Long Yun, Su Longxiang, Zhang Qing, Zhou Xiang, Wang Hao, Cui Na, Chai Wenzhao, Wang Xiaoting, Rui Xi, Liu Dawei
All authors: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Crit Care Med. 2017 May;45(5):e485-e492. doi: 10.1097/CCM.0000000000002290.
The relationship between respiratory mechanical parameters and hemodynamic variables remains unclear. This study was performed to determine whether mean airway pressure and central venous pressure in the first day of mechanical ventilation are associated with patient outcomes.
Retrospective first 24-hour comparison during ICU stay.
The Department of Critical Care Medicine of Peking Union Medical College Hospital.
Patients with mechanical ventilation.
None.
The clinical data of patients who received mechanical ventilation, especially respiratory and hemodynamic data, were collected and analyzed. In terms of the hemodynamic and perfusion data, the nonsurvivors group (177/2,208) had higher heart rate, respiratory rate, central venous pressure, and lactates and a lower perfusion index and P(v-a)CO2 (p < 0.05). In terms of respiratory condition, mean airway pressure, peak airway pressure, positive end-expiratory pressure, driving pressure, and inspiratory time/total respiration time of nonsurvivors were significantly higher, and arterial oxygen pressure and dynamic compliance worsened and were lower than the survivors (p < 0.05). Increased central venous pressure (odds ratio, 1.125; 95% CI, 1.069-1.184; p < 0.001) and elevated mean airway pressure (odds ratio, 1.125; 95% CI, 1.069-1.184; p < 0.001) were independently associated with 28-day mortality. The area under receiver operating characteristic demonstrated that central venous pressure and mean airway pressure were measured at 0.795 (95% CI, 0.654-0.757) and 0.833 (95% CI, 0.608-0.699), respectively. Based on the cutoff of central venous pressure and mean airway pressure, all of the participants were divided into the following groups: low central venous pressure and mean airway pressure, only high central venous pressure or mean airway pressure, or high central venous pressure and mean airway pressure. Post hoc tests showed significant differences among these three groups based on 28-day survival (log rank [Mantel-Cox], 131.931; p < 0.001).
During the first 24 hours of mechanical ventilation, patients with elevated mean airway pressure and elevated central venous pressure had worse outcomes.
呼吸力学参数与血流动力学变量之间的关系仍不明确。本研究旨在确定机械通气第一天的平均气道压和中心静脉压是否与患者预后相关。
重症监护病房（ICU）住院期间的回顾性头24小时比较。
北京协和医院重症医学科。
接受机械通气的患者。
无。
收集并分析接受机械通气患者的临床资料，尤其是呼吸和血流动力学数据。在血流动力学和灌注数据方面，非存活组（177/2208）的心率、呼吸频率、中心静脉压和乳酸水平较高，灌注指数和P（v-a）CO2较低（p<0.05）。在呼吸状况方面，非存活者的平均气道压、气道峰压、呼气末正压、驱动压和吸气时间/总呼吸时间显著更高，动脉血氧分压和动态顺应性恶化且低于存活者（p<0.05）。中心静脉压升高（比值比，1.125；95%置信区间，1.069-1.184；p<0.001）和平均气道压升高（比值比，1.125；95%置信区间，1.069-1.184；p<0.001）与28天死亡率独立相关。受试者工作特征曲线下面积显示，中心静脉压和平均气道压分别为0.795（95%置信区间，0.654-0.757）和0.833（95%置信区间，0.608-0.699）。根据中心静脉压和平均气道压的截断值，将所有参与者分为以下几组：低中心静脉压和平均气道压组、仅中心静脉压或平均气道压高组、中心静脉压和平均气道压高组。事后检验显示，基于28天生存率，这三组之间存在显著差异（对数秩[曼德尔-考克斯]，131.931；p<0.001）。
在机械通气的头24小时内，平均气道压升高和中心静脉压升高的患者预后较差。
