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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2024年06期

页码:

942-947

栏目:

论著

出版日期:

2024-12-25

文章信息/Info

Title:

Prognostic significance of dead space fraction in acute respiratory distress syndrome

作者:

陈 丽; 郭俊氚; 马红梅; 刘遵季

830001 乌鲁木齐,新疆维吾尔自治区人民医院重症医学科

Author(s):

Chen Li;  Guo Juntai;  Ma Hongmei;  Liu Zunji.

Department of Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi, Xinjiang 830001, China

关键词:

急性呼吸窘迫综合征;  计算死腔分数;  病死率;  VD/VT_phys;  VD/VT_HB

Keywords:

Acute respiratory distress syndrome;  Estimation of dead cavity score;  Mortality;  VD/VT_phys;  VD/VT_HB

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2024.06.016

摘要:

目的 分析死腔分数(dead cavity score, VD/VT)对急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)预后预测意义。方法 选择2021年3月至2024年3月我院收治的86例ARDS患者,院内死亡49例为观察组,存活37例为对照组。入院后第1天和第3天记录急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ, APACHEⅡ)及呼气终末正压(positive end-expiratory pressure, PEEP)、氧合指数(PaO₂/FiO₂),院内病死率。每6 h进行血气检查,采用Harris-Benedict公式(VD/VT_HB)及生理变量直接估计公式(VD/VT_phys)计算VD/VT。使用限制性三次样条(restricted cubic splines, RCS)分析VD/VT_phys、VD/VT_HB与病死率的关联。绘制受试者工作特征(receiver operating characteristic, ROC)曲线分析预测ARDS院内预后的曲线下面积(area under the curve, AUC)。结果 观察组第1天及第3天的VD/VT_phys(0.56±0.04)、(0.59±0.06),VD/VT_HB(0.57±0.07)、(0.59±0.08)高于对照组第1天及第3天的VD/VT_phys(0.60±0.05)、(0.63±0.05),VD/VT_HB(0.62±0.08)、(0.66±0.08)(P<0.05)。观察组第3天 VD/VT_phys(0.63±0.05)、VD/VT_HB(0.66±0.08)较第1天 VD/VT_phys(0.60±0.05)、VD/VT_HB(0.62±0.08)升高,对照组第3天 VD/VT_phys(0.59±0.06)较第1天 VD/VT_phys(0.56±0.04)升高。多因素Logistic回归分析显示,第3天VD/VT_phys、VD/VT_HB与ARDS患者院内预后相关(P<0.001)。RCS分析显示,第3天VD/VT_phys或VD/VT_HB与预后风险为非线性关系,VD/VT_HB低于0.58时,呈负相关。入院后第3天APACHEⅡ、PEEP、PaO₂/FiO₂为基础加入第3天VD/VT_phys及VD/VT_HB,提升ARDS院内预后预测(P<0.05)。结论 计算入院后第3天的VD/VT值, VD/VT_phys可预测ARDS院内预后,具有临床意义。

Abstract:

Objective To analyze the prognostic significance of dead cavity score(VD/VT)in acute respiratory distress syndrome(ARDS). Methods A total of 86 ARDS patients admitted to our hospital from March 2021 to March 2024 were selected. 49 of them died in hospital in the observation group and 37 survived in the control group. Acute physiological and chronic health score Ⅱ(APACHEⅡ), positive end-expiratory pressure(PEEP)and oxygenation index(PaO₂/FiO₂)were recorded on the 1st and 3rd day after admission. in-hospital mortality was recorded. Blood gas tests were performed every 6 hours, and VD/VT was calculated using the Harris-Benedict formula(VD/VT_HB)and the direct physiological variable estimation formula(VD/VT_phys). The association between VD/VT_phys, VD/VT_HB and mortality was analyzed using restricted cubic splines(RCS). Receiver operating characteristic(ROC)curve was drawn to analyze the area under the curve(AUC)for predicting in-hospital observation in ARDS. Results VD/VT_phys(0.56±0.04)and(0.59±0.06)on day 1 and day 3 in the death group, VD/VT_HB(0.57±0.07),(0.59±0.08)were higher than those of control group(0.60±0.05),(0.63±0.05), VD/VT_HB(0.62±0.08),(0.66±0.08)on day 1 and day 3(P<0.05). On day 3, VD/VTphys(0.63±0.05)and VD/VT_HB(0.66±0.08)in the observation group were higher than those on day 1, compared with(0.60±0.05)and(0.62±0.08). VD/VT_phys on day 3(0.59±0.06)was higher than that on day 1(0.56±0.04)in control group. Multivariate Logistic regression analysis showed that third dVD/VT_phys and VD/VT_HB were associated with in-hospital death in ARDS patients(P<0.001). RCS analysis showed that the relationship between VD/VT_phys or VD/VT_HB and mortality risk at day 3 was non-linear, with a negative correlation when VD/VTHB was below 0.58. After admission, dVD/VT_phys and VD/VT_HB were added on the basis of dAPACHEⅡ, PEEP and PaO₂/FiO₂ to improve the predictive value of ARDS hospital death(P<0.05). Conclusion Estimation of VD/VT value on the 3rd day after admission can predict the prognosis of ARDS in hospital, which has clinical significance.

参考文献/References:

1 Cao S, Li H, Xin J, et al. Identification of genetic profile and biomarkers involved in acute respiratory distress syndrome[J]. Intensive Care Med, 2024, 50(1): 46-55.
2 徐汉瑾, 杨 英, 张文华, 等. 正压通气时间对急性呼吸窘迫综合征患者死亡率的影响研究[J]. 实用心脑肺血管病杂志, 2021, 29(7): 57-61,67.
3 甘志新, 王 丹, 贺斌峰, 等. 急性呼吸窘迫综合征的诊疗标记物[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(4): 519-522.
4 赵和萌, 李晓娜, 黄圆美, 等. 肺泡死腔分数与急性呼吸窘迫综合征患儿预后分析[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(5): 620-622.
5 Sedhai YR, Yuan M, Ketcham SW, et al. Validating measures of disease severity in acute respiratory distress syndrome[J]. Ann Am Thorac Soc, 2021, 18(7): 1211-1218.
6 Kim JM, Lee JK, Choi SM, et al. Diagnostic and prognostic values of serum activin-a levels in patients with acute respiratory distress syndrome[J]. BMC Pulm Med, 2019, 19(1): 115.
7 Scaramuzzo G, Karbing DS, Ball L, et al. Intraoperative ventilation/perfusion mismatch and postoperative pulmonary complications after major noncardiac surgery: a prospective cohort study[J]. Anesthesiology, 2024, 141(4): 693-706.
8 Leprat T, Ivanes F, Bernard A, et al. Transcutaneous PCO₂^- based dead space ventilation at submaximal exercise accurately discriminates healthy controls from patients with chronic obstructive pulmonary disease[J]. Clin Physiol Funct Imaging, 2021, 41(3): 253-261.
9 Balmain BN, Tomlinson AR, MacNamara JP, et al. Estimating exercise PaCO₂ in patients with heart failure with preserved ejection fraction[J]. J Appl Physiol, 2022, 132(1): 36-45.
10 Beitler JR, Thompson BT, Matthay MA, et al. Estimating dead-space fraction for secondary analyses of acute respiratory distress syndrome clinical trials[J]. Crit Care Med, 2015, 43(5): 1026-1035.
11 Morales-Quinteros L, Neto AS, Artigas A, et al. Dead space estimates may not be independently associated with 28-day mortality in COVID-19 ARDS[J]. Crit Care, 2021, 25(1): 171.
12 Morales-Quinteros L, Schultz MJ, Bringué J, et al. Estimated dead space fraction and the ventilatory ratio are associated with mortality in early ARDS[J]. Ann Intensive Care, 2019, 9(1): 128.
13 ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition[J]. JAMA, 2012, 307(23): 2526-2533.
14 Issaris V, Milas GP, Dragonas CG, et al. The dead space fraction as a prognostic death indicator in patients with ARDS: a systematic review and meta-analysis[J]. Crit Care Med, 2024, 28: 4561-4575.
15 Kallet RH, Lipnick MS. End-tidal-to-arterial PCO₂ ratio as signifier for physiologic dead-space ratio and oxygenation dysfunction in acute respiratory distress syndrome[J]. Respir Care, 2021, 66(2): 263-268.
16 Smith J, Zyl JM. An overview of acute lung injury in general and in particular viral infections with specific reference to nebulized surfactant and anticoagulation[J]. Am Rev Respir Dis, 2020, 2: 1-26.
17 Smadja DM, Mentzer SJ, Fontenay M, et al. COVID-19 is a systemic vascular hemopathy: insight for mechanistic and clinical aspects[J]. Angiogenesis, 2021, 24: 755-788.
18 Chuang ML. Mechanisms affecting exercise ventilatory inefficiency-airflow obstruction relationship in male patients with chronic obstructive pulmonary disease[J]. Respir Res, 2020, 21(1): 206.
19 Chuang ML, Hsieh BY, Lin IF. Resting dead space fraction as related to clinical characteristics, lung function, and gas exchange in male patients with chronic obstructive pulmonary disease[J]. Int J Gen Med, 2021, 14: 169-177.
20 Chuang ML. Hierarchical stratification of the factors related to exertional dyspnoea and exercise intolerance in male COPD patients[J]. Ann Med, 2022, 54(1): 2941-2950.
21 Sinha P, Calfee CS, Beitler JR, et al. Physiologic analysis and clinical performance of the ventilatory ratio in acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2019, 199(3): 333-341.
22 Jayasimhan D, Chieng J, Kolbe J, et al. Dead-space ventilation indices and mortality in acute respiratory distress syndrome: a systematic review and meta-analysis[J]. Crit Care Med, 2023, 51(10): 1363-1372.
23 Oh SB, Aguilan A, Tan HL, et al. The association between alveolar dead space fraction and mortality in pediatric acute respiratory distress syndrome: a prospective cohort study[J]. Front Pediatr, 2022, 10: 814484.
24 马四清, 王志健, 郭利涛. 死腔分数对急性呼吸窘迫综合征治疗指导及预后评价[J]. 中华危重病急救医学, 2022, 34(12): 1333-1336.
25 郭 闯, 储 蕴, 付海燕. 急性呼吸窘迫综合征患者死腔分数与肺部超声评分的相关性及其对预后的评估作用[J]. 中华危重病急救医学, 2022, 34(5): 514-518.
26 Jiang L, Chen H, Xie J, et al. Prognostic value of time-varying dead space estimates in mechanically ventilated patients with acute respiratory distress syndrome[J]. J Intensive Med, 2023, 4(2): 187-193.
27 Balmain BN, Tomlinson AR, MacNamara JP, et al. Physiological dead space during exercise in patients with heart failure with preserved ejection fraction[J]. J Appl Physiol(1985), 2022, 132(3): 632-640.
28 Alkhatib A, Price LL, Esteitie R, et al. A predictive model for acute respiratory distress syndrome mortality using red cell distribution width[J]. Crit Care Res Pract, 2020, 2020: 3832683.
29 Belliato M, Cremascoli L, Epis F, et al. Carbon dioxide elimination during veno-venous extracorporeal membrane oxygenation weaning: a pilot study[J]. ASAIO J, 2021, 67(6): 700-708.
30 Clarkson JM, Martin JE, Sparrey J, et al. Striving for humane deaths for laboratory mice: hypobaric hypoxia provides a potential alternative to carbon dioxide exposure[J]. Proc Biol Sci, 2023, 290(1997): 20222446.
31 Allado E, Poussel M, Valentin S, et al. The fundamentals of respiratory physiology to manage the COVID-19 pandemic: an overview[J]. Front Physiol, 2021, 11: 615690.
32 Yang Y, Chi Y, Yuan S, et al. The relationship between ventilatory ratio(VR)and 28-day hospital mortality by restricted cubic splines(RCS)in 14,328 mechanically ventilated ICU patients[J]. BMC Pulm Med, 2022, 22(1): 229.

备注/Memo

备注/Memo:

基金项目: 新疆维吾尔自治区自然科学基金资助项目(2022D01C600)
通信作者: 刘遵季, Email: Lzj801101@163.com

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更新日期/Last Update: 2024-12-25