Mao Jia-Yu, Li Dong-Kai, Ding Xin, Zhang Hong-Min, Long Yun, Wang Xiao-Ting, Liu Da-Wei
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Pulm Circ. 2020 Nov 25;10(4):2045894020970363. doi: 10.1177/2045894020970363. eCollection 2020 Oct-Dec.
Inappropriate mechanical ventilation may induce hemodynamic alterations through cardiopulmonary interactions. The aim of this study was to explore the relationship between airway pressure and central venous pressure during the first 72 h of mechanical ventilation and its relevance to patient outcomes. We conducted a retrospective study of the Department of Critical Care Medicine of Peking Union Medical College Hospital and a secondary analysis of the MIMIC-III clinical database. The relationship between the ranges of driving pressure and central venous pressure during the first 72 h and their associations with prognosis were investigated. Data from 2790 patients were analyzed. Wide range of driving airway pressure (odds ratio, 1.0681; 95% CI, 1.0415-1.0953; < 0.0001) were independently associated with mortality, ventilator-free time, intensive care unit and hospital length of stay. Furthermore, wide range of driving pressure and elevated central venous pressure exhibited a close correlation. The area under receiver operating characteristic demonstrated that range of driving pressure and central venous pressure were measured at 0.689 (95% CI, 0.670-0.707) and 0.681 (95% CI, 0.662-0.699), respectively. Patients with high ranges of driving pressure and elevated central venous pressure had worse outcomes. Post hoc tests showed significant differences in 28-day survival rates (log-rank (Mantel-Cox), 184.7; < 0.001). In conclusion, during the first 72 h of mechanical ventilation, patients with hypoxia with fluctuating driving airway pressure have elevated central venous pressure and worse outcomes.
不适当的机械通气可能通过心肺相互作用诱发血流动力学改变。本研究的目的是探讨机械通气最初72小时内气道压力与中心静脉压之间的关系及其与患者预后的相关性。我们对北京协和医院重症医学科进行了一项回顾性研究，并对MIMIC-III临床数据库进行了二次分析。研究了最初72小时内驱动压力范围与中心静脉压之间的关系及其与预后的关联。分析了2790例患者的数据。驱动气道压力范围广泛（比值比，1.0681；95%置信区间，1.0415 - 1.0953；P < 0.0001）与死亡率、无呼吸机使用时间、重症监护病房住院时间和住院时间独立相关。此外，驱动压力范围广泛与中心静脉压升高密切相关。受试者工作特征曲线下面积显示，驱动压力范围和中心静脉压的测量值分别为0.689（95%置信区间，0.670 - 0.707）和0.681（95%置信区间，0.662 - 0.699）。驱动压力范围高且中心静脉压升高的患者预后较差。事后检验显示28天生存率存在显著差异（对数秩（曼特尔 - 考克斯），184.7；P < 0.001）。总之，在机械通气的最初72小时内，驱动气道压力波动的缺氧患者中心静脉压升高且预后较差。
