[Visualization method of mechanical power exposure intensity and duration in mechanical ventilation patients].

Q3 Medicine
Jingru Zhang, Zhizhong Chen, Shurong Gong, Han Chen
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引用次数: 0

Abstract

Objective: To visualize the relationship between different combinations of mechanical power exposure intensity-duration and death risk in mechanical ventilation patients using a visualization method.

Methods: Critically ill patients receiving mechanical ventilation were selected from the Medical Information Mart for Intensive Care- IV v1.0 (MIMIC- IV v1.0) database. The patients were divided into four subgroups according to oxygenation index (PaO2/FiO2) including > 300 mmHg (1 mmHg ≈ 0.133 kPa) group, 201-300 mmHg group, 101-200 mmHg group and ≤100 mmHg group. The baseline characteristics, ventilator parameters, and prognostic indicators for different patient populations were collected. For each patient, the mechanical power thresholds from low to high (5-30 J/min, increasing at intervals of 1 J/min) were used to evaluate the different exposures of mechanical power (above the set threshold was recorded as one exposure), and the number of events with different exposure intensity-duration combinations was counted based on their corresponding durations. Based on the 28-day survival/non-survival status, the number of exposures for survivors and non-survivors in each exposure intensity-duration combination was calculated, and the survival odds ratio (OR) for different mechanical power exposure intensity-duration combinations was subsequently computed. Two-dimensional tables were generated with mechanical power exposure duration on the x-axis and exposure intensity on the y-axis, and the heatmap and its corresponding equipotential line view were used to visualize the OR value to assess the risk of death.

Results: A total of 5 378 patients receiving mechanical ventilation were enrolled in the study, of whom 2 069 patients in the PaO2/FiO2 > 300 mmHg group, 813 patients in the 201-300 mmHg group, 1 493 patients in the 101-200 mmHg group, and 1 003 patients in the ≤100 mmHg group. The severity scores of patients, including sequential organ failure assessment (SOFA) score and simplified acute physiology score II (SAPS II), gradually increased following the decrease in PaO2/FiO2, and the incidence of co-morbidities also gradually increased. In terms of ventilator parameters, mechanical power was increased gradually with decrease in PaO2/FiO2, measuring 10.4 (7.8, 13.9), 11.3 (8.5, 14.7), 13.6 (10.0, 18.2), and 16.7 (12.5, 22.0) J/min (P < 0.01). In terms of prognosis, 28-day mortality of patients was gradually increased with decrease in PaO2/FiO2 [29.1% (601/2 069), 26.9% (219/813), 28.1% (420/1 493), and 33.3% (334/1 003), respectively, P < 0.05]. In the heatmap, it could be observed that the 28-day death risk of mechanical ventilation patients was gradually increased with increase in mechanical power exposure intensity and long duration, showing two distinct areas: a region near the bottom left corner (representing low mechanical power exposure intensity and short duration) was blue, indicating a greater chance of survival. In contrast, another region near the top right corner (representing high mechanical power exposure intensity and long duration) was red, indicating a higher risk of death. According to the fitted lines of death risk, for the same risk of death, a shorter mechanical power exposure duration was required for higher exposure intensity, while lower mechanical power exposure intensity required a longer exposure duration. The above trend of change was similarly reflected in the overall population and different oxygenation populations.

Conclusions: Cumulative mechanical power exposure to higher intensity and/or longer duration is associated with worse outcomes in mechanical ventilation patients. Considering both the mechanical power exposure intensity and duration may help to evaluate the effectiveness of lung protection in mechanical ventilation patients and guide adjustments in mechanical ventilation strategy to reduce the risk of ventilator-induced lung injury.

[机械通气患者机械动力暴露强度和持续时间的可视化方法]。
目的采用可视化方法观察机械通气患者机械通气强度-持续时间不同组合与死亡风险之间的关系:从重症监护医学信息市场-IV v1.0(MIMIC- IV v1.0)数据库中选取接受机械通气的重症患者。根据氧合指数(PaO2/FiO2)将患者分为四个亚组,包括大于 300 mmHg(1 mmHg ≈ 0.133 kPa)组、201-300 mmHg 组、101-200 mmHg 组和小于 100 mmHg 组。收集了不同患者群体的基线特征、呼吸机参数和预后指标。对于每位患者,从低到高的机械功率阈值(5-30 焦耳/分钟,每隔 1 焦耳/分钟增加一次)用于评估不同的机械功率暴露(超过设定阈值记录为一次暴露),并根据相应的持续时间计算不同暴露强度-持续时间组合的事件数。根据 28 天存活/非存活状态,计算出每种暴露强度-持续时间组合中存活者和非存活者的暴露次数,然后计算出不同机械动力暴露强度-持续时间组合的存活几率比(OR)。以机械动力暴露持续时间为X轴,暴露强度为Y轴,生成二维表格,热图及其相应的等势线视图用于直观显示OR值,以评估死亡风险:该研究共纳入了5 378名接受机械通气的患者,其中PaO2/FiO2>300 mmHg组2 069名,201-300 mmHg组813名,101-200 mmHg组1 493名,≤100 mmHg组1 003名。患者的严重程度评分,包括序贯器官衰竭评估(SOFA)评分和简化急性生理学评分 II(SAPS II),随着 PaO2/FiO2 的降低而逐渐增加,并发症的发生率也逐渐增加。在呼吸机参数方面,机械功率随着PaO2/FiO2的降低而逐渐增加,分别为10.4(7.8,13.9)、11.3(8.5,14.7)、13.6(10.0,18.2)和16.7(12.5,22.0)焦耳/分钟(P<0.01)。在预后方面,患者的 28 天死亡率随着 PaO2/FiO2 的降低而逐渐升高[分别为 29.1%(601/2 069)、26.9%(219/813)、28.1%(420/1 493)和 33.3%(334/1 003),P <0.05]。从热图中可以观察到,机械通气患者的 28 天死亡风险随着机械动力暴露强度的增加和持续时间的延长而逐渐增加,呈现出两个明显的区域:靠近左下角的区域(代表机械动力暴露强度低和持续时间短)为蓝色,表示存活几率较大。相反,靠近右上角的另一个区域(代表机械动力暴露强度高、持续时间长)为红色,表明死亡风险较高。根据拟合的死亡风险线,在死亡风险相同的情况下,暴露强度越高,所需的机械动力暴露持续时间越短,而暴露强度越低,所需的机械动力暴露持续时间越长。上述变化趋势同样反映在总体人群和不同氧合人群中:结论:较高强度和/或较长持续时间的累积机械动力暴露与机械通气患者较差的预后有关。同时考虑机械动力暴露强度和持续时间有助于评估机械通气患者肺保护的有效性,并指导调整机械通气策略以降低呼吸机诱发肺损伤的风险。
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
Zhonghua wei zhong bing ji jiu yi xue
Zhonghua wei zhong bing ji jiu yi xue Medicine-Critical Care and Intensive Care Medicine
CiteScore
1.00
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