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Open Access 01-08-2010 | Research

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

Authors: Hassan Siddiki, Marija Kojicic, Guangxi Li, Murat Yilmaz, Taylor B Thompson, Rolf D Hubmayr, Ognjen Gajic

Published in: Critical Care | Issue 4/2010

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 \times {\dot{V} CO}_{2est}) / (VE \times {PaCO}_{2})]

where

{\dot{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.

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Title: Bedside quantification of dead-space fraction using routine clinical data in patients with acute lung injury: secondary analysis of two prospective trials
Authors: Hassan Siddiki
Marija Kojicic
Guangxi Li
Murat Yilmaz
Taylor B Thompson
Rolf D Hubmayr
Ognjen Gajic
Publication date: 01-08-2010
Publisher: BioMed Central
Published in: Critical Care / Issue 4/2010
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc9206

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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