Construction And Verification Of A Risk Prediction Model For Reintubation In Intensive Care Unit Patients On Mechanical Ventilation

Objective:Construction and verification of a nomogram model for reintubation in intensive care unit（ICU）patients on mechanical ventilation,in order to identify the risk of reintubation in mechanically ventilated patients at an early stage.To provide a basis for earlier targeted interventions to improve clinical outcomes for patients.Methods:1.Literature review:The Chinese and English databases were searched for literature on influencing factors of reintubation in mechanically ventilated patients.The search period was from the date of inception to May 2022.Researchers conduct literature screening,data extraction and reviewed the quality of the included studies according to the inclusion and exclusion criteria.Meta-analysis of risk factors for reintubation in mechanically ventilated patients in the ICU was performed using Rev Man 5.4 statistical software.Data collection forms were designed based on the results of Meta-analysis and clinical experience.2.Model construction:This study was a case-control study.Retrospective data were collected from January 2018 to June 2022 on mechanically ventilated patients in the Department of Intensive Care Unit at the First Hospital of Lanzhou University,and the patients were divided into case and control groups according to whether reintubation occurred.Risk factors were derived from univariate analysis and logistic regression analysis by SPSS 26.0 software,with P<0.05 being a statistically significant difference.The nomogram model was constructed using R 4.1.2 software,and the receiver operating characteristic curve（ROC）,calibration curve,and decision curve analysis（DCA）were used to evaluate the differentiation,calibration,and effectiveness of the model in the clinical situations.3.External verification:The information of mechanically ventilated patients in the Department of Intensive Care Unit at the First Hospital of Lanzhou University from September 2022 to February 2023 was collected for external validation.The portability and generalization of the model was evaluated by ROC,calibration curves and DCA.Results:1.The results of Meta-analysis:There were 38 studies finally included according to the criteria,and the results of Meta-analysis showed that older age,higher APACHE II scores,COPD,pneumonia,shock,low Sa O₂,low Pa O₂,low Pa O₂/Fi O₂,low hemoglobin,low albumin,high brain natriuretic peptide,low p H,high respiratory rate,low tidal volume,a higher rapid shallow breathing index,a lower vital capacity,a higher number of spontaneous breathing trials,prolonged length of mechanical ventilation,weak cough,a reduced patient’s cough peak flow and positive cuff leak test were risk factors for reintubation in mechanically ventilated patients in the ICU.2.Model construction:A total of 414 patients were included,of which 207 were in the case group and 207 were in the control group.The results of the univariate analysis showed statistical differences（P<0.05）in 27 factors:APACHE II score,SOFA score,length of mechanical ventilation,ROX index,rapid shallow breathing index,COPD,severe pneumonia,respiratory failure,sepsis,electrolyte disturbances,Pa CO₂,Pa O₂,hemoglobin,mean corpuscular hemoglobin contentration,percentage of basophils,absolute basophil count,albumin,globulin,total bilirubin,indirect bilirubin,cholinesterase,total bile acid,ECO₂,urea,serum magnesium,fibrinogen,fibrin/fibrinogen degradation products.The 27 factors with statistical differences were used as independent variables and whether reintubation occurred as the dependent variable in a binary logistic regression,and 6 predictors were derived,including APACHE II score,length of mechanical ventilation,ROX index,COPD,Pa O₂ and hemoglobin.To develop a nomogram model for reintubation of mechanically ventilated patients in ICU.The results showed that the total score of the nomogram model ranged from 0 to 240,and the predicted risk values ranged from 0.05 to 0.99.The ROC,calibration curve and DCA were plotted using the modeling group data,and the results showed that the area under curve（AUC）of ROC for the modeling group was 0.773,and the Hosmer-Lemeshow test showed that P=0.099,the calibration curve was close to the standard curve,the DCA curve is above the two extreme curves in the range of about 5%to 73%.3.External validation:A total of 134 patients were included,of which 23 patients were experiencing reintubation.The results of the study showed that the AUC for external validation was 0.738,the calibration curve was closer to the standard curve and the DCA curve is above the two extreme curves in the range of about 5%to 55%.Conclusion:This study constructed a nomogram model for reintubation of mechanically ventilated patients in ICU with well differentiation,calibration and clinical usefulness,which can better predict the risk of reintubation of patients and has certain clinical utility.