Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Department of Discipline Evaluation and Quality Management, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, Anhui Province, China.
Crit Care Med. 2019 May;47(5):685-690. doi: 10.1097/CCM.0000000000003661.
This study aimed to explore the relationship between the variables of mechanical ventilation and circulatory perfusion and its association with ICU mortality during the first day of mechanical ventilation.
Retrospective cohort study.
The Department of Critical Care Medicine, Peking Union Medical College Hospital.
Patients who have undergone mechanical ventilation.
None.
This study used the main clinical data obtained from the real-time bedside messaging systems of mechanically ventilated patients during their first day in the ICU from May 2013 to May 2016, including data on the variables of mechanical ventilation and circulatory perfusion. An analysis was then performed on the association of the above data with the patient's in-ICU mortality. There were 5,103 patients who received mechanical ventilation during this period, and of these, 309 patients died during their ICU treatment. Peak airway pressure, mean airway pressure, respiratory rate, heart rate, mean arterial pressure, FIO2, blood oxygen saturation, PO2, peripheral perfusion index, and lactate level were correlated with patient outcomes. A Cox logistic regression analysis suggested that mean airway pressure and perfusion index were the most independent risk and protective factors, respectively, for patient ICU mortality. The areas under the curve for a poor prognosis for mean airway pressure and perfusion index were 0.799 (95% CI, 0.77-0.829) and 0.759 (95% CI, 0.729-0.789), respectively. Further, mean airway pressure and perfusion index exhibited a causal interaction. The relative excess risk due to interaction was 2.061 (-0.691 to 4.814), the attributable proportion due to interaction was 0.210 (-0.027 to 0.447), and the synergy index was 1.306 (0.930-1.833).
A higher mean airway pressure and lower perfusion index provided a worse prognosis in mechanically ventilated patients, and it appears that these two variables have a casual interaction.
本研究旨在探讨机械通气变量与循环灌注之间的关系及其与机械通气第 1 天 ICU 死亡率的相关性。
回顾性队列研究。
北京协和医学院医院重症监护医学科。
接受机械通气的患者。
无。
本研究使用了 2013 年 5 月至 2016 年 5 月期间 ICU 内机械通气患者实时床边信息系统获得的主要临床数据，包括机械通气和循环灌注变量的数据。然后对上述数据与患者 ICU 死亡率的相关性进行了分析。在此期间，共有 5103 例患者接受机械通气，其中 309 例患者在 ICU 治疗期间死亡。气道峰压、平均气道压、呼吸频率、心率、平均动脉压、FIO2、血氧饱和度、PO2、外周灌注指数和乳酸水平与患者预后相关。Cox 逻辑回归分析表明，平均气道压和灌注指数分别是患者 ICU 死亡率的最独立的风险和保护因素。平均气道压和灌注指数预后不良的曲线下面积分别为 0.799（95%CI，0.77-0.829）和 0.759（95%CI，0.729-0.789）。此外，平均气道压和灌注指数表现出因果相互作用。交互引起的相对超额风险为 2.061（-0.691 至 4.814），交互归因比例为 0.210（-0.027 至 0.447），协同指数为 1.306（0.930-1.833）。
较高的平均气道压和较低的灌注指数预示着机械通气患者的预后较差，而且这两个变量似乎存在因果关系。
