NDLI: Bedside quantification of dead-space fraction using routine clinical data in patients with acute lung injury: secondary analysis of two prospective trials

Content Provider	Springer Nature : BioMed Central
Author	Siddiki, Hassan Kojicic, Marija Li, Guangxi Yilmaz, Murat Thompson, Taylor B Hubmayr, Rolf D Gajic, Ognjen
Abstract	Introduction Dead-space fraction (Vd/Vt) has been shown to be a powerful predictor of mortality in acute lung injury (ALI) patients. The measurement of Vd/Vt is based on the analysis of expired CO2 which is not a part of standard practice thus limiting widespread clinical application of this method. The objective of this study was to determine prognostic value of Vd/Vt estimated from routinely collected pulmonary variables. Methods Secondary analysis of the original data from two prospective studies of ALI patients. Estimated Vd/Vt was calculated using the rearranged alveolar gas equation: Vd / Vt = 1 − [ ( 0. 86 × V ˙ CO 2est ) / ( VE × PaCO 2 ) ] where V ˙ CO 2 est is the estimated CO2 production calculated from the Harris Benedict equation, minute ventilation (VE) is obtained from the ventilator rate and expired tidal volume and PaCO2 from arterial gas analysis. Logistic regression models were created to determine the prognostic value of estimated Vd/Vt. Results One hundred and nine patients in Mayo Clinic validation cohort and 1896 patients in ARDS-net cohort demonstrated an increase in percent mortality for every 10% increase in Vd/Vt in a dose response fashion. After adjustment for non-pulmonary and pulmonary prognostic variables, both day 1 (adjusted odds ratio-OR = 1.07, 95%CI 1.03 to 1.13) and day 3 (OR = 1.12, 95% CI 1.06 to 1.18) estimated dead-space fraction predicted hospital mortality. Conclusions Elevated estimated Vd/Vt predicts mortality in ALI patients in a dose response manner. A modified alveolar gas equation may be of clinical value for a rapid bedside estimation of Vd/Vt, utilizing routinely collected clinical data.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc9206.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc9206
Journal	Critical Care
Issue Number	4
Volume Number	14
Language	English
Publisher	BioMed Central
Publisher Date	2010-07-29
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Acute Lung Injury Acute Respiratory Distress Syndrome Minute Ventilation Oxygenation Index Validation Cohort
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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Erratum to: Bedside quantification of dead-space fraction using routine clinical data in patients with acute lung injury: secondary analysis of two prospective trials

Estimating Dead-Space Fraction for Secondary Analyses of Acute Respiratory Distress Syndrome Clinical Trials

Bench-to-bedside review: High-frequency oscillatory ventilation in adults with acute respiratory distress syndrome

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Correction: Bedside quantification of dead-space fraction using routine clinical data in patients with acute lung injury: secondary analysis of two prospective trials

Diagnostic test of the desaturation index and the calculated desaturation index to identify acute lung injury and/or acute respiratory distress syndrome at the bedside

The prognostic value of the change of oxygenation index after starting prone position ventilation in ARF

Bench-to-bedside review: Permissive hypercapnia

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Bedside quantification of dead-space fraction using routine clinical data in patients with acute lung injury: secondary analysis of two prospective trials

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Erratum to: Bedside quantification of dead-space fraction using routine clinical data in patients with acute lung injury: secondary analysis of two prospective trials

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