Dataset Information

Twenty-four-hour mechanical power variation rate is associated with mortality among critically ill patients with acute respiratory failure: a retrospective cohort study.

ABSTRACT:

Objectives

Defined as the energy applied to the respiratory system by ventilator, mechanical power (MP) of ventilation reflects the risk of ventilation-induced lung injury. This study aims to explore the relationship between dynamic changes in MP and prognosis in critically ill patients.

Methods

This was a single-centre retrospective cohort study. Patients receiving mechanical ventilation with acute respiratory failure (ARF) and MP > 10 J/min on admission in the ICU were included. MP (J/min) was calculated as 0.098 × minute ventilation (L/min) × [(peak inspiratory pressure + positive end-expiratory pressure)/2] and the MP variation rate (%) as ([baseline MP - 24-h MP]/baseline MP) × 100. Patients were divided into two groups according to whether MP decreased 24 h after admission (MP-improved group defined as 24-h MP variation rate > 0% vs. MP-worsened group defined as 24-h MP variation rate ≤ 0%).

Results

In total, 14,463 patients were screened between January 2015 and June 2020, and finally, a study cohort of 602 patients was obtained. The MP-improved group had a lower ICU mortality rate than the MP-worsened group (24% vs. 36%; p = 0.005). The 24-h MP variation rate was associated with ICU mortality after adjusting for confounders (odds ratio, 0.906 [95% CI 0.833-0.985]; p = 0.021), while baseline MP (p = 0.909) and 24-h MP (p = 0.059) were not. All MP components improved in the MP-improved group, while minute ventilation and positive end-expiratory pressure contributed to the increase in MP in the MP-worsened group.

Conclusions

The 24-h MP variation rate was an independent risk factor for ICU mortality among ARF patients with elevated MP. Early decreases in MP may provide prognostic benefits in this population.

SUBMITTER: Chi Y

PROVIDER: S-EPMC8543779 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

Twenty-four-hour mechanical power variation rate is associated with mortality among critically ill patients with acute respiratory failure: a retrospective cohort study.

Chi Yi Y Zhang Qing Q Yuan Siyi S Zhao Zhanqi Z Long Yun Y He Huaiwu H

BMC pulmonary medicine 20211025 1

<h4>Objectives</h4>Defined as the energy applied to the respiratory system by ventilator, mechanical power (MP) of ventilation reflects the risk of ventilation-induced lung injury. This study aims to explore the relationship between dynamic changes in MP and prognosis in critically ill patients.<h4>Methods</h4>This was a single-centre retrospective cohort study. Patients receiving mechanical ventilation with acute respiratory failure (ARF) and MP > 10 J/min on admission in the ICU were included. ...[more]

PMID: 34696739

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Project description:BackgroundAcute respiratory failure (ARF) is the leading cause of ICU admission. Viruses are increasingly recognized as a cause of pneumonia in immunocompromised patients, but epidemiologic data are scarce. We used the Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie's database (2003-2017, 72 intensive care units) to describe the spectrum of critically ill immunocompromised patients with virus-detected ARF and to report their outcomes. Then, patients with virus-detected ARF were matched based on clinical characteristics and severity (1:3 ratio) with patients with ARF from other origins.ResultsOf the 4038 immunocompromised patients in the whole cohort, 370 (9.2%) had a diagnosis of virus-detected ARF and were included in the study. Influenza was the most common virus (59%), followed by respiratory syncytial virus (14%), with significant seasonal variation. An associated bacterial infection was identified in 79 patients (21%) and an invasive pulmonary aspergillosis in 23 patients (6%). The crude in-hospital mortality rate was 37.8%. Factors associated with mortality were: neutropenia (OR = 1.74, 95% confidence interval, CI [1.05-2.89]), poor performance status (OR = 1.84, CI [1.12-3.03]), and the need for invasive mechanical ventilation on the day of admission (OR = 1.97, CI [1.14-3.40]). The type of virus was not associated with mortality. After matching, patients with virus-detected ARF had lower mortality (OR = 0.77, CI [0.60-0.98]) than patients with ARF from other causes. This result was mostly driven by influenza-like viruses, namely, respiratory syncytial virus, parainfluenza virus, and human metapneumovirus (OR = 0.54, CI [0.33-0.88]).ConclusionsIn immunocompromised patients with virus-detected ARF, mortality is high, whatever the species, mainly influenced by clinical severity and poor general status. However, compared to non-viral ARF, in-hospital mortality was lower, especially for patients with detected viruses other than influenza.

Dataset Information

Twenty-four-hour mechanical power variation rate is associated with mortality among critically ill patients with acute respiratory failure: a retrospective cohort study.

Objectives

Methods

Results

Conclusions

Publications

Twenty-four-hour mechanical power variation rate is associated with mortality among critically ill patients with acute respiratory failure: a retrospective cohort study.

Similar Datasets

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