Randomized Controlled Trial

. 2014 Nov;59(11):1611-8.

doi: 10.4187/respcare.02593. Epub 2013 Dec 31.

The association between physiologic dead-space fraction and mortality in subjects with ARDS enrolled in a prospective multi-center clinical trial

Richard H Kallet¹, Hanjing Zhuo², Kathleen D Liu³, Carolyn S Calfee⁴, Michael A Matthay²; National Heart Lung and Blood Institute ARDS Network Investigators

Collaborators, Affiliations

Collaborators

National Heart Lung and Blood Institute ARDS Network Investigators:
J S Steingrub, M Tidswell, L DeSouza, C Kardos, L Kozikowski, K Kozikowski, R G Brower, H E Fessler, D N Hager, P A Mendez-Tellez, K Oakjones, D M Needham, J Sevransky, A Workneh, S Han, S Murray, C Shanholtz, G Netzer, P Rock, A Sampaio, J Titus, T Harrington, D Herr, B Lee, N Bolouri, G R Khorjekar, H P Wiedemann, R W Ashton, D A Culver, T Frederick, J J Komara, J A Guzman, A J Reddy, R Hejal, M Andrews, D Haney, A F Connors, S Lasalvia, J D Thornton, E L Warren, M Moss, A B Benson, E L Burnham, B J Clark, L Gray, C Higgins, B J Maloney, M Mealer, I Douglas, K Overdier, K Thompson, R Wolken, S S Carson, L Chang, J Lanier, R D Hite, P E Morris, A Howard, A Harvey, K Bender, P E Wright, C Carter-Cole, S Gross, J McLean, A Overton, J D Truwit, K Enfield, M Marshall, C G Irvin, T P Clemmer, L K Weaver, J Gleed, M Zenger, J Krueger, A H Morris, A Ahmed, A Austin, N C Dean, C K Grissom, E Hirshberg, N Kumar, R R Miller, L Napoli, J F Orme, S Pandita, G Schreiber, L Struck, F Thomas, G E Thomsen, C Lawton, F Leung, P Kim, T Fujii, J Baughman, B Kerwin, D Hanselman, J d'Hulst, K M Sundar, W Alward, T Hill, E J Campbell, K A Ludwig, D B Nielsen, M J Pearce, M A Matthay, C S Calfee, B M Daniel, M Eisner, O Garcia, E R Johnson, K Kordesch, K D Liu, H Zhou, M W Peterson, J Blaauw, T E Albertson, E Vlastelin, J V Diaz, E R Johnson, R H Kallet, R D Hubmayr, D R Brown, O Gajic, R Hinds, S R Holets, D J Kor, M Passe, B P deBoisblanc, P Lauto, C Romaine, G Meyaski, J P Hunt, A Marr, S Brierre, C LeBlanc, T Jagneaux, D E Taylor, S Jain, L Seoane, F Simeone, J Fearon, J Duchesne, D A Schoenfeld, M Aquino, D Dorer, M Guha, E Hammond, N Lavery, P Lazar, I Molina, R Morse, C F Oldmixon, B Rawal, N J Ringwood, A Shui, E Smoot, B T Thompson, A L Harabin, S Bredow, M A Waclawiw, G G Weinmann, R G Spragg, A S Slutsky, M M Levy, B P Markovitz, E Petkova, C Weijer, D F Willson, J I Sznajder, M Begg, E Israel, J Lewis, P E Parsons

Affiliations

¹ Respiratory Care Services, University of California San Francisco Department of Anesthesia at San Francisco General Hospital.
² Cardiovascular Research Institute, University of California, San Francisco.
³ Department of Nephrology, University of California, San Francisco.
⁴ Department of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California.

PMID: 24381187
PMCID: PMC4077995
DOI: 10.4187/respcare.02593

Randomized Controlled Trial

The association between physiologic dead-space fraction and mortality in subjects with ARDS enrolled in a prospective multi-center clinical trial

Richard H Kallet et al. Respir Care. 2014 Nov.

. 2014 Nov;59(11):1611-8.

doi: 10.4187/respcare.02593. Epub 2013 Dec 31.

Authors

Richard H Kallet¹, Hanjing Zhuo², Kathleen D Liu³, Carolyn S Calfee⁴, Michael A Matthay²; National Heart Lung and Blood Institute ARDS Network Investigators

Collaborators

National Heart Lung and Blood Institute ARDS Network Investigators:
J S Steingrub, M Tidswell, L DeSouza, C Kardos, L Kozikowski, K Kozikowski, R G Brower, H E Fessler, D N Hager, P A Mendez-Tellez, K Oakjones, D M Needham, J Sevransky, A Workneh, S Han, S Murray, C Shanholtz, G Netzer, P Rock, A Sampaio, J Titus, T Harrington, D Herr, B Lee, N Bolouri, G R Khorjekar, H P Wiedemann, R W Ashton, D A Culver, T Frederick, J J Komara, J A Guzman, A J Reddy, R Hejal, M Andrews, D Haney, A F Connors, S Lasalvia, J D Thornton, E L Warren, M Moss, A B Benson, E L Burnham, B J Clark, L Gray, C Higgins, B J Maloney, M Mealer, I Douglas, K Overdier, K Thompson, R Wolken, S S Carson, L Chang, J Lanier, R D Hite, P E Morris, A Howard, A Harvey, K Bender, P E Wright, C Carter-Cole, S Gross, J McLean, A Overton, J D Truwit, K Enfield, M Marshall, C G Irvin, T P Clemmer, L K Weaver, J Gleed, M Zenger, J Krueger, A H Morris, A Ahmed, A Austin, N C Dean, C K Grissom, E Hirshberg, N Kumar, R R Miller, L Napoli, J F Orme, S Pandita, G Schreiber, L Struck, F Thomas, G E Thomsen, C Lawton, F Leung, P Kim, T Fujii, J Baughman, B Kerwin, D Hanselman, J d'Hulst, K M Sundar, W Alward, T Hill, E J Campbell, K A Ludwig, D B Nielsen, M J Pearce, M A Matthay, C S Calfee, B M Daniel, M Eisner, O Garcia, E R Johnson, K Kordesch, K D Liu, H Zhou, M W Peterson, J Blaauw, T E Albertson, E Vlastelin, J V Diaz, E R Johnson, R H Kallet, R D Hubmayr, D R Brown, O Gajic, R Hinds, S R Holets, D J Kor, M Passe, B P deBoisblanc, P Lauto, C Romaine, G Meyaski, J P Hunt, A Marr, S Brierre, C LeBlanc, T Jagneaux, D E Taylor, S Jain, L Seoane, F Simeone, J Fearon, J Duchesne, D A Schoenfeld, M Aquino, D Dorer, M Guha, E Hammond, N Lavery, P Lazar, I Molina, R Morse, C F Oldmixon, B Rawal, N J Ringwood, A Shui, E Smoot, B T Thompson, A L Harabin, S Bredow, M A Waclawiw, G G Weinmann, R G Spragg, A S Slutsky, M M Levy, B P Markovitz, E Petkova, C Weijer, D F Willson, J I Sznajder, M Begg, E Israel, J Lewis, P E Parsons

Affiliations

¹ Respiratory Care Services, University of California San Francisco Department of Anesthesia at San Francisco General Hospital.
² Cardiovascular Research Institute, University of California, San Francisco.
³ Department of Nephrology, University of California, San Francisco.
⁴ Department of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California.

PMID: 24381187
PMCID: PMC4077995
DOI: 10.4187/respcare.02593

Abstract

Background: We tested the association between pulmonary dead-space fraction (ratio of dead space to tidal volume [V(D)/V(T)]) and mortality in subjects with ARDS (Berlin definition, P(aO2)/F(IO2) ≤ 300 mm Hg; PEEP ≥ 5 cm H2O) 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. V(D)/V(T) 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 V(D)/V(T) compared with survivors (0.62 ± 0.11 vs 0.56 ± 0.11, respectively, P = .08). Differences in V(D)/V(T) 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 V(D)/V(T) [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 V(D)/V(T), P(aO2)/F(IO2), oxygenation index, vasopressor use, and the primary risk for ARDS. Using a Cox proportional hazard model, V(D)/V(T) 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 V(D)/V(T) (≥ 0.60) in early ARDS is associated with higher mortality. Measuring V(D)/V(T) may be useful in identifying ARDS patients at increased risk of death who are enrolled into a therapeutic trial.

Keywords: acute lung injury; acute respiratory distress syndrome; mechanical ventilation; physiologic dead-space fraction; single-breath test for carbon dioxide.

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Figures

**FIG 1**
Enrollment and dead-space measurements

**FIG 2**
Dead-space fraction and outcome by study day.

See this image and copyright information in PMC

References

1. Luce JM. Acute lung injury and the acute respiratory distress syndrome. Crit Care Med. 1998;26(2):369–376. - PubMed
1. Nuckton T, Alonso J, Kallet R, Daniel B, Pittet JP, Eisner M, Matthay MA. Early elevation in dead-space ventilation is associated with mortality risk in patients with acute respiratory distress syndrome. N Engl J Med. 2002;346(17):1281–1286. - PubMed
1. Lucangelo U, Bernabe F, Vatua S, Degrassi G, Villagra A, Fernandez R, Romero PV, Saura P, Borelli M, Blanch L. Prognostic value of different dead space indices in mechanically ventilated patients with acute lung injury. Chest. 2008;133(1):62–71. - PubMed
1. Cepkova M, Kapur V, Ren X, Quinn T, Zhuo H, Foster E, et al. Pulmonary dead space fraction and pulmonary artery systolic pressure as early predictors of clinical outcome in acute lung injury. Chest. 2007;132(3):836–842. - PubMed
1. Raurich JM, Vilar M, Colomar A, Ibanez J, Ayestaran I, Perez-Barcena J, Llompart-Pou JA. Prognostic value of the pulmonary dead-space fraction during early and intermediate phases of acute respiratory distress syndrome. Respir Care. 2010;55(3):282–287. - PubMed

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The association between physiologic dead-space fraction and mortality in subjects with ARDS enrolled in a prospective multi-center clinical trial

Collaborators

Affiliations

The association between physiologic dead-space fraction and mortality in subjects with ARDS enrolled in a prospective multi-center clinical trial

Authors

Collaborators

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources