Cargando…
The relationship between ventilatory ratio (VR) and 28-day hospital mortality by restricted cubic splines (RCS) in 14,328 mechanically ventilated ICU patients
BACKGROUND: Previous studies found that high levels of ventilatory ratio (VR) were associated with a poor prognosis due to worse ventilatory efficiency in acute respiratory distress syndrome patients. However, relatively few large studies have assessed the association between VR and intensive care u...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9191763/ https://www.ncbi.nlm.nih.gov/pubmed/35698114 http://dx.doi.org/10.1186/s12890-022-02019-6 |
_version_ | 1784726087744356352 |
---|---|
author | Yang, Yingying Chi, Yi Yuan, Siyi Zhang, Qing Su, Longxiang Long, Yun He, Huaiwu |
author_facet | Yang, Yingying Chi, Yi Yuan, Siyi Zhang, Qing Su, Longxiang Long, Yun He, Huaiwu |
author_sort | Yang, Yingying |
collection | PubMed |
description | BACKGROUND: Previous studies found that high levels of ventilatory ratio (VR) were associated with a poor prognosis due to worse ventilatory efficiency in acute respiratory distress syndrome patients. However, relatively few large studies have assessed the association between VR and intensive care unit (ICU) mortality in the general adult ventilated population. METHODS: The present study is a retrospective cohort study. Patients mechanically ventilated for more than 12 h were included. VR was calculated based on a previously reported formula. Restricted cubic spline models were used to fit the relationship between VR and mortality risks. RESULTS: A total of 14,328 mechanically ventilated ICU patients were included in the study, of which 1311 died within 28 days. The results of the study are as follows: (1) In the general adult ventilated population, VR was positively associated with 28-day mortality when VR ≥ 1.3 (increase of 0.1 per VR; HR 1.05, p < 0.001). The same tendency was also observed in the populations of severe hypoxemia with a PaO(2)/FiO(2) (P/F) ratio < 200 mmHg. (2) However, in the population with a P/F ratio ≥ 200, a J-shaped dose–response association between VR and the risk of mortality was observed, with the risk of death positively associated with VR when VR ≥ 0.9 (10% increase in HR for every 0.1 increase in VR, p = 0.000) but negatively associated with VR when VR < 0.9 (10% decrease in HR for every 0.1 increase in VR, p = 0.034). In the population of P/F ratio ≥ 200 with VR less than 0.9, compared to the survival group, the nonsurvival group had a lower level PCO(2) (33 mmHg [29.1, 37.9] vs. 34.4 mmHg [30.6, 38.5]), rather than a significant level of measured minute ventilation or P/F ratio. CONCLUSIONS: VR was positively associated with the risk of death in the general ICU population; however, VR was inversely associated with 28-day mortality in the population with a P/F ratio ≥ 200 and low VR . Further research should investigate this relationship, and VR should be interpreted with caution in clinical practice. |
format | Online Article Text |
id | pubmed-9191763 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-91917632022-06-15 The relationship between ventilatory ratio (VR) and 28-day hospital mortality by restricted cubic splines (RCS) in 14,328 mechanically ventilated ICU patients Yang, Yingying Chi, Yi Yuan, Siyi Zhang, Qing Su, Longxiang Long, Yun He, Huaiwu BMC Pulm Med Research BACKGROUND: Previous studies found that high levels of ventilatory ratio (VR) were associated with a poor prognosis due to worse ventilatory efficiency in acute respiratory distress syndrome patients. However, relatively few large studies have assessed the association between VR and intensive care unit (ICU) mortality in the general adult ventilated population. METHODS: The present study is a retrospective cohort study. Patients mechanically ventilated for more than 12 h were included. VR was calculated based on a previously reported formula. Restricted cubic spline models were used to fit the relationship between VR and mortality risks. RESULTS: A total of 14,328 mechanically ventilated ICU patients were included in the study, of which 1311 died within 28 days. The results of the study are as follows: (1) In the general adult ventilated population, VR was positively associated with 28-day mortality when VR ≥ 1.3 (increase of 0.1 per VR; HR 1.05, p < 0.001). The same tendency was also observed in the populations of severe hypoxemia with a PaO(2)/FiO(2) (P/F) ratio < 200 mmHg. (2) However, in the population with a P/F ratio ≥ 200, a J-shaped dose–response association between VR and the risk of mortality was observed, with the risk of death positively associated with VR when VR ≥ 0.9 (10% increase in HR for every 0.1 increase in VR, p = 0.000) but negatively associated with VR when VR < 0.9 (10% decrease in HR for every 0.1 increase in VR, p = 0.034). In the population of P/F ratio ≥ 200 with VR less than 0.9, compared to the survival group, the nonsurvival group had a lower level PCO(2) (33 mmHg [29.1, 37.9] vs. 34.4 mmHg [30.6, 38.5]), rather than a significant level of measured minute ventilation or P/F ratio. CONCLUSIONS: VR was positively associated with the risk of death in the general ICU population; however, VR was inversely associated with 28-day mortality in the population with a P/F ratio ≥ 200 and low VR . Further research should investigate this relationship, and VR should be interpreted with caution in clinical practice. BioMed Central 2022-06-13 /pmc/articles/PMC9191763/ /pubmed/35698114 http://dx.doi.org/10.1186/s12890-022-02019-6 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Yang, Yingying Chi, Yi Yuan, Siyi Zhang, Qing Su, Longxiang Long, Yun He, Huaiwu The relationship between ventilatory ratio (VR) and 28-day hospital mortality by restricted cubic splines (RCS) in 14,328 mechanically ventilated ICU patients |
title | The relationship between ventilatory ratio (VR) and 28-day hospital mortality by restricted cubic splines (RCS) in 14,328 mechanically ventilated ICU patients |
title_full | The relationship between ventilatory ratio (VR) and 28-day hospital mortality by restricted cubic splines (RCS) in 14,328 mechanically ventilated ICU patients |
title_fullStr | The relationship between ventilatory ratio (VR) and 28-day hospital mortality by restricted cubic splines (RCS) in 14,328 mechanically ventilated ICU patients |
title_full_unstemmed | The relationship between ventilatory ratio (VR) and 28-day hospital mortality by restricted cubic splines (RCS) in 14,328 mechanically ventilated ICU patients |
title_short | The relationship between ventilatory ratio (VR) and 28-day hospital mortality by restricted cubic splines (RCS) in 14,328 mechanically ventilated ICU patients |
title_sort | relationship between ventilatory ratio (vr) and 28-day hospital mortality by restricted cubic splines (rcs) in 14,328 mechanically ventilated icu patients |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9191763/ https://www.ncbi.nlm.nih.gov/pubmed/35698114 http://dx.doi.org/10.1186/s12890-022-02019-6 |
work_keys_str_mv | AT yangyingying therelationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT chiyi therelationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT yuansiyi therelationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT zhangqing therelationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT sulongxiang therelationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT longyun therelationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT hehuaiwu therelationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT yangyingying relationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT chiyi relationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT yuansiyi relationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT zhangqing relationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT sulongxiang relationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT longyun relationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients AT hehuaiwu relationshipbetweenventilatoryratiovrand28dayhospitalmortalitybyrestrictedcubicsplinesrcsin14328mechanicallyventilatedicupatients |