Estimated dead space fraction and the ventilatory ratio are associated with mortality in early ARDS
Morales-Quinteros, Luis (Hospital del Sagrat Cor (Barcelona, Catalunya))
Schultz, M. J. (Academic Medical Center (Amsterdam, Països Baixos). Department of Intensive Care)
Bringué, Josep (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Calfee, Carolyn S (Cardiovascular Research Institute. University of California. San Francisco)
Camprubí-Rimblas, Marta (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Cremer, O. L. (Department of Intensive Care Medicine. University Medical Center Utrecht)
Horn, Janneke (Academic Medical Center (Amsterdam, Països Baixos))
van der Poll, T. (Division of Infectious Diseases. Academic Medical Center. University of Amsterdam)
Sinha, P. (Department of Anesthesia. University of California. San Francisco)
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Bos, Lieuwe D.. (Academic Medical Center (Amsterdam, Països Baixos). Department of Respiratory Medicine)
Molecular Diagnosis and Risk Stratification of Sepsis (MARS) Consortium

Data:	2019
Resum:	Background: Indirect indices for measuring impaired ventilation, such as the estimated dead space fraction and the ventilatory ratio, have been shown to be independently associated with an increased risk of mortality. This study aimed to compare various methods for dead space estimation and the ventilatory ratio in patients with acute respiratory distress syndrome (ARDS) and to determine their independent values for predicting death at day 30. The present study is a post hoc analysis of a prospective observational cohort study of ICUs of two tertiary care hospitals in the Netherlands. Results: Individual patient data from 940 ARDS patients were analyzed. Estimated dead space fraction and the ventilatory ratio at days 1 and 2 were significantly higher among non-survivors (p < 0. 01). Dead space fraction calculation using the estimate from physiological variables [V/V] and the ventilatory ratio at day 2 showed independent association with mortality at 30 days (odds ratio 1. 28 [95% CI 1. 02-1. 61], p < 0. 03 and 1. 20 [95% CI, 1. 01-1. 40], p < 0. 03, respectively); whereas, the Harris-Benedict [V/V] and Penn State [V/V] estimations were not associated with mortality. The predicted validity of the estimated dead space fraction and the ventilatory ratio improved the baseline model based on PEEP, PaO/FiO, driving pressure and compliance of the respiratory system at day 2 (AUROCC 0. 72 vs. 0. 69, p < 0. 05). Conclusions: Estimated methods for dead space calculation and the ventilatory ratio during the early course of ARDS are associated with mortality at day 30 and add statistically significant but limited improvement in the predictive accuracy to indices of oxygenation and respiratory system mechanics at the second day of mechanical ventilation.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acute respiratory distress syndrome (ARDS) ; Respiratory dead space ; Dead space ; Ventilatory ratio ; Intensive care unit ; Prognostication ; Prediction ; Mortality
Publicat a:	Annals of Intensive Care, Vol. 9 Núm. 1 (january 2019) , p. 128, ISSN 2110-5820

DOI: 10.1186/s13613-019-0601-0
PMID: 31754866

9 p, 1.4 MB

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