Effect of transpulmonary driving pressure guided positive end-expiratory pressure ventilation on pulmonary function and prognosis in patients with acute respiratory distress syndrome

doi:10.3877/cma.j.issn.1674-6902.2025.06.003

Abstract

Abstract:

Objective

To investigate the effect of transpulmonary driving pressure-guided positive end-expiratory pressure (PEEP) ventilation on lung function and prognosis in patients with acute respiratory distress syndrome (ARDS).

Methods

Fifty-one ARDS patients admitted to our hospital from May 2021 to July 2024 were selected and randomly divided into a control group (n=25) and an observation group (n=26). The control group received tidal volume PEEP titration, while the observation group received transpulmonary driving pressure-guided PEEP titration. Lung function parameters and hemodynamic parameters were measured, and hospital stay, ICU stay, duration of mechanical ventilation, weaning success rate, incidence of atelectasis, and in-hospital mortality were recorded.

Results

The PEEP in the observation group was (8.36±1.72) cmH₂O, higher than that in the control group (6.17±1.58) cmH₂O(t=4.730, P<0.05). The physiological dead space fraction (Vd/Vt) in the observation group was (31.97±8.22)%, lower than that in the control group (37.24±10.26)%(t=2.028, P<0.05). There were no statistically significant differences in respiratory mechanics and blood gas analysis between the two groups before ICU admission (P>0.05). After 48 hours of mechanical ventilation, the observation group showed higher static compliance (45.76±20.00) ml/cmH₂O, arterial partial pressure of oxygen (PaO₂) (127.73±32.27) mmHg, and oxygenation index (PaO₂/FiO₂) (380.40±106.53) compared to the control group′s static compliance (36.40±11.97) ml/cmH₂O, PaO₂(106.96±30.76)mmHg, and PaO₂/FiO₂(310.17 ± 97.29) (r=2.048, 2.351, 2.455, P<0.05). Additionally, the observation group′s dynamic compliance (29.27±8.17) ml/cmH₂O, airway resistance (9.20±5.67) cmH₂O·L^-1·s^-1, and blood oxygen saturation (SaO₂) (105.29±19.64)% were better than the control group′s dynamic compliance (25.88±5.73) ml/cmH₂O, airway resistance (11.25±7.65) cmH₂O·L^-1·s^-1, and SaO₂ (103.08±17.25)% (t=1.709, 1.090, 0.427, P>0.05). There were no statistically significant differences in hemodynamic parameters between the two groups (P>0.05). The duration of mechanical ventilation [8.00(6.00, 13.00)days], hospital stay [15.00 (9.50, 26.50) days], and incidence of atelectasis [2 cases (7.69%)] in the observation group were lower than those in the control group [20.00 (9.00, 28.00) days, 33.00 (12.50, 62.00) days, and 5 cases (20.00%), respectively]. The weaning success rate in the observation group [14 cases (53.85%)] was higher than that in the control group [5 cases(20.00%)] (P<0.05). During hospitalization, there were 20 survivors (76.92%) and 6 deaths (23.08%) in the observation group, compared to 12 survivors (48.00%) and 13 deaths (52.00%) in the control group. The median survival time in the observation group was 30 days, longer than that in the control group (23 days) (P<0.05).

Conclusion

Transpulmonary driving pressure-guided PEEP can improve oxygenation and lung compliance in ARDS patients, reduce the duration of mechanical ventilation, lower the risk of atelectasis and in-hospital mortality, and help improve the weaning success rate.

Key words: Acute respiratory distress syndrome, Transpulmonary driving pressure, positive end-expiratory pressure ventilation, Pulmonary function, Prognosis

Rong Wu, Zheyi Cai, Yunhua Huang, Jinhai Le, Ping Zhang, Xian Chen, Qiong Yi. Effect of transpulmonary driving pressure guided positive end-expiratory pressure ventilation on pulmonary function and prognosis in patients with acute respiratory distress syndrome[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(06): 866-871.

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References 25

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临床资料	观察组(n＝26)	对照组(n＝25)	t/χ²/Z值	P值
体质量指数[kg/m²，(±s)]	25.89±5.36	27.50±6.96	0.928	0.358
查尔森合并症指数[分，M(Q25，Q75)]	3.00(1.00，4.00)	3.00(2.00，4.00)	－0.931	0.352
SOFA评分[分，M(Q25，Q75)]	4.00(4.00，5.00)	4.00(3.00，4.00)	－0.960	0.337
实验室指标[M(Q25，Q75)]
WBC(/mm³)	7 800.00(7 080.00，11 625.00)	8 940.00(7 670.00，12 000.00)	－0.989	0.323
LYM(/mm³)	9.00(6.00，13.45)	8.00(5.95，11.00)	－0.936	0.349
CRP(mg/dl)	12.53(2.75，17.23)	13.00(5.92，17.15)	－0.716	0.474
PCT(ng/ml)	0.11(0.05，0.19)	0.14(0.06，0.29)	－0.340	0.734
入ICU前住院时间[d，(±s)]	33.42±10.75	32.56±9.89	0.297	0.768

临床资料	观察组(n＝26)	对照组(n＝25)	t/χ²/Z值	P值
体质量指数[kg/m²，(±s)]	25.89±5.36	27.50±6.96	0.928	0.358
查尔森合并症指数[分，M(Q25，Q75)]	3.00(1.00，4.00)	3.00(2.00，4.00)	－0.931	0.352
SOFA评分[分，M(Q25，Q75)]	4.00(4.00，5.00)	4.00(3.00，4.00)	－0.960	0.337
实验室指标[M(Q25，Q75)]
WBC(/mm³)	7 800.00(7 080.00，11 625.00)	8 940.00(7 670.00，12 000.00)	－0.989	0.323
LYM(/mm³)	9.00(6.00，13.45)	8.00(5.95，11.00)	－0.936	0.349
CRP(mg/dl)	12.53(2.75，17.23)	13.00(5.92，17.15)	－0.716	0.474
PCT(ng/ml)	0.11(0.05，0.19)	0.14(0.06，0.29)	－0.340	0.734
入ICU前住院时间[d，(±s)]	33.42±10.75	32.56±9.89	0.297	0.768

呼吸力学/血气分析参数	观察组(n＝26)	对照组(n＝25)	t值	P值
静态顺应性(ml/cmH₂O)
基线	34.56±10.70	35.53±13.29	0.288	0.775
机械通气48 h	45.76±20.00^a	36.40±11.97	2.048	0.046
动态顺应性(ml/cmH₂O)
基线	25.52±6.88	25.53±5.23	0.006	0.995
机械通气48 h	29.27±8.17	25.88±5.73	1.709	0.094
气道阻力(ml/cmH₂O·L^－1·s^－1)
基线	9.32±5.91	11.44±8.79	1.014	0.315
机械通气48 h	9.20±5.67	11.25±7.65	1.090	0.281
pH
基线	7.31±0.09	7.35±0.09	1.587	0.119
机械通气48 h	7.35±0.38	7.45±0.33	1.002	0.321
PaO₂(mmHg)
基线	108.19±30.98	103.44±33.57	0.551	0.584
机械通气48 h	127.73±32.27	106.96±30.76	2.351	0.023
PaCO₂(mmHg)
基线	48.96±12.75	45.56±11.36	1.146	0.257
机械通气48 h	46.35±11.41	42.84±9.56	1.188	0.240
PaO₂/FiO₂
基线	298.08±126.81	308.72±118.12	0.310	0.758
机械通气48 h	380.40±106.53^a	310.17±97.29	2.455	0.018
SaO₂(%)
基线	91.37±17.28	89.65±16.84	0.360	0.720
机械通气48 h	105.29±19.64^a	103.08±17.25^a	0.427	0.671

呼吸力学/血气分析参数	观察组(n＝26)	对照组(n＝25)	t值	P值
静态顺应性(ml/cmH₂O)
基线	34.56±10.70	35.53±13.29	0.288	0.775
机械通气48 h	45.76±20.00^a	36.40±11.97	2.048	0.046
动态顺应性(ml/cmH₂O)
基线	25.52±6.88	25.53±5.23	0.006	0.995
机械通气48 h	29.27±8.17	25.88±5.73	1.709	0.094
气道阻力(ml/cmH₂O·L^－1·s^－1)
基线	9.32±5.91	11.44±8.79	1.014	0.315
机械通气48 h	9.20±5.67	11.25±7.65	1.090	0.281
pH
基线	7.31±0.09	7.35±0.09	1.587	0.119
机械通气48 h	7.35±0.38	7.45±0.33	1.002	0.321
PaO₂(mmHg)
基线	108.19±30.98	103.44±33.57	0.551	0.584
机械通气48 h	127.73±32.27	106.96±30.76	2.351	0.023
PaCO₂(mmHg)
基线	48.96±12.75	45.56±11.36	1.146	0.257
机械通气48 h	46.35±11.41	42.84±9.56	1.188	0.240
PaO₂/FiO₂
基线	298.08±126.81	308.72±118.12	0.310	0.758
机械通气48 h	380.40±106.53^a	310.17±97.29	2.455	0.018
SaO₂(%)
基线	91.37±17.28	89.65±16.84	0.360	0.720
机械通气48 h	105.29±19.64^a	103.08±17.25^a	0.427	0.671

血流动力学特　征	观察组(n＝26)	对照组(n＝25)	t值	P值
心率(次/min)
基线	100.93±20.57	104.35±23.12	0.559	0.579
机械通气48 h	97.26±20.17	102.03±18.29	0.884	0.381
平均动脉压(mmHg)
基线	79.57±13.05	81.44±16.28	0.451	0.654
机械通气48 h	80.14±12.79	82.36±15.01	0.569	0.572
中心静脉压(mmHg)
基线	10.19±2.91	10.01±3.04	0.216	0.830
机械通气48 h	11.27±2.93	10.36±2.88	1.118	0.269

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