Pulmonary dead space fraction and pulmonary artery systolic pressure as early predictors of clinical outcome in acute lung injury.

Abstract:

STUDY OBJECTIVE:The primary objective of this study was to test whether an elevated systolic pulmonary artery (PA) pressure or an elevated pulmonary dead space fraction (Vd/Vt) in early acute lung injury (ALI) is associated with poor clinical outcomes in the era of lung-protective ventilation. DESIGN:Prospective observational cohort study. SETTING:ICUs of a university hospital. PATIENTS:Forty-two patients with ALI receiving mechanical ventilation. MEASUREMENTS:PA pressure was measured noninvasively using transthoracic echocardiography. Vd/Vt was measured by volumetric capnography (NICO Cardiopulmonary Management System; Novametrix; Wallingford, CT). MAIN RESULTS:There was no difference in the mean systolic PA pressure in patients who died compared to those who survived (43 +/- 9 mm Hg vs 41 +/- 9 mm Hg, p = 0.54) [mean +/- SD]. In contrast to the PA systolic pressure, Vd/Vt was significantly higher in patients who died compared to those who survived (0.61 +/- 0.09 vs 0.53 +/- 0.10, p = 0.02). Similarly, Vd/Vt was higher in patients with < 7 ventilator-free days during the first 28 days after enrollment compared to those with > 7 ventilator-free days (0.61 +/- 0.08 vs 0.52 +/- 0.11, p = 0.008). CONCLUSION:In the era of lung-protective ventilation, systolic PA pressure early in the course of ALI is elevated but not predictive of outcome. However, elevated Vd/Vt in early ALI is associated with increased mortality and with fewer ventilator-free days.

journal_name

Chest

journal_title

Chest

authors

Cepkova M,Kapur V,Ren X,Quinn T,Zhuo H,Foster E,Liu KD,Matthay MA

doi

10.1378/chest.07-0409

subject

Has Abstract

pub_date

2007-09-01 00:00:00

pages

836-42

issue

3

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)36648-4

journal_volume

132

pub_type

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