Dataset Information

Product of driving pressure and respiratory rate for predicting weaning outcomes.

ABSTRACT:

Objective

Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning.

Methods

Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH₂O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated.

Results

Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH₂O breaths/minute in the success group and 230.2±52.2 cmH₂O breaths/minute in the failure group. A DP×RR index >170.8 cmH₂O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning.

Conclusions

Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure.Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3.

SUBMITTER: Gong J

PROVIDER: S-EPMC8113923 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Product of driving pressure and respiratory rate for predicting weaning outcomes.

Gong Ju J Zhang Bibo B Huang Xiaowen X Li Bin B Huang Jian J

The Journal of international medical research 20210501 5

<h4>Objective</h4>Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning.<h4>Methods</h4>Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH<sub>2</sub>O. Pplat and ...[more]

PMID: 33969736

Similar Datasets

Project description:Rationale: Clinicians commonly use short-term physiologic markers to assess the benefit of ventilator adjustments. Improved arterial oxygen tension/pressure (PaO2)/fraction of inspired oxygen (FiO2) after ventilator adjustment in acute respiratory distress syndrome is associated with lower mortality. However, as driving pressure (ΔP) reflects lung stress and strain, changes in ΔP may more accurately reflect benefits or harms of ventilator adjustments compared with changes in oxygenation.Objectives: We aimed to compare the association between mortality and the changes in PaO2/FiO2 and ΔP following protocolized ventilator changes.Methods: We assessed associations between mortality and changes in PaO2/FiO2 (ΔPaO2/FiO2) and ΔP (ΔΔP) after postrandomization positive end-expiratory pressure (PEEP) and tidal volume adjustment in reanalyses of the ALVEOLI (Assessment of Low Tidal Volume and Elevated End-Expiratory Volume to Obviate Lung Injury) and ExPress (Expiratory Pressure) trials. We included subjects with available pre- and postintervention PaO2/FiO2 and ΔP (372 in ALVEOLI and 596 in ExPress). In each separate trial cohort, we performed multivariable Cox regression testing the association between ΔPaO2/FiO2 and ΔΔP with mortality.Results: In ALVEOLI, when analyzed as separate variables, ΔPaO2/FiO2 was associated with mortality only in subjects in whom PEEP increased, whereas ΔΔP was associated with mortality irrespective of direction of PEEP change. When modeled together, improved ΔPaO2/FiO2 was not associated with mortality, whereas ΔΔP remained associated with mortality (adjusted hazard ratio [aHR], 1.50 per 5 cm H2O increase; 95% confidence interval [95% CI], 1.21-1.85). When modeled together in ExPress, ΔΔP (aHR, 1.42; 95% CI, 1.14-1.78) was more strongly associated with mortality than ΔPaO2/FiO2 (aHR, 0.95 per 25 mm Hg increase; 95% CI, 0.90-1.00).Conclusions: Reduced ΔP following protocolized ventilator changes was more strongly and consistently associated with lower mortality than was increased PaO2/FiO2, making ΔΔP more informative about benefit from ventilator adjustments. Our results reinforce the primacy of ΔP, rather than oxygenation, as the key variable associated with outcome.

Project description:ImportanceMechanical power and driving pressure have known associations with survival for patients with acute respiratory distress syndrome.ObjectivesTo further understand the relative importance of mechanical power and driving pressure as clinical targets for ventilator management.DesignSecondary observational analysis of randomized clinical trial data.Setting and participantsPatients with the acute respiratory distress syndrome from three Acute Respiratory Distress Syndrome Network trials.Main outcomes and measuresAfter adjusting for patient severity in a multivariate Cox proportional hazards model, we examined the relative association of driving pressure and mechanical power with hospital mortality. Among 2,410 patients, the relationship between driving pressure and mechanical power with mortality was modified by respiratory rate, positive end-expiratory pressure, and flow.ResultsAmong patients with low respiratory rate (< 26), only power was significantly associated with mortality (power [hazard ratio, 1.82; 95% CI, 1.41-2.35; p < 0.001] vs driving pressure [hazard ratio, 1.01; 95% CI, 0.84-1.21; p = 0.95]), while among patients with high respiratory rate, neither was associated with mortality. Both power and driving pressure were associated with mortality at high airway flow (power [hazard ratio, 1.28; 95% CI, 1.15-1.43; p < 0.001] vs driving pressure [hazard ratio, 1.15; 95% CI, 1.01-1.30; p = 0.041]) and neither at low flow. At low positive end-expiratory pressure, neither was associated with mortality, whereas at high positive end-expiratory pressure (≥ 10 cm H2O), only power was significantly associated with mortality (power [hazard ratio, 1.22; 95% CI, 1.09-1.37; p < 0.001] vs driving pressure [hazard ratio, 1.16; 95% CI, 0.99-1.35; p = 0.059]).Conclusions and relevanceThe relationship between mechanical power and driving pressure with mortality differed within severity subgroups defined by positive end-expiratory pressure, respiratory rate, and airway flow.

Project description:Driving pressure (DP) is a marker of severity of lung injury in patients with acute respiratory distress syndrome (ARDS) and has a strong association with outcome. However, it is uncertain whether limiting DP can reduce the mortality of patients with acute hypoxemic respiratory failure (AHRF). Therefore, this study aimed to determine the correlation between the initial DP setting and the clinical outcomes of patients with AHRF upon their initial admission to the intensive care unit (ICU). The Medical Information Mart for Intensive Care IV (MIMIC-IV) database was used to search the data of patients with AHRF, with 180-day mortality representing the primary outcome. Multiple regression analysis was subsequently performed to evaluate the initial DP and 180-day mortality association. The reliability of the results was validated using restricted cubic splines and interaction studies. This study retrospectively analyzed data from 907 patients-581 (64.06%) in the survival group and 326 (35.94%) in the nonsurvival group (NSG)-who were followed up 180 days after admission. The results revealed that an elevated initial DP was significantly correlated with 180-day mortality (HR 1.071 (95% CI 1.040, 1.102)), especially when the initial DP exceeded 12 cmH2O. AHRF patients with an initial DP > 12 cmH2O had significantly greater mortality at 28 days (p = 0.0082), 90 days (p = 0.0083), and 180 days (p = 0.0039) than those with an initial DP ≤ 12 cmH2O. Among severe patients with AHRF, 180-day mortality was significantly greater in the group with an initial DP > 12 cmH2O than in the group with an initial DP ≤ 12 cmH2O (p = 0.029). The hospital length of stay (LOS) for patients with an initial DP < 12 cmH2O was significantly longer than that for those with an initial DP > 12 cmH2O (p = 0.029). Among patients with AHRF and an initial DP > 12 cmH2O, the survival group had a significantly longer LOS in the ICU than the NSG (p = 0.00026). The initial DP settings were correlated with 180-day mortality among patients with AHRF admitted to the ICU. Particularly for patients with AHRF, it is crucial to consider implementing early restrictive DP ventilation as a potential means to mitigate mortality, and close monitoring is essential to evaluate its impact.

Project description:ObjectivesDriving pressure (ratio of tidal volume over respiratory system compliance) is associated with mortality in acute respiratory distress syndrome. We sought to evaluate if such association could be identified in critically ill children.DesignWe studied the association between driving pressure on day 1 of mechanical ventilation and ventilator-free days at day 28 through secondary analyses of prospectively collected physiology data.SettingMedical-surgical university hospital PICU.PatientsChildren younger than 18 years (stratified by Pediatric Mechanical Ventilation Consensus Conference clinical phenotype definitions) without evidence of spontaneous respiration.InterventionsInspiratory hold maneuvers.Measurements and main resultsData of 222 patients with median age 11 months (2-51 mo) were analyzed. Sixty-five patients (29.3%) met Pediatric Mechanical Ventilation Consensus Conference criteria for restrictive and 78 patients (35.1%) for mixed lung disease, and 10.4% of all patients had acute respiratory distress syndrome. Driving pressure calculated by the ratio of tidal volume over respiratory system compliance for the whole cohort was 16 cm H2O (12-21 cm H2O) and correlated with the static airway pressure gradient (plateau pressure minus positive end-expiratory pressure) (Spearman correlation coefficient = 0.797; p < 0.001). Bland-Altman analysis showed that the dynamic pressure gradient (peak inspiratory pressure minus positive end-expiratory pressure) overestimated driving pressure (levels of agreement -2.295 to 7.268). Rematching the cohort through a double stratification procedure (obtaining subgroups of patients with matched mean levels for one variable but different mean levels for another ranking variable) showed a reduction in ventilator-free days at day 28 with increasing driving pressure in patients ventilated for a direct pulmonary indication. Competing risk regression analysis showed that increasing driving pressure remained independently associated with increased time to extubation (p < 0.001) after adjusting for Pediatric Risk of Mortality III 24-hour score, presence of direct pulmonary indication jury, and oxygenation index.ConclusionsHigher driving pressure was independently associated with increased time to extubation in mechanically ventilated children. Dynamic assessments of driving pressure should be cautiously interpreted.

Project description:ObjectivesPrevious studies have suggested that heart rate and blood pressure play important roles in the development of adverse outcomes in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). However, the relationship between the rate pressure product (RPP) and long-term outcomes has rarely been investigated. This study investigated the effects of RPP on the clinical outcomes of patients with CAD who underwent PCI.DesignIn this study, a total of 6015 patients with CAD were enrolled. All patients were from the CORFCHD-PCI (Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI) Study. They were divided into two groups according to RPP (RPP <10 269, n=4018 and RPP ≥10 269, n=1997). In addition, the median follow-up time was 32 months.ParticipantsData was obtained from 6050 patients with CAD who underwent PCI at the First Affiliated Hospital of Xinjiang Medical University from January 2008 to December 2016.Primary and secondary outcome measuresThe primary endpoint was long-term mortality, including all-cause mortality (ACM) and cardiac mortality (CM). The secondary endpoints were major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs).ResultsWe found that there were significant differences between the two groups in the incidence of ACM, CM, MACCEs and MACEs (all p<0.05). Among the patients with CAD having ACM, CM, MACCEs and MACEs, the mean survival time of the low-value group was significantly higher than that of the high-value group. Multivariate Cox regression analyses showed that RPP was an independent predictor for ACM (HR=1.605, 95% CI: 1.215-2.120, p=0.001), CM (HR=1.733, 95% CI: 1.267-2.369, p=0.001), MACCEs (HR=1.271, 95% CI: 1.063-1.518, p=0.008) and MACEs (HR=1.315, 95% CI: 1.092-1.584, p=0.004) in patients with stable CAD. On the other hand, there was no significant correlation between the RPP and the adverse outcomes in patients with acute coronary syndrome.ConclusionIn summary, RPP is an independent predictor of long-term prognosis in patients with CAD who underwent PCI. A higher baseline RPP before PCI increased the risk of adverse outcomes. Compared with heart rate and blood pressure alone, RPP has a higher predictive value for adverse clinical outcomes.

Dataset Information

Product of driving pressure and respiratory rate for predicting weaning outcomes.

Objective

Methods

Results

Conclusions

Publications

Product of driving pressure and respiratory rate for predicting weaning outcomes.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets