CÁC YẾU TỐ DỰ ĐOÁN ĐÁP ỨNG THÔNG KHÍ NẰM SẤP TRÊN BỆNH NHÂN CÓ HỘI CHỨNG SUY HÔ HẤP CẤP TIẾN TRIỂN THEO DÕI BẰNG CẮT LỚP TRỞ KHÁNG LỒNG NGỰC

Abstract

Objective: To identify baseline clinical, mechanical, and Electrical Impedance Tomography (EIT) parameters that can predict the response to prone position ventilation in ARDS patients. Subjects and Methods: In this prospective observational study, 17 patients with severe ARDS undergoing prone mechanical ventilation were enrolled, with a total of 24 EIT measurements performed. Baseline characteristics and EIT-derived parameters were collected both before and after prone positioning. Patients were defined as responders if the P/F ratio increased by more than 20 mmHg after 6 hours in the prone position. The associations between baseline variables and clinical response were subsequently analyzed using statistical testing algorithms in SPSS. Results: A total of 17 patients with severe ARDS underwent 24 sessions of prone mechanical ventilation with EIT measurements. The mean P/F ratio was 93.23, and the mean SOFA score was 11.76. The mean age was 51.88 ± 22.34 years; 64.7% were male and 35.3% were obese. Seventeen sessions (70.8%) were classified as responsive to prone ventilation. Seventeen patients (70.8%) were classified as responders to prone ventilation. Univariate logistic regression analysis showed that patients with reduced initial posterior ventilation (TVP) were 11.67 times more likely to respond to prone positioning (95% CI: 1.49-91.54; p = 0.019). Similarly, reduced ventilation in the most dependent lung region (TVROI4) at baseline was also significantly associated with responsiveness (OR = 2.43; 95% CI: 0.997-5.91; p = 0.048). In contrast, a lower A/P ratio tended to predict a better response (OR = 0.161; 95% CI: 0.023-1.128; p = 0.066), though it did not reach statistical significance, possibly due to the small sample size. Correlation analysis revealed that this heterogeneous ventilation pattern with predictive value was associated with baseline clinical characteristics, including higher BMI (r = -0.453; p = 0.026) and higher LIS scores (r = 0.472; p = 0.02). Conclusion: Baseline EIT parameters reflecting a heterogeneous gas distribution, specifically reduced posterior ventilation (TVp) and an A/P ratio > 1, are strong predictors of response to prone ventilation.