Liu Jiaping, Shao Tianyu, Chen Hanwen, Ma Chenyang, Lu Xiaohui, Yang Xiaoming, Song Kang, Wang Lu, Lei Shu, Wang Dafen
The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Oncology, Guang' Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Front Med (Lausanne). 2023 Jul 12;10:1175089. doi: 10.3389/fmed.2023.1175089. eCollection 2023.
The objective of this study is to examine the correlation between patient serum cholinesterase (SCHE) concentration and weaning failure in the context of invasive mechanical ventilation (IMV), as well as to identify predictors of ventilator weaning failure. Additionally, this study investigates the potential relationship between SCHE and nutritional risk for developing more effective weaning strategies.
A retrospective observational study was conducted. The sample was collected from 227 patients with IMV over 48 h who underwent SBT before weaning. Relevant experimental samples and data collection were analyzed at the time of patient admission and before the initiation of the SBT. The correlation between SCHE and weaning failure was determined by multifactorial logistic regression and propensity matching scores.
Weaning was successful in 127 patients and failed in 100 patients. Depending on the difficulty of weaning, 55 of these patients had difficulty in weaning and 45 had long-term weaning. In the crude cohort, experimental data collected on the day of SBT showed that SCHE concentrations were higher in patients with successful weaning than in those with failed weaning (4,514 u/l vs. 3,190 u/l < 0.01). The critical value for predicting weaning failure was SCHE 3,228 u/l ( < 0.01). Ventilator weaning failure was predicted by multifactorial logistic regression analysis of SCHE, heart rate, and PaO before SBT, with SCHE predicting ventilator weaning failure (AUC 0.714; 95% CI 0.647-0.782) better than heart rate (AUC 0.618; 95% CI 0.545-0.690), PaO (AUC 0.59; 95% CI 0.515-0.664). After propensity-matched scores, SCHE remained an independent predictor of weaning failure ( = 0.05). And the SCHE concentration was strongly correlated with the patient's weaning difficulties ( < 0.01). The Nutrition Risk in Critically Ill (NUTRIC) score was also significantly correlated with SCHE according to Spearman's correlation analysis ( < 0.01).
Our study revealed that the patients who experienced weaning failure exhibited lower SCHE values compared to those who successfully underwent weaning. Before spontaneous breathing trial (SBT), SCHE, heart rate, and PaO were identified as independent predictors of weaning failure. Following propensity score matching (PSM), SCHE and heart rate remained independent predictors. Patients with SCHE levels below 3,228 u/l should undergo careful evaluation before weaning. Our findings suggest that malnutrition may be a contributing factor to weaning failure in patients.
本研究的目的是在有创机械通气（IMV）的背景下，研究患者血清胆碱酯酶（SCHE）浓度与撤机失败之间的相关性，并确定呼吸机撤机失败的预测因素。此外，本研究还探讨了SCHE与营养风险之间的潜在关系，以制定更有效的撤机策略。
进行一项回顾性观察研究。样本取自227例接受IMV超过48小时且在撤机前进行自主呼吸试验（SBT）的患者。在患者入院时和SBT开始前分析相关实验样本和数据收集情况。通过多因素逻辑回归和倾向匹配评分确定SCHE与撤机失败之间的相关性。
127例患者撤机成功，100例患者撤机失败。根据撤机难度，其中55例患者撤机困难，45例患者撤机时间长。在原始队列中，SBT当天收集的实验数据显示，撤机成功患者的SCHE浓度高于撤机失败患者（4,514 u/l对3,190 u/l ，<0.01）。预测撤机失败的临界值为SCHE 3,228 u/l（<0.01）。通过对SBT前的SCHE、心率和动脉血氧分压（PaO）进行多因素逻辑回归分析预测呼吸机撤机失败，结果显示SCHE预测呼吸机撤机失败（曲线下面积[AUC] 0.714；95%置信区间[CI] 0.647 - 0.782）优于心率（AUC 0.618；95% CI 0.545 - 0.690）和PaO（AUC 0.59；95% CI 0.515 - 0.664）。经过倾向匹配评分后，SCHE仍然是撤机失败的独立预测因素（P = 0.05）。并且SCHE浓度与患者的撤机困难密切相关（<0.01）。根据Spearman相关性分析，危重症患者营养风险（NUTRIC）评分也与SCHE显著相关（<0.01）。
我们的研究表明，与成功撤机的患者相比，撤机失败的患者SCHE值较低。在自主呼吸试验（SBT）前，SCHE、心率和PaO被确定为撤机失败的独立预测因素。经过倾向评分匹配（PSM）后，SCHE和心率仍然是独立预测因素。SCHE水平低于3,228 u/l的患者在撤机前应进行仔细评估。我们的研究结果表明，营养不良可能是患者撤机失败的一个因素。
