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Chest. 2007 Sep;132(3):836-42. Epub 2007 Jun 15.

Pulmonary dead space fraction and pulmonary artery systolic pressure as early predictors of clinical outcome in acute lung injury.

Author information

1
Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA.

Abstract

STUDY OBJECTIVE:

The primary objective of this study was to test whether an elevated systolic pulmonary artery (PA) pressure or an elevated pulmonary dead space fraction (Vd/Vt) in early acute lung injury (ALI) is associated with poor clinical outcomes in the era of lung-protective ventilation.

DESIGN:

Prospective observational cohort study.

SETTING:

ICUs of a university hospital.

PATIENTS:

Forty-two patients with ALI receiving mechanical ventilation.

MEASUREMENTS:

PA pressure was measured noninvasively using transthoracic echocardiography. Vd/Vt was measured by volumetric capnography (NICO Cardiopulmonary Management System; Novametrix; Wallingford, CT).

MAIN RESULTS:

There was no difference in the mean systolic PA pressure in patients who died compared to those who survived (43 +/- 9 mm Hg vs 41 +/- 9 mm Hg, p = 0.54) [mean +/- SD]. In contrast to the PA systolic pressure, Vd/Vt was significantly higher in patients who died compared to those who survived (0.61 +/- 0.09 vs 0.53 +/- 0.10, p = 0.02). Similarly, Vd/Vt was higher in patients with < 7 ventilator-free days during the first 28 days after enrollment compared to those with > 7 ventilator-free days (0.61 +/- 0.08 vs 0.52 +/- 0.11, p = 0.008).

CONCLUSION:

In the era of lung-protective ventilation, systolic PA pressure early in the course of ALI is elevated but not predictive of outcome. However, elevated Vd/Vt in early ALI is associated with increased mortality and with fewer ventilator-free days.

PMID:
17573490
DOI:
10.1378/chest.07-0409
[Indexed for MEDLINE]

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