The correlation between bladder pressure and diaphragm excursion in patients with severe acute pancreatitis combined with acute respiratory distress syndrome and its predictive value for weaning outcomes_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

GUO Chuang ¹ ,  CHU Yun ² , ZHANG Fengxiang ³ , CUI Xiangfei ⁴

1. Department of Cardio-Thoracic Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, Liaoning, P.R.China;
2. Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, Liaoning, P.R.China;
3. Department of Intensive Care Unit, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, Liaoning, P.R.China;
4. Nephrology department, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, Liaoning, P.R.China;

Corresponding author：

CHU Yun, Email: 236408918@qq.com

Keywords：

severe acute pancreatitis; acute respiratory distress syndrome; intravesical pressure; diaphragm excursion; Withdrawal outcome; predictive value

DOI：

10.7507/1671-6205.202402018

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Objective Exploring the correlation between intravesical pressure (IP) and diaphragm excursion (DE) in patients with severe acute pancreatitis (SAP) and acute respiratory distress syndrome (ARDS), and evaluating its predictive value for weaning outcomes. Methods A retrospective analysis was conducted on the clinical data of 144 SAP patients with ARDS admitted between 2020 and 2023. By collecting the outcome of weaning, collect data on gender, age, acute physiology and chronic health score II (APACHE II), oxygenation index, and IP and DE before weaning and extubation for all patients. Based on weaning outcomes, divide patients into successful and failed groups, and compare the differences in various indicators between the two groups; Use binary logistic regression to analyze whether IP and DE are risk factors affecting weaning in SAP patients with ARDS, and use Pearson correlation analysis to examine the correlation between IP and DE; Use receiver operating characteristic curve (ROC curve) to analyze the predictive value of IP and DE on weaning outcomes in SAP patients with ARDS. Results A total of 144 SAP patients with ARDS were included, of which 108 were successfully weaned and 36 were unsuccessful. There were no statistically significant differences in gender, age, and APACHE II scores between the successful and failed groups (males: 62.96% (68/108) compared to 69.44% (25/36), age (years): 41.91 ± 8.14 compared to 42.42 ± 6.22, APACHE II score (points): 18.28 ± 2.22 compared to 18.97 ± 1.83, P>0.05). The IP of the successful group was significantly lower than that of the failed group, and the DE was significantly higher than that of the failed group [IP (mmHg): 18.45 ± 3.76 compared to 23.92 ± 5.65, DE (mm): 16.18 ± 4.23 compared to 12.28 ± 4.44, all P<0.05]. All patients showed a significant negative correlation between IP and DE (r=–0.457, P<0.001). ROC curve analysis showed that the area under the curve (AUC) of IP predicting the withdrawal outcome of SAP patients with ARDS was 0.805, with a 95% confidence interval (95%CI) of 0.724-0.885 and P<0.001. When the cutoff value was 19.5 mmHg, the sensitivity was 91.57% and the specificity was 47.54%; The AUC for predicting the withdrawal outcome of SAP patients with ARDS by DE was 0.738, with a 95%CI of 0.641-0.834 and P<0.001. When the cutoff value was 11.5 points, the sensitivity was 84.82% and the specificity was 59.38%. Conclusions There is a significant negative correlation between IP and DE in SAP combined with ARDS patients, and both have certain predictive value for weaning outcomes.

Citation： GUO Chuang, CHU Yun, ZHANG Fengxiang, CUI Xiangfei. The correlation between bladder pressure and diaphragm excursion in patients with severe acute pancreatitis combined with acute respiratory distress syndrome and its predictive value for weaning outcomes. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(8): 563-568. doi: 10.7507/1671-6205.202402018 Copy

1.	Ramia JM, Azagra JS, De la Plaza R, et al. Laparoscopic longitudinal pancreaticojejunostomy for chronic pancreatitis: systematic review of the literature. Surgeon, 2020, 18(3): 137-141.
2.	Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol, 2019, 16(3): 175-184.
3.	卢洪军, 厉兵, 崔乃强, 等. 重症急性胰腺炎合并ARDS 早期风险因素分析及预测模型建立. 中国中西医结合急救杂志, 2021, 28(6): 658-661.
4.	Zambon M, Greco M, Bocchino S, et al. Assessment of diaphragmatic dy-sfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med, 2016, 43(1): 29-38.
5.	Luo J, Han X, Fan M, et al. Guiding significance of diaphragm function evaluation in ventilation weaning. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2017, 29(11): 1035-1038.
6.	龚菊, 詹英, 张碧波. 自主呼吸试验时超声测量膈肌移动度变化预测机械通气患者撤机成功的价值. 中华麻醉学杂志, 2016, 36(12): 1489-1492.
7.	Goligher EC, Brochard LJ, Reid WD, et al. Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure. Lancet Respir Med, 2019, 7(1): 90-98.
8.	Demoule A, Jung B, Prodanovic H, et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-A prospective study. Am J Respir Crit Care Med, 2013, 188(2): 213-219.
9.	McCool FD, Oyiengo DO, Koo P. The utility of diaphragm ultrasound in reducing time to extubation. Lung, 2020, 198(3): 499-505.
10.	Scarlata S, Mancini D, Laudisio A, et al. Reproducibility and clinic-al correlates of supine diaphragmatic motion measured by M-mode ultr-asonography in healthy volunteers. Respiration, 2018, 96(3): 259-266.
11.	Elshazly MI, Kamel KM, Elkorashy RI, et al. Role of bedside ultrason-ography in assessment of diaphragm function as a predictor of success of weaning in mechanically ventilated patients. Tuberc Respir Dis(Seoul), 2020, 83(4): 295-302.
12.	马金兰, 杨光飞, 杨红晓, 等. 脓毒症患者膈肌功能障碍的床旁超声评估的应用价值研究. 中华急诊医学杂志, 2022, 31(5): 650-657.
13.	van Dijk SM, Hallensleben NDL, van Santvoort HC, et al. Acute pancreatitis: recent advances through randomised trials. Gut, 2017, 66(11): 2024-2032.
14.	陈倩, 顾丽华, 沈梅芬, 等. 拔管前腹内压变化值对机械通气患者拔管失败的预测价值. 中国急救医学, 2021, 41(11): 938-942.
15.	王晓冬, 罗家鑫, 霍习敏, 等. 腹内压监测在小儿重症肺炎机械通气中的应用价值. 中国全科医学, 2021, 24(5): 555-560.
16.	邸兴伟, 李晓东, 李甜, 等. 膈肌增厚分数与腹内压导向的风险预测模型对重症急性胰腺炎患者撤机失败的预测价值. 中华危重病急救医学, 2023, 35(2): 177-181.
17.	Sakka SG. Der Patient mit intraabdomineller Hypertension - Was gilt es beim anästhesiologischen Management zu beachten? [The patient with intra-abdominal hypertension]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2016, 51(1): 8-16. German.
18.	Iyer D, Rastogi P, Aneman A, et al. Early screening to identify patients at risk of developing intra-abdominal hypertension and ab-dominal compartment syndrome. Acta Anaesthesiol Scand, 2014, 58(10): 1267-1275.
19.	Lee RK. The effects of nursing activities on the intra-abdominal pressure of patients at risk for intra-abdominal hypertension. Anaesthesiol Intensive Ther. 2017, 49(2): 116-121.
20.	Chen YZ, Yan SY, Chen YQ, et al. Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension. World J Emerg Med, 2015, 6(2): 137-141.

1. Ramia JM, Azagra JS, De la Plaza R, et al. Laparoscopic longitudinal pancreaticojejunostomy for chronic pancreatitis: systematic review of the literature. Surgeon, 2020, 18(3): 137-141.
2. Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol, 2019, 16(3): 175-184.
3. 卢洪军, 厉兵, 崔乃强, 等. 重症急性胰腺炎合并ARDS 早期风险因素分析及预测模型建立. 中国中西医结合急救杂志, 2021, 28(6): 658-661.
4. Zambon M, Greco M, Bocchino S, et al. Assessment of diaphragmatic dy-sfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med, 2016, 43(1): 29-38.
5. Luo J, Han X, Fan M, et al. Guiding significance of diaphragm function evaluation in ventilation weaning. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2017, 29(11): 1035-1038.
6. 龚菊, 詹英, 张碧波. 自主呼吸试验时超声测量膈肌移动度变化预测机械通气患者撤机成功的价值. 中华麻醉学杂志, 2016, 36(12): 1489-1492.
7. Goligher EC, Brochard LJ, Reid WD, et al. Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure. Lancet Respir Med, 2019, 7(1): 90-98.
8. Demoule A, Jung B, Prodanovic H, et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-A prospective study. Am J Respir Crit Care Med, 2013, 188(2): 213-219.
9. McCool FD, Oyiengo DO, Koo P. The utility of diaphragm ultrasound in reducing time to extubation. Lung, 2020, 198(3): 499-505.
10. Scarlata S, Mancini D, Laudisio A, et al. Reproducibility and clinic-al correlates of supine diaphragmatic motion measured by M-mode ultr-asonography in healthy volunteers. Respiration, 2018, 96(3): 259-266.
11. Elshazly MI, Kamel KM, Elkorashy RI, et al. Role of bedside ultrason-ography in assessment of diaphragm function as a predictor of success of weaning in mechanically ventilated patients. Tuberc Respir Dis(Seoul), 2020, 83(4): 295-302.
12. 马金兰, 杨光飞, 杨红晓, 等. 脓毒症患者膈肌功能障碍的床旁超声评估的应用价值研究. 中华急诊医学杂志, 2022, 31(5): 650-657.
13. van Dijk SM, Hallensleben NDL, van Santvoort HC, et al. Acute pancreatitis: recent advances through randomised trials. Gut, 2017, 66(11): 2024-2032.
14. 陈倩, 顾丽华, 沈梅芬, 等. 拔管前腹内压变化值对机械通气患者拔管失败的预测价值. 中国急救医学, 2021, 41(11): 938-942.
15. 王晓冬, 罗家鑫, 霍习敏, 等. 腹内压监测在小儿重症肺炎机械通气中的应用价值. 中国全科医学, 2021, 24(5): 555-560.
16. 邸兴伟, 李晓东, 李甜, 等. 膈肌增厚分数与腹内压导向的风险预测模型对重症急性胰腺炎患者撤机失败的预测价值. 中华危重病急救医学, 2023, 35(2): 177-181.
17. Sakka SG. Der Patient mit intraabdomineller Hypertension - Was gilt es beim anästhesiologischen Management zu beachten? [The patient with intra-abdominal hypertension]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2016, 51(1): 8-16. German.
18. Iyer D, Rastogi P, Aneman A, et al. Early screening to identify patients at risk of developing intra-abdominal hypertension and ab-dominal compartment syndrome. Acta Anaesthesiol Scand, 2014, 58(10): 1267-1275.
19. Lee RK. The effects of nursing activities on the intra-abdominal pressure of patients at risk for intra-abdominal hypertension. Anaesthesiol Intensive Ther. 2017, 49(2): 116-121.
20. Chen YZ, Yan SY, Chen YQ, et al. Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension. World J Emerg Med, 2015, 6(2): 137-141.

Chinese Journal of Respiratory and Critical Care Medicine

The correlation between bladder pressure and diaphragm excursion in patients with severe acute pancreatitis combined with acute respiratory distress syndrome and its predictive value for weaning outcomes

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