Jonas Rusnak, Tobias Schupp, Kathrin Weidner, Marinela Ruka, Sascha Egner-Walter, Alexander Schmitt, Muharrem Akin, Péter Tajti, Kambis Mashayekhi, Mohamed Ayoub, Michael Behnes, Ibrahim Akin
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Statistical analyses comprised <i>t</i>-tests, analysis of variance (ANOVA), Kruskal-Wallis-tests, Spearman's correlation, Kaplan-Meier survival analyses, and Cox regression.</p><p><strong>Results: </strong>A total of 141 patients with CS requiring invasive mechanical ventilation were included. Stratification by quartiles revealed that patients with the lowest lung compliance (≤23.8 mL/cmH<sub>2</sub>O) experienced the highest mortality rates (77.1% vs. 66.7% vs. 48.6% vs. 51.4%; log-rank <i>p</i> = 0.018) both overall and among the subgroup of CS-patients with cardiac arrest (80% vs. 74% vs. 53% vs. 59%; log-rank <i>p</i> = 0.037). After stratifying by the median, patients with lung compliance <30.4 mL/cmH<sub>2</sub>O demonstrated a significantly higher 30-day all-cause mortality compared to those above this threshold (71.8% vs. 50.0%; log-rank <i>p</i> = 0.007) for both the overall cohort and the cardiac arrest subgroup (77.2% vs. 55.9%; log-rank <i>p</i> = 0.008). Multivariable adjustment confirmed that lung compliance <30.4 mL/cmH<sub>2</sub>O was significantly associated with increased 30-day all-cause mortality in the entire cohort (hazard ratio [HR] = 1.698; 95% CI 1.085-2.659; <i>p</i> = 0.021). Notably, this association was not significant in CS-patients with cardiac arrest (HR = 1.523; 95% CI 0.952-2.438; <i>p</i> = 0.080). Additionally, those with lung compliance below the median experienced fewer ventilator-free days (<i>p</i> = 0.003).</p><p><strong>Conclusions: </strong>In invasively ventilated CS-patients, low lung compliance was associated with higher all-cause mortality and fewer ventilator-free days at 30 days.</p><p><strong>Clinical trial registration: </strong>NCT05575856, https://clinicaltrials.gov/study/NCT05575856.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"420"},"PeriodicalIF":1.9000,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607489/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prognostic Influence of Lung Compliance in Patients with Cardiogenic Shock and Invasive Mechanical Ventilation.\",\"authors\":\"Jonas Rusnak, Tobias Schupp, Kathrin Weidner, Marinela Ruka, Sascha Egner-Walter, Alexander Schmitt, Muharrem Akin, Péter Tajti, Kambis Mashayekhi, Mohamed Ayoub, Michael Behnes, Ibrahim Akin\",\"doi\":\"10.31083/j.rcm2511420\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is limited data regarding the influence of lung compliance on the outcome of patients with cardiogenic shock (CS). 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Stratification by quartiles revealed that patients with the lowest lung compliance (≤23.8 mL/cmH<sub>2</sub>O) experienced the highest mortality rates (77.1% vs. 66.7% vs. 48.6% vs. 51.4%; log-rank <i>p</i> = 0.018) both overall and among the subgroup of CS-patients with cardiac arrest (80% vs. 74% vs. 53% vs. 59%; log-rank <i>p</i> = 0.037). After stratifying by the median, patients with lung compliance <30.4 mL/cmH<sub>2</sub>O demonstrated a significantly higher 30-day all-cause mortality compared to those above this threshold (71.8% vs. 50.0%; log-rank <i>p</i> = 0.007) for both the overall cohort and the cardiac arrest subgroup (77.2% vs. 55.9%; log-rank <i>p</i> = 0.008). Multivariable adjustment confirmed that lung compliance <30.4 mL/cmH<sub>2</sub>O was significantly associated with increased 30-day all-cause mortality in the entire cohort (hazard ratio [HR] = 1.698; 95% CI 1.085-2.659; <i>p</i> = 0.021). 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引用次数: 0
摘要
背景：关于肺顺应性对心源性休克（CS）患者预后影响的数据有限。因此，我们进行了一项登记研究，以评估有创通气CS患者肺顺应性对预后的影响。方法：收集2019年6月至2021年5月连续有创通气cs患者的医院记录，并进行前瞻性登记。我们的研究评估了肺顺应性对30天全因死亡率的预后影响。统计分析包括t检验、方差分析（ANOVA）、kruskal - wallis检验、Spearman相关、Kaplan-Meier生存分析和Cox回归。结果：共纳入141例需要有创机械通气的CS患者。四分位数分层显示，肺顺应性最低（≤23.8 mL/cmH2O）的患者死亡率最高(77.1% vs. 66.7% vs. 48.6% vs. 51.4%；log-rank p = 0.018)，总体和cs -心脏骤停患者亚组(80% vs. 74% vs. 53% vs. 59%；logrank p = 0.037)。按中位数分层后，肺顺应性为20的患者30天全因死亡率明显高于高于该阈值的患者(71.8% vs 50.0%；Log-rank p = 0.007)，总体队列和心脏骤停亚组(77.2% vs 55.9%；logrank p = 0.008)。多变量调整证实，在整个队列中，肺顺应性2O与30天全因死亡率增加显著相关(风险比[HR] = 1.698；95% ci 1.085-2.659；P = 0.021)。值得注意的是，这种关联在伴有心脏骤停的cs患者中不显著(HR = 1.523；95% ci 0.952-2.438；P = 0.080)。此外，肺顺应性低于中位数的患者无呼吸机天数更少（p = 0.003）。结论：在有创通气的cs患者中，低肺顺应性与较高的全因死亡率和30天无呼吸机天数相关。临床试验注册：NCT05575856， https://clinicaltrials.gov/study/NCT05575856。
Prognostic Influence of Lung Compliance in Patients with Cardiogenic Shock and Invasive Mechanical Ventilation.
Background: There is limited data regarding the influence of lung compliance on the outcome of patients with cardiogenic shock (CS). Thus, a registry study was conducted to assess the prognostic influence of lung compliance in invasively ventilated patients with CS.
Methods: Hospital records for consecutive invasively ventilated CS-patients from June 2019 to May 2021 were collected into a prospective registry. Our study evaluated the prognostic influence of lung compliance on 30-day all-cause mortality. Statistical analyses comprised t-tests, analysis of variance (ANOVA), Kruskal-Wallis-tests, Spearman's correlation, Kaplan-Meier survival analyses, and Cox regression.
Results: A total of 141 patients with CS requiring invasive mechanical ventilation were included. Stratification by quartiles revealed that patients with the lowest lung compliance (≤23.8 mL/cmH2O) experienced the highest mortality rates (77.1% vs. 66.7% vs. 48.6% vs. 51.4%; log-rank p = 0.018) both overall and among the subgroup of CS-patients with cardiac arrest (80% vs. 74% vs. 53% vs. 59%; log-rank p = 0.037). After stratifying by the median, patients with lung compliance <30.4 mL/cmH2O demonstrated a significantly higher 30-day all-cause mortality compared to those above this threshold (71.8% vs. 50.0%; log-rank p = 0.007) for both the overall cohort and the cardiac arrest subgroup (77.2% vs. 55.9%; log-rank p = 0.008). Multivariable adjustment confirmed that lung compliance <30.4 mL/cmH2O was significantly associated with increased 30-day all-cause mortality in the entire cohort (hazard ratio [HR] = 1.698; 95% CI 1.085-2.659; p = 0.021). Notably, this association was not significant in CS-patients with cardiac arrest (HR = 1.523; 95% CI 0.952-2.438; p = 0.080). Additionally, those with lung compliance below the median experienced fewer ventilator-free days (p = 0.003).
Conclusions: In invasively ventilated CS-patients, low lung compliance was associated with higher all-cause mortality and fewer ventilator-free days at 30 days.
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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