Kor Chew-Teng, Lin Kai-Huang, Wang Chen-Hsu, Lin Jui-Feng, Kuo Cheng-Deng
Internal Medicine Research Center, Department of Research, Changhua Christian Hospital, Changhua 500, Taiwan.
Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 500, Taiwan.
Diagnostics (Basel). 2021 Apr 3;11(4):648. doi: 10.3390/diagnostics11040648.
This study investigated the usefulness of ventilator parameters in the prediction of development and outcome of acute respiratory distress syndrome (ARDS) in postoperative patients with esophageal or lung cancer on admission to the surgical intensive care unit (SICU). A total of 32 post-operative patients with lung or esophageal cancer from SICU in a tertiary medical center were retrospectively analyzed. The study patients were divided into an ARDS group ( = 21) and a non-ARDS group ( = 11). The ARDS group contained the postoperative patients who developed ARDS after lung or esophageal cancer surgery. The ventilator variables were analyzed in this study. Principal component analysis (PCA) was performed to reduce the correlated ventilator variables to a small set of variables. The top three ventilator variables with large coefficients, as determined by PCA, were considered as sensitive variables and included in the analysis model based on the rule of 10 events per variable. Firth logistic regression with selective stepwise elimination procedure was performed to identify the most important predictors of morbidity and mortality in patients with ARDS. Ventilator parameters, including rapid shallow breath index during mechanical ventilation (RSBIv), rate pressure product of ventilation (RPPv), rate pressure volume index (RPVI), mechanical work (MW), and inspiration to expiration time ratio (IER), were analyzed in this study. It was found that the ARDS patients had significantly greater respiratory rate (RR), airway resistance (Raw), RSBIv, RPPv, RPVI, positive end-expiratory pressure (PEEP), and IER and significantly lower respiratory interval (RI), expiration time (Te), flow rate (V˙), tidal volume (V), dynamic compliance (Cdyn), mechanical work of ventilation (MW), and MW/IER ratio than the non-ARDS patients. The non-survivors of ARDS had significantly greater peak inspiratory pressure above PEEP (PIP), RSBIv, RPPv, and RPVI than the survivors of ARDS. By using PCA, the MW/IER was found to be the most important predictor of the development of ARDS, and both RPPv and RPVI were significant predictors of mortality in patients with ARDS. In conclusion, some ventilator parameters, such as RPPv, RPVI, and MW/IER defined in this study, can be derived from ventilator readings and used to predict the development and outcome of ARDS in mechanically ventilated patients on admission to the SICU.
本研究调查了术后食管癌或肺癌患者入住外科重症监护病房（SICU）时，呼吸机参数对急性呼吸窘迫综合征（ARDS）发生及预后的预测价值。回顾性分析了某三级医疗中心SICU的32例肺癌或食管癌术后患者。研究对象分为ARDS组（n = 21）和非ARDS组（n = 11）。ARDS组包括肺癌或食管癌手术后发生ARDS的患者。本研究对呼吸机变量进行了分析。采用主成分分析（PCA）将相关的呼吸机变量减少为一小部分变量。根据PCA确定的系数较大的前三个呼吸机变量被视为敏感变量，并根据每个变量10个事件的规则纳入分析模型。采用Firth逻辑回归和选择性逐步排除程序，以确定ARDS患者发病和死亡的最重要预测因素。本研究分析了呼吸机参数，包括机械通气期间的快速浅呼吸指数（RSBIv）、通气率压积（RPPv）、率压容积指数（RPVI）、机械功（MW）和吸气与呼气时间比（IER）。结果发现，ARDS患者的呼吸频率（RR）、气道阻力（Raw）、RSBIv、RPPv、RPVI、呼气末正压（PEEP）和IER显著高于非ARDS患者，而呼吸间隔（RI）、呼气时间（Te）、流速（V˙）、潮气量（V）、动态顺应性（Cdyn）、通气机械功（MW）和MW/IER比显著低于非ARDS患者。ARDS的非幸存者的呼气末正压之上的吸气峰压（PIP）、RSBIv、RPPv和RPVI显著高于ARDS的幸存者。通过PCA发现，MW/IER是ARDS发生的最重要预测因素，RPPv和RPVI都是ARDS患者死亡的显著预测因素。总之，本研究中定义的一些呼吸机参数，如RPPv、RPVI和MW/IER，可以从呼吸机读数中得出，并用于预测入住SICU的机械通气患者ARDS的发生及预后。
