Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

Prolonged mechanical ventilation (PMV) after lung transplantation poses several risks, including higher tracheostomy rates and increased in-hospital mortality. Mechanical power (MP) of artificial ventilation unifies the ventilatory variables that determine gas exchange and may be related to allograf...

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Autores principales: Ghiani, Alessandro, Kneidinger, Nikolaus, Neurohr, Claus, Frank, Sandra, Hinske, Ludwig Christian, Schneider, Christian, Michel, Sebastian, Irlbeck, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548550/
https://www.ncbi.nlm.nih.gov/pubmed/37799668
http://dx.doi.org/10.3389/ti.2023.11506
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author Ghiani, Alessandro
Kneidinger, Nikolaus
Neurohr, Claus
Frank, Sandra
Hinske, Ludwig Christian
Schneider, Christian
Michel, Sebastian
Irlbeck, Michael
author_facet Ghiani, Alessandro
Kneidinger, Nikolaus
Neurohr, Claus
Frank, Sandra
Hinske, Ludwig Christian
Schneider, Christian
Michel, Sebastian
Irlbeck, Michael
author_sort Ghiani, Alessandro
collection PubMed
description Prolonged mechanical ventilation (PMV) after lung transplantation poses several risks, including higher tracheostomy rates and increased in-hospital mortality. Mechanical power (MP) of artificial ventilation unifies the ventilatory variables that determine gas exchange and may be related to allograft function following transplant, affecting ventilator weaning. We retrospectively analyzed consecutive double lung transplant recipients at a national transplant center, ventilated through endotracheal tubes upon ICU admission, excluding those receiving extracorporeal support. MP and derived indexes assessed up to 36 h after transplant were correlated with invasive ventilation duration using Spearman’s coefficient, and we conducted receiver operating characteristic (ROC) curve analysis to evaluate the accuracy in predicting PMV (>72 h), expressed as area under the ROC curve (AUROC). PMV occurred in 82 (35%) out of 237 cases. MP was significantly correlated with invasive ventilation duration (Spearman’s ρ = 0.252 [95% CI 0.129–0.369], p < 0.01), with power density (MP normalized to lung-thorax compliance) demonstrating the strongest correlation (ρ = 0.452 [0.345–0.548], p < 0.01) and enhancing PMV prediction (AUROC 0.78 [95% CI 0.72–0.83], p < 0.01) compared to MP (AUROC 0.66 [0.60–0.72], p < 0.01). Mechanical power density may help identify patients at risk for PMV after double lung transplantation.
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spelling pubmed-105485502023-10-05 Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation Ghiani, Alessandro Kneidinger, Nikolaus Neurohr, Claus Frank, Sandra Hinske, Ludwig Christian Schneider, Christian Michel, Sebastian Irlbeck, Michael Transpl Int Health Archive Prolonged mechanical ventilation (PMV) after lung transplantation poses several risks, including higher tracheostomy rates and increased in-hospital mortality. Mechanical power (MP) of artificial ventilation unifies the ventilatory variables that determine gas exchange and may be related to allograft function following transplant, affecting ventilator weaning. We retrospectively analyzed consecutive double lung transplant recipients at a national transplant center, ventilated through endotracheal tubes upon ICU admission, excluding those receiving extracorporeal support. MP and derived indexes assessed up to 36 h after transplant were correlated with invasive ventilation duration using Spearman’s coefficient, and we conducted receiver operating characteristic (ROC) curve analysis to evaluate the accuracy in predicting PMV (>72 h), expressed as area under the ROC curve (AUROC). PMV occurred in 82 (35%) out of 237 cases. MP was significantly correlated with invasive ventilation duration (Spearman’s ρ = 0.252 [95% CI 0.129–0.369], p < 0.01), with power density (MP normalized to lung-thorax compliance) demonstrating the strongest correlation (ρ = 0.452 [0.345–0.548], p < 0.01) and enhancing PMV prediction (AUROC 0.78 [95% CI 0.72–0.83], p < 0.01) compared to MP (AUROC 0.66 [0.60–0.72], p < 0.01). Mechanical power density may help identify patients at risk for PMV after double lung transplantation. Frontiers Media S.A. 2023-09-20 /pmc/articles/PMC10548550/ /pubmed/37799668 http://dx.doi.org/10.3389/ti.2023.11506 Text en Copyright © 2023 Ghiani, Kneidinger, Neurohr, Frank, Hinske, Schneider, Michel and Irlbeck. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Archive
Ghiani, Alessandro
Kneidinger, Nikolaus
Neurohr, Claus
Frank, Sandra
Hinske, Ludwig Christian
Schneider, Christian
Michel, Sebastian
Irlbeck, Michael
Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation
title Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation
title_full Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation
title_fullStr Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation
title_full_unstemmed Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation
title_short Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation
title_sort mechanical power density predicts prolonged ventilation following double lung transplantation
topic Health Archive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548550/
https://www.ncbi.nlm.nih.gov/pubmed/37799668
http://dx.doi.org/10.3389/ti.2023.11506
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