Relación entre intensidad de la ventilación mecánica y agravamiento de la disfunción multiorgánica por la COVID-19 / Relationship between intensity of mechanical ventilation and multiple organ dysfunction worsening by COVID-19

RESUMEN Introducción: La intensidad de la ventilación mecánica está reflejada por la presión de conducción dinámica y el poder mecánico. Es un predictor de lesión pulmonar inducida por el ventilador y está asociada a la mortalidad. Objetivo: Determinar si existe relación entre intensidad de la ventilación mecánica y el ΔSOFA>0 (agravamiento) en los pacientes con la COVID-19 a las 72 horas después de la intubación. Material y Métodos: Grupo de estudio conformado por 35 pacientes diagnosticados con la COVID-19 que estuvieron ventilados por más de 72 horas. Se empleó la prueba de Chi cuadrado (X 2 ) o test exacto de Fisher para comparar variables cualitativas; para las cuantitativas se empleó la prueba t de Student o U de Mann-Whitney. Se realizó una Regresión Logística Binaria Simple para encontrar relación de las variables con ΔSOFA dicotomizada para ΔSOFA≤0 y ΔSOFA>0. La capacidad discriminativa de los modelos se evaluó mediante la Curva ROC. Resultados: Presentaron SOFA>0 21 pacientes (60 %). No se encontraron diferencias significativas de la Presión de Conducción entre ambos grupos (15 vs. 18, U=94.00, z= -1,795, p=0,77). Fueron buenas predictoras de ΔSOFA>0 el Poder Mecánico (OR 3,421 [95 % IC1,510 a 7,750, p=0,003]) y el Volumen Tidal (OR 1,03 [95 % IC 1,012 a 1,068], p=0,005). El Modelo Predictivo de ΔSOFA>0 en función del Poder Mecánico (AUC 0,888 [95 % IC 0,775 a 1], p<0,001) mostró una buena capacidad discriminatoria. Conclusiones: El Poder Mecánico está relacionado con el agravamiento de la disfunción multiorgánica en pacientes sometidos a ventilación mecánica por la COVID-19.

ABSTRACT Introduction: The intensity of mechanical ventilation is reflected by driving pressure and mechanical power. It is a predictor of ventilator-induced lung injury and it can be associated with mortality. Objective: To determine if there is a relationship between intensity of mechanical ventilation and ΔSOFA>0 (worsening) in patients with COVID-19 at 72 h after intubation. Material and Methods: Study group composed of 35 COVID-19 patients who were ventilated for more than 72 hours. Chi-square test (X 2 ) or Fisher's exact test was used to compare qualitative variables; Student t test or Mann-Whitney U test was employed for quantitative ones. A Simple Binary Logistic Regression Model was performed in order to find the relationship between variables and dichotomized ΔSOFA for ΔSOFA≤0 and ΔSOFA>0. The discriminatory capacity of the models was tested by using ROC Curve. Results: A total of 21 patients (60 %) presented ΔSOFA>0 (worsening). No significant differences related to Driving Pressure were found between the two groups (15 vs. 18, U=94,00, z= -1,795, p=0,77). Mechanical Power (OR 3,421 [95 % CI 1,510 a 7,750, p=0,003]) and Tidal Volume (OR 1,03 [95 % CI 1,012 a 1,068], p=0,005) were good predictors of ΔSOFA>0. The Predictive Model of ΔSOFA>0 depending on Mechanical Power (AUC 0,888 [95 % CI 0,775 a 1], p<0,001) showed a good discriminatory capacity. Conclusions: Mechanical Power is related to multi-organ dysfunction worsening in mechanically ventilated patients with COVID-19.

Early Changes in the Sequential Organ Failure Assessment (SOFA) Score as a Prognostic Factor in Acute Respiratory Failure in Children with Mechanical Ventilator Support / 소아알레르기및호흡기학회지

PURPOSE: In pediatric acute respiratory failure patients requiring mechanical ventilator support, mortality is seldom related to respiratory disease alone, but more generally to multiple organ dysfunction syndrome. The purpose of this study is to evaluate whether early changes in the SOFA score (Delta-SOFA) are more effective for predicting the outcome than a single assessment upon admission for pediatric acute respiratory failure patients requiring mechanical ventilator support. METHODS: The medical records of pediatric patients with acute respiratory failure requiring mechanical ventilator support for more than 72 hours in the PICU of the Asan Medical Center Children's Hospital, Seoul, Korea, between January 2008 and May 2009 were retrospectively reviewed. RESULTS: Early Delta-SOFA showed a significantly stronger correlation with patient mortality compared with the initial SOFA score, PRISM III score and PELOD score (P<0.05). When analyzing the trends in the SOFA score during the first 72 hours, the mortality rate was significantly higher in children with increased and unchanged SOFA scores 72 hours after admission than in children with a decreased SOFA score. (14.5% vs. 42.9%, P<0.05) CONCLUSION: Regardless of the initial SOFA score, early serial evaluation of the SOFA scores during the first 3 days of PICU admission is a better indicator of the prognosis than a single assessment obtained at admission in acute respiratory failure patients mechanically ventilated for more than 3 days.