centers participating in Acute Respiratory Distress Syndrome Network clinical trials.
None.
Of the 1,398 patients in our study, 288 (20.6%) had elevated plateau pressure on day 1. Severity of illness indices and demographic factors (younger age, greater body mass index, and non-white race) were independently associated with elevated plateau pressure. The multivariable logistic regression model for predicting elevated plateau pressure had an area under the receiving operator characteristic curve of 0.71 for both the developmental and the validation subsets.
acute lung injury patients receiving lower tidal volume ventilation often have a plateau pressure that exceeds Acute Respiratory Distress Syndrome Network goals. Race, body mass index, and severity of lung injury are each independently associated with elevated plateau pressure. Selecting a smaller initial tidal volume for non-white patients and patients with higher severity of illness may decrease the incidence of elevated plateau pressure. Prospective studies are needed to evaluate this approach.
采用小潮气量和低平台压的肺保护性通气策略可降低急性肺损伤和急性呼吸窘迫综合征患者的死亡率。本研究旨在明确接受小潮气量通气的急性肺损伤/急性呼吸窘迫综合征患者中平台压升高的发生率，并确定预测这些患者平台压升高的因素。
我们纳入了急性呼吸窘迫综合征网络研究中的 1398 例患者，这些患者接受小潮气量通气（≤6.5ml/kg 预测体重）。
我们将第 1 天平台压＞30cmH2O 且/或潮气量＜5.5ml/kg 预测体重的患者定义为“平台压升高”。我们采用 logistic 回归分析明确与平台压升高相关的基线临床变量，并采用 1188 例患者的亚组数据建立预测平台压升高的模型。我们在未用于模型建立的 210 例患者中验证了该模型。
参与急性呼吸窘迫综合征网络临床试验的医疗中心。
无。
在我们的研究中，1398 例患者中有 288 例（20.6%）在第 1 天出现平台压升高。疾病严重程度指标和人口统计学因素（年龄较小、体重指数较大和非白种人）与平台压升高独立相关。该多变量 logistic 回归模型对开发和验证亚组的平台压升高均具有 0.71 的受试者工作特征曲线下面积。
接受小潮气量通气的急性肺损伤患者的平台压常超过急性呼吸窘迫综合征网络的目标值。种族、体重指数和肺损伤严重程度均与平台压升高独立相关。为非白种人和病情更重的患者选择较小的初始潮气量可能会降低平台压升高的发生率。需要前瞻性研究来评估该方法。
