Exploring phenotype-based ventilator parameter optimization to mitigate postoperative pulmonary complications: a retrospective observational cohort study.
Exploring phenotype-based ventilator parameter optimization to mitigate postoperative pulmonary complications: a retrospective observational cohort study.
复制标题
探索基于表型的呼吸机参数优化以减轻术后肺部并发症：一项回顾性观察队列研究。
DOI：
10.1007/s00595-023-02785-8
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发表时间：
2023
期刊：
影响因子：
2.5
通讯作者：
Pan,Wei
中科院分区：
文献类型：
--
作者：
Tsumura,Hideyo;Brandon,Debra;Vacchiano,Charles;Krishnamoorthy,Vijay;Bartz,Raquel;Pan,Wei
目的根据术前特征，确定潮气量(VT)和呼气末正压(PEEP)与每种表型术后肺部并发症(PPC)发生率和严重程度的相关性。首先，使用最小绝对收缩和选择算子回归来选择相关的术前特征。然后，建立分类回归树(CART)进行表型鉴定。最后，我们从Logistic回归中计算受试者操作特征曲线下的面积，以确定VT和PEEP与每种表型PPC的最低发生率和严重程度相关。发生PPC的概率从最低(3.51%)到最高(68.57%)，而发生最高水平PPC的概率从3.3%到91.0%。在所有表型中，与最理想结果相关的VT和PEEP在预测体重VT7-8毫升/公斤的小范围内，PEEP在6-8 cmH2O之间。结论无论表型如何，最佳VT和PEEP的范围都很小，具有广泛的风险特征。
PurposeTo identify tidal volume (VT) and positive end-expiratory pressure (PEEP) associated with the lowest incidence and severity of postoperative pulmonary complications (PPCs) for each phenotype based on preoperative characteristics.MethodsThe subjects of this retrospective observational cohort study were 34,910 adults who underwent surgery, using general anesthesia with mechanical ventilation. Initially, the least absolute shrinkage and selection operator regression was employed to select relevant preoperative characteristics. Then, the classification and regression tree (CART) was built to identify phenotypes. Finally, we computed the area under the receiver operating characteristic curves from logistic regressions to identify VTand PEEP associated with the lowest incidence and severity of PPCs for each phenotype.ResultsCARTs classified seven phenotypes for each outcome. A probability of the development of PPCs ranged from the lowest (3.51%) to the highest (68.57%), whereas the probability of the development of the highest level of PPC severity ranged from 3.3% to 91.0%. Across all phenotypes, the VTand PEEP associated with the most desirable outcomes were within a small range of VT7–8 ml/kg predicted body weight with PEEP of between 6 and 8 cmH2O.ConclusionsThe ranges of optimal VTand PEEP were small, regardless of the phenotypes, which had a wide range of risk profiles.