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. 2023 Feb;58(2):559-565.
doi: 10.1002/ppul.26237. Epub 2022 Dec 1.

Alveolar dead space fraction is not associated with early RV systolic dysfunction in pediatric ARDS

Daniel Chilcote  1 , Laura Mercer-Rosa  2 , Yan Wang  2 , Steven M Kawut  3 , Robert A Berg  1 , Nadir Yehya  1 , Adam S Himebauch  1
Affiliations

Alveolar dead space fraction is not associated with early RV systolic dysfunction in pediatric ARDS

Daniel Chilcote et al. Pediatr Pulmonol. 2023 Feb.

Abstract

Primary hypothesis: We hypothesized that higher alveolar dead space fraction (AVDSf) at pediatric acute respiratory distress syndrome (PARDS) onset would be associated with right ventricular (RV) systolic dysfunction within the first 24 h of PARDS.

Study design and methods: We performed a retrospective single-center cohort study of PARDS patients with clinically obtained echocardiograms within 24 h. Primary exposure was AVDSf at PARDS onset. Primary outcome was RV systolic dysfunction as defined by RV global longitudinal strain (GLS) (>-18%). Secondary outcomes included pulmonary hypertension (PH) and RV systolic dysfunction as defined by other echocardiogram parameters, and measures of oxygenation. Unadjusted and adjusted logistic and linear regression were used to investigate AVDSf associations with outcomes.

Results: Ninety-one patients were included: median age 6.2 years, 46% female, and 65% with moderate or severe PARDS. Median AVDSf was 0.2 (interquartile range [IQR] 0.0-0.3), 33% had RV dysfunction, and 21% had PH. Unadjusted and adjusted logistic regression showed no association between AVDSf and RV systolic dysfunction or PH by any echocardiographic measure, but unadjusted and adjusted linear regression did show an association between AVDSf and PaO2 /FiO2 .

Conclusion: AVDSf at PARDS onset was not associated with RV systolic dysfunction or PH within 24 h but was associated with PaO2 /FiO2 ratio and may be more reflective of pulmonary causes of ventilation-perfusion mismatch. Future investigations should focus on clarifying the clinical utility of AVDSf in relation to existing metrics throughout the course of PARDS.

Keywords: echocardiography; hypoxemic respiratory failure; pediatrics; respiratory dead space.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study flowchart. PARDS, pediatric acute respiratory distress syndrome
FIGURE 2
FIGURE 2
Box plots of alveolar dead space fraction (AVDSf) values in patients with normal and abnormal right ight ventricular (RV) global longitudinal strain (GLS) as well as with and without echocardiographic evidence of pulmonary hypertension (PH).
See this image and copyright information in PMC

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