Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

Table 1 Single-factor analysis of patient population and characteristic clinical parameters in the two groups

Index	Sequential group (n = 54)	Regular group (n = 54)	t/χ2	P value
Age (yr)	65.9 ± 5.5	65.2 ± 6.5	0.604	0.547
Height (cm)	165.8 ± 5.0	165.3 ± 4.4	0.552	0.582
Body weight (kg)	66.4 ± 6.2	65.8 ± 5.7	0.524	0.602
APACHE II score (scores)	19.8 ± 3.0	20.3 ± 3.4	-0.810	0.420
CPIS score (scores)	9.9 ± 1.1	10.1 ± 1.3	-0.863	0.390
Heart rate (times/min)	74.3 ± 6.0	76.2 ± 7.4	-1.466	0.146
Sex, n (%)			0.336	0.562
Male	31 (57.41)	28 (51.85)
Female	23 (42.59)	26 (48.15)
Hypertension, n (%)			2.897	0.087
Yes	14 (25.93)	7 (12.96)
No	40 (74.07)	47 (87.04)
Diabetes, n (%)			0.911	0.340
Yes	4 (7.41)	7 (12.96)
No	50 (92.59)	47 (87.04)
Dyslipidemia, n (%)			2.445	0.117
Yes	28 (51.85)	36 (66.67)
No	26 (48.15)	18 (33.33)
Smoking, n (%)			1.462	0.227
Yes	22 (40.74)	16 (29.63)
No	32 (59.26)	38 (70.37)

Table 2 Comparison of blood-gas parameters between the two groups of patients before and after treatment (mean ± SD)

Group	Before treatment	Treatment 24 h	Treatment 48 h	Treatment 72 h
PaO2 (mmHg)
Sequential group (n = 54)	36.11 ± 2.88	74.31 ± 4.17	85.32 ± 5.40	93.84 ± 5.50
Regular group (n = 54)	35.74 ± 3.01	70.58 ± 3.96	82.74 ± 4.86	91.70 ± 4.96
t value	0.653	4.766	2.610	2.123
P value	0.515	0.000	0.010	0.036
PaCO2 (mmHg)
Sequential group (n = 54)	68.42 ± 3.03	54.29 ± 3.75	45.63 ± 3.80	37.03 ± 3.94
Regular group (n = 54)	69.03 ± 2.96	55.70 ± 4.03	46.80 ± 4.25	38.64 ± 4.41
t value	-1.058	-1.882	-1.508	-2.001
P value	0.292	0.063	0.135	0.048
pH (mmHg)
Sequential group (n = 54)	7.22 ± 0.05	7.33 ± 0.05	7.37 ± 0.05	7.39 ± 0.04
Regular group (n = 54)	7.23 ± 0.05	7.31 ± 0.04	7.36 ± 0.05	7.37 ± 0.05
t value	-1.039	2.295	1.039	2.295
P value	0.301	0.024	0.301	0.024

PaO₂: Oxygen partial pressure; PaCO₂: Carbon dioxide partial pressure.

Table 3 Comparison of hemodynamic parameters before and after treatment between the two groups (mean ± SD)

Group	Before treatment	Treatment 24 h	Treatment 48 h	Treatment 72 h
CVP (mmHg)
Sequential group (n = 54)	7.75 ± 0.54	8.34 ± 0.66	8.40 ± 0.58	8.38 ± 0.57
Regular group (n = 54)	7.81 ± 0.48	8.06 ± 0.53	8.23 ± 0.55	8.21 ± 0.60
t value	-0.610	2.431	1.563	1.509
P value	0.543	0.017	0.121	0.134
HR (times/min)
Sequential group (n = 54)	90.3 ± 6.9	88.8 ± 7.4	89.4 ± 7.8	88.5 ± 8.0
Regular group (n = 54)	92.0 ± 7.3	90.5 ± 8.2	88.6 ± 8.2	89.3 ± 7.4
t value	-1.244	-1.131	0.519	-0.539
P value	0.216	0.261	0.605	0.591
CO (L/min)
Sequential group (n = 54)	3.82 ± 0.67	3.94 ± 0.62	4.04 ± 0.58	4.09 ± 0.62
Regular group (n = 54)	3.90 ± 0.52	3.87 ± 0.55	3.91 ± 0.52	4.00 ± 0.57
t value	-0.693	0.621	1.226	0.785
P value	0.490	0.536	0.223	0.434
CI
Sequential group (n = 54)	3.04 ± 0.48	3.14 ± 0.51	3.11 ± 0.48	3.15 ± 0.45
Regular group (n = 54)	3.11 ± 0.42	3.04 ± 0.48	3.04 ± 0.45	3.10 ± 0.47
t value	-0.807	1.049	0.782	0.565
P value	0.422	0.296	0.436	0.573
SVV (%)
Sequential group (n = 54)	4.51 ± 0.38	4.72 ± 0.34	4.58 ± 0.41	4.59 ± 0.38
Regular group (n = 54)	4.46 ± 0.40	4.50 ± 0.38	4.34 ± 0.35	4.42 ± 0.41
t value	0.666	3.171	3.272	2.235
P value	0.507	0.002	0.001	0.028

CVP: Central venous pressure; HR: Heart rate; CO: Cardiac displacement; CI: Cardiac index; SVV: Stroke volume variation rate.

Table 4 Comparison of the respiratory system’s compliance indexes between the two groups of patients before and after treatment (mean ± SD)

Group	Before treatment	Treatment 24 h	Treatment 48 h	Treatment 72 h
Raw [cmH2O/ (L·S)]
Sequential group (n = 54)	23.85 ± 2.74	18.63 ± 2.58	17.40 ± 2.44	18.18 ± 2.60
Regular group (n = 54)	23.33 ± 2.60	19.94 ± 2.71	18.87 ± 2.73	18.83 ± 2.84
t value	1.012	-2.573	-2.950	-1.241
P value	0.314	0.011	0.004	0.218
Tidal volume (mL/kg)
Sequential group (n = 54)	6.58 ± 1.04	9.58 ± 1.14	9.40 ± 0.96	9.62 ± 1.20
Regular group (n = 54)	6.82 ± 0.95	8.81 ± 1.23	9.13 ± 1.02	9.32 ± 0.98
t value	-1.252	3.374	1.416	1.423
P value	0.213	0.001	0.160	0.158
Cst (mL/cmH2O)
Sequential group (n = 54)	22.84 ± 2.60	24.73 ± 2.94	26.58 ± 3.02	25.72 ± 2.54
Regular group (n = 54)	23.36 ± 2.72	23.60 ± 2.76	24.81 ± 3.13	25.00 ± 2.62
t value	-1.016	2.059	2.990	1.450
P value	0.312	0.042	0.003	0.150

Table 5 Comparison of serum inflammatory response indexes before and after treatment between the two groups (mean ± SD)

Group	n	IL-6 (ng/L)		IL-8 (ng/L)		TNF-α (ng/L)
		Before treatment	Treatment 72 h	Before treatment	Treatment 72 h	Before treatment	Treatment 72 h
Sequential group	54	169.5 ± 24.8	97.4 ± 16.3	209.5 ± 38.6	118.7 ± 19.5	249.5 ± 48.5	131.8 ± 24.0
Regular group	54	173.4 ± 26.1	108.0 ± 23.5	202.7 ± 35.4	126.2 ± 23.0	260.3 ± 51.2	150.8 ± 27.5
t value		-0.796	-2.724	0.954	-1.828	-1.125	-3.825
P value		0.428	0.008	0.342	0.070	0.263	0.000

IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-α.

Table 6 Comparison of treatment outcomes between the two groups, n (%)

Group	n	Total time of mechanical ventilation (d)	Reintubation rate	Case fatality rate
Sequential group	54	12.7 ± 2.9	1 (1.85)	2 (3.70)
Regular group	54	14.1 ± 3.2	3 (5.56)	4 (7.41)
t/χ2		-2.382	1.038	0.706
P value		0.019	0.308	0.401