The Study On The Correlation Between Mechanical Power And Mortality In Critically Ill Patients By Mechanical Ventilation

BackgroundMechanical ventilation is a commonly used life support method for severe patients,but the mortality rate of patients receiving mechanical ventilation is high,which is related to the critical condition of the patients themselves,as well as the delay in the detection of disease changes and the lack of early prediction.Mechanical Power（MP）has been proposed in recent years,which can be integrated with many ventilator parameters and can be calculated at the bedside.Further studies have confirmed that MP can be a comprehensive assessment of ventilator-associated lung injury in acute respiratory distress syndrome and is associated with mortality in patients on Mechanical ventilation.The distribution of patients requiring mechanical ventilation in Emergency Intensive Care units（EICUs）is diverse,and it is necessary to further understand the correlation between mechanical power and its dynamic changes and the outcomes of patients on mechanical ventilation.ObjectiveTo investigate the relationship between mechanical power and death of patients with mechanical ventilation.Materials and methodsCollect on December 1,2017 to October 31,2020,guangzhou medical college EICU need mechanical ventilation patients in our hospital data,including the general situation,history,preliminary diagnosis,tracheal intubation reason,for the first time of mechanical ventilation related information,intubation inspection index,the disease severity score,24 hours test indicators,vital signs at the time of endotracheal intubation,EICU hospitalization costs and total hospitalization costs.Patients were screened according to the standard of NAS in this study,and were divided into survival group and death group according to whether they died in hospital.The baseline characteristics,ventilator parameters characteristics,distribution of mechanical power,changes of mechanical power within 24 hours and the relationship between these two groups and death were analyzed.Results1.A total of 105 cases were included in this study,including 80 cases in the survival group and 25 cases in the death group,of which there were 78 males and 27females.The causes of mechanical ventilation were heart failure,cardiac and respiratory arrest,airway protection,neuromuscular diseases,surgery,upper respiratory diseases,and thoracic and pleural diseases.2.During endotracheal intubation,compared with the death group,the oxygen partial pressure（110.00mm Hg vs.73.00mm Hg,p=0.005）oxygen index（241.27 vs.182.77,p=0.046）in the survival group was significantly increased,and the difference was statistically significant.Blood lactic acid（2.10mmol/L vs.3.51mmol/L,p=0.020）was significantly reduced（0.31ng/m L vs.3.55ng/m L,p=0.028）,and the difference was statistically significant.3.After mechanical ventilation,compared with the death group,the oxygen partial pressure（118.00mm Hg vs.89.00mm Hg,p=0.005）and oxygenation index（271.35 vs.217.37,p=0.020）of the survival group were significantly increased.Blood lactic acid（1.59mmol/L vs.2.56mmol/L,p=0.000）was significantly decreased,and the difference was statistically significant.4.Of the 105 patients studied,91.4%used volume controlled ventilation mode and 8.6%used pressure controlled ventilation mode.In the volume controlled ventilation mode,MP in the survival group was significantly lower than that in the death group（14.37J/min vs.16.12J/min,p=0.041）,and the difference was statistically significant.In the pressure-controlled ventilation mode,there was no significant difference in MP and ventilator parameters between the survival group and the death group.5.Among the risk factors associated with mortality in patients on mechanical ventilation,MP（OR:1.683,96%CI:1.133-2.498,p=0.010）、OI（OR:1.033,96%CI:1.008-1.059,p=0.009）、SOFA（OR:1.849,96%CI:1.208-2.830,p=0.004）were significantly associated with death in patients with mechanical ventilation,both of which were statistically significant.6.The AUC of MP for predicting the death of patients on mechanical ventilation was 0.548（95%CI:0.427-0.666）,while the AUC of APACHE II score was0.635（95%CI:0.530-0.731）.The AUC of SOFA score was 0.756（95%CI:0.6433-0.849）.The AUC of MP combined with Apache II score was 0.726（95%CI:0.608-0.959）and the AUC of MP combined with SOFA score was0.764（95%CI:0.650-0.856）,and MP combined with Apache The AUC of II score and MP combined SOFA score in predicting death of patients with mechanical ventilation were both higher than that of MP alone（p<0.05）,with statistical significance.7.ΔSpearman correlation coefficient between Pa CO₂and Al MP was-0.284,p=0.010<0.05,which was statistically significant.ConclusionMechanical ventilation mechanical power is associated with hospital mortality in critically ill patients.Combined mechanical ventilation mechanical power and disease severity score can improve the predictive efficacy of mechanical ventilation mechanical power and disease severity score for hospital mortality in patients with invasive mechanical ventilation.