The value of mechanical power to predict the potential of lung recruitment maneuvers and assess prognosis in patients with acute respiratory distress syndrome

Abstract

Objective To investigate the value of mechanical power (MP) to predict the potential of the lung recruitment maneuver and assess prognoses in patients with acute respiratory distress syndrome (ARDS). Methods Patients with moderate-to-severe ARDS who required mechanical ventilation therapy longer than 24 hours were randomly selected April 2017 to April 2019. The lung recruitment maneuver (RM) protocol was performed according to the patient's condition, their MP, lung ultrasound score (LUS), oxygenation index (P/F), and dead volume ratio (Vd/Vt), which were monitored before the RM and one hour after the RM. The patients were divided into the lung recruitment maneuver potential positive group (RMP-P group) and lung recruitment maneuver potential negative group (RMP-N group) according to whether the variation in the patient's RM aeration score (ΔLUS) was≥5. Differences in MP between the two groups were compared and correlations between MP variation (ΔMP), aeration score variation (ΔLUS), oxygenation index variation (ΔP/F), and dead volume ratio variation (ΔVd/Vt) were analyzed. The receiver operating characteristic curve (ROC) was used to calculate the predictive value of MP for the potential of RM and the prognosis (28-day mortality) of patients with moderate or severe ARDS. Results Eighty-three patients were enrolled in the study, 45 in the RMP-P group and 38 in the RMP-N group. There was no statistical difference in the baseline levels between the two groups (P>0.05). After RM treatment, MP, LUS scores, and Vd/Vt for each patient in the two groups decreased significantly compared to the pre-RM values, whereas, the P/F increased significantly (P 0.05). The ΔMP, ΔLUS, and ΔVd/Vt in the RMP-P group were significantly higher than those in the RMP-N group (P 0.05). There was a significant positive correlation between ΔMP and ΔLUS and ΔVd/Vt in all patients (r=0.4746, 0.3995, P 0.05). The area under the ROC curves of ΔMP for predicting the potential of RM was 0.856, with a sensitivity of 91.1% and a specificity of 63.2%. The AUC of the 28-day survival status was 0.788, with a sensitivity of 84.3% and a specificity of 62.5% (P<0.05). Conclusions Mechanical power monitoring before and after RM can be used to predict the potential of the lung recruitment maneuver and assess the prognosis in patients with moderate-to-severe ARDS. Key words: Acute respiratory distress syndrome; Mechanical power; Recruitment maneuver potential; Lung ultrasound score; Prognosis