Mechanical power normalisation methods to predict ICU mortality: a retrospective cohort study.

IF 5.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Reza Khorasanee, Barnaby Sanderson, Emilia Tomarchio, Patrick D Collins, Riccardo Del Signore, Sridevi Shetty, Mara Chioccola, Francesca Pugliese, Francesca Collino, Louise Rose, Lorenzo Giosa, Luigi Camporota
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引用次数: 0

Abstract

Background: The optimal mechanical ventilation strategy to minimise ventilator-induced lung injury (VILI) remains uncertain. Mechanical power (MP) is a key VILI determinant, but whether and how MP should be normalised to individual patient characteristics is unclear. In this study, we aimed to evaluate whether the discriminatory accuracy of MP for ICU mortality in mechanically ventilated patients improves when normalised to physiologically relevant variables that reflect individual susceptibility to VILI. We also explored whether the relationship between MP, MPratio, and mortality is linear or exhibits a threshold effect.

Methods: In this retrospective observational study, we extracted granular electronic healthcare record data for mechanically ventilated adults in a single centre over a seven-year period. Primary exposures were MP with five normalisations: for dead space (expressed as corrected minute ventilation, ventilatory ratio, or end-tidal to arterial CO2 ratio); aerated lung size (compliance), and normal idealised MP (MPratio). We used logistic regression to assess associations with ICU mortality. We calculated the Area Under the Receiver Operating Characteristic Curve (AUROC) to compare discriminative accuracy of individual models. Additionally, we evaluated the linearity or presence of a threshold for the relationships between MP, MPratio and ICU mortality.

Result: We included 3,578 patients in our analyses. We found MP normalised to compliance (AUROC 0.71, 95% confidence interval (CI) 0.69-0.73, p = 0.007 (DeLong's test)) and MPratio (AUROC 0.71, 95% CI 0.68-0.73, p = 0.0014) performed better than MP alone (AUROC 0.69, 95% CI 0.66-0.71) for predicting ICU mortality. Other methods of MP normalisation were no more discriminative than MP without normalisation. The relationship between MP and MPratio with ICU mortality showed a statistically significant but small departure from linearity.

Conclusions: Mechanical power normalised to compliance and MPratio had better discrimination for ICU mortality than MP, although the difference was modest and absolute predictive power remained limited.

机械功率正常化方法预测ICU死亡率:一项回顾性队列研究。
背景:减少呼吸机诱导肺损伤(VILI)的最佳机械通气策略仍不确定。机械功率(MP)是VILI的关键决定因素,但MP是否以及如何与个体患者特征标准化尚不清楚。在这项研究中,我们的目的是评估当与反映个体对VILI易感性的生理相关变量归一化后,MP对ICU机械通气患者死亡率的歧视性准确性是否会提高。我们还探讨了MP、mratio和死亡率之间的关系是线性的还是表现出阈值效应。方法:在这项回顾性观察性研究中,我们提取了单个中心七年期间机械通气成人的颗粒电子医疗记录数据。主要暴露是MP,有五种标准化:死亡空间(表示为校正的分钟通气量、通气量比或末潮与动脉CO2比);通气肺大小(顺应性)和正常理想MP (mratio)。我们使用逻辑回归来评估与ICU死亡率的关联。我们计算了接收者工作特征曲线下的面积(AUROC)来比较各个模型的判别精度。此外,我们评估了MP、mratio和ICU死亡率之间的线性关系或阈值的存在。结果:我们在分析中纳入了3578例患者。我们发现MP与依从性归一化(AUROC 0.71, 95%可信区间(CI) 0.69-0.73, p = 0.007 (DeLong检验))和mratio (AUROC 0.71, 95% CI 0.68-0.73, p = 0.0014)在预测ICU死亡率方面优于单独使用MP (AUROC 0.69, 95% CI 0.66-0.71)。其他MP归一化方法与未归一化的MP没有区别。MP和mratio与ICU死亡率之间的关系具有统计学意义,但线性偏差较小。结论:机械功率归一化至依从性和MPratio对ICU死亡率的判别优于MP,尽管差异不大,绝对预测能力仍然有限。
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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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