Lv Wen-Yi, Liu Shuai, Zhang Linlin, Zhou Jian-Xin
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Emergency and Critical Care Center, Clinical and Research Center on Acute Lung Injury, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Front Med (Lausanne). 2025 Mar 5;12:1561017. doi: 10.3389/fmed.2025.1561017. eCollection 2025.
During pressure support ventilation (PSV), the accuracy of non-invasive indicators in diagnosing high or low inspiratory effort has been validated. However, the correlation and agreement of these indicators remain unclear. This study aims to investigate the correlation and agreement among non-invasive inspiratory effort indicators, and to compare characteristics of inspiratory effort in neurocritical and non-neurocritical patients.
This was a single-centre prospective observational study. We collected three non-invasive inspiratory effort indicators, pressure muscular index (PMI), the maximal negative swing of airway pressure during expiratory occlusion (ΔPocc), and the airway occlusion pressure during the first 100ms (P0.1). Cutoff values for these indicators derived from esophageal pressure-time product (PTPmus) were chosen for this study. The correlation and agreement of these indicators were analyzed using Spearman's rank correlation test and linear weighted Kappa analysis. Characteristics of PSV settings and inspiratory effort in neurocritical and non-neurocritical patients were compared.
Ninety-seven patients were enrolled in this study. Correlation analysis showed a moderate correlation between PMI and ΔPocc (rho = -0.524, < 0.001), ΔPocc and P0.1 (rho = 0.588, < 0.001), while no correlation between PMI and P0.1 (rho = -0.140, = 0.172). There was a moderate agreement between ΔPocc and P0.1 ( = 0.459, < 0.001), a fair agreement between PMI and ΔPocc ( = 0.362, < 0.001), but no agreement between PMI and P0.1 ( = 0.134, = 0.072). The correlation of these indicators was similar in neurocritical patients compared with non-neurocritical patients, but agreement was poor.
The study showed that PMI and ΔPocc had moderate correlation and fair agreement, ΔPocc and P0.1 had moderate correlation and agreement, while PMI and P0.1 had no correlation and agreement.
在压力支持通气（PSV）期间，非侵入性指标在诊断吸气用力过高或过低方面的准确性已得到验证。然而，这些指标之间的相关性和一致性仍不明确。本研究旨在探讨非侵入性吸气用力指标之间的相关性和一致性，并比较神经危重症患者和非神经危重症患者的吸气用力特征。
这是一项单中心前瞻性观察性研究。我们收集了三个非侵入性吸气用力指标，压力肌肉指数（PMI）、呼气末阻断期间气道压力的最大负向摆动（ΔPocc）以及前100毫秒内的气道阻断压力（P0.1）。本研究选择了源自食管压力-时间乘积（PTPmus）的这些指标的截断值。使用Spearman等级相关检验和线性加权Kappa分析来分析这些指标的相关性和一致性。比较了神经危重症患者和非神经危重症患者的PSV设置和吸气用力特征。
本研究共纳入97例患者。相关性分析显示PMI与ΔPocc之间存在中度相关性（rho = -0.524，P < 0.001），ΔPocc与P0.1之间存在中度相关性（rho = 0.588，P < 0.001），而PMI与P0.1之间无相关性（rho = -0.140，P = 0.172）。ΔPocc与P0.1之间存在中度一致性（kappa = 0.459，P < 0.001），PMI与ΔPocc之间存在中等一致性（kappa = 0.362，P < 0.001），但PMI与P0.1之间无一致性（kappa = 0.134，P = 0.072）。与非神经危重症患者相比，这些指标在神经危重症患者中的相关性相似，但一致性较差。
研究表明，PMI与ΔPocc具有中度相关性和中等一致性，ΔPocc与P0.1具有中度相关性和一致性，而PMI与P0.1无相关性和一致性。
