关键词:

脓毒症, 呼吸衰竭, 撤机失败, 风险模型

Abstract:

Objective　To construct and validate a risk model for initial weaning failure in patients with sepsis and respiratory failure. Methods　This study included 120 patients with sepsis and respiratory failure admitted to the Emergency Center, East Hospital, the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to January 2024. According to the outcome of weaning, they were divided into a successful weaning group (102 cases) and a failed weaning group (18 cases). There were 53 males and 49 females in the successful weaning group, aged (61.77±7.15) years. In the failed weaning group, there were 11 males and 7 females, aged (62.12±7.21) years. The general data were compared between the two groups. A risk model for initial weaning failure was constructed based on the results of logistic regression analysis and a nomogram was developed. The receiver operating characteristic curve (ROC) was established with initial weaning failure as the positive sample, and the fit of the risk model was verified by Hosmer-Lemeshow. Statistical methods used were t test and χ² test. Results　The smoking ratio, duration of mechanical ventilation, sepsis related Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, and rapid shallow breathing index (RSBI) in the failed weaning group were higher than those in the successful weaning group [72.2% (13/18) vs. 46.5% (47/102), (9.04±1.14) d vs. (6.58±0.96) d, (7.47±1.09) min vs. (5.14±0.84) min, (19.71±1.80) min vs. (17.39±1.64) min, (79.31±8.42) breaths/min/L vs. (58.38±6.45) breaths/min/L], with statistically significant differences (χ²=4.18, t=9.74, 10.35, 5.11, and 10.04, all P<0.05). Logistic regression analysis showed that smoking [P=0.011, 95% confidence interval (CI) 1.679-55.648], duration of mechanical ventilation (P=0.024, 95%CI 1.087-3.189), SOFA score (P=0.009, 95%CI 1.281-5.874), APACHEⅡ score (P<0.001, 95%CI 1.890-7.384), and RSBI (P=0.003, 95%CI 1.041-1.215) were the influential factors for initial weaning failure in patients with sepsis and respiratory failure. The ROC results showed that the combined prediction of smoking, duration of mechanical ventilation, SOFA score, APACHEⅡ score, and RSBI [area under the curve (AUC) = 0.980, sensitivity=94.7%, and specificity=92.1%] was significantly better than that of smoking (AUC=0.609, sensitivity=68.4%, and specificity=53.5%), duration of mechanical ventilation (AUC=0.868, sensitivity=57.9%, and specificity=99.0%), SOFA score (AUC=0.876, sensitivity=89.5%, and specificity=68.3%), APACHEⅡ score (AUC=0.811, sensitivity=73.7%, and specificity=78.2%), and RSBI alone (AUC=0.927, sensitivity=94.7%, and specificity=79.2%), and the risk model showed good fit through Hosmer-Lemeshow test. Conclusions　Smoking, duration of mechanical ventilation, SOFA score, APACHEⅡ score, and RSBI are significantly associated with initial weaning failure in patients with sepsis and respiratory failure. The constructed risk model has a good fit.

Key words:

Sepsis, Respiratory failure, Weaning failure, Risk model