Lianlian Jiang, Hui Chen, Wei Chang, Qin Sun, Xueyan Yuan, Zongsheng Wu, Jianfeng Xie, Ling Liu, Yi Yang
{"title":"急性呼吸窘迫综合征患者随时间变化的呼吸效率低下和死亡率。","authors":"Lianlian Jiang, Hui Chen, Wei Chang, Qin Sun, Xueyan Yuan, Zongsheng Wu, Jianfeng Xie, Ling Liu, Yi Yang","doi":"10.1186/s13613-025-01427-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The association between bedside ventilatory parameters-specifically arterial carbon dioxide pressure (PaCO<sub>2</sub>) and ventilatory ratio (VR)-and mortality in patients with acute respiratory distress syndrome (ARDS) remains a topic of debate. Additionally, the persistence of this association over time is unclear. This study aims to investigate the relationship between 28-day mortality in ARDS patients and their longitudinal exposure to ventilatory inefficiency, as reflected by serial measurements of PaCO<sub>2</sub> and VR.</p><p><strong>Methods: </strong>We conducted a secondary analysis of four randomized controlled trials (FACTT, ALTA, EDEN, and SAILS) from the ARDS Network. All included patients were intubated and received mechanical ventilation. Patients were excluded if they underwent extracorporeal life support or were on mechanical ventilation for less than one day. The primary outcome was 28-day mortality. Bayesian joint models were employed to estimate the strength of associations over time.</p><p><strong>Results: </strong>A total of 2,851 patients were included in our analysis. The overall 28-day mortality rate was 21.3%, with a median duration of invasive mechanical ventilation of 9 days (IQR: 4-28 days). After adjustment, each daily increment in PaCO<sub>2</sub> (HR 1.008, 95% CI 0.997-1.018) was not associated with mortality, while a daily increment in VR (HR 1.548, 95% CI 1.309-1.835) was associated with increased mortality. This association persisted during the prolonged stages (Days 0-23) of mechanical ventilation. Furthermore, a significant increase in the risk of death was related to daily exposure to VR > 2 (HR 1.088 per day, 95% CI 1.034-1.147) and its cumulative effect (HR 1.085 per area, 95% CI 1.050-1.122), whereas PaCO<sub>2</sub> was found to be insignificant.</p><p><strong>Conclusion: </strong>VR, which reflects ventilatory inefficiency, should be closely monitored during invasive mechanical ventilation. Cumulative exposure to high intensities of VR may be associated with increased mortality in patients with ARDS.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"6"},"PeriodicalIF":5.7000,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729588/pdf/","citationCount":"0","resultStr":"{\"title\":\"Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome.\",\"authors\":\"Lianlian Jiang, Hui Chen, Wei Chang, Qin Sun, Xueyan Yuan, Zongsheng Wu, Jianfeng Xie, Ling Liu, Yi Yang\",\"doi\":\"10.1186/s13613-025-01427-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The association between bedside ventilatory parameters-specifically arterial carbon dioxide pressure (PaCO<sub>2</sub>) and ventilatory ratio (VR)-and mortality in patients with acute respiratory distress syndrome (ARDS) remains a topic of debate. Additionally, the persistence of this association over time is unclear. This study aims to investigate the relationship between 28-day mortality in ARDS patients and their longitudinal exposure to ventilatory inefficiency, as reflected by serial measurements of PaCO<sub>2</sub> and VR.</p><p><strong>Methods: </strong>We conducted a secondary analysis of four randomized controlled trials (FACTT, ALTA, EDEN, and SAILS) from the ARDS Network. All included patients were intubated and received mechanical ventilation. Patients were excluded if they underwent extracorporeal life support or were on mechanical ventilation for less than one day. The primary outcome was 28-day mortality. Bayesian joint models were employed to estimate the strength of associations over time.</p><p><strong>Results: </strong>A total of 2,851 patients were included in our analysis. The overall 28-day mortality rate was 21.3%, with a median duration of invasive mechanical ventilation of 9 days (IQR: 4-28 days). After adjustment, each daily increment in PaCO<sub>2</sub> (HR 1.008, 95% CI 0.997-1.018) was not associated with mortality, while a daily increment in VR (HR 1.548, 95% CI 1.309-1.835) was associated with increased mortality. This association persisted during the prolonged stages (Days 0-23) of mechanical ventilation. Furthermore, a significant increase in the risk of death was related to daily exposure to VR > 2 (HR 1.088 per day, 95% CI 1.034-1.147) and its cumulative effect (HR 1.085 per area, 95% CI 1.050-1.122), whereas PaCO<sub>2</sub> was found to be insignificant.</p><p><strong>Conclusion: </strong>VR, which reflects ventilatory inefficiency, should be closely monitored during invasive mechanical ventilation. Cumulative exposure to high intensities of VR may be associated with increased mortality in patients with ARDS.</p>\",\"PeriodicalId\":7966,\"journal\":{\"name\":\"Annals of Intensive Care\",\"volume\":\"15 1\",\"pages\":\"6\"},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2025-01-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729588/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Intensive Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13613-025-01427-1\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13613-025-01427-1","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景：急性呼吸窘迫综合征（ARDS）患者床边通气参数（特别是动脉二氧化碳压（PaCO2）和通气比（VR））与死亡率之间的关系仍然是一个有争议的话题。此外，随着时间的推移，这种联系的持久性尚不清楚。本研究旨在通过PaCO2和VR的连续测量，探讨ARDS患者28天死亡率与其呼吸效率低下的纵向暴露之间的关系。方法：我们对来自ARDS网络的四项随机对照试验（FACTT、ALTA、EDEN和SAILS）进行了二次分析。所有患者均插管并接受机械通气。如果患者接受体外生命支持或机械通气少于一天，则排除在外。主要终点为28天死亡率。贝叶斯联合模型被用来估计随时间的关联强度。结果：共有2851例患者纳入我们的分析。总28天死亡率为21.3%，中位有创机械通气持续时间为9天（IQR: 4-28天）。调整后，PaCO2每日增加（HR 1.008, 95% CI 0.997-1.018）与死亡率无关，而VR每日增加（HR 1.548, 95% CI 1.309-1.835）与死亡率增加相关。这种关联在机械通气的延长阶段（0-23天）持续存在。此外，死亡风险的显著增加与每日暴露于VR bbbb2（每日危险度1.088,95% CI 1.034-1.147）及其累积效应（每区域危险度1.085,95% CI 1.050-1.122）有关，而PaCO2发现不显著。结论：在有创机械通气过程中，应密切监测反映通气效率低下的VR。累积暴露于高强度VR可能与ARDS患者死亡率增加有关。
Time-varying intensity of ventilatory inefficiency and mortality in patients with acute respiratory distress syndrome.
Background: The association between bedside ventilatory parameters-specifically arterial carbon dioxide pressure (PaCO2) and ventilatory ratio (VR)-and mortality in patients with acute respiratory distress syndrome (ARDS) remains a topic of debate. Additionally, the persistence of this association over time is unclear. This study aims to investigate the relationship between 28-day mortality in ARDS patients and their longitudinal exposure to ventilatory inefficiency, as reflected by serial measurements of PaCO2 and VR.
Methods: We conducted a secondary analysis of four randomized controlled trials (FACTT, ALTA, EDEN, and SAILS) from the ARDS Network. All included patients were intubated and received mechanical ventilation. Patients were excluded if they underwent extracorporeal life support or were on mechanical ventilation for less than one day. The primary outcome was 28-day mortality. Bayesian joint models were employed to estimate the strength of associations over time.
Results: A total of 2,851 patients were included in our analysis. The overall 28-day mortality rate was 21.3%, with a median duration of invasive mechanical ventilation of 9 days (IQR: 4-28 days). After adjustment, each daily increment in PaCO2 (HR 1.008, 95% CI 0.997-1.018) was not associated with mortality, while a daily increment in VR (HR 1.548, 95% CI 1.309-1.835) was associated with increased mortality. This association persisted during the prolonged stages (Days 0-23) of mechanical ventilation. Furthermore, a significant increase in the risk of death was related to daily exposure to VR > 2 (HR 1.088 per day, 95% CI 1.034-1.147) and its cumulative effect (HR 1.085 per area, 95% CI 1.050-1.122), whereas PaCO2 was found to be insignificant.
Conclusion: VR, which reflects ventilatory inefficiency, should be closely monitored during invasive mechanical ventilation. Cumulative exposure to high intensities of VR may be associated with increased mortality in patients with ARDS.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
