Investigation of mechanical ventilation pressure parameters’ effect on the prognosis of acute respiratory distress syndrome

Abstract

Objective To find out whether we can get the optimality in the prognosis of acute respiratory distress syndrome (ARDS) by combing the pressure parameters in mechanical ventilation with traditional PaO2/FiO2. Methods This is a retrospective study. Patients included here were diagnosed as ARDS in the Emergency Unit (EICU) of the First Affiliated Hospital of China Medical University from January 2018 to December 2018. All the patients were intubated and mechanically ventilated. Patients with a short observation time (< 48 h) or unable to cooperate with treatment were excluded. According to the patient's 28-day survival, patients were divided into the survival and non-survival groups. Parameters in the two groups such as basic characteristics, SOFA score, non-respiratory system SOFA score (nR-SOFA), and PaO2/FiO2 were analyzed with LSD-t test or rank sum test. Simultaneously, plateau pressure, driving pressure, mean airway pressure and the ratio of these mechanical ventilation pressure parameters to the PaO2/FiO2 were also analyzed. Results A total of 147 patients were included in the study and 117 of them were analyzed. The overall 28-day mortality was 31.62% (n=37). There were no significant differences in gender, age, body mass index, initial arterial oxygen partial pressure and carbon dioxide partial pressure between the survival group and non-survival groups (P >0.05). But there was a significant difference in SOFA score(6.53 ± 2.96 vs 8.65 ± 3.00) and nR -SOFA(3.44 ± 2.98 vs 5.27 ± 2.86). Among the evaluation indexes, the PPOI obtained the AUC of 0.828, with the sensitivity of 86.5%, and specificity of 71.2%.The AUC of the SOFA score was 0.707, while the AUC of the PPOI combined with the SOFA score was 0.833. Conclusion Mechanical ventilation pressure parameters can be used to predict the prognosis of patients with ARDS. PPOI may evaluate the prognosis of ARDS in a more simple, timely and real-time manner. Key words: Acute respiratory distress syndrome; Plateau pressure; Driving pressure; Mean airway pressure; Plateau pressure oxygenation index; Prognosis