Liu Na, Zhang Qi, Wang Huiyong, Ding Renshuang, Geng Xiaoyong, Wang Li, Wang Zhiyong, Fang Mingxing
Department of Emergency, Forth hospital of Hebei Medical University, Hebei, China.
Department of Critical Care Medicine, Hebei Medical University Third Hospital, Hebei, China.
PLoS One. 2025 Jun 18;20(6):e0326060. doi: 10.1371/journal.pone.0326060. eCollection 2025.
This study examined the effect of target transpulmonary driving pressure on mortality in patients with Acute Respiratory Distress Syndrome, assessing how varying levels of transpulmonary driving pressure influence clinical outcomes.
This retrospective study utilized data from the MIMIC-IV database to evaluate the relationship between transpulmonary driving pressure and mortality in Acute Respiratory Distress Syndrome. Associations between transpulmonary driving pressure levels and 28-day, ICU, and hospital mortality were analyzed. Propensity score matching was employed to balance covariates, while causal mediation analysis assessed whether peak airway pressure mediated the effect of transpulmonary driving pressure on mortality.
Among 4721 patients with Acute Respiratory Distress Syndrome, 295 received transpulmonary driving pressure targeting. The optimal transpulmonary driving pressure threshold was identified as 12.5 cmH2O. Patients with transpulmonary driving pressure >12.5 cmH2O had significantly higher 28-day, ICU, and hospital mortality, particularly in those with moderate to severe Acute Respiratory Distress Syndrome (p < 0.05). After propensity score matching, targeting transpulmonary driving pressure was associated with lower ICU mortality (HR 0.676, 95% CI 0.511-0.894, p = 0.006). Phenotypic analysis showed that elevated transpulmonary driving pressure was linked to worse outcomes in Phenotype-I(High Mechanical Power with Moderate Lung Compliance) and Phenotype-II (High Spontaneous Breathing with Better Lung Compliance), but not in Phenotype-III (Low Tidal Volume with Reduced Lung Compliance). Mediation analysis revealed that 7.0% of the mortality risk associated with transpulmonary driving pressure >12.5 cmH2O was mediated through peak airway pressure.
Transpulmonary driving pressure exceeding 12.5 cmH2O is associated with higher mortality in Acute Respiratory Distress Syndrome patients, with peak airway pressure contributing to this effect.
本研究探讨了目标跨肺驱动压对急性呼吸窘迫综合征患者死亡率的影响，评估不同水平的跨肺驱动压如何影响临床结局。
这项回顾性研究利用多中心重症医学信息数据库第四版（MIMIC-IV）的数据，评估跨肺驱动压与急性呼吸窘迫综合征患者死亡率之间的关系。分析了跨肺驱动压水平与28天、重症监护病房（ICU）及医院死亡率之间的关联。采用倾向评分匹配法平衡协变量，同时进行因果中介分析，以评估气道峰压是否介导了跨肺驱动压对死亡率的影响。
在4721例急性呼吸窘迫综合征患者中，295例接受了跨肺驱动压目标治疗。确定最佳跨肺驱动压阈值为12.5 cmH₂O。跨肺驱动压>12.5 cmH₂O的患者28天、ICU及医院死亡率显著更高，尤其是在中重度急性呼吸窘迫综合征患者中（p<0.05）。倾向评分匹配后，目标跨肺驱动压与较低的ICU死亡率相关（风险比[HR] 0.676, 95%置信区间[CI] 0.511-0.894, p = 0.006）。表型分析表明，跨肺驱动压升高与I型（高机械功率伴中度肺顺应性）和II型（高自主呼吸伴较好肺顺应性）表型的不良结局相关，但与III型（低潮气量伴降低的肺顺应性）表型无关。中介分析显示，与跨肺驱动压>12.5 cmH₂O相关的死亡风险中有7.0%是通过气道峰压介导的。
跨肺驱动压超过12.5 cmH₂O与急性呼吸窘迫综合征患者较高的死亡率相关，气道峰压促成了这一效应。
