Bedside estimates of dead space using end-tidal CO2 are independently associated with mortality in ARDS
© 2021. The Author(s)..
PURPOSE: In acute respiratory distress syndrome (ARDS), dead space fraction has been independently associated with mortality. We hypothesized that early measurement of the difference between arterial and end-tidal CO2 (arterial-ET difference), a surrogate for dead space fraction, would predict mortality in mechanically ventilated patients with ARDS.
METHODS: We performed two separate exploratory analyses. We first used publicly available databases from the ALTA, EDEN, and OMEGA ARDS Network trials (N = 124) as a derivation cohort to test our hypothesis. We then performed a separate retrospective analysis of patients with ARDS using University of Chicago patients (N = 302) as a validation cohort.
RESULTS: The ARDS Network derivation cohort demonstrated arterial-ET difference, vasopressor requirement, age, and APACHE III to be associated with mortality by univariable analysis. By multivariable analysis, only the arterial-ET difference remained significant (P = 0.047). In a separate analysis, the modified Enghoff equation ((PaCO2-PETCO2)/PaCO2) was used in place of the arterial-ET difference and did not alter the results. The University of Chicago cohort found arterial-ET difference, age, ventilator mode, vasopressor requirement, and APACHE II to be associated with mortality in a univariate analysis. By multivariable analysis, the arterial-ET difference continued to be predictive of mortality (P = 0.031). In the validation cohort, substitution of the arterial-ET difference for the modified Enghoff equation showed similar results.
CONCLUSION: Arterial to end-tidal CO2 (ETCO2) difference is an independent predictor of mortality in patients with ARDS.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
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| Enthalten in: |
Critical care (London, England) - 25(2021), 1 vom: 15. Sept., Seite 333 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lecompte-Osorio, Paola [VerfasserIn] |
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| Links: |
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| Themen: |
142M471B3J |
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| Anmerkungen: |
Date Completed 18.10.2021 Date Revised 18.10.2021 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s13054-021-03751-x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM330680919 |
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| 245 | 1 | 0 | |a Bedside estimates of dead space using end-tidal CO2 are independently associated with mortality in ARDS |
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| 500 | |a Date Revised 18.10.2021 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. The Author(s). | ||
| 520 | |a PURPOSE: In acute respiratory distress syndrome (ARDS), dead space fraction has been independently associated with mortality. We hypothesized that early measurement of the difference between arterial and end-tidal CO2 (arterial-ET difference), a surrogate for dead space fraction, would predict mortality in mechanically ventilated patients with ARDS | ||
| 520 | |a METHODS: We performed two separate exploratory analyses. We first used publicly available databases from the ALTA, EDEN, and OMEGA ARDS Network trials (N = 124) as a derivation cohort to test our hypothesis. We then performed a separate retrospective analysis of patients with ARDS using University of Chicago patients (N = 302) as a validation cohort | ||
| 520 | |a RESULTS: The ARDS Network derivation cohort demonstrated arterial-ET difference, vasopressor requirement, age, and APACHE III to be associated with mortality by univariable analysis. By multivariable analysis, only the arterial-ET difference remained significant (P = 0.047). In a separate analysis, the modified Enghoff equation ((PaCO2-PETCO2)/PaCO2) was used in place of the arterial-ET difference and did not alter the results. The University of Chicago cohort found arterial-ET difference, age, ventilator mode, vasopressor requirement, and APACHE II to be associated with mortality in a univariate analysis. By multivariable analysis, the arterial-ET difference continued to be predictive of mortality (P = 0.031). In the validation cohort, substitution of the arterial-ET difference for the modified Enghoff equation showed similar results | ||
| 520 | |a CONCLUSION: Arterial to end-tidal CO2 (ETCO2) difference is an independent predictor of mortality in patients with ARDS | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a ARDS | |
| 650 | 4 | |a Blood gas analysis | |
| 650 | 4 | |a End-tidal CO2 | |
| 650 | 4 | |a Mortality | |
| 650 | 7 | |a Carbon Dioxide |2 NLM | |
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| 700 | 1 | |a Pieroni, Cole H |e verfasserin |4 aut | |
| 700 | 1 | |a Stutz, Matthew R |e verfasserin |4 aut | |
| 700 | 1 | |a Pohlman, Anne S |e verfasserin |4 aut | |
| 700 | 1 | |a Lin, Julie |e verfasserin |4 aut | |
| 700 | 1 | |a Hall, Jesse B |e verfasserin |4 aut | |
| 700 | 1 | |a Htwe, Yu M |e verfasserin |4 aut | |
| 700 | 1 | |a Belvitch, Patrick G |e verfasserin |4 aut | |
| 700 | 1 | |a Dudek, Steven M |e verfasserin |4 aut | |
| 700 | 1 | |a Wolfe, Krysta |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Bhakti K |e verfasserin |4 aut | |
| 700 | 1 | |a Kress, John P |e verfasserin |4 aut | |
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