The Mechanical Power in Patients with Acute Respiratory Distress Syndrome Undergoing Prone Positioning Can Predict Mortality

被引：1

作者：

Chang, Ko-Wei ^{[1
,2
,3
]}

Leu, Shaw-Woei ^{[1
]}

Hu, Han-Chung ^{[1
,4
]}

Chan, Ming-Cheng ^{[5
,6
]}

Liang, Shinn-Jye ^{[7
]}

Yang, Kuang-Yao ^{[8
,9
]}

Chiu, Li-Chung ^{[1
]}

Fang, Wen-Feng ^{[10
,11
]}

Sheu, Chau-Chyun ^{[12
,13
]}

Chien, Ying-Chun ^{[14
]}

Peng, Chung-Kan ^{[15
]}

Huang, Ching-Tzu ^{[4
,16
]}

Kao, Kuo-Chin ^{[1
,4
]}

机构：

[1] Chang Gung Mem Hosp, Dept Thorac Med, Taoyuan 333, Taiwan

[2] Chang Gung Univ, Grad Inst Clin Med Sci, Coll Med, Taoyuan 333, Taiwan

[3] Natl Tsing Hua Univ, Sch Med, Hsinchu 300, Taiwan

[4] Chang Gung Univ, Coll Med, Dept Resp Therapy, Taoyuan 333, Taiwan

[5] Taichung Vet Gen Hosp, Dept Internal Med, Div Crit Care & Resp Therapy, Taichung 407, Taiwan

[6] Tunghai Univ, Dept Environm Sci & Engn, Taichung 407, Taiwan

[7] China Med Univ Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Taichung 404, Taiwan

[8] Taipei Vet Gen Hosp, Dept Chest Med, Taipei 112, Taiwan

[9] Natl Yang Ming Univ, Inst Emergency & Crit Care Med, Sch Med, Taipei 112, Taiwan

[10] Kaohsiung Chang Gung Mem Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Kaohsiung 833, Taiwan

[11] Chang Gung Univ Sci & Technol, Dept Resp Care, Chiayi 613, Taiwan

[12] Kaohsiung Med Univ Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Kaohsiung 807, Taiwan

[13] Kaohsiung Med Univ, Coll Med, Sch Med, Dept Internal Med, Kaohsiung 807, Taiwan

[14] Natl Taiwan Univ Hosp, Dept Internal Med, Div Chest Med, Taipei 100, Taiwan

[15] Natl Def Med Ctr, Triserv Gen Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Taipei 114, Taiwan

[16] Chang Gung Mem Hosp, Dept Resp Therapy, Taoyuan 333, Taiwan

来源：

DIAGNOSTICS | 2025年 / 15卷 / 02期

关键词：

mechanical power; prone positioning; acute respiratory distress syndrome; LUNG INJURY; VENTILATION; PERFUSION; FAILURE;

D O I：

10.3390/diagnostics15020158

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background/Objectives: Mechanical power (MP) refers to ventilator-delivered energy to the lungs, which may induce lung injury. We examined the relationship between MP and mortality in patients with acute respiratory distress syndrome (ARDS) who underwent prone positioning. Methods: This multicenter retrospective study included data on all patients admitted to the intensive care units of eight referral hospitals in Taiwan from October 2015 to March 2016, and in Chang Gung Memorial Hospital Linkou branch from January 2017 to October 2023. The data were obtained from the electronic medical records of each hospital by using a standard case report form. MP was calculated as follows: MP (J/min) = 0.098 x VT x RR x (Ppeak - 1/2 x Delta P). Results: We included 135 patients who underwent prone positioning. Among them, 28-day survivors had significantly lower MP (22.6 +/- 6.5 vs. 25.3 +/- 6.2 J/min, p = 0.024), MP/predicted body weight (PBW) (396.9 +/- 118.9 vs. 449.3 +/- 118.8 10(-3) J/min/kg, p = 0.018), MP/compliance values (0.8 +/- 0.3 vs. 1.1 +/- 0.4 J/min/mL/cmH(2)O, p = 0.048) after prone positioning, and significantly lower changes in MP, MP/PBW, and MP/compliance (-0.6 +/- 5.7 vs. 2.5 +/- 7.4 J/min, p = 0.007; -9.2 +/- 97.5 vs. 42.1 +/- 127.9 10(-3) J/min/kg, p = 0.010; -0.1 +/- 0.3 vs. 0.2 +/- 0.3 J/min/mL/cmH(2)O, p < 0.001, respectively). Multivariate Cox regression revealed that the change in MP/compliance (HR: 7.972, p < 0.001) was an independent predictive factor for 28-day mortality. Conclusions: In ARDS patients treated with prone positioning, MP/compliance, and change in MP, MP/PBW, and MP/compliance after prone positioning differed significantly between 28-day survivors and nonsurvivors. Further randomized controlled research is required to elucidate the potential causality of decreased MP and improved clinical outcomes.

引用

页数：13

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