肺炎患者机械通气时较高的驱动压与死亡率升高相关，而患者并无急性呼吸窘迫综合征。

The association between higher driving pressure and higher mortality in patients with pneumonia without acute respiratory distress syndrome.

机构信息

Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.

Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.

出版信息

J Formos Med Assoc. 2021 Jan;120(1 Pt 1):204-211. doi: 10.1016/j.jfma.2020.04.027. Epub 2020 May 1.

DOI:10.1016/j.jfma.2020.04.027

PMID:32376124

Abstract

PURPOSE

Recent studies reported that driving pressure has been associated with increased mortality in acute respiratory distress syndrome (ARDS) patients. We aimed to explore the association between 28-day mortality and driving pressure in patients with severe pneumonia without ARDS.

METHODS

In total, 207 non-ARDS patients with severe pneumonia were enrolled. Serial driving pressures were recorded daily for either 21 days or until ventilator support was no longer required. The relationships between all variables and 28-day mortality were analyzed using binary logistic regression analyses.

RESULTS

Non-survivors (56 patients) demonstrated high incidences of shock (55.4% vs. 24.5%, p < 0.001), acute renal failure (55.4% vs. 31.1%, p = 0.001), gastrointestinal bleeding (21.4% vs. 9.9%, p = 0.029), thrombocytopenia (53.6% vs. 23.2%, p < 0.001), jaundice (12.5% vs. 1.3%, p = 0.002), and driving pressure on Day 1 (19.9 ± 4.1 vs. 17.4 ± 4.5 cmHO, p = 0.001). The ratio of arterial partial pressure of oxygen to fraction of inspired oxygen was lower in non-survivors than in survivors (281.5 ± 139.3 vs. 376.2 ± 211.9, p = 0.002). Regression analysis revealed that driving pressure was an independent factor associated with 28-day mortality (odds ratio, 1.110; 95% confidence interval, 1.013-1.217).

CONCLUSION

Driving pressure was associated with 28-day mortality in patients with severe pneumonia without ARDS.

摘要

目的

最近的研究报告指出，驱动压与急性呼吸窘迫综合征（ARDS）患者的死亡率增加有关。我们旨在探讨无 ARDS 的严重肺炎患者 28 天死亡率与驱动压之间的关系。

方法

共纳入 207 例无 ARDS 的严重肺炎患者。连续记录每日驱动压，时间为 21 天或直至不再需要呼吸机支持。使用二元逻辑回归分析评估所有变量与 28 天死亡率之间的关系。

结果

非幸存者（56 例）表现出休克（55.4%比 24.5%，p<0.001）、急性肾功能衰竭（55.4%比 31.1%，p=0.001）、胃肠道出血（21.4%比 9.9%，p=0.029）、血小板减少症（53.6%比 23.2%，p<0.001）、黄疸（12.5%比 1.3%，p=0.002）和第 1 天的驱动压（19.9±4.1 比 17.4±4.5 cmH2O，p=0.001）发生率较高。非幸存者的动脉血氧分压与吸入氧分数比值低于幸存者（281.5±139.3 比 376.2±211.9，p=0.002）。回归分析显示，驱动压是与 28 天死亡率相关的独立因素（优势比，1.110；95%置信区间，1.013-1.217）。