The correlation between bladder pressure and diaphragm excursion in patients with severe acute pancreatitis combined with acute respiratory distress syndrome and its predictive value for weaning outcomes
Objective Exploring the correlation between intravesical pressure(IP)and diaphragm excursion(DE)in patients with severe acute pancreatitis(SAP)and acute respiratory distress syndrome(ARDS),and evaluating its predictive value for weaning outcomes.Methods A retrospective analysis was conducted on the clinical data of 144 SAP patients with ARDS admitted between 2020 and 2023.By collecting the outcome of weaning,collect data on gender,age,acute physiology and chronic health score Ⅱ(APACHE Ⅱ),oxygenation index,and IP and DE before weaning and extubation for all patients.Based on weaning outcomes,divide patients into successful and failed groups,and compare the differences in various indicators between the two groups;Use binary logistic regression to analyze whether IP and DE are risk factors affecting weaning in SAP patients with ARDS,and use Pearson correlation analysis to examine the correlation between IP and DE;Use receiver operating characteristic curve(ROC curve)to analyze the predictive value of IP and DE on weaning outcomes in SAP patients with ARDS.Results A total of 144 SAP patients with ARDS were included,of which 108 were successfully weaned and 36 were unsuccessful.There were no statistically significant differences in gender,age,and APACHE Ⅱ scores between the successful and failed groups(males:62.96％(68/108)compared to 69.44％(25/36),age(years):41.91±8.14 compared to 42.42±6.22,APACHE Ⅱ score(points):18.28±2.22 compared to 18.97±1.83,P＞0.05).The IP of the successful group was significantly lower than that of the failed group,and the DE was significantly higher than that of the failed group[IP(mmHg):18.45±3.76 compared to 23.92±5.65,DE(mm):16.18±4.23 compared to 12.28±4.44,all P＜0.05].All patients showed a significant negative correlation between IP and DE(r=-0.457,P＜0.001).ROC curve analysis showed that the area under the curve(AUC)of IP predicting the withdrawal outcome of SAP patients with ARDS was 0.805,with a 95％confidence interval(95％CI)of 0.724-0.885 and P＜0.001.When the cutoff value was 19.5 mmHg,the sensitivity was 91.57％and the specificity was 47.54％;The AUC for predicting the withdrawal outcome of SAP patients with ARDS by DE was 0.738,with a 95％CI of 0.641-0.834 and P＜0.001.When the cutoff value was 11.5 points,the sensitivity was 84.82％and the specificity was 59.38％.Conclusions There is a significant negative correlation between IP and DE in SAP combined with ARDS patients,and both have certain predictive value for weaning outcomes.
severe acute pancreatitisacute respiratory distress syndromeintravesical pressurediaphragm excursionWithdrawal outcomepredictive value
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