Outcome prediction in critically ill patients under invasive ventilation remains extremely challenging. The driving pressure (ΔP) and the mechanical power of ventilation (MP) are associated with patient-centered outcomes like mortality and duration of ventilation. The objective of this study was to assess the predictive validity for mortality of the ΔP and the MP at 24 h after start of invasive ventilation. This is a post hoc analysis of an observational study in intensive care unit patients, restricted to critically ill patients receiving invasive ventilation for at least 24 h. The two exposures of interest were the modified ΔP and the MP at 24 h after start of invasive ventilation. The primary outcome was 90-day mortality; secondary outcomes were ICU and hospital mortality. The predictive validity was measured as incremental 90-day mortality beyond that predicted by the Acute Physiology, Age and Chronic Health Evaluation (APACHE) IV score and the Simplified Acute Physiology Score (SAPS) II. The analysis included 839 patients with a 90-day mortality of 42%. The median modified ΔP at 24 h was 15 [interquartile range 12 to 19] cm H2O; the median MP at 24 h was 206 [interquartile range 145 to 298] 10−3 J/min/kg predicted body weight (PBW). Both parameters were associated with 90-day mortality (odds ratio (OR) for 1 cm H2O increase in the modified ΔP, 1.05 [95% confidence interval (CI) 1.03 to 1.08]; P < 0.001; OR for 100 10−3 J/min/kg PBW increase in the MP, 1.20 [95% CI 1.09 to 1.33]; P < 0.001). Area under the ROC for 90-day mortality of the modified ΔP and the MP were 0.70 [95% CI 0.66 to 0.74] and 0.69 [95% CI 0.65 to 0.73], which was neither different from that of the APACHE IV score nor that of the SAPS II. In adult patients under invasive ventilation, the modified ΔP and the MP at 24 h are associated with 90 day mortality. Neither the modified ΔP nor the MP at 24 h has predictive validity beyond the APACHE IV score and the SAPS II.

中文翻译：

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驱动压力和通气机械功率死亡率的预测效度

有创通气下危重患者的预后预测仍然极具挑战性。驱动压力 (ΔP) 和机械通气功率 (MP) 与以患者为中心的结果相关，例如死亡率和通气持续时间。本研究的目的是评估有创通气开始后 24 小时 ΔP 和 MP 死亡率的预测有效性。这是对重症监护病房患者的观察性研究的事后分析，仅限于接受有创通气至少 24 小时的危重患者。两个感兴趣的暴露是修改后的 ΔP 和有创通气开始后 24 小时的 MP。主要结果是 90 天死亡率；次要结果是ICU和住院死亡率。预测有效性被衡量为超出急性生理学、年龄和慢性健康评估 (APACHE) IV 评分和简化急性生理学评分 (SAPS) II 预测值的 90 天死亡率增量。该分析包括 839 名患者，90 天死亡率为 42%。24 小时时修正 ΔP 的中位数为 15 [四分位距 12 至 19] cm H2O；24 小时的 MP 中位数为 206 [四分位距 145 至 298] 10-3 J/min/kg 预测体重 (PBW)。这两个参数都与 90 天死亡率相关（改良 ΔP 增加 1 cm H2O 的比值比 (OR)，1.05 [95% 置信区间 (CI) 1.03 至 1.08]；P < 0.001；OR 为 100 10−3 J） MP 中的 /min/kg PBW 增加 1.20 [95% CI 1.09 至 1.33]；P < 0.001)。修正 ΔP 和 MP 的 90 天死亡率的 ROC 下面积分别为 0.70 [95% CI 0.66 至 0.74] 和 0。69 [95% CI 0.65 至 0.73]，与 APACHE IV 评分和 SAPS II 评分均无差异。在有创通气下的成年患者中，修正后的 ΔP 和 24 小时 MP 与 90 天死亡率相关。修改后的 ΔP 和 24 小时的 MP 都没有超出 APACHE IV 评分和 SAPS II 的预测有效性。