Objective To investigate the titration of best positive end-expiratory pressure (Best PEEP) based on mechanical power (MP) and transpulmonary pressure monitoring during lung reexpansion in patients with acute respiratory distress syndrome (ARDS), and to analyze the value of both in evaluating the prognosis of ARDS patients.Methods ARDS patients treated in the intensive care Unit of the First Affiliated Hospital of Jinzhou Medical University from September 2021 to March 2023 were selected and divided into survival group and death group according to the 28-day mortality rate. After full sedation, esophageal pressure tube was inserted through the nasal passage, and lung recruitment maneuvers (RM) was performed by incremental PEEP method. The Best PEEP method was titrated based on MP and transpulmonary pressure. Pearson correlation analysis was used to analyze the correlation between MP at RM 30 min and 2 h and transpulmonary pressure. The changes of clinical indicators at 30 minutes and 2 hours after RM were compared between the two groups with different outcomes. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of 2 h MP and transpulmonary pressure for 28-day mortality in ARDS patients. Results MP and transpulmonary pressure in the survival group decreased significantly at 30 min and 2 h, while MP and transpulmonary pressure in the death group showed a significant upward trend (P < 0.05). The Best PEEP and RR at 30 min and 2 h of the RM in the survival group were lower than those in the death group (P < 0.05). Pearson correlation analysis showed that MP at RM 30 min and 2 h was significantly correlated with transpulmonary pressure (r = 0.710 and 0.804, P < 0.05). The area under the ROC curve of MP and transpulmonary pressure were 0.812 and 0.795, respectively. 95% confidencial interval: 0.704 - 0.920 and 0.687 - 0.903 (P < 0.05); The sensitivity was 86.95% and 82.50%, respectively. The specificity were 76.67% and 59.40%; The positive predictive values were 0.851 and 0.688; The negative predictive values were 0.793 and 0.759; The optimal cut-off values were 15.5 and 17.5, respectively. RM 2 h MP and transpulmonary pressure have good predictive value for 28-day mortality in ARDS patients. Conclusion Monitoring MP and transpulmonary pressure during lung recruitment maneuver can effectively guide the titration of Best PEEP in ARDS patients, and both have good evaluation value for the prognosis of ARDS patients.
ObjectiveTo investigate the relationship between the changes in preoperative serum creatinine (Cr), myoglobin (Mb), alanine aminotransferase (ALT) and postoperative fibrinogen (Fib), C- reactive protein (CRP) expression levels and postoperative hypoxemia in patients with aortic dissection aneurysm (ADA), and construct a predictive model. Additionally, the study explores the role of transpulmonary pressure-guided positive end expiratory pressure (PEEP) in improving postoperative hypoxemia. MethodsA retrospective analysis was conducted on the clinical data of ADA patients admitted to Tianjin Chest Hospital from April 2021 to August 2023. Patients were divided into a hypoxemia group [partial pressure of oxygen/fraction of inspiration oxygen (PaO2/FiO2) ≤200 mm Hg] and a non-hypoxemia group (PaO2/FiO2 >200 mm Hg) based on whether they developed postoperative hypoxemia. Univariate and multivariate regression analyses were used to identify risk factors for postoperative hypoxemia in ADA patients and to construct a predictive model for postoperative hypoxemia. The receiver operating characteristic (ROC) curve was plotted, and the Hosmer-Lemeshow goodness-of-fit test was used to evaluate the predictive value of the model. Furthermore, the impact of different ventilation modes on the improvement of postoperative hypoxemia was analyzed. From April 2021 to August 2023, 16 ADA patients with postoperative hypoxemia who received conventional mechanical ventilation were included in the control group. From September 2023 to December 2024, 28 ADA patients with postoperative hypoxemia who received transpulmonary pressure-guided PEEP were included in the experimental group. ICU stay duration, mechanical ventilation duration, hospital mortality rate, and respiratory and circulatory parameters were analyzed to evaluate the effect of transpulmonary pressure-guided PEEP on patients with postoperative hypoxemia after acute aortic dissection. ResultsA total of 98 ADA patients were included, of which 79 (80.61%) were males and 19 (19.39%) were females. Their ages ranged from 32 to 79 years, with an average age of (49.4±11.2) years. Sixteen (16.3%) patients developed postoperative hypoxemia. Body mass index (BMI), smoking history, cardiopulmonary bypass (CPB) duration, preoperative serum Cr, Mb, ALT, and postoperative Fib and CRP showed a certain correlation with postoperative hypoxemia in ADA patients (P<0.05). There was no statistical difference in other baseline data between the two groups (P>0.05). Logistic regression analysis results indicated that BMI [OR=1.613, 95%CI (1.260, 2.065)] and preoperative Mb [OR=2.344, 95%CI (1.048, 5.246)], ALT [OR=1.012, 95%CI (1.000, 1.024)], Cr [OR=1.752, 95%CI (1.045, 2.940)], postoperative Fib [OR=1.165, 95%CI (1.080, 1.258)] and intraoperative CPB time [OR=1.433, 95%CI (1.017, 2.020)] were influencing factors of postoperative hypoxemia in ADA patients (P<0.05). Based on this, a prediction model for postoperative hypoxemia in ADA patients was established. The area under the curve corresponding to the optimal critical point was 0.837 [95%CI (0.799, 0.875)], with a sensitivity of 87.5% and a specificity of 79.3%. The Hosmer-Lemeshow goodness of fit test showed P=0.536. Before treatment, there were no statistical differences in respiratory and circulatory parameters between the control group and the experimental group (P>0.05). After treatment, the levels of PEEP, PaO2/FiO2, end-expiratory esophageal pressure, and end-inspiratory transpulmonary pressure in the experimental group were higher than those in the control group (P<0.05). The duration of mechanical ventilation and ICU stay in the experimental group were shorter than those in the control group (P<0.05), while there was no statistical difference in mortality between the two groups (P=0.626). ConclusionThe hypoxia prediction model based on preoperative Cr, Mb, ALT and postoperative Fib levels, combined with transpulmonary pressure-guided PEEP optimization, provides a scientific basis for the precise management of postoperative hypoxemia in ADA. This approach not only improves the predictive ability of hypoxemia risk but also significantly improves the postoperative oxygenation status of patients through personalized mechanical ventilation strategies, providing new insights into the management of postoperative complications.