Assessment of mortality risk by respiratory rate-specific quartiles in mechanically ventilated patients with acute respiratory distress syndrome in Mexico.
Jesús S Sánchez-Díaz, Karla G Peniche-Moguel, José Manuel Reyes-Ruiz, Luis Del Carpio-Orantes, Diego Escarramán-Martínez, Éder I Zamarrón-López, Orlando R Pérez-Nieto, María Veronica Calyeca-Sánchez
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引用次数: 0
Abstract
Objective: The respiratory rate (RR) is a fundamental parameter in the setting of mechanical ventilation (MV) in acute respiratory distress syndrome (ARDS), where an increase in RR may be associated with higher energy delivered to the lungs, thereby augmenting lung injury and inflammation, which can lead to death. The establishment of RR ranges that allow for the identification of ARDS patients at risk of mortality is required. Therefore, this study aimed to assess the association between the RR quartiles and mortality in a Mexican cohort of patients with ARDS who received MV.
Material and methods: This retrospective, observational, longitudinal study was conducted in the intensive care unit at a tertiary care center. One hundred ninety patients admitted between January 1, 2016, and December 31, 2022, were diagnosed with ARDS according to the Berlin criteria, of which 158 met the inclusion criteria. Univariable and multivariable Cox regression models, along with Kaplan-Meier survival analysis and the log-rank test, were used to evaluate the impact of clinical prognostic factors on mortality.
Results: Multivariable Cox regression revealed that the body mass index [BMI] (Hazard Ratio [HR] = 1.05, 95% confidence interval [CI] 1.012-1.08; p = 0.008) and RR were risk factors (HR = 1.13, 95% CI 1.004-1.26; p = 0.043) to predict mortality in patients with ARDS and MV. When the predictive power of RR was confirmed, the patients were stratified according to RR quartiles (Q1: 18-23 breaths per min (bpm), Q2: 24 bpm, Q3: 25-26 bpm, and Q4: 27-35 bpm) and analyzed separately. The RR Q4 was independently associated with poor outcomes (HR = 1.959, 95% CI 1.221-3.142; p = 0.005). In a Cox proportional hazards model adjusting for the impact of BMI and smoking, RR Q4 was an independent risk factor for predicting mortality (HR = 1.944, 95% CI 1.208-3.129; p = 0.006).
Conclusion: These results suggested that a Q4 of RR (27-35 bpm) has a substantial predictive value and could be a marker of disease severity and a potential modifiable target in patients with ARDS and MV.
期刊介绍：
Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries. Occasionally IEM accepts unsolicited Reviews, Commentaries or Editorials. The journal is divided into three sections, i.e., Internal Medicine, Emergency Medicine and Clinical Evidence and Health Technology Assessment, with three separate editorial boards. In the Internal Medicine section, invited Case records and Physical examinations, devoted to underlining the role of a clinical approach in selected clinical cases, are also published. The Emergency Medicine section will include a Morbidity and Mortality Report and an Airway Forum concerning the management of difficult airway problems. As far as Critical Care is becoming an integral part of Emergency Medicine, a new sub-section will report the literature that concerns the interface not only for the care of the critical patient in the Emergency Department, but also in the Intensive Care Unit. Finally, in the Clinical Evidence and Health Technology Assessment section brief discussions of topics of evidence-based medicine (Cochrane’s corner) and Research updates are published. IEM encourages letters of rebuttal and criticism of published articles. Topics of interest include all subjects that relate to the science and practice of Internal and Emergency Medicine.
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