Progressive changes in pulmonary gas exchange during invasive respiratory support for COVID-19 associated acute respiratory failure: A retrospective study of the association with 90-day mortality.

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Acta Anaesthesiologica Scandinavica Pub Date : 2024-07-01 Epub Date: 2024-04-02 DOI:10.1111/aas.14415

Ylva Konsberg, Anders Åneman, Fredrik Olsen, Fredrik Hessulf, Bengt Nellgård, Mathias Hård Af Segerstad, Keti Dalla

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Abstract

Background: Ratio of arterial pressure of oxygen and fraction of inspired oxygen (P/F ratio) together with the fractional dead space (V_d/V_t) provides a global assessment of pulmonary gas exchange. The aim of this study was to assess the potential value of these variables to prognosticate 90-day survival in patients with COVID-19 associated ARDS admitted to the Intensive Care Unit (ICU) for invasive ventilatory support.

Methods: In this single-center observational, retrospective study, P/F ratios and V_d/V_t were assessed up to 4 weeks after ICU-admission. Measurements from the first 2 weeks were used to evaluate the predictive value of P/F ratio and V_d/V_t for 90-day mortality and reported by the adjusted hazard ratio (HR) and 95% confidence intervals [95%CI] by Cox proportional hazard regression.

Results: Almost 20,000 blood gases in 130 patients were analyzed. The overall 90-day mortality was 30% and using the data from the first ICU week, the HR was 0.85 [0.77-0.94] for every 10 mmHg increase in P/F ratio and 1.61 [1.20-2.16] for every 0.1 increase in V_d/V_t. In the second week, the HR for 90-day mortality was 0.82 [0.75-0.89] for every 10 mmHg increase in P/F ratio and 1.97 [1.42-2.73] for every 0.1 increase in V_d/V_t.

Conclusion: The progressive changes in P/F ratio and V_d/V_t in the first 2 weeks of invasive ventilatory support for COVID-19 ARDS were significant predictors for 90-day mortality.

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在对 COVID-19 相关急性呼吸衰竭进行有创呼吸支持期间，肺气体交换发生了渐进性变化：与 90 天死亡率相关性的回顾性研究。

背景：动脉血氧压与吸入氧分压之比（P/F 比值）以及死腔分数（Vd/Vt）可对肺气体交换进行全面评估。本研究的目的是评估这些变量对入住重症监护室（ICU）接受有创通气支持的 COVID-19 相关 ARDS 患者 90 天生存率预后的潜在价值：在这项单中心观察性回顾研究中，对入住 ICU 4 周后的 P/F 比值和 Vd/Vt 进行了评估。前两周的测量结果用于评估 P/F 比值和 Vd/Vt 对 90 天死亡率的预测价值，并通过 Cox 比例危险回归得出调整后的危险比（HR）和 95% 置信区间 [95%CI]：对 130 名患者的近 20,000 次血气进行了分析。90 天总死亡率为 30%，根据重症监护室第一周的数据，P/F 比值每增加 10 mmHg，HR 为 0.85 [0.77-0.94]；Vd/Vt 每增加 0.1，HR 为 1.61 [1.20-2.16]。第二周，P/F 比值每增加 10 mmHg，90 天死亡率为 0.82 [0.75-0.89]；Vd/Vt 每增加 0.1，90 天死亡率为 1.97 [1.42-2.73]：结论：COVID-19 ARDS患者在接受有创通气支持的头两周内，P/F比值和Vd/Vt的逐渐变化是90天死亡率的重要预测因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Anaesthesiologica Scandinavica 医学-麻醉学

CiteScore

4.30

自引率

9.50%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Acta Anaesthesiologica Scandinavica publishes papers on original work in the fields of anaesthesiology, intensive care, pain, emergency medicine, and subjects related to their basic sciences, on condition that they are contributed exclusively to this Journal. Case reports and short communications may be considered for publication if of particular interest; also letters to the Editor, especially if related to already published material. The editorial board is free to discuss the publication of reviews on current topics, the choice of which, however, is the prerogative of the board. Every effort will be made by the Editors and selected experts to expedite a critical review of manuscripts in order to ensure rapid publication of papers of a high scientific standard.