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Poder lineal y mortalidad en el síndrome de dificultad respiratorio por COVID-19 / Linear power and mortality in COVID-19 respiratory difficulty syndrome
Resumen
Resumen
Introducción: el síndrome de dificultad respiratoria aguda (SDRA) secundario a COVID-19 abarrotó las terapias intensivas en el mundo con una alta mortalidad. La ventilación mecánica fue pilar en el tratamiento; sin embargo, la evidencia de los marcadores ventilatorios asociados a mortalidad no está del todo clara. En el 2021 se describió el poder lineal, que fue superior a otros marcadores. Al momento no se ha descrito su posible utilidad en pacientes con SDRA por COVID-19.
Objetivo: evaluar el poder lineal como riesgo de mortalidad en los pacientes con SDRA por COVID-19 en terapia intensiva.
Material y métodos: estudio de cohorte retrospectiva en pacientes que ingresaron a la terapia intensiva con SDRA secundaria a COVID-19. Se calculó el poder lineal a los pacientes que fallecieron y los pacientes que sobrevivieron en terapia intensiva. Se empleó U de Mann-Whitney y regresión de Cox multivariable (hazard ratio [HR] con intervalos de confianza del 95% [IC 95%]).
Resultados: se estudiaron 60 pacientes con una mortalidad de 43.3%. Aquellos que fallecieron tuvieron un mayor poder lineal (89.5 frente a 78, p = 0.031) y el mejor punto de corte fue 84 cmH2O/rpm (AUC 0.663, p = 0.031, LR 2.02); además, tuvieron una mejor supervivencia acumulada aquellos con un poder lineal < 84 (p = 0.050)
Conclusión: el poder lineal es un posible factor de riesgo de mortalidad en los pacientes con SDRA secundaria a COVID-19 en la terapia intensiva.
Abstract
Background: Acute respiratory distress syndrome (ARDS) secondary to COVID-19 crowded intensive care units in the world with high mortality. Mechanical ventilation was fundamental in the treatment; however, the evidence of ventilatory markers associated with mortality is not entirely clear. In 2021 it was described the linear power, which was superior to other markers. At the moment its possible utility in patients with ARDS due to COVID-19 has not been described.
Objective: To evaluate linear power as a risk factor for mortality in patients with ARDS due to COVID-19 in intensive care.
Material and methods: Retrospective cohort study in patients admitted to intensive care with ARDS secondary to COVID-19. Linear power was calculated for patients who died and patients who survived in intensive care. Mann-Whitney U test and multivariable Cox regression (hazard ratio [HR] with 95% confidence intervals [95% CI]) were performed.
Results: 60 patients were studied with a mortality of 43.3%. Those who died had a higher linear power (89.5 vs. 78, p = 0.031) and the best cut-off point was 84 cmH2O/rpm (AUC 0.663, p = 0.031, LR 2.02); in addition, those with linear power < 84 (p = 0.050) had a better cumulative survival.
Conclusions: Linear power is a possible risk factor for mortality in patients with ARDS secondary to COVID-19 in intensive care.
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DOI: https://doi.org/10.24875/10.5281/zenodo.12668053
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