Wang Bin, Cheng Li, Lin GuoYing, Yang Ci, Zhao HuiYing
Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
Department of Intensive Care Medicine, Xizang Autonomous Region People's Hospital, Lhasa, Tibet, China.
Anesthesiol Res Pract. 2025 Mar 11;2025:9934525. doi: 10.1155/anrp/9934525. eCollection 2025.
This study aimed to develop a predictive model for weaning failure in critically ill patients at high altitudes. Data of patients requiring invasive mechanical ventilation admitted to the Department of Intensive Care Medicine of Xizang Autonomous Region People's Hospital from January 1, 2023, to November 31, 2023, were retrospectively collected as the train set. The patients were weaned according to the conventional clinical strategy and divided into successful and failed weaning groups. Univariate analysis was performed between the weaning success and weaning failure groups. Indicators with inter-group differences were included in the Lasso regression for further screening and then included in the multivariate logistic regression analysis to establish independent risk factors. Subsequently, a nomogram prediction model was constructed. Data of patients from December 1, 2023, to April 30, 2024, were retrospectively collected as a validation set to verify the prediction model. A total of 226 patients were included in the train set, of which 61 (27.0%) had weaning failure. The length of intensive care unit stay, mechanical ventilation time, mortality, and medical costs of patients in the weaning failure group were higher than those in the success group. After univariate comparison and Lasso regression, hypertension, lower serum albumin, sequential organ failure assessment (SOFA) score, tidal volume, and respiratory rate were identified as independent risk factors for weaning failure. The area under the receiver operating characteristic curve was 0.895 (95% confidence interval (CI): 0.848-0.943) in the training set and 0.886 (95% CI: 0.814-0.958) in the validation set. Hypertension, lower serum albumin, higher SOFA scores, smaller tidal volumes, and faster respiratory rates were independent risk factors for weaning failure in critically ill patients living in high-altitude areas. A prediction model for weaning failure was constructed, and it showed good prediction efficiency after verification.
本研究旨在建立一种针对高原地区危重症患者撤机失败的预测模型。回顾性收集2023年1月1日至2023年11月31日在西藏自治区人民医院重症医学科接受有创机械通气治疗患者的数据作为训练集。患者按照传统临床策略进行撤机，并分为撤机成功组和撤机失败组。对撤机成功组和撤机失败组进行单因素分析。将组间有差异的指标纳入Lasso回归进行进一步筛选，然后纳入多因素logistic回归分析以确定独立危险因素。随后，构建列线图预测模型。回顾性收集2023年12月1日至2024年4月30日患者的数据作为验证集，以验证该预测模型。训练集共纳入226例患者，其中61例（27.0%）撤机失败。撤机失败组患者的重症监护病房住院时间、机械通气时间、死亡率和医疗费用均高于成功组。经过单因素比较和Lasso回归分析，高血压、血清白蛋白降低、序贯器官衰竭评估（SOFA）评分、潮气量和呼吸频率被确定为撤机失败的独立危险因素。训练集受试者工作特征曲线下面积为0.895（95%置信区间（CI）：0.848 - 0.943），验证集为0.886（95%CI：0.814 - 0.958）。高血压、血清白蛋白降低、SOFA评分升高、潮气量减小和呼吸频率加快是高原地区危重症患者撤机失败的独立危险因素。构建了撤机失败的预测模型，验证后显示出良好的预测效能。
