通气比值（VR）与 14328 例机械通气 ICU 患者 28 天住院死亡率的关系：受限立方样条（RCS）分析。
The relationship between ventilatory ratio (VR) and 28-day hospital mortality by restricted cubic splines (RCS) in 14,328 mechanically ventilated ICU patients.
机构信息
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China.
出版信息
BMC Pulm Med. 2022 Jun 13;22(1):229. doi: 10.1186/s12890-022-02019-6.
BACKGROUND
Previous studies found that high levels of ventilatory ratio (VR) were associated with a poor prognosis due to worse ventilatory efficiency in acute respiratory distress syndrome patients. However, relatively few large studies have assessed the association between VR and intensive care unit (ICU) mortality in the general adult ventilated population.
METHODS
The present study is a retrospective cohort study. Patients mechanically ventilated for more than 12 h were included. VR was calculated based on a previously reported formula. Restricted cubic spline models were used to fit the relationship between VR and mortality risks.
RESULTS
A total of 14,328 mechanically ventilated ICU patients were included in the study, of which 1311 died within 28 days. The results of the study are as follows: (1) In the general adult ventilated population, VR was positively associated with 28-day mortality when VR ≥ 1.3 (increase of 0.1 per VR; HR 1.05, p < 0.001). The same tendency was also observed in the populations of severe hypoxemia with a PaO/FiO (P/F) ratio < 200 mmHg. (2) However, in the population with a P/F ratio ≥ 200, a J-shaped dose-response association between VR and the risk of mortality was observed, with the risk of death positively associated with VR when VR ≥ 0.9 (10% increase in HR for every 0.1 increase in VR, p = 0.000) but negatively associated with VR when VR < 0.9 (10% decrease in HR for every 0.1 increase in VR, p = 0.034). In the population of P/F ratio ≥ 200 with VR less than 0.9, compared to the survival group, the nonsurvival group had a lower level PCO (33 mmHg [29.1, 37.9] vs. 34.4 mmHg [30.6, 38.5]), rather than a significant level of measured minute ventilation or P/F ratio.
CONCLUSIONS
VR was positively associated with the risk of death in the general ICU population; however, VR was inversely associated with 28-day mortality in the population with a P/F ratio ≥ 200 and low VR . Further research should investigate this relationship, and VR should be interpreted with caution in clinical practice.
背景
先前的研究发现，通气比值（VR）较高与急性呼吸窘迫综合征患者通气效率较差有关，因此预后较差。然而，很少有大型研究评估 VR 与一般成人机械通气患者重症监护病房（ICU）死亡率之间的关系。
方法
本研究为回顾性队列研究。纳入机械通气时间超过 12 小时的患者。根据先前报道的公式计算 VR。采用限制性立方样条模型拟合 VR 与死亡率风险之间的关系。
结果
共纳入 14328 例机械通气 ICU 患者，其中 1311 例在 28 天内死亡。研究结果如下：（1）在一般成人通气人群中，当 VR≥1.3 时（VR 每增加 0.1，HR1.05，p<0.001），VR 与 28 天死亡率呈正相关。在 PaO/FiO（P/F）比值<200mmHg 的严重低氧血症人群中也观察到同样的趋势。（2）然而，在 P/F 比值≥200mmHg 的人群中，VR 与死亡率风险之间存在 J 形剂量反应关系，当 VR≥0.9 时，死亡风险与 VR 呈正相关（每增加 0.1，HR 增加 10%，p=0.000），而当 VR<0.9 时，死亡风险与 VR 呈负相关（每增加 0.1，HR 降低 10%，p=0.034）。在 P/F 比值≥200mmHg 且 VR<0.9 的人群中，与存活组相比，非存活组的 PCO 水平较低（33mmHg[29.1,37.9] vs. 34.4mmHg[30.6,38.5]），而分钟通气量或 P/F 比值并无显著差异。
结论
在一般 ICU 人群中，VR 与死亡风险呈正相关；然而，在 P/F 比值≥200mmHg 且 VR 较低的人群中，VR 与 28 天死亡率呈负相关。进一步的研究应该调查这种关系，在临床实践中应谨慎解释 VR。
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