The relationship of tidal volume and driving pressure with mortality in hypoxic patients receiving mechanical ventilation

Purpose To determine whether tidal volume/predicted body weight (TV/PBW) or driving pressure (DP) are associated with mortality in a heterogeneous population of hypoxic mechanically ventilated patients. Methods A retrospective cohort study involving 18 intensive care units included consecutive patients ≥18 years old, receiving mechanical ventilation for ≥3 days, with a PaO2/FiO2 ratio ≤300 mmHg, whether or not they met full criteria for ARDS. The main outcome was hospital mortality. Multiple logistic regression (MLR) incorporated TV/PBW, DP, and potential confounders including age, APACHE IVa® predicted hospital mortality, respiratory system compliance (CRS), and PaO2/FiO2. Predetermined strata of TV/PBW were compared using MLR. Results Our cohort comprised 5,167 patients with mean age 61.9 years, APACHE IVa® score 79.3, PaO2/FiO2 166 mmHg and CRS 40.5 ml/cm H2O. Regression analysis revealed that patients receiving DP one standard deviation above the mean or higher (≥19 cmH20) had an adjusted odds ratio for mortality (ORmort) = 1.10 (95% CI: 1.06–1.13, p = 0.009). Regression analysis showed a U-shaped relationship between strata of TV/PBW and adjusted mortality. Using TV/PBW 4–6 ml/kg as the referent group, patients receiving >10 ml/kg had similar adjusted ORmort, but those receiving 6–7, 7–8 and 8–10 ml/kg had lower adjusted ORmort (95%CI) of 0.81 (0.65–1.00), 0.78 (0.63–0.97) and 0.80 0.67–1.01) respectively. The adjusted ORmort in patients receiving 4–6 ml/kg was 1.26 (95%CI: 1.04–1.52) compared to patients receiving 6–10 ml/kg. Conclusions Driving pressures ≥19 cmH2O were associated with increased adjusted mortality. TV/PBW 4-6ml/kg were used in less than 15% of patients and associated with increased adjusted mortality compared to TV/PBW 6–10 ml/kg used in 82% of patients. Prospective clinical trials are needed to prove whether limiting DP or the use of TV/PBW 6–10 ml/kg versus 4–6 ml/kg benefits mortality.

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Interaction between regional lung volumes and ventilator-induced lung injury in the normal and endotoxemic lung

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00492.2019 ◽

2020 ◽

Vol 318 (3) ◽

pp. L494-L499 ◽

Cited By ~ 2

Author(s):

Seiha Yen ◽

Melissa Preissner ◽

Ellen Bennett ◽

Stephen Dubsky ◽

Richard Carnibella ◽

...

Keyword(s):

Mechanical Ventilation ◽

Lung Injury ◽

Tidal Volume ◽

Lung Volumes ◽

Mechanically Ventilated ◽

Ventilator Induced Lung Injury ◽

Computed Tomography Images ◽

Gas Trapping ◽

Regional Lung ◽

The Relationship

Both overdistension and atelectasis contribute to lung injury and mortality during mechanical ventilation. It has been proposed that combinations of tidal volume and end-expiratory lung volume exist that minimize lung injury linked to mechanical ventilation. The aim of this study was to examine this at the regional level in the healthy and endotoxemic lung. Adult female BALB/c mice were injected intraperitoneally with 10 mg/kg lipopolysaccharide (LPS) in saline or with saline alone. Four hours later, mice were mechanically ventilated for 2 h. Regional specific end-expiratory volume (sEEV) and tidal volume (sVt) were measured at baseline and after 2 h of ventilation using dynamic high-resolution four-dimensional computed tomography images. The regional expression of inflammatory genes was quantified by quantitative PCR. There was a heterogenous response in regional sEEV whereby endotoxemia increased gas trapping at end-expiration in some lung regions. Within the healthy group, there was a relationship between sEEV, sVt, and the expression of Tnfa, where high Vt in combination with high EEV or very low EEV was associated with an increase in gene expression. In endotoxemia there was an association between low sEEV, particularly when this was combined with moderate sVt, and high expression of IL6. Our data suggest that preexisting systemic inflammation modifies the relationship between regional lung volumes and inflammation and that although optimum EEV-Vt combinations to minimize injury exist, further studies are required to identify the critical inflammatory mediators to assess and the effect of different injury types on the response.

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Association between Early Fluid Overload and Mortality in Critically-ill Mechanically Ventilated Children: A Single Center Prospective Cohort Study

10.21203/rs.3.rs-518747/v1 ◽

2021 ◽

Author(s):

Xiangmei Kong ◽

Xiaodong Zhu ◽

Yueniu Zhu

Keyword(s):

Mechanical Ventilation ◽

Regression Analysis ◽

Hospital Mortality ◽

Critically Ill ◽

Fluid Overload ◽

Stepwise Logistic Regression ◽

Stepwise Logistic Regression Analysis ◽

Mechanically Ventilated ◽

Significant Difference ◽

Early Fluid

Abstract Background: This study retrospectively analyzed the relationship between early fluid overload(FO) and in-hospital mortality in Children with mechanical ventilation in pediatric intensive care unit.Methods: Patients who were on mechanical ventilation (MV) for≥48 h and aged over 28 days and less than 18 years from March 2014 to March 2019 in department of PICU, Xinhua hospital. Daily FO was calculated as {(daily fluid intake-daily fluid output)/weight at ICU admission * 100%}.We defined the early FO as the FO in the first three days of mechanical ventilation, and divided it into four bands: %FO ≤ 0%, 0%＜%FO≤ 10%, 10%＜%FO≤ 20%, and %FO > 20%. We compared the mortality in discharge between groups with different FO. We also compared the early FO between survivors and non-survivors. Multivariate stepwise logistic regression analysis was used to analyze the prognostic factors of mortality in hospital.Results: 309 patients were included. There were 202 cases in non-operative and 107 cases in operative. The mean early FO was 8.83 ± 8.81%, and the mortality in hospital was 26.2% (81/309). The percentage of % FO＞10% was in present 41.4%(131/309) and %FO＞20% was in present 8.7% (27/309). There was no significant difference in discharge-mortality between different FO groups(p=0.053) and in FO between survivors and non-survivors(p=0.992). Regression analysis demonstrated that the more vasoactive drugs, the presence of MODS, the longer duration of MV, and the non-operation reason for PICU admission were related to the increase of mortality(p＜0.05); although early FO and %FO>10% were not associated with in-hospital mortality(β=0.030, p=0.090, 95% C.I.=0.995~1.067; β=0.479, p=0.153, 95% C.I.= 0.837~3.117), %FO>20% was related to the increase of mortality (β=1.057, OR=2.878, p=0.029, 95% C.I.=1.116~7.418). There was positive correlation between early FO and LOS in PICU (r=0.148, p=0.009), but the relation is weak.Conclusions: Affected by interventions and the severity of the disease, the correlation between the early FO and %FO>10% with mortality was not clear, but %FO>20% was related to the increase of mortality in critically-ill mechanically ventilated Children. Trial registration: Not applicable

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Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Critical Care ◽

10.1186/s13054-020-03455-8 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Yasser Sakr ◽

◽

Bruno François ◽

Jordi Solé-Violan ◽

Katarzyna Kotfis ◽

...

Keyword(s):

Mechanical Ventilation ◽

Tidal Volume ◽

Invasive Mechanical Ventilation ◽

Mortality Rates ◽

Plateau Pressure ◽

Temporal Changes ◽

Driving Pressure ◽

Hospital Death ◽

Predicted Body Weight ◽

Risk Of Death

Abstract Background Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies.

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Study on the relationship of depression, anxiety, lifestyle and eating habits with the severity of reflux esophagitis

BMC Gastroenterology ◽

10.1186/s12876-021-01717-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rongxin Wang ◽

Jing Wang ◽

Shuiqing Hu

Keyword(s):

Quality Of Life ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Reflux Esophagitis ◽

Eating Habits ◽

Positive Correlation ◽

Relationship Of ◽

The Relationship

Abstract Background The etiology of reflux esophagitis (RE) is multi-factorial. This study analyzed the relationship of depression, anxiety, lifestyle and eating habits with RE and its severity and further explored the impact of anxiety and depression on patients’ symptoms and quality of life. Methods From September 2016 to February 2018, a total of 689 subjects at Xuanwu Hospital Capital Medical University participated in this survey. They were divided into the RE group (patients diagnosed with RE on gastroscopy, n = 361) and the control group (healthy individuals without heartburn, regurgitation and other gastrointestinal symptoms, n = 328). The survey included general demographic information, lifestyle habits, eating habits, comorbidities, current medications, the gastroesophageal reflux disease (GERD) questionnaire (GerdQ), the Patient Health Questionnaire-9 depression scale and the General Anxiety Disorder-7 anxiety scale. Results The mean age and sex ratio of the two groups were similar. Multivariate logistic regression analysis identified the following factors as related to the onset of RE (p < 0.05): low education level; drinking strong tea; preferences for sweets, noodles and acidic foods; sleeping on a low pillow; overeating; a short interval between dinner and sleep; anxiety; depression; constipation; history of hypertension; and use of oral calcium channel blockers. Ordinal logistic regression analysis revealed a positive correlation between sleeping on a low pillow and RE severity (p = 0.025). Depression had a positive correlation with the severity of symptoms (rs = 0.375, p < 0.001) and patients’ quality of life (rs = 0.306, p < 0.001), whereas anxiety showed no such association. Conclusions Many lifestyle factors and eating habits were correlated with the onset of RE. Notably, sleeping on a low pillow was positively correlated with RE severity, and depression was positively related to the severity of symptoms and patients’ quality of life.

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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HUBUNGAN PERSEPSI TENTANG PROFESI FISIOTERAPI DENGAN MOTIVASI BELAJAR MAHASISWA AKADEMI FISIOTERAPI UKI

Jurnal Dinamika Pendidikan ◽

10.33541/jdp.v10i3.630 ◽

2018 ◽

Vol 10 (3) ◽

pp. 226

Author(s):

Maksimus Bisa

Keyword(s):

Regression Analysis ◽

Linear Regression ◽

Correlation Analysis ◽

Correlation Coefficient ◽

Linear Regression Analysis ◽

Motivation To Learn ◽

Simple Linear Regression ◽

Level 1 ◽

Relationship Of ◽

The Relationship

ABSTRACTThis study is descriptive analitik, aims to describe the relationship of perceptions about the physiotherapy profession with the motivation to learn students of the Academy of Physiotherapy UKI. Data collection through questionnaires to students of Physiotherapy Academy UKI level 1, 2, and 3 with a sample of 53 students, then give a score of each statement of questionnaire.The result of correlation analysis shows that p = 0,584> Î± (0,05) ho is accepted, so there is no significant relationship between the two variables. To measure the closeness and intensity of the relationship between the two variables, test of correlation coefficient and simple linear regression. The result of correlation coefficient test (r) obtained by -0,077, lies below the value of -0.30 (very weak) thus can be said there is no relation between perception about physiotherapy profession with motivation learn student Akfis UKI. Result of linear regression analysis obtained equation: Y = 73,52 + (-0,088) X. This means that every 1 point decrease of perception value will influence motivation value equal to 0,088 times.Keywords: Perception, motivation, physiotherapy profession, and learning achievement. ABSTRAKPenelitian ini bersifat deskriptif analitik, bertujuan untuk mendeskripsikan hubungan persepsi tentang profesi fisioterapi dengan motivasi belajar siswa Akademi Fisioterapi UKI. Pengumpulan data melalui kuesioner kepada siswa Fisioterapi Academy UKI tingkat 1, 2, dan 3 dengan sampel sebanyak 53 siswa, kemudian memberikan skor masing-masing kuesioner pernyataan. Hasil analisis korelasi menunjukkan bahwa p = 0,584> Î± (0,05) ho diterima, sehingga tidak ada hubungan yang signifikan antara kedua variabel tersebut. Untuk mengukur kedekatan dan intensitas hubungan antara kedua variabel tersebut, uji koefisien korelasi dan regresi linier sederhana. Hasil uji koefisien korelasi (r) diperoleh sebesar -0,077, berada di bawah nilai -0,30 (sangat lemah) sehingga dapat dikatakan tidak ada hubungan antara persepsi tentang profesi fisioterapi dengan motivasi belajar siswa Akfis UKI. Hasil analisis regresi linier diperoleh persamaan: Y = 73,52 + (-0,088) X. Artinya setiap 1 titik penurunan nilai persepsi akan mempengaruhi nilai motivasi sebesar 0,088 kali.Kata kunci: Persepsi, motivasi, profesi fisioterapi, dan prestasi belajar.

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The Influence of the Application of Marketing Mix on the Purchase Decision of Prospective Consumers of Grand Cempaka Housing

KnE Social Sciences ◽

10.18502/kss.v4i3.6391 ◽

2020 ◽

Author(s):

Gesang Sudrajad ◽

J.E Sutanto

Keyword(s):

Regression Analysis ◽

Data Analysis ◽

Quantitative Methods ◽

Linear Regression Analysis ◽

Multiple Linear Regression Analysis ◽

Marketing Mix ◽

Marketing Strategies ◽

Purchase Decision ◽

Relationship Of ◽

The Relationship

The purpose of this study was to examine the effect of simultaneous and partial marketing mix on the purchase decision of prospective consumers of Grand Cempaka Housing.This research uses quantitative methods, and is a survey research from the types of explanatory research whose focus is placed on relational research: studying the relationship of variables. The object of research is the residents of Pasuruan City and the sample in this study is the Prospective Consumer of Grand Cempaka Housing. Data analysis uses multiple linear regression analysis methods.The results of the analysis show that Products, Prices, Places and Promotions simultaneously have a significant effect on the Decision of Purchasing Prospective Consumers of Grand Cempaka Housing. This shows that the marketing mix is one of the marketing strategies that should be considered so that the implementation of the marketing strategy can run successfully because the elements in the marketing mix influence each other. Variables in the marketing mix which include Products, Prices, Places and Promotions partially have a significant effect on the Decision of Purchasing Prospective Consumers of Grand Cempaka Housing. Keywords: marketing mix; purchase decision; property; housing

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Kinerja Dan Kompensasi Masa Depan Di Bank Syariah Dan Konvensional

JURNAL AKUNTANSI DAN KEUANGAN ISLAM ◽

10.35836/jakis.v5i1.15 ◽

2019 ◽

Vol 5 (1) ◽

pp. 83-96

Author(s):

Evy Rahman Utami

Keyword(s):

Regression Analysis ◽

Agency Theory ◽

Board Of Directors ◽

Positive Relationship ◽

Financial Statements ◽

Islamic Banking ◽

Stewardship Theory ◽

Research Questions ◽

Relationship Of ◽

The Relationship

The objective of this study is to examine the relationship between changes of performance and changes of compensation of board commissioners and board of directors. In contrast to previous research, this study compare the relationship on conventional banking and Islamic banking in Indonesia. The samples of this research are conventional and Islamic banking between periode 2011-2015. Data in this study were obtained from financial statements. Regression analysis will be employed to answer the research questions. The result showed that there is a positive relationship between changes of performance and compensation. However, there is no difference the relationship of performance and compensation on the conventional and Islamic banking. This study supported the agency theory, but it does not support the stewardship theory.

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HUBUNGAN KEKUATAN OTOT TUNGKAI DAN KOORDINASI MATA KAKI TERHADAP HASIL SHOOTING BOLA DIAM KE ARAH GAWANG

Jurnal Ilmu Keolahragaan ◽

10.26418/jilo.v2i1.32630 ◽

2019 ◽

Vol 2 (1) ◽

pp. 36

Author(s):

Jack suman Rulis Manurung

Keyword(s):

Regression Analysis ◽

Data Analysis ◽

Muscle Strength ◽

Measurement Techniques ◽

Sampling Technique ◽

Leg Muscle ◽

Relationship Of ◽

The Relationship ◽

Computerized System ◽

Method Of Correlation

The purpose of this research is to find out: 1) The relationship of leg muscle strength to the results of shooting the silent ball towards the goal. 2) Relationship between ankle coordination and the result of shooting the ball silently towards the goal. 3) The relationship between leg muscle strength and ankle coordination towards the results of shooting the ball silently towards the goal.The method used in this study is a method of correlation with test and measurement techniques. Data analysis was carried out by a computerized system with simple or multiple regression analysis. The population in this study were students who participated in extra-curricular football at Pontianak's N 8 High School, totaling 22 people. In this study, there was no sampling technique because it took all the population who participated in 22 extra-curricular activities.The results of the analysis of the data obtained indicate that: 1) There is a relationship between leg muscle strength to the results of shooting the silent ball towards the goal. 2) There is a coordination relationship between the ankles and the result of shooting the silent ball towards the goal. 3) There is a relationship between leg muscle strength and ankle coordination towards the results of shooting the silent ball towards the goal.The amount of donation given by leg muscle strength to the results of silent ball shooting towards the goal was 52.1%, while the coordination contribution of the ankle to the results of silent ball shooting towards the goal was 25.3%. While the magnitude of the contribution given by the two variables, namely leg muscle strength and ankle coordination was 59% of the results of shooting the silent ball towards the goal. It is recommended that in addition to practicing silent ball shooting techniques towards the goal, leg muscle strength should be taken into consideration for the trainer in giving a portion of training.

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SISTEM PENGHARGAAN SEBAGAI VARIABEL MODERATING DALAM HUBUNGAN ANTARA GAYA KEPEMIMPINAN DAN KINERJA MANAJERIAL (STUDI PADA SUPERMARKET DI KOTA MATARAM)

GANEC SWARA ◽

10.35327/gara.v15i1.195 ◽

2021 ◽

Vol 15 (1) ◽

pp. 940

Author(s):

SRI AYU FEBRIANTI ◽

I GUSTI AYU OKA NETRAWATI ◽

I GUSTI PUTU BAGUS SUASTINA

Keyword(s):

Regression Analysis ◽

Leadership Style ◽

Sampling Technique ◽

Reward System ◽

Managerial Performance ◽

Simple Regression Analysis ◽

Relationship Of ◽

The Relationship ◽

Simple Regression

The aim of this study is to analyzed the influence of leadership style on managerial performance and the reward system as the moderating variable that may affect the relationship of leadership style on managerial performance. The type of this research is associative. Respondents are managers and staff with the lowest level of supervisor in the entire supermarket in Mataram, as many as 66 respondents. Sampling technique is census. Using simple regression analysis and Moderated Regression Analysis (MRA) as analysis. The results showed that leadership style negative significantly influence on managerial performance and the reward system influence negatively significant the relationship of leadership style on managerial performance.

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