在接受压力控制机械通气的急性呼吸窘迫综合征患者中，机械功率、通气比率及其他呼吸指数与死亡率的相关性。
Associations of mechanical power, ventilatory ratio, and other respiratory indices with mortality in patients with acute respiratory distress syndrome undergoing pressure-controlled mechanical ventilation.
作者信息
Kim Tae Wan, Chung Chi Ryang, Nam Miryeo, Ko Ryoung-Eun, Suh Gee Young
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
Front Med (Lausanne). 2025 Apr 4;12:1553672. doi: 10.3389/fmed.2025.1553672. eCollection 2025.
BACKGROUND
Mechanical power (MP) and ventilatory ratio (VR) are crucial metrics in the management of acute respiratory distress syndrome (ARDS). This study aimed to evaluate the impact of these factors on ICU mortality in patients with ARDS undergoing pressure-controlled ventilation.
METHODS
In this retrospective study, we included 600 adult patients with ARDS who required mechanical ventilation for > 48 h between March 2018 and February 2021 in a tertiary referral hospital in Korea. The MP was calculated using Becher's simplified equation, and the VR was determined using standard formulas. The ventilatory parameters were measured hourly during the first 12 h of ventilation. Clinical characteristics, ventilator settings, and outcomes were compared between the survivors and non-survivors. Multiple logistic regression models were used to assess the predictive performance of the respiratory and mechanical ventilation parameters for ICU mortality.
RESULTS
Of the 600 patients, 61.5% ( = 369) survived to hospital discharge. Non-survivors had higher rates of chronic liver disease, hematologic malignancies, and solid tumors. The survivors demonstrated lower respiratory rates (21 vs. 22 breaths/min, < 0.001), tidal volumes (491 vs. 445 mL, = 0.048), and peak pressures (22.0 vs. 24.3 cm HO, < 0.001). Significant differences were observed in driving pressure (15.0 vs. 16.0 cm HO, = 0.001), MP (18.8 vs. 21.8 J/min, < 0.001), LTC-MP (7,371 vs. 8,780 cm HO/min, < 0.001), and power index (5,429 vs. 6,386 cm HO/min, = 0.005) between survivors and non-survivors. In adjusted models, MP (OR 1.03, 95% CI 1.01-1.05, = 0.006), VR (OR 1.39, 95% CI 1.02-1.92, = 0.040), and PBW-adjusted MP (OR 1.02, 95% CI 1.00-1.03, = 0.009) were significant predictors of ICU mortality.
CONCLUSION
Our findings indicate that MP and VR were independently associated with ICU mortality in patients with ARDS undergoing pressure-controlled ventilation.
背景
机械功率（MP）和通气比（VR）是急性呼吸窘迫综合征（ARDS）管理中的关键指标。本研究旨在评估这些因素对接受压力控制通气的ARDS患者重症监护病房（ICU）死亡率的影响。
方法
在这项回顾性研究中，我们纳入了2018年3月至2021年2月期间在韩国一家三级转诊医院需要机械通气超过48小时的600例成年ARDS患者。使用贝歇尔简化方程计算MP，并使用标准公式确定VR。在通气的前12小时内每小时测量通气参数。比较幸存者和非幸存者的临床特征、呼吸机设置和结局。使用多因素逻辑回归模型评估呼吸和机械通气参数对ICU死亡率的预测性能。
结果
600例患者中，61.5%（n = 369）存活至出院。非幸存者患慢性肝病、血液系统恶性肿瘤和实体瘤的比例更高。幸存者的呼吸频率（21次/分钟对22次/分钟，P < 0.001）、潮气量（491毫升对445毫升，P = 0.048）和峰值压力（22.0厘米水柱对24.3厘米水柱，P < 0.001）较低。在驱动压力（15.0厘米水柱对16.0厘米水柱，P = 0.001）、MP（18.8焦耳/分钟对21.8焦耳/分钟，P < 0.001）、长时程MP（7371厘米水柱/分钟对8780厘米水柱/分钟，P < 0.001）和功率指数（5429厘米水柱/分钟对6386厘米水柱/分钟，P = 0.005）方面，幸存者和非幸存者之间存在显著差异。在调整模型中，MP（比值比[OR]1.03，95%置信区间[CI]1.01 - 1.05，P = 0.006）、VR（OR 1.39，95% CI 1.02 - 1.92，P = 0.040）和经预测体重（PBW）调整的MP（OR 1.02，95% CI 1.00 - 1.03，P = 0.009）是ICU死亡率的显著预测因素。
结论
我们的研究结果表明，在接受压力控制通气的ARDS患者中，MP和VR与ICU死亡率独立相关。
Zotero 插件