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. ResultsA 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.
Objective To investigate the predictive value of inferior vena cava variability (ΔDIVC) combined with the diaphragmatic-rapid shallow breathing index (D-RSBI) for weaning outcomes in elderly mechanically ventilated (MV) patients. Methods Clinical data from 298 elderly MV patients (age≥60 years) admitted to the ICU of the First Affiliated Hospital of Jinzhou Medical University between January and December 2023 were retrospectively analyzed. According to weaning outcomes (success: extubation without reintubation within 48 hours; failure: reintubation within 48 hours), patients were divided into a success group (n=211) and a failure group (n=87). Bedside ultrasound was used to measure ΔDIVC and D-RSBI. Receiver operating characteristic (ROC) curve analysis and Pearson correlation were employed to evaluate their predictive efficacy. Results The success group showed significantly higher ΔDIVC (25.24±4.48% vs. 20.18±3.24%, P<0.001) and lower D-RSBI (1.61±0.22 vs. 2.20±0.33, P<0.001) than the failure group. For predicting weaning success, ΔDIVC yielded an AUC of 0.813 (sensitivity 78.20%, specificity 65.52%, cut-off 21.5%). For predicting weaning failure, D-RSBI yielded an AUC of 0.918 (sensitivity 89.10%, specificity 89.66%, cut-off 1.85 counts·min-1·mm-1). The combined model achieved an AUC of 0.954 (95%CI 0.930~0.978), significantly outperforming either parameter alone (P<0.05). ΔDIVC and D-RSBI were negatively correlated (r=–0.351, P<0.001). Conclusion The combination of ΔDIVC and D-RSBI significantly improves the accuracy of predicting weaning outcomes in elderly MV patients, providing a reliable basis for individualized clinical weaning strategies.
