The value of mechanical power to predict the potential of lung recruitment maneuvers and assess prognosis in patients with acute respiratory distress syndrome
10.3760/cma.j.issn.1671-0282.2019.12.015
- VernacularTitle: 机械功对急性呼吸窘迫综合征患者肺复张潜能及预后的评估
- Author:
Yongpeng XIE
1
;
Kexi LIU
1
;
Yanli WANG
2
;
Suxia LIU
1
;
Hui ZHENG
1
;
Lijuan CAO
1
;
Xiaomin LI
2
Author Information
1. Department of Critical Care Medicine, Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang 222000, China
2. Department of Emergency Medicine, Hospital of Lianyungang Affiliated to Xuzhou Medical University, Lianyungang 222000, China
- Publication Type:Clinical Trail
- Keywords:
Acute respiratory distress syndrome;
Mechanical power;
Recruitment maneuver potential;
Lung ultrasound score;
Prognosis
- From:
Chinese Journal of Emergency Medicine
2019;28(12):1533-1538
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the value of mechanical power (MP) to predict the potential of the lung recruitment maneuver and assess prognoses in patients with acute respiratory distress syndrome (ARDS).
Methods:Patients with moderate-to-severe ARDS who required mechanical ventilation therapy longer than 24 hours were randomly selected April 2017 to April 2019. The lung recruitment maneuver (RM) protocol was performed according to the patient's condition, their MP, lung ultrasound score (LUS), oxygenation index (P/F), and dead volume ratio (Vd/Vt), which were monitored before the RM and one hour after the RM. The patients were divided into the lung recruitment maneuver potential positive group (RMP-P group) and lung recruitment maneuver potential negative group (RMP-N group) according to whether the variation in the patient's RM aeration score (ΔLUS) was≥5. Differences in MP between the two groups were compared and correlations between MP variation (ΔMP), aeration score variation (ΔLUS), oxygenation index variation (ΔP/F), and dead volume ratio variation (ΔVd/Vt) were analyzed. The receiver operating characteristic curve (ROC) was used to calculate the predictive value of MP for the potential of RM and the prognosis (28-day mortality) of patients with moderate or severe ARDS.
Results:Eighty-three patients were enrolled in the study, 45 in the RMP-P group and 38 in the RMP-N group. There was no statistical difference in the baseline levels between the two groups (P>0.05). After RM treatment, MP, LUS scores, and Vd/Vt for each patient in the two groups decreased significantly compared to the pre-RM values, whereas, the P/F increased significantly (P<0.05). The MP, LUS scores, and Vd/Vt in the RMP-P group were significantly lower than those in the RMP-N group (P<0.05), whereas there was no difference in the P/F between the two groups after RM treatment (P>0.05). The ΔMP, ΔLUS, and ΔVd/Vt in the RMP-P group were significantly higher than those in the RMP-N group (P<0.05). There was no difference in the ΔP/F between the two groups (P>0.05). There was a significant positive correlation between ΔMP and ΔLUS and ΔVd/Vt in all patients (r=0.4746, 0.3995, P<0.01) and no significant correlation withΔP/F (r=0.0314, P>0.05). The area under the ROC curves of ΔMP for predicting the potential of RM was 0.856, with a sensitivity of 91.1% and a specificity of 63.2%. The AUC of the 28-day survival status was 0.788, with a sensitivity of 84.3% and a specificity of 62.5% (P<0.05).
Conclusions:Mechanical power monitoring before and after RM can be used to predict the potential of the lung recruitment maneuver and assess the prognosis in patients with moderate-to-severe ARDS.
