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<p>Objective: The respiratory rate (RR) is a fundamental parameter in the setting of mechanical ventilation (MV) in acute respiratory distress syndrome (ARDS), where an increase in RR may be associated with higher energy delivered to the lungs, thereby augmenting lung injury and inflammation, which can lead to death. The establishment of RR ranges that allow for the identification of ARDS patients at risk of mortality is required. Therefore, this study aimed to assess the association between the RR quartiles and mortality in a Mexican cohort of patients with ARDS who received MV. Material and methods: This retrospective, observational, longitudinal study was conducted in the intensive care unit at a tertiary care center. One hundred ninety patients admitted between January 1, 2016, and December 31, 2022, were diagnosed with ARDS according to the Berlin criteria, of which 158 met the inclusion criteria. Univariable and multivariable Cox regression models, along with Kaplan–Meier survival analysis and the log-rank test, were used to evaluate the impact of clinical prognostic factors on mortality. Results: Multivariable Cox regression revealed that the body mass index [BMI] (Hazard Ratio [HR] = 1.05, 95% confidence interval [CI] 1.012–1.08; <i>p</i> = 0.008) and RR were risk factors (HR = 1.13, 95% CI 1.004–1.26; <i>p</i> = 0.043) to predict mortality in patients with ARDS and MV. When the predictive power of RR was confirmed, the patients were stratified according to RR quartiles (Q1: 18–23 breaths per min (bpm), Q2: 24 bpm, Q3: 25–26 bpm, and Q4: 27–35 bpm) and analyzed separately. The RR Q4 was independently associated with poor outcomes (HR = 1.959, 95% CI 1.221–3.142; <i>p</i> = 0.005). In a Cox proportional hazards model adjusting for the impact of BMI and smoking, RR Q4 was an independent risk factor for predicting mortality (HR = 1.944, 95% CI 1.208–3.129; <i>p</i> = 0.006). Conclusion: These results suggested that a Q4 of RR (27–35 bpm) has a substantial predictive value and could be a marker of disease severity and a potential modifiable target in patients with ARDS and MV.</p>

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Assessment of mortality risk by respiratory rate-specific quartiles in mechanically ventilated patients with acute respiratory distress syndrome in Mexico

  • 期刊论文

  • 发表日期：

    2025年9月15日

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  • Jesús S. Sánchez-Díaz,
  • Karla G. Peniche-Moguel,
  • José Manuel Reyes-Ruiz,
  • Luis Del Carpio-Orantes,
  • Diego Escarramán-Martínez,
  • Éder I. Zamarrón-López,
  • Orlando R. Pérez-Nieto,
  • María Veronica Calyeca-Sánchez

摘要

Objective: The respiratory rate (RR) is a fundamental parameter in the setting of mechanical ventilation (MV) in acute respiratory distress syndrome (ARDS), where an increase in RR may be associated with higher energy delivered to the lungs, thereby augmenting lung injury and inflammation, which can lead to death. The establishment of RR ranges that allow for the identification of ARDS patients at risk of mortality is required. Therefore, this study aimed to assess the association between the RR quartiles and mortality in a Mexican cohort of patients with ARDS who received MV. Material and methods: This retrospective, observational, longitudinal study was conducted in the intensive care unit at a tertiary care center. One hundred ninety patients admitted between January 1, 2016, and December 31, 2022, were diagnosed with ARDS according to the Berlin criteria, of which 158 met the inclusion criteria. Univariable and multivariable Cox regression models, along with Kaplan–Meier survival analysis and the log-rank test, were used to evaluate the impact of clinical prognostic factors on mortality. Results: Multivariable Cox regression revealed that the body mass index [BMI] (Hazard Ratio [HR] = 1.05, 95% confidence interval [CI] 1.012–1.08; p = 0.008) and RR were risk factors (HR = 1.13, 95% CI 1.004–1.26; p = 0.043) to predict mortality in patients with ARDS and MV. When the predictive power of RR was confirmed, the patients were stratified according to RR quartiles (Q1: 18–23 breaths per min (bpm), Q2: 24 bpm, Q3: 25–26 bpm, and Q4: 27–35 bpm) and analyzed separately. The RR Q4 was independently associated with poor outcomes (HR = 1.959, 95% CI 1.221–3.142; p = 0.005). In a Cox proportional hazards model adjusting for the impact of BMI and smoking, RR Q4 was an independent risk factor for predicting mortality (HR = 1.944, 95% CI 1.208–3.129; p = 0.006). Conclusion: These results suggested that a Q4 of RR (27–35 bpm) has a substantial predictive value and could be a marker of disease severity and a potential modifiable target in patients with ARDS and MV.