Evaluation of sublingual microcirculation on prognosis of elderly patients with severe pneumonia undergoing mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YANG Jinghui ¹ , JIA Ling ¹ , ZHAO Wei ¹ , XUE Xiang ¹ , CHEN Jiao ¹ , CAI Jianqin ¹ , CHEN Kunlun ¹ , GAO Wei ² ,  LI Wei ²

1. Department of Critical Care Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P. R. China;
2. Department of Critical Care Medicine, Hospital of Integrated Traditional Chinese and Western Medicine, Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210023, P. R. China;

Corresponding author：

LI Wei, Email: nightswing@163.com

Keywords：

Severe pneumonia; sublingual microcirculation; mechanical ventilation; weaning; prognosis

DOI：

10.7507/1671-6205.202210054

Video：

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Objective To evaluate the relationship between sublingual microcirculation differences and weaning success rate and prognosis in elderly patients with severe pneumonia. Methods A retrospective observation cohort study was conducted. Forty-two elderly patients with severe pneumonia who underwent mechanical ventilation in the intensive care unit of Sir Run Run Hospital, Nanjing Medical University from February 2022 to August 2022 were recruited in the study. They were divided into a high-flow nasal cannula oxygen group (HFNC group, n=33) and a non-invasive positive pressure ventilation group (NIPPV group, n=9) according to the mode of post-weaning ventilation. The differences of N-terminal brain natriuretic peptide precursor (NT-proBNP), cardiac index (CI) and sublingual microcirculation indexes between the two groups were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of each parameter on weaning success rate and case fatality rate. Results Compared with the NIPPV group, CI, propotion of perfused vessels (PPV) and perfused vessel density (PVD) were higher, and NT-proBNP and total vessel density (TVD) were lower in the HFNC group (all P<0.05). The prediction value of PPV combined with PVD was the largest, with area under the ROC curve (AUC) of 0.875, sensitivity of 75.8%, specificity of 88.9%. CI, NT-proBNP, CI combined with NT-proBNP, PPV, PVD all had predictive value. Compared with the death group, the survival group had higher CI, central venous-to-arterial carbon dioxide difference [P_(v-a)CO₂] and PPV. For the prediction value of weaning success, CI combined with NT-proBNP had the largest predictive value, with AUC of 0.919, sensitivity of 81.8%, specificity of 100.0%, followed by CI. NT-proBNP, PPV, PVD, PPV combined with PVD all had predictive value. Compared with the death group, the survival group had higher CI, P_(v-a)CO₂ and PPV (all P<0.05). For predictive value assessment of 28-day survival rate, CI plus PPV had the largest AUC of 0.875, with sensitivity of 69.4%, and specificity of 100.0%. CI, P_(v-a)CO₂ and PPV all have predictive value. Conclusions Both CI and PPV can be used as predictors of weaning success rate and survival rate. PPV combined with PVD is an ideal predictor of survival rate.

Citation： YANG Jinghui, JIA Ling, ZHAO Wei, XUE Xiang, CHEN Jiao, CAI Jianqin, CHEN Kunlun, GAO Wei, LI Wei. Evaluation of sublingual microcirculation on prognosis of elderly patients with severe pneumonia undergoing mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(1): 18-23. doi: 10.7507/1671-6205.202210054 Copy

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5.	Kanoore Edul VS, Caminos Eguillor JF, Ferrara G, et al. Microcirculation alterations in severe COVID-19 pneumonia. J Crit Care, 2021, 61: 73-75.
6.	Ospina-Tascón GA, Bautista DF, Madriñán HJ, et al. Microcirculatory dysfunction and dead-space ventilation in early ARDS: a hypothesis-generating observational study. Ann Intensive Care, 2020, 10(1): 35.
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10.	王小亭, 刘大为, 于凯江, 等. 中国重症超声专家共识. 中华内科杂志, 2016, 11(55): 900-912.
11.	Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet, 2015, 386: 1097-1108.
12.	Fang WF, Yang KY, Wu CL, et al. Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia. Critical care, 2011, 15: R32.
13.	Song JH, Oh WS, Kang CI, et al. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents, 2008, 31: 107-114.
14.	Guo SR, Mao XH, Liang M. The moderate predictive value of serial serum CRP and PCT levels for the prognosis of hospitalized community-acquired pneumonia. Respir Res, 2018, 19(1): 193.
15.	刘春桃, 付敏, 陈希, 等. 无创通气失败风险预测模型的研究进展. 中国呼吸与危重监护杂志, 2022, 21(9): 678-684.
16.	马德胜, 甄玲玲, 马莉, 等. 经鼻高流量氧疗在慢性阻塞性肺疾病急性加重期的研究进展. 中国呼吸与危重监护杂志, 2022, 21(9): 670-673.
17.	彭拓, 张媛莉. 舌下微循环测量指标的研究进展. 医学理论与实践, 2020, 33(12): 4.
18.	Pinheiro T, Freitas F, Coimbra K, et al. MOESM1 of short-term effects of passive mobilization on the sublingual microcirculation and on the systemic circulation in patients with septic shock. Ann Intensive Care, 2017, (7): 95.
19.	Ltaief Z, Schneider AG, Liaudet L. Pathophysiology and clinical implications of the veno-arterial PCO₂ gap. Critical Care, 2021, 25(1): 318.

1. Laporte L, Hermetet C, Jouan Y, et al. Ten-year trends in intensive care admissions for respiratory infections in the elderly. Ann Intensive Care, 2018, 8(1): 84.
2. Cillóniz C, Dominedò C, Garcia-Vidal C, et al. Community-acquired pneumonia as an emergency condition. Curr Opin Crit Care, 2018, 24(6): 531-539.
3. Torrini F, Gendreau S, Morel J, et al. Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis. Crit Care, 2021, 25(1): 391.
4. Di Dedda U, Ascari A, Fantinato A, et al. Microcirculatory alterations in critically ill patients with COVID-19-associated acute respiratory distress syndrome. J Clin Med, 2022, 11(4): 1032.
5. Kanoore Edul VS, Caminos Eguillor JF, Ferrara G, et al. Microcirculation alterations in severe COVID-19 pneumonia. J Crit Care, 2021, 61: 73-75.
6. Ospina-Tascón GA, Bautista DF, Madriñán HJ, et al. Microcirculatory dysfunction and dead-space ventilation in early ARDS: a hypothesis-generating observational study. Ann Intensive Care, 2020, 10(1): 35.
7. Abou-Arab O, Beyls C, Khalipha A, et al. Microvascular flow alterations in critically ill COVID-19 patients: a prospective study. PLoS One, 2021, 16(2): e0246636.
8. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
9. 张晓蕾, 李莉, 彭倩宜, 等. 感染性休克患者舌下微循环障碍分型及与预后的研究初探. 中华内科杂志, 2021, 60(10): 898-903.
10. 王小亭, 刘大为, 于凯江, 等. 中国重症超声专家共识. 中华内科杂志, 2016, 11(55): 900-912.
11. Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet, 2015, 386: 1097-1108.
12. Fang WF, Yang KY, Wu CL, et al. Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia. Critical care, 2011, 15: R32.
13. Song JH, Oh WS, Kang CI, et al. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents, 2008, 31: 107-114.
14. Guo SR, Mao XH, Liang M. The moderate predictive value of serial serum CRP and PCT levels for the prognosis of hospitalized community-acquired pneumonia. Respir Res, 2018, 19(1): 193.
15. 刘春桃, 付敏, 陈希, 等. 无创通气失败风险预测模型的研究进展. 中国呼吸与危重监护杂志, 2022, 21(9): 678-684.
16. 马德胜, 甄玲玲, 马莉, 等. 经鼻高流量氧疗在慢性阻塞性肺疾病急性加重期的研究进展. 中国呼吸与危重监护杂志, 2022, 21(9): 670-673.
17. 彭拓, 张媛莉. 舌下微循环测量指标的研究进展. 医学理论与实践, 2020, 33(12): 4.
18. Pinheiro T, Freitas F, Coimbra K, et al. MOESM1 of short-term effects of passive mobilization on the sublingual microcirculation and on the systemic circulation in patients with septic shock. Ann Intensive Care, 2017, (7): 95.
19. Ltaief Z, Schneider AG, Liaudet L. Pathophysiology and clinical implications of the veno-arterial PCO₂ gap. Critical Care, 2021, 25(1): 318.

Chinese Journal of Respiratory and Critical Care Medicine

Evaluation of sublingual microcirculation on prognosis of elderly patients with severe pneumonia undergoing mechanical ventilation

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