Abstract
Purpose:To assess the value of the driving pressure variation rate(△P％)in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.Methods:In this case-control study,a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled.Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days.Outcome measures including driving pressure,PaO2:FiO2,and positive end-expiratory pressure,etc.were assessed every 24 h from day 0 to day 14 until successful weaning was achieved.The measurement data of non-normal distribution were presented as median(Q1,Q3),and the differences between groups were compared by Wilcoxon rank sum test.And categorical data use the Chi-square test or Fisher's exact test to compare.The predictive value of △P％in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves.Results:Of the total 35 patients included in the study,17 were successful vs.18 failed in weaning from a ventilator after 14 days of mechanical ventilation.The cut-off values of the median △P％measured by Operator 1 vs.Operator 2 in the first 4 days were ≥ 4.17％and 4.55％,respectively(p＜0.001),with the area under curve of 0.804(sensitivity of 88.2％,specificity of 64.7％)and 0.770(sensitivity of 88.2％,specificity of 64.7％),respectively.There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group(8(6,13)vs.12(7.5,17.3),p=0.043).The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group(0.2‰ vs.2.3‰,p=0.001).There was a significant difference noted between these 2 groups in the 28-day mortality(11.8％vs.66.7％,p=0.003).Conclusion:The median △P％in the first 4 days of mechanical ventilation showed good predictive per-formance in predicting the outcome of weaning from mechanical ventilation within 14 days.Further study is needed to confirm this finding.
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