Effect of Deep Sedation on Mechanical Power in Moderate to Severe Acute Respiratory Distress Syndrome: A Prospective Self-Control Study

Xie, Yongpeng; Cao, Lijuan; Qian, Ying; Zheng, Hui; Liu, Kexi; Li, Xiaomin

doi:10.1155/2020/2729354

Cited by 13 publications

(16 citation statements)

References 29 publications

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“…The MP between survivors and non-survivors was similar only on Day 18 of ICU admission in all patients statistically. Our study not only con rmed that baseline MP was associated with mortality [11][12][13][14], but also found that the association persisted for 11 days. In the Kaplan-Meier curves of the ARDS group, the two curves were similar within the rst 10 days and separated later evidently.…”

Section: Discussionsupporting

confidence: 73%

“…This implied that the bene t of lower MP required a period of time to develop in patients with more severe pneumonia. Furthermore, deep sedation signi cantly reduced MP in patients with moderate to severe ARDS, thereby reducing the occurrence of VILI [14]. All the above suggested that MP might be the cause of VILI, resulting in increased mortality rate.…”

Section: Discussionmentioning

confidence: 93%

“…Serpa et al reported that MP of ventilation in the rst 48 h is associated with mortality in critically ill patients in two observational cohorts. In patients with ARDS, initial MP was also associated with mortality [12][13][14]. These four studies all used simpli ed equation proposed by Gattinoni et al to calculate MP in patients with volume-controlled ventilation [9,15].…”

Section: The Association Between Mechanical Power and Mortality In Vementioning

confidence: 99%

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The Association Between Mechanical Power and Mortality in Ventilated Patients with Pneumonia

Chu

Chuang

et al. 2020

Preprint

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Background: Recent studies reported that mechanical power (MP) has been associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate the association between 28-day mortality and MP in patients with severe pneumonia. Methods: In total, 313 patients with severe pneumonia were enrolled. Serial MP was recorded daily for either 21 days or until ventilator support was no longer required. The associations between all variables and 28-day mortality were analyzed using binary logistic regression analyses. Results: The ARDS group (106 patients) demonstrated lower age, higher Acute Physiology and Chronic Health Evaluation II score, lower history of diabetes mellitus, high incidences of shock and jaundice, higher MP and driving pressure on Day 1, and higher death within 28 days than the non-ARDS group. Regression analysis revealed that MP was an independent factor associated with 28-day mortality (odds ratio, 1.041; 95% confidence interval, 1.013-1.071). MP persisted high in non-survivors and low in survivors among the ARDS group, the non-ARDS group and all patients.Conclusions: MP was associated with the 28-day mortality in ventilated patients with severe pneumonia both in the ARDS and non-ARDS groups. MP had better predicted value for 28-day mortality than driving pressure.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 93%

Section: The Association Between Mechanical Power and Mortality In Vementioning

confidence: 99%

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The Association Between Mechanical Power and Mortality in Ventilated Patients with Pneumonia

Chu

Chuang

et al. 2020

Preprint

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“…Pulmonary edema became worse over time, the area of lung ventilation gradually decreased or was lost, and MP progressively increased. Higher LUS in the death group represents more severe alveolar collapse, pulmonary edema, and lung consolidation [ 23 ]. In the process of mechanical ventilation, in order to maintain the collapsed lungs in an open state, the ventilator requires more mechanical power [ 19 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation Analysis between Mechanical Power and Lung Ultrasound Score and Their Evaluation of Severity and Prognosis in ARDS Patients

Xie

Liu

Mou

et al. 2021

BioMed Research International

Self Cite

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Background and Objective. During mechanical ventilation, the energy delivered by a ventilator to the respiratory system in one minute is defined as mechanical power (MP). It describes the combined effects of several mechanical factors, including tidal volume, driving pressure, transpulmonary pressure, flow rate, positive end-expiratory pressure, and respiratory rate on lung ventilation. As such, MP may be useful for evaluating the severity and prognosis of acute respiratory distress syndrome (ARDS), as improvements in pulmonary ventilation directly affect a patient’s prognosis. Recent advances in lung ultrasound technology make it possible to evaluate lung ventilation at the bedside. In this study, MP was monitored in ARDS patients, and its correlation with lung ultrasound scores (LUS) was evaluated. Further analysis also explored the value of MP in evaluating the severity and prognosis of ARDS. Methods. A total of 121 patients with moderate to severe ARDS admitted to the intensive care unit (ICU) from June 2017 to April 2020 and treated with invasive mechanical ventilation were sequentially included in this study. Their general information was collected, and MP was recorded at 0 h, 24 h, 48 h, and 72 h after admission to the ICU. Professionally trained researchers performed the LUS assessments. Patients were divided into the death and survival groups according to their 28-day prognosis. The trend of MP and LUS at the four time points was analyzed. A receiver operating characteristic curve (ROC) was used to analyze the predictive value of MP and LUS scores at 0 h and 72 h for the prognosis (28-day mortality rate) of patients with moderate to severe ARDS. Results. 121 patients were included in the analysis, of which 73 were male and 48 were female. When patients entered the ICU, their oxygenation index ( t : 30885, P < 0.01 ), APACHE II score ( t : 2.105, P < 0.05 ), and SOFA score ( t : 4.134, P < 0.001 ) were higher in the death group than the survival group. The death group had significantly higher MP and LUS at each time point (0 h, 24 h, 48 h, and 72 h) compared to the survival group (all P < 0.05 ). There was a significant upward trend over time in the MP and LUS of the death group, contrasting to a significant downward trend in the survival group (all P < 0.05 ). The Pearson correlation analysis showed that MP and LUS were significantly positively correlated at each time point ( r values: 0 h: 0.3027; 24 h: 0.3705; 48 h: 0.3902; 72 h: 0.5916; all P < 0.01 ). The ROC curves showed that MP and LUS at 72 h were of significant value in predicting the prognosis of ARDS patients, with areas under the curve of 0.866 ± 0.032 and 0.839 ± 0.037 , respectively. Conclusion. There was a significant correlation between the MP and LUS of ARDS patients at four time points from 0 to 72 h, which has a clinical value in evaluating severity and prognosis.

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“…Serpa et al reported that the MP of ventilation in the first 48 h is associated with mortality in critically ill patients in two observational cohorts. In patients with ARDS, initial MP was also associated with mortality [11][12][13]. These four studies all used a simplified equation proposed by Gattinoni et al to calculate MP in patients with volume-controlled ventilation [8,14].…”

Section: Introductionmentioning

confidence: 99%

The Association between Mechanical Power and Mortality in Patients with Pneumonia Using Pressure-Targeted Ventilation

Chu

Chuang

et al. 2021

Diagnostics

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Recent studies have reported that mechanical power (MP) is associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate the association between 28-day mortality and MP in patients with severe pneumonia. In total, the data of 313 patients with severe pneumonia were used for analysis. Serial MP was calculated daily for either 21 days or until ventilator support was no longer required. Compared with the non-ARDS group, the ARDS group (106 patients) demonstrated lower age, a higher Acute Physiology and Chronic Health Evaluation II score, lower history of diabetes mellitus, elevated incidences of shock and jaundice, higher MP and driving pressure on Day 1, and more deaths within 28 days. Regression analysis revealed that MP was an independent factor associated with 28-day mortality (odds ratio, 1.048; 95% confidence interval, 1.020–1.077). MP was persistently high in non-survivors and low in survivors among the ARDS group, the non-ARDS group, and all patients. These findings indicate that MP is associated with the 28-day mortality in ventilated patients with severe pneumonia, both in the ARDS and non-ARDS groups. MP had a better predicted value for the 28-day mortality than the driving pressure.

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Effect of Deep Sedation on Mechanical Power in Moderate to Severe Acute Respiratory Distress Syndrome: A Prospective Self-Control Study

Cited by 13 publications

References 29 publications

The Association Between Mechanical Power and Mortality in Ventilated Patients with Pneumonia

The Association Between Mechanical Power and Mortality in Ventilated Patients with Pneumonia

Correlation Analysis between Mechanical Power and Lung Ultrasound Score and Their Evaluation of Severity and Prognosis in ARDS Patients

The Association between Mechanical Power and Mortality in Patients with Pneumonia Using Pressure-Targeted Ventilation

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