A Clinical Study About Drive Pressure And Plateau Pressure To Predict Acute Respiratory Distress Syndrome Patients’ 28-day Survival

Objective:To investigate the predictive value of driving pressure and plateau pressure on the prognosis of acute respiratory distress syndrome（ARDS）patients during mechanical ventilation therapy,and to provide a theoretical basis for the clinical formulation of a reasonable selection of mechanical ventilation therapy strategy for ARDS patients.Methods:Patients admitted to the intensive care medicine department of a tertiary care hospital from September 1,2019 to October30,2021 who received mechanical ventilation and met the 2012 Berlin diagnostic criteria for ARDS were collected,and relevant clinical data including age,sex,height,ideal weight,cause of illness,APACHE II score,and survival status on day28 after being treated with mechanical ventilation were recorded.The parameters of arterial blood gas analysis before and after mechanical ventilation were recorded:acidity,carbon dioxide partial pressure,oxygen partial pressure,and blood lactate.To record patients’respiratory rate,tidal volume,positive end-expiratory pressure,and plateau pressure before and after mechanical ventilation therapy and driving pressure.Patients were divided into survival and death groups according to their clinical outcomes on the 28th day after starting treatment with mechanical ventilation.Results:1.A total of 76 cases conforming to the labeled cases were included,including 37 surviving patients and 39deceased patients.The age and APACHE II scores of patients in the death group were significantly higher than those in the survival group,but the number of days of ICU stay was lower than those in the survival group,and the difference between the groups was statistically significant（P<0.05）.2.The differences in oxygenation index,positive end-expiratory pressure,acidity and alkalinity of blood gas analysis,Lac,Pa O₂and Pa CO₂between the two groups before treatment were not statistically significant（P>0.05）,but the plateau pressure and driving pressure in the death group were significantly higher than those in the survival group,and the differences between the groups were statistically significant（P<0.05）.The oxygenation index was significantly higher in the survival group than in the death group,and the difference between the groups was statistically significant（P<0.05）.3.Binary logistic regression equation analysis showed that APACHE II score,both plateau pressure and driving pressure before or after mechanical ventilation treatment were the independent risk factors for death in ARDS patients（P<0.05）,while age,days of ICU stay,and oxygen and the index had some influence on the prognosis of ARDS patients,but were not independent risk factors for death in ARDS patients（P>0.05）.4.In the ROC curve analysis of plateau pressure,driving pressure,and APACHE II score before and after mechanical ventilation treatment,the area under the ROC curve（AUC）of driving pressure after mechanical ventilation treatment was the largest（0.837）（P<0.05）,and its sensitivity and specificity in determining death were 0.615 and0.919,respectively,when 13.5 cm H₂O was used as the critical value for determining prognosis 0.919,which was better than other factors.5.In the ROC curve analysis of APACHE II score,post-mechanical ventilation driving pressure,and post-mechanical ventilation plateau pressure,the area under the curve of post-mechanical driving pressure combined with APACHE II score was the largest（0.879）（P<0.05）,and its sensitivity and specificity for determining death were 0.692 and 0.919,respectively,which were generally better than that of post-mechanical plateau pressure combined with APACHE II score.Conclusions:1.APACHE II score,plateau pressure,and driving pressure are all important influencing factors affecting the prognosis of ARDS patients.2.The higher the APACHE II score,plateau pressure,and driving pressure in ARDS patients,the higher the mortality rate.3.Driving pressure is a better clinical indicator to assess the prognosis of ARDS patients,and when the driving pressure is>13.5cm H₂O,it indicates a poor prognosis of ARDS patients.4.Driving pressure combined with APACHE II score has higher sensitivity in predicting prognosis of ARDS patients and may be of more clinical value.