Department of Intensive Care Unit, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China.
Surgery. 2024 Nov;176(5):1507-1515. doi: 10.1016/j.surg.2024.07.027. Epub 2024 Aug 20.
This study aimed to develop and validate a model to predict the risk of prolonged weaning from mechanical ventilation in patients with abdominal trauma.
Patients with abdominal trauma were included and were divided into the training cohort and the validation cohort. The model was constructed using predictive factors identified by univariable and multivariable logistic regressions, and was validated by receiver operating characteristic curve, calibration curve, and decision curve analysis. Clinical outcomes were compared between model-stratified risk groups.
In total,190 patients were included, with 133 in the training cohort and 57 in the validation cohort. Six predictive factors, the Acute Physiology and Chronic Health Evaluation II score, Injury Severity Score, Glasgow coma scale, total bilirubin, skeletal muscle index, and abdominal fat index, were identified and were included in the model. The model predicting prolonged weaning owned a good discrimination, had an excellent calibration, and exhibited a favorable net benefit within a reasonable range of threshold probabilities. Significant differences were shown in prolonged weaning and clinical outcomes between the high-risk and low-risk groups (P < .05). Multivariable Cox regression analysis showed that patients in the high-risk group had greater risk of 28-day mortality (P < .05).
This study established a model to predict the risk of prolonged weaning from mechanical ventilation and clinical outcomes in patients with abdominal trauma. Skeletal muscle index was identified as one of independent risk factors of prolonged weaning. The findings offer valuable insights for respiratory management in patients with abdominal trauma.
本研究旨在开发和验证一种预测腹部创伤患者机械通气撤机时间延长风险的模型。
纳入腹部创伤患者，并将其分为训练队列和验证队列。使用单变量和多变量逻辑回归确定的预测因素构建模型，并通过接收者操作特征曲线、校准曲线和决策曲线分析进行验证。比较模型分层风险组之间的临床结局。
共纳入 190 例患者，其中训练队列 133 例，验证队列 57 例。确定了 6 个预测因素，即急性生理学和慢性健康评估 II 评分、损伤严重程度评分、格拉斯哥昏迷评分、总胆红素、骨骼肌指数和腹部脂肪指数，并将其纳入模型。预测机械通气撤机时间延长的模型具有良好的区分度，具有极好的校准度，并且在合理的阈值概率范围内具有良好的净获益。高危组和低危组在机械通气撤机时间延长和临床结局方面存在显著差异（P <.05）。多变量 Cox 回归分析显示，高危组患者 28 天死亡率更高（P <.05）。
本研究建立了一种预测腹部创伤患者机械通气撤机时间延长和临床结局的模型。骨骼肌指数被确定为机械通气撤机时间延长的独立危险因素之一。这些发现为腹部创伤患者的呼吸管理提供了有价值的见解。
