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
{"title":"墨西哥急性呼吸窘迫综合征机械通气患者呼吸频率特异性四分位数的死亡风险评估","authors":"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","doi":"10.1007/s11739-025-04112-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Material and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessment of mortality risk by respiratory rate-specific quartiles in mechanically ventilated patients with acute respiratory distress syndrome in Mexico.\",\"authors\":\"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\",\"doi\":\"10.1007/s11739-025-04112-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Material and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":13662,\"journal\":{\"name\":\"Internal and Emergency Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-09-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Internal and Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11739-025-04112-0\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Internal and Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11739-025-04112-0","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
目的：呼吸速率（RR）是急性呼吸窘迫综合征（ARDS）机械通气（MV）设置的一个基本参数，RR的升高可能与更高的肺能量传递相关，从而增加肺损伤和炎症，从而导致死亡。需要建立RR范围，以便识别有死亡风险的ARDS患者。因此，本研究旨在评估墨西哥一组接受MV治疗的ARDS患者的RR四分位数与死亡率之间的关系。材料和方法：这项回顾性、观察性、纵向研究是在三级保健中心的重症监护病房进行的。2016年1月1日至2022年12月31日期间入院的190例患者根据柏林标准诊断为ARDS，其中158例符合纳入标准。采用单变量和多变量Cox回归模型，以及Kaplan-Meier生存分析和log-rank检验来评估临床预后因素对死亡率的影响。结果：多变量Cox回归显示，身体质量指数（BMI）（危险比[HR] = 1.05, 95%可信区间[CI] 1.012-1.08; p = 0.008）和RR （HR = 1.13, 95% CI 1.004-1.26; p = 0.043）是预测ARDS合并MV患者死亡率的危险因素。当RR的预测能力得到确认后，根据RR四分位数（Q1: 18-23次/ min (bpm)， Q2: 24次/ min， Q3: 25-26次/ min， Q4: 27-35次/ min）对患者进行分层，并分别进行分析。RR Q4与不良结局独立相关（HR = 1.959, 95% CI 1.221-3.142; p = 0.005）。在校正BMI和吸烟影响的Cox比例风险模型中，RR Q4是预测死亡率的独立危险因素（HR = 1.944, 95% CI 1.208-3.129; p = 0.006）。结论：这些结果表明，Q4 RR （27-35 bpm）具有重要的预测价值，可以作为ARDS和MV患者疾病严重程度的标志和潜在的可修改靶标。
Assessment of mortality risk by respiratory rate-specific quartiles in mechanically ventilated patients with acute respiratory distress syndrome in Mexico.
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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