Dead-Space Ventilation Indices and Mortality in Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.

Autor:	Jayasimhan D; Cardiothoracic and Vascular Intensive Care Unit, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand.; Respiratory Services, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand., Chieng J; Respiratory Services, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand., Kolbe J; Respiratory Services, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand.; Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand., Sidebotham DA; Cardiothoracic and Vascular Intensive Care Unit, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand.; Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2023 Oct 01; Vol. 51 (10), pp. 1363-1372. Date of Electronic Publication: 2023 May 19.
DOI:	10.1097/CCM.0000000000005921
Abstrakt:	Objectives: Acute respiratory distress syndrome (ARDS) is associated with high ventilation-perfusion heterogeneity and dead-space ventilation. However, whether the degree of dead-space ventilation is associated with outcomes is uncertain. In this systematic review and meta-analysis, we evaluated the ability of dead-space ventilation measures to predict mortality in patients with ARDS. Data Sources: MEDLINE, CENTRAL, and Google Scholar from inception to November 2022. Study Selection: Studies including adults with ARDS reporting a dead-space ventilation index and mortality. Data Extraction: Two reviewers independently identified eligible studies and extracted data. We calculated pooled effect estimates using a random effects model for both adjusted and unadjusted results. The quality and strength of evidence were assessed using the Quality in Prognostic Studies and Grading of Recommendations, Assessment, Development, and Evaluation, respectively. Data Synthesis: We included 28 studies in our review, 21 of which were included in our meta-analysis. All studies had a low risk of bias. A high pulmonary dead-space fraction was associated with increased mortality (odds ratio [OR], 3.52; 95% CI, 2.22-5.58; p < 0.001; I2 = 84%). After adjusting for other confounding variables, every 0.05 increase in pulmonary-dead space fraction was associated with an increased odds of death (OR, 1.23; 95% CI, 1.13-1.34; p < 0.001; I2 = 57%). A high ventilatory ratio was also associated with increased mortality (OR, 1.55; 95% CI, 1.33-1.80; p < 0.001; I2 = 48%). This association was independent of common confounding variables (OR, 1.33; 95% CI, 1.12-1.58; p = 0.001; I2 = 66%). Conclusions: Dead-space ventilation indices were independently associated with mortality in adults with ARDS. These indices could be incorporated into clinical trials and used to identify patients who could benefit from early institution of adjunctive therapies. The cut-offs identified in this study should be prospectively validated. Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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