驱动压力和通气机械功率对死亡率的预测效度。
The predictive validity for mortality of the driving pressure and the mechanical power of ventilation.
作者信息
van Meenen David M P, Serpa Neto Ary, Paulus Frederique, Merkies Coen, Schouten Laura R, Bos Lieuwe D, Horn Janneke, Juffermans Nicole P, Cremer Olaf L, van der Poll Tom, Schultz Marcus J
机构信息
Department of Intensive Care, University of Amsterdam, Amsterdam University Medical Centers, Location "Academic Medical Center", Meibergdreeg 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Morumbi, São Paulo, Brazil.
出版信息
Intensive Care Med Exp. 2020 Dec 18;8(Suppl 1):60. doi: 10.1186/s40635-020-00346-8.
BACKGROUND
Outcome prediction in critically ill patients under invasive ventilation remains extremely challenging. The driving pressure (ΔP) and the mechanical power of ventilation (MP) are associated with patient-centered outcomes like mortality and duration of ventilation. The objective of this study was to assess the predictive validity for mortality of the ΔP and the MP at 24 h after start of invasive ventilation.
METHODS
This is a post hoc analysis of an observational study in intensive care unit patients, restricted to critically ill patients receiving invasive ventilation for at least 24 h. The two exposures of interest were the modified ΔP and the MP at 24 h after start of invasive ventilation. The primary outcome was 90-day mortality; secondary outcomes were ICU and hospital mortality. The predictive validity was measured as incremental 90-day mortality beyond that predicted by the Acute Physiology, Age and Chronic Health Evaluation (APACHE) IV score and the Simplified Acute Physiology Score (SAPS) II.
RESULTS
The analysis included 839 patients with a 90-day mortality of 42%. The median modified ΔP at 24 h was 15 [interquartile range 12 to 19] cm HO; the median MP at 24 h was 206 [interquartile range 145 to 298] 10 J/min/kg predicted body weight (PBW). Both parameters were associated with 90-day mortality (odds ratio (OR) for 1 cm HO increase in the modified ΔP, 1.05 [95% confidence interval (CI) 1.03 to 1.08]; P < 0.001; OR for 100 10 J/min/kg PBW increase in the MP, 1.20 [95% CI 1.09 to 1.33]; P < 0.001). Area under the ROC for 90-day mortality of the modified ΔP and the MP were 0.70 [95% CI 0.66 to 0.74] and 0.69 [95% CI 0.65 to 0.73], which was neither different from that of the APACHE IV score nor that of the SAPS II.
CONCLUSIONS
In adult patients under invasive ventilation, the modified ΔP and the MP at 24 h are associated with 90 day mortality. Neither the modified ΔP nor the MP at 24 h has predictive validity beyond the APACHE IV score and the SAPS II.
背景
对接受有创通气的重症患者进行预后预测仍然极具挑战性。驱动压（ΔP）和通气机械功率（MP）与以患者为中心的预后相关，如死亡率和通气时间。本研究的目的是评估有创通气开始后24小时时ΔP和MP对死亡率的预测效度。
方法
这是一项对重症监护病房患者的观察性研究的事后分析，仅限于接受有创通气至少24小时的重症患者。两个感兴趣的暴露因素是有创通气开始后24小时时的改良ΔP和MP。主要结局是90天死亡率；次要结局是重症监护病房（ICU）死亡率和医院死亡率。预测效度通过超出急性生理与慢性健康状况评分系统（APACHE）IV评分和简化急性生理学评分（SAPS）II预测的90天死亡率增量来衡量。
结果
分析纳入了839例患者，90天死亡率为42%。24小时时改良ΔP的中位数为15[四分位间距12至19]cm H₂O；24小时时MP的中位数为206[四分位间距145至298]10 J/min/kg预测体重（PBW）。两个参数均与90天死亡率相关（改良ΔP每增加1 cm H₂O的比值比（OR）为1.05[95%置信区间（CI）1.03至1.08]；P<0.001；MP每增加100 10 J/min/kg PBW的OR为1.20[95%CI 1.09至1.33]；P<0.001）。改良ΔP和MP对90天死亡率的ROC曲线下面积分别为0.70[95%CI 0.66至0.74]和0.69[95%CI 0.65至0.73]，与APACHE IV评分和SAPS II的ROC曲线下面积均无差异。
结论
在接受有创通气的成年患者中，24小时时的改良ΔP和MP与90天死亡率相关。24小时时的改良ΔP和MP均不具有超出APACHE IV评分和SAPS II的预测效度。
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