Clinical application and prognostic value of elastic power in lung-protective ventilation in prone mechanical ventilation patients with moderate-to-severe ARDS
Li Xiaodong
Li Tian
Yuan Yuan
Hu Zhansheng
Di Xingwei
Di Meiying
Abstract：Objective To explore the clinical application value of elastic power(EP)in lung-protective ventilation for prone position mechanical ventilation patients with moderate-to-severe acute respiratory distress syndrome(ARDS)and the prognostic evaluation for 28-day status.Methods A prospective,observational cohort study was performed on the patients diagnosed with moderate-to-severe ARDS in the Intensive Care Unit of the First Affiliated Hospital of Jinzhou Medical University from January 2021 to December 2023.The patients were divided into survival group and death group according to the 28-day prognosis.Prone position ventilation treatment was implemented based on the changes of their conditions,and baseline data and respiratory indexes were collected.EP,mechanical power(MP),respiratory rate(RR),tidal volume(VT)and best positive end expiratory pressure(PEEP)were compared between the two groups at 16 h and 48 h after prone position ventilation.COX multivariate regression was used to evaluate the 28-day mortality risk of moderate-to-severe ARDS patients undergoing prone position ventilation;the assessment value of elastic power/compliance(EP/Cst)normalized by compliance in 28-day mortality was analyzed by the receiver operating characteristic(ROC)curve and Kaplan-Meier survival curve.Results 102 patients with moderate-to-severe ARDS treated with prone position ventilation were divided into the survival group(n=68)and the death group(n=34).There were no significant differences in age,gender,body mass index(BMI),underlying disease,oxygenation index(PaO2/FiO2,P/F)between two groups(all P＞0.05).Compared with the survival group,APACHE Ⅱ score and SOFA score in the death group were significantly increased[APACHE Ⅱ(score):21.37±3.22 vs.23.53±3.52,SOFA(score):10.78±2.52 vs.12.03±2.42,all P＜0.05].EP,MP,EP/Cst,MP/Cst,RR and best PEEP were all lower in the survival group than in the death group at 16 h and 48 h after prone ventilation treatment,and VT was higher than that in the death group[EP16 h(cmH2O):16.70±2.76 vs.18.18±3.34,EP48h(cmH2O):15.97±2.69 vs.20.06±2.86;MP16 h(cmH2 O):19.16±2.57 vs.20.38±3.25,MP48h(cmH2O):17.90±4.14 vs.21.11±4.37;EP/Cst16h(J/min × cmH2O/mL × 10-3):484.25±85.16 vs.529.18±76.38,EP/Cst48 h(J/min × cmH2O/mL × 10-3):480.41±82.85 vs.533.29±67.29;MP/Cst16h(J/min × cmH2O/mL × 10-3):513.53±85.09 vs.551.24±53.00,MP/Cst48h(J/min × cmH2O/mL × 10-3):499.81±43.29 vs.552.24±47.83;VT16h(mL):323.41±37.99 vs.309.71±16.36,VT48h(mL):338.57±34.86 vs.300.91±28.49;RR16 h(times/min):19.87±4.63 vs.23.50±4.35,RR48 h(times/min):18.44±4.41 vs.24.14±5.18;Best PEEP16h(cmH2O):13.38±2.67 vs.15.00±2.88,Best PEEP48 h(cmH2 O):11.51±2.35 vs.17.15±2.83,all P＜0.05].COX multivariate regression results showed that EP/Cst16 h,MP/Cst16 h and RR16 h were independent risk factors for prone mechanical ventilation in ARDS patients.ROC curve analysis showed that the area under curve of EP/Cst16h was 0.829,and the best cutoff value was 524.50;The area under curve of MP/Cst16h was 0.715,and the best cutoff value was 514.50;The combined area under the curve of EP/Cst16h and MP/Cst16h was 0.832,the best cutoff value was 492.50,all P＜0.001.Kaplan-Meier survival curve analysis of EP/Cst between the two groups showed that the 28-day cumulative survival rate of the high EP/Cst group was significantly lower than that of EP/Cst group(Log Rank=6.499,P=0.011).Conclusions EP and EP/Cst have good clinical value for lung-protective ventilation in prone mechanical ventilation patients with moderate-to-severe ARDS,and EP/Cst can be used to evaluate the 28-day prognosis.
Keywords：Acute respiratory distress syndromeElastic powerMechanical powerPrognosisProne position
Publication Date：2025-09-10
Online Publishing Date：2025-10-17(First online date of this platform, not the publication date of the document)
Pages：6( 791-796 )