Study on the relationship between intra-abdominal pressure and respiratory function in children with severe pneumonia undergoing mechanical ventilation and its prognostic value
Objective To investigate the relationship between intra-abdominal pressure(IAP)and respiratory function in mechanically ventilated children with severe pneumonia and its prognostic value.Methods A case-series study.Ninety-two children with severe pneumonia who were treated with mechanical ventilation in the Intensive Care Unit of Children's Hospital Affiliated to Zhengzhou University from May 2019 to May 2021 were taken as the study subjects.The IAP and respiratory function-related indexes of the children were monitored.Those with IAP ≥12 mmHg(1 mmHg=0.133 kPa)were divided into the study group,and those with IAP＜12 mmHg were divided into the control group.The difference in respiratory function related indexes between the 2 groups was compared,and the relationship between IAP and respiratory function indexes was analyzed by Pearson correlation.The children were divided into a good prognosis group and a poor prognosis group according to their prognosis.The relevant clinical data of the children in the 2 groups were collected for univariate analysis,and multivariate Logistic regression was used to analyze the risk factors affecting the prognosis of children with mechanical ventilation for severe pneumonia.A receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of IAP on the prognosis of mechanically ventilated children with severe pneumonia.Results The arterial partial pressure of oxygen(PaO2)[(80.15±8.23)mmHg],arterial blood oxygen saturation(SaO2)[(91.32±2.13)％],and oxygenation index(PaO2/FiO2)[(198.29±20.25)mmHg]in the study group were lower than those in the control group[(85.74±8.42)mmHg,(97.05±2.47)％,and(234.84±25.24)mmHg],while the respiratory rate(RR)[(56.23±2.16)breaths/min vs.(50.41±2.24)breaths/min],partial pressure of carbon dioxide(PaCO2)[(36.48±3.72)mmHg vs.(33.29±3.46)mmHg],fraction of inspired oxygen(FiO2)[(40.42±4.25)％vs.(36.51±3.72)％],mean arterial pressure(MAP)[(55.98±5.69)mmHg vs.(52.79±5.43)mmHg],and positive end expiratory pressure(PEEP)[(5.03±0.52)cmH2O vs.(4.52±0.47)cmH2O,1 cmH2O=0.098 kPa]were higher than those in the control group,and the differences were all statistically significant(all P＜0.05).The IAP of the children in the study group was(14.25±1.83)mmHg,and that in the control group was(10.38±1.14)mmHg.Pearson correlation analysis showed that IAP was negatively correlated with PaO2,SaO2,and PaO2/FiO2(r=-0.615,-0.587,and-0.647,all P＜0.05),and was positively correlated with RR,PaCO2,FiO2,MAP,and PEEP(r=0.618,0.634,0.579,0.578,0.593,all P＜0.05).IAP[(14.76±1.58)mmHg],PaCO2[(39.95±4.21)mmHg],FiO2[(50.29±5.12)％],alanine aminotransferase[(42.08±4.15)U/L],and total bilirubin[(17.92±1.87)μmol/L]in the poor prognosis group were greater than those[(10.75±1.19)mmHg,(35.37±3.64)mmHg,(45.38±4.47)％,(39.87±4.06)U/L,and(17.09±1.75)μmol/L]in the good prognosis group,while PaO2[(65.42±7.86)mmHg vs.(76.42±7.51)mmHg],SaO2[(90.65±9.26)％vs.(96.21±2.19)％],and PaO2/FiO2[(130.09±15.15)mmHg vs.(168.40±20.17)mmHg]were smaller than those in the good prognosis group,and the differences were statistically significant(all P＜0.05).Logistic regression analysis showed that IAP,PaO2,PaCO2,and SaO2 were risk factors affecting the prognosis of mechanically ventilated children with severe pneumonia(all P＜0.05).The optimal cut-off point of IAP for predicting a poor prognosis in mechanically ventilated children with severe pneumonia was 14.55 mmHg,and the area under the ROC curve was 0.873,with a sensitivity of 88.10％and a specificity of 76.00％.Conclusions IAP has a certain relationship with the respiratory function of mechanically ventilated children with severe pneumonia,and has a good predictive value for the prognosis of the children.
Severe pneumoniaMechanical ventilationIntra-abdominal pressureRespiratory functionPrognosis
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