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
Chestjournal_title
Chestauthors
Cepkova M,Kapur V,Ren X,Quinn T,Zhuo H,Foster E,Liu KD,Matthay MAdoi
10.1378/chest.07-0409subject
Has Abstractpub_date
2007-09-01 00:00:00pages
836-42issue
3eissn
0012-3692issn
1931-3543pii
S0012-3692(15)36648-4journal_volume
132pub_type
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