The Association Between Physiologic Dead-Space Fraction and Mortality in Subjects With ARDS Enrolled in a Prospective Multi-Center Clinical Trial.
BACKGROUND: We tested the association between pulmonary dead-space fraction (ratio of dead space to tidal volume [VD/VT]) and mortality in subjects with ARDS (Berlin definition, PaO2/FIO2 ≤ 300 mm Hg; PEEP ≥ 5 cmH2O) enrolled into a clinical trial incorporating lung-protective ventilation. METHODS:...
| Publicado en: | Respiratory Care Vol. 59; no. 11; pp. 1611 - 1619 |
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| Autores principales: | , , , , |
| Formato: | clinical trial research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Nov2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103777219&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103777219 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Nov2014 vid: 59 iid: 11 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 103777219 99111377 10.4187/respcare.02593 NLM24381187 103777219 ppf: 1611 ppct: 8 formats: fmt: @attributes: type: P tig: atl: The Association Between Physiologic Dead-Space Fraction and Mortality in Subjects With ARDS Enrolled in a Prospective Multi-Center Clinical Trial. aug: au: Kallet, Richard H. Hanjing Zhuo Liu, Kathleen D. Calfee, Carolyn S. Matthay, Michael A. affil: Respiratory Care Services, University of California San Francisco Department of Anesthesia at San Francisco General Hospital sug: subj: Respiratory Distress Syndrome, Acute Mortality Lung Physiology Acute Lung Injury Respiration, Artificial Tidal Volume Evaluation Risk Assessment Survival Analysis Human Descriptive Statistics Female Male Middle Age Adult Aged Prospective Studies Multicenter Studies Clinical Trials United States Confidence Intervals Funding Source Nonexperimental Studies Wilcoxon Rank Sum Test Chi Square Test Fisher's Exact Test Logistic Regression Cox Proportional Hazards Model Data Analysis Software Odds Ratio Education, Continuing (Credit) Middle Aged: 45-64 years Adult: 19-44 years Aged: 65+ years Female Male ab: BACKGROUND: We tested the association between pulmonary dead-space fraction (ratio of dead space to tidal volume [VD/VT]) and mortality in subjects with ARDS (Berlin definition, PaO2/FIO2 ≤ 300 mm Hg; PEEP ≥ 5 cmH2O) enrolled into a clinical trial incorporating lung-protective ventilation. METHODS: We conducted a prospective, multi-center study at medical-surgical ICUs in the United States. A total of 126 ALI subjects with acute lung injury were enrolled into a phase 3 randomized, placebo-controlled study of aerosolized albuterol. VD/VT and pulmonary mechanics were measured within 4 h of enrollment and repeated daily on study days 1 and 2 in subjects requiring arterial blood gases for clinical management. RESULTS: At baseline, non-survivors had a trend toward higher VD/VT compared with survivors (0.62 ± 0.11 vs 0.56 ± 0.11, respectively, P = .08). Differences in VD/VT between non-survivors and survivors became significant on study days 1 (0.64 ± 0.12 vs 0.55 ± 0.11, respectively, P = .01) and 2 (0.67 ± 0.12 vs 0.56 ± 0.11, respectively, P = .004). Likewise, the association between VD/VT and mortality was significant on study day 1 (odds ratio per 0.10 change in VD/VT [95% CI]: 6.84 [1.62–28.84] P =.01; and study day 2: 4.90 [1.28 –18.73] P = .02) after adjusting for VD/VT, PaO2/FIO2, oxygenation index, vasopressor use, and the primary risk for ARDS. Using a Cox proportional hazard model, VD/VT was associated with a trend toward higher mortality (HR = 4.37 [CI 0.99 –19.32], P = .052) that became significant when the analysis was adjusted for daily oxygenation index (HR = 1.74 [95% CI 1.12–3.35] P = .04). CONCLUSIONS: Markedly elevated VD/VT (≥ 0.60) in early ARDS is associated with higher mortality. Measuring VD/VT may be useful in identifying ARDS patients at increased risk of death who are enrolled into a therapeutic trial. pubtype: Academic Journal doctype: clinical trial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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