Individualized Mechanical power-based ventilation strategy for acute respiratory failure formalized by finite mixture modeling and dynamic treatment regimen

Yucai Hong; Lin Chen; Qing Pan; Huiqing Ge; Lifeng Xing; Zhongheng Zhang

doi:10.1016/j.eclinm.2021.100898

Individualized Mechanical power-based ventilation strategy for acute respiratory failure formalized by finite mixture modeling and dynamic treatment regimen

EClinicalMedicine. 2021 May 24:36:100898. doi: 10.1016/j.eclinm.2021.100898. eCollection 2021 Jun.

Authors

Yucai Hong¹, Lin Chen², Qing Pan³, Huiqing Ge⁴, Lifeng Xing¹, Zhongheng Zhang¹

Affiliations

¹ Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
² Department of Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
³ College of Information Engineering, Zhejiang University of Technology, 310023, Hangzhou, China.
⁴ Department of Respiratory Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Abstract

Background: Mechanical ventilation (MV) is the key to the successful treatment of acute respiratory failure (ARF) in the intensive care unit (ICU). The study aims to formalize the concept of individualized MV strategy with finite mixture modeling (FMM) and dynamic treatment regime (DTR).

Methods: ARF patients requiring MV for over 48 h from 2008 to 2019 were included. FMM was conducted to identify classes of ARF. Static and dynamic mechanical power (MP_static and MP_dynamic) and relevant clinical variables were calculated/collected from hours 0 to 48 at an interval of 8 h. $Δ M P$ was calculated as the difference between actual and optimal MP.

Findings: A total of 8768 patients were included for analysis with a mortality rate of 27%. FFM identified three classes of ARF, namely, the class 1 (baseline), class 2 (critical) and class 3 (refractory respiratory failure). The effect size of MP_static on mortality is the smallest in class 1 (HR for every 5 Joules/min increase: 1.29; 95% CI: 1.15 to 1.45; p < 0.001) and the largest in class 3 (HR for every 5 Joules/min increase: 1.83; 95% CI: 1.52 to 2.20; p < 0.001).

Interpretation: MP has differing therapeutic effects for subtypes of ARF. Optimal MP estimated by DTR model may help to improve survival outcome.

Funding: The study was funded by Health Science and Technology Plan of Zhejiang Province (2021KY745), Key Research & Development project of Zhejiang Province (2021C03071) and Yilu "Gexin" - Fluid Therapy Research Fund Project (YLGX-ZZ-2,020,005).