期刊论文详细信息
Critical Care
The end-tidal alveolar dead space fraction for risk stratification during the first week of invasive mechanical ventilation: an observational cohort study
Research
Christopher J. L. Newth1  Anoopindar K. Bhalla1  Robinder G. Khemani1  Ariya Chau2 
[1] Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, MS#12, 90027, Los Angeles, CA, USA;Division of Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA;
关键词: Ventilators;    Mechanical;    Respiratory distress syndrome;    Mortality;    Pediatrics;    Critical care outcomes;   
DOI  :  10.1186/s13054-023-04339-3
 received in 2022-12-19, accepted in 2023-01-30,  发布年份 2023
来源: Springer
PDF
【 摘 要 】

BackgroundThe end-tidal alveolar dead space fraction (AVDSf = [PaCO2−PETCO2]/PaCO2) is a metric used to estimate alveolar dead space. Higher AVDSf on the first day of mechanical ventilation is associated with mortality and fewer ventilator-free days. It is not clear if AVDSf is associated with length of ventilation in survivors, how AVDSf performs for risk stratification beyond the first day of ventilation, or whether AVDSf adds predictive value to oxygenation (oxygenation index [OI]) or severity of illness (Pediatric Risk of Mortality [PRISM III]) markers.MethodsRetrospective single-center observational cohort study of children and young adults receiving invasive mechanical ventilation. In those with arterial or capillary blood gases, AVDSf was calculated at the time of every blood gas for the first week of mechanical ventilation.ResultsThere were 2335 children and young adults (median age 5.8 years [IQR 1.2, 13.2]) enrolled with 8004 analyzed AVDSf values. Higher AVDSf was associated with mortality and longer length of ventilation in survivors throughout the first week of ventilation after controlling for OI and PRISM III. Higher OI was not associated with increased mortality until ≥ 48 h of ventilation after controlling for AVDSf and PRISM III. When using standardized variables, AVDSf effect estimates were generally higher than OI for mortality, whereas OI effect estimates were generally higher than AVDSf for the length of ventilation in survivors. An AVDSf > 0.3 was associated with a higher mortality than an AVDSf < 0.2 within each pediatric acute respiratory distress syndrome severity category.The maximum AVDSf within 12 h of intensive care unit admission demonstrated good risk stratification for mortality (AUC 0.768 [95% CI 0.732, 0.803]). AVDSf did not improve mortality risk stratification when added to PRISM III but did improve mortality risk stratification when added to the gas exchange components of PRISM III (minimum 12-h PaO2 and maximum 12-h PCO2) (p < 0.00001).ConclusionsAVDSf is associated with mortality and length of ventilation in survivors throughout the first week of invasive mechanical ventilation. Some analyses suggest AVDSf may better stratify mortality risk than OI, whereas OI may better stratify risk for prolonged ventilation in survivors than AVDSf.

【 授权许可】

CC BY   
© The Author(s) 2023

【 预 览 】
附件列表
Files Size Format View
RO202305151935319ZK.pdf 939KB PDF download
13731_2023_266_Article_IEq9.gif 1KB Image download
Fig. 1 170KB Image download
Fig. 1 111KB Image download
【 图 表 】

Fig. 1

Fig. 1

13731_2023_266_Article_IEq9.gif

【 参考文献 】
  • [1]
  • [2]
  • [3]
  • [4]
  • [5]
  • [6]
  • [7]
  • [8]
  • [9]
  • [10]
  • [11]
  • [12]
  • [13]
  • [14]
  • [15]
  • [16]
  • [17]
  • [18]
  • [19]
  • [20]
  • [21]
  • [22]
  • [23]
  • [24]
  • [25]
  • [26]
  文献评价指标  
  下载次数:5次 浏览次数:0次