Predictive value analysis of mechanical power in the weaning outcome of ARDS patients with adaptive mechanical ventilation plus intelligent trigger mode_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CHEN Yue ¹ ,  LI Xiaodong ¹ , LI Tian ² , XU Peifeng ³ , LIU Jingyu ² , FU Haiyan ¹ , HU Zhansheng ¹ , DI Xingwei ¹

1. The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P. R. China;
2. The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, P. R. China;
3. The Shaw Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang 315000, P. R. China;

Corresponding author：

LI Xiaodong, Email: 1303627356@qq.com

Keywords：

Acute respiratory distress syndrome; adaptive mechanical ventilation; mechanical power; weaning

DOI：

10.7507/1671-6205.202107063

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Objective To investigate the predictive value of mechanical power (MP) in the weaning outcome of adaptive mechanical ventilation plus intelligent trigger (AMV+IntelliCycle, simply called AMV) mode for acute respiratory distress syndrome (ARDS) patients. Methods From November 2019 to March 2021, patients with mild to moderate ARDS who were treated with invasive mechanical ventilation in the intensive care unit of the First Affiliated Hospital of Jinzhou Medical University were divided into successful weaning group and failed weaning group according to the outcome of weaning. All patients were treated with AMV mode during the trial. The MP, oral closure pressure (P0.1), respiratory rate (RR) and tidal volume (V_T) of the two groups were compared 30 min and 2 h after spontaneous breathing trial (SBT). The correlation between 30 min and 2 h MP and shallow rapid respiratory index (RSBI) was analyzed by Pearson correlation. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of 30 min MP in ARDS patients with AMV mode weaning failure. Results Sixty-eight patients were included in the study, 49 of them were successfully removed and 19 of them failed. There was no statistical significance in age, gender, body mass index, oxygenation index, acute physiology and chronic health evaluation Ⅱ score, reasons for mechanical ventilation (respiratory failure, sepsis, intracranial lesions, and others) between the two groups (all P>0.05). The MP, P0.1 and RR at SBT 30 min and 2 h of the successful weaning group was lower than those of the failed weaning group (all P<0.05), but the V_T of the successful weaning group was higher than the failed weaning group (all P<0.05). There was a significant relation between the MP at SBT 30 min and 2 h and RSBI (r value was 0.640 and 0.702 respectively, both P<0.05). The area under ROC curve of MP was 0.674, 95% confidence interval was 0.531 - 0.817, P value was 0.027, sensitivity was 71.73%, specificity was 91.49%, positive predictive value was 0.789, negative predictive value was 0.878, optimal cutoff value was 16.500. The results showed that 30 min MP had a good predictive value for the failure of weaning in AMV mode in ARDS patients. Conclusion MP can be used as an accurate index to predict the outcome of weaning in ARDS patients with AMV mode.

Citation： CHEN Yue, LI Xiaodong, LI Tian, XU Peifeng, LIU Jingyu, FU Haiyan, HU Zhansheng, DI Xingwei. Predictive value analysis of mechanical power in the weaning outcome of ARDS patients with adaptive mechanical ventilation plus intelligent trigger mode. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(2): 112-117. doi: 10.7507/1671-6205.202107063 Copy

1.	李晓东, 李甜, 邸兴伟. 基于肺动脉压力导向的最佳呼气末正压对ARDS患者氧合指数及血流动力学的影响研究. 中国急救医学, 2020, 40(7): 619-623.
2.	Banavasi H, Nguyen P, Osman H, et al. Management of ARDS - What works and what does not. Am J Med Sci, 2021, 362(1): 13-23.
3.	Tonna JE, Peltan I, Brown SM, et al. Mechanical power and driving pressure as predictors of mortality among patients with ARDS. Intensive Care Med, 2020, 46(10): 1941-1943.
4.	柳知含, 邸兴伟, 钟磊, 等. 自适应分钟通气+智能触发通气模式在轻中度急性呼吸窘迫综合征患者中的临床应用. 中华危重病急救医学, 2020, 32(1): 20-25.
5.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
6.	Peñuelas O, Frutos-Vivar F, Fernández C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med, 2011, 184(4): 430-437.
7.	Pensier J, de Jong A, Hajjej Z, et al. Effect of lung recruitment maneuver on oxygenation, physiological parameters and mortality in acute respiratory distress syndrome patients: a systematic review and meta-analysis. Intensive Care Med, 2019, 45(12): 1691-1702.
8.	Schreiber AF, Ceriana P, Ambrosino N, et al. Physiotherapy and weaning from prolonged mechanical ventilation. Respir Care, 2019, 64(1): 17-25.
9.	Maia LA, Samary CS, Oliveira MV, et al. Impact of different ventilation strategies on driving pressure, mechanical power, and biological markers during open abdominal surgery in rats. Anesth Analg, 2017, 125(4): 1364-1374.
10.	李晓东, 李甜, 郝春艳, 等. 自适应支持通气+智能模式对老年慢阻肺合并呼吸衰竭患者呼吸力学的影响. 中国老年学杂志, 2020, 40(14): 2979-2981.
11.	Arnal JM, Saoli M, Garnero A. Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients. Heart Lung, 2020, 49(4): 427-434.
12.	Becher T, Adelmeier A, Frerichs I, et al. Adaptive mechanical ventilation with automated minimization of mechanical power-a pilot randomized cross-over study. Crit Care, 2019, 23(1): 338.
13.	谢永鹏, 钱颖, 刘克喜, 等. ARDS患者机械功与肺部超声评分的相关性以及二者对预后的评估价值. 中华危重病急救医学, 2019, 31(6): 704-708.
14.	Spassov S, Wenzel C, Lozano-Zahonero S, et al. Sine ventilation in lung injury models: a new perspective for lung protective ventilation. Sci Rep, 2020, 10(1): 11690.
15.	Beloncle F, Piquilloud L, Olivier PY, et al. Accuracy of P0.1 measurements performed by ICU ventilators: a bench study. Ann Intensive Care, 2019, 9(1): 104.
16.	Albaiceta GM, Blanch L. Beyond volutrauma in ARDS: the critical role of lung tissue deformation. Crit Care, 2011, 15(2): 304.
17.	Sato R, Hasegawa D, Hamahata NT, et al. The predictive value of airway occlusion pressure at 100 msec (P0.1) on successful weaning from mechanical ventilation:a systematic review and meta-analysis. J Crit Care, 2021, 63: 124-132.
18.	Silva PL, Ball L, Rocco PRM, et al. Power to mechanical power to minimize ventilator-induced lung injury?. Intensive Care Med Exp, 2019, 7(Suppl 1): 38.
19.	Akoumianaki E, Lyazidi A, Rey N, et al. Mechanical ventilation-induced reverse-triggered breaths: a frequently unrecognized form of neuromechanical coupling. Chest, 2013, 143(4): 927-938.
20.	Goligher EC, Brochard LJ, Reid WD, et al. Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure. Lancet Respir Med, 2019, 7(1): 90-98.

1. 李晓东, 李甜, 邸兴伟. 基于肺动脉压力导向的最佳呼气末正压对ARDS患者氧合指数及血流动力学的影响研究. 中国急救医学, 2020, 40(7): 619-623.
2. Banavasi H, Nguyen P, Osman H, et al. Management of ARDS - What works and what does not. Am J Med Sci, 2021, 362(1): 13-23.
3. Tonna JE, Peltan I, Brown SM, et al. Mechanical power and driving pressure as predictors of mortality among patients with ARDS. Intensive Care Med, 2020, 46(10): 1941-1943.
4. 柳知含, 邸兴伟, 钟磊, 等. 自适应分钟通气+智能触发通气模式在轻中度急性呼吸窘迫综合征患者中的临床应用. 中华危重病急救医学, 2020, 32(1): 20-25.
5. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
6. Peñuelas O, Frutos-Vivar F, Fernández C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med, 2011, 184(4): 430-437.
7. Pensier J, de Jong A, Hajjej Z, et al. Effect of lung recruitment maneuver on oxygenation, physiological parameters and mortality in acute respiratory distress syndrome patients: a systematic review and meta-analysis. Intensive Care Med, 2019, 45(12): 1691-1702.
8. Schreiber AF, Ceriana P, Ambrosino N, et al. Physiotherapy and weaning from prolonged mechanical ventilation. Respir Care, 2019, 64(1): 17-25.
9. Maia LA, Samary CS, Oliveira MV, et al. Impact of different ventilation strategies on driving pressure, mechanical power, and biological markers during open abdominal surgery in rats. Anesth Analg, 2017, 125(4): 1364-1374.
10. 李晓东, 李甜, 郝春艳, 等. 自适应支持通气+智能模式对老年慢阻肺合并呼吸衰竭患者呼吸力学的影响. 中国老年学杂志, 2020, 40(14): 2979-2981.
11. Arnal JM, Saoli M, Garnero A. Airway and transpulmonary driving pressures and mechanical powers selected by INTELLiVENT-ASV in passive, mechanically ventilated ICU patients. Heart Lung, 2020, 49(4): 427-434.
12. Becher T, Adelmeier A, Frerichs I, et al. Adaptive mechanical ventilation with automated minimization of mechanical power-a pilot randomized cross-over study. Crit Care, 2019, 23(1): 338.
13. 谢永鹏, 钱颖, 刘克喜, 等. ARDS患者机械功与肺部超声评分的相关性以及二者对预后的评估价值. 中华危重病急救医学, 2019, 31(6): 704-708.
14. Spassov S, Wenzel C, Lozano-Zahonero S, et al. Sine ventilation in lung injury models: a new perspective for lung protective ventilation. Sci Rep, 2020, 10(1): 11690.
15. Beloncle F, Piquilloud L, Olivier PY, et al. Accuracy of P0.1 measurements performed by ICU ventilators: a bench study. Ann Intensive Care, 2019, 9(1): 104.
16. Albaiceta GM, Blanch L. Beyond volutrauma in ARDS: the critical role of lung tissue deformation. Crit Care, 2011, 15(2): 304.
17. Sato R, Hasegawa D, Hamahata NT, et al. The predictive value of airway occlusion pressure at 100 msec (P0.1) on successful weaning from mechanical ventilation:a systematic review and meta-analysis. J Crit Care, 2021, 63: 124-132.
18. Silva PL, Ball L, Rocco PRM, et al. Power to mechanical power to minimize ventilator-induced lung injury?. Intensive Care Med Exp, 2019, 7(Suppl 1): 38.
19. Akoumianaki E, Lyazidi A, Rey N, et al. Mechanical ventilation-induced reverse-triggered breaths: a frequently unrecognized form of neuromechanical coupling. Chest, 2013, 143(4): 927-938.
20. Goligher EC, Brochard LJ, Reid WD, et al. Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure. Lancet Respir Med, 2019, 7(1): 90-98.

Chinese Journal of Respiratory and Critical Care Medicine

Predictive value analysis of mechanical power in the weaning outcome of ARDS patients with adaptive mechanical ventilation plus intelligent trigger mode

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