Wu Huang-Pin, Leu Shaw-Woei, Lin Shih-Wei, Hung Chen-Yiu, Chen Ning-Hung, Hu Han-Chung, Huang Chung-Chi, Kao Kuo-Chin
Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Diagnostics (Basel). 2023 Mar 24;13(7):1226. doi: 10.3390/diagnostics13071226.
Driving pressure (ΔP) and mechanical power (MP) are associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate which was better to predict mortality between changes in ΔP and MP. We reanalyzed data from a prospective observational cohort study of patients with ARDS in our hospital. Serial ΔP and MP values were calculated. The factors associated with survival were analyzed. Binary logistic regression showed that age (odds ratio (OR), 1.012; 95% confidence interval (CI), 1.003-1.022), Sequential Organ Failure assessment (SOFA) score (OR, 1.144; 95% CI, 1.086-1.206), trauma (OR, 0.172; 95% CI, 0.035-0.838), ΔP (OR, 1.077; 95% CI, 1.044-1.111), change in ΔP (OR, 1.087; 95% CI, 1.054-1.120), and change in MP (OR, 1.018; 95% CI, 1.006-1.029) were independently associated with 30-day mortality. Change in MP, change in ΔP, and SOFA scores were superior to ΔP in terms of the accuracy of predicting 30-day mortality. In conclusion, calculating change in ΔP is easy for respiratory therapists in clinical practice and may be used to predict mortality in patients with ARDS.
驱动压（ΔP）和机械功率（MP）与急性呼吸窘迫综合征（ARDS）患者死亡率增加相关。我们旨在研究在ΔP和MP的变化中，哪一个更能预测死亡率。我们重新分析了我院对ARDS患者进行的一项前瞻性观察队列研究的数据。计算了连续的ΔP和MP值。分析了与生存相关的因素。二元逻辑回归显示，年龄（比值比（OR），1.012；95%置信区间（CI），1.003 - 1.022）、序贯器官衰竭评估（SOFA）评分（OR，1.144；95% CI，1.086 - 1.206）、创伤（OR，0.172；95% CI，0.035 - 0.838）、ΔP（OR，1.077；95% CI，1.044 - 1.111）、ΔP的变化（OR，1.087；95% CI，1.054 - 1.120）以及MP的变化（OR，1.018；95% CI，1.006 - 1.029）与30天死亡率独立相关。在预测30天死亡率的准确性方面，MP的变化、ΔP的变化和SOFA评分优于ΔP。总之，在临床实践中，呼吸治疗师计算ΔP的变化很容易，并且可用于预测ARDS患者的死亡率。
