Department of Emergency and Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222000, Jiangsu, China.
Department of Emergency and Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222000, Jiangsu, China; Department of Critical Care Medicine, The Second People's Hospital of Lianyungang City, Lianyungang 222000, Jiangsu, China.
J Crit Care. 2023 Dec;78:154380. doi: 10.1016/j.jcrc.2023.154380. Epub 2023 Jul 20.
To explore the predictive value of the new comprehensive respiratory mechanics parameters elastic power (EP) and elastic power normalized to the compliance (Cst-EP) in the evaluation of the severity and 28-day prognosis of ARDS patients.
The MIMIC-III database was used to identify ARDS patients under invasive mechanical ventilation for at least 48 h. Their baseline data and ventilatory variables were collected. EP, elastic energy, driving pressure and mechanical power were calculated according to the corresponding formulas. Their value in assessing the severity of ARDS was evaluated. The correlation between Cst-EP and 28-day prognosis of ARDS patients was analyzed.
EP was independently associated with the severity of the ARDS and the odds ratio (OR) was 1.301 [95% CI (1.190-1.423), p < 0.001]. It has higher accuracy for the severity of ARDS, with an optimal cut-off value of 14.6 J/min. The Cst-EP was significantly associated with increased risk of death and the hazard ratio (HR) per 100 J/min × cmHO/ml × 10 was 1.169 [95% CI (1.093-1.250), p < 0.001]. In addition, the 28-day cumulative survival rate of the high Cst-EP group was significantly lower than that of the low Cst-EP group.
EP can be used to predict the severity of ARDS, and Cst-EP is associated with mortality during controlled mechanical ventilation in ARDS.
探讨新的综合呼吸力学参数弹性能（EP）及其与顺应性标准化的弹性能（Cst-EP）对评估 ARDS 患者严重程度和 28 天预后的预测价值。
使用 MIMIC-III 数据库确定至少接受 48 小时有创机械通气的 ARDS 患者。收集他们的基线数据和通气变量。根据相应公式计算 EP、弹性能、驱动压和机械功率。评估 EP 在评估 ARDS 严重程度方面的价值。分析 Cst-EP 与 ARDS 患者 28 天预后的相关性。
EP 与 ARDS 的严重程度独立相关，优势比（OR）为 1.301 [95%置信区间（1.190-1.423），p<0.001]。它对 ARDS 的严重程度具有更高的准确性，最佳截断值为 14.6 J/min。Cst-EP 与死亡风险增加显著相关，每 100 J/min×cmHO/ml×10 的风险比（HR）为 1.169 [95%置信区间（1.093-1.250），p<0.001]。此外，高 Cst-EP 组的 28 天累积生存率明显低于低 Cst-EP 组。
EP 可用于预测 ARDS 的严重程度，Cst-EP 与 ARDS 患者在控制机械通气期间的死亡率相关。
