The Association Between Physiologic Dead-Space Fraction and Mortality in Subjects With ARDS Enrolled in a Prospective Multi-Center Clinical Trial.

Autor:	Kallet, Richard H., Hanjing Zhuo, Liu, Kathleen D., Calfee, Carolyn S., Matthay, Michael A.
Předmět:	LUNG physiology ARTIFICIAL respiration CHI-squared test CLINICAL trials CONFIDENCE intervals FISHER exact test LONGITUDINAL method LUNG injuries MEDICAL cooperation SCIENTIFIC observation RESEARCH RESEARCH funding RESPIRATORY measurements ADULT respiratory distress syndrome RISK assessment STATISTICS SURVIVAL analysis (Biometry) LOGISTIC regression analysis DATA analysis CONTINUING education units PROPORTIONAL hazards models ACUTE diseases DATA analysis software DESCRIPTIVE statistics ODDS ratio
Zdroj:	Respiratory Care; Nov2014, Vol. 59 Issue 11, p1611-1618, 8p, 1 Diagram, 3 Charts, 1 Graph
Abstrakt:	BACKGROUND: We tested the association between pulmonary dead-space fraction (ratio of dead space to tidal volume [VD/VT]) and mortality in subjects with ARDS (Berlin definition, PaO2/FIO2 ≤ 300 mm Hg; PEEP ≥ 5 cmH2O) 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. VD/VT 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 VD/VT compared with survivors (0.62 ± 0.11 vs 0.56 ± 0.11, respectively, P = .08). Differences in VD/VT 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 VD/VT [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 VD/VT, PaO2/FIO2, oxygenation index, vasopressor use, and the primary risk for ARDS. Using a Cox proportional hazard model, VD/VT 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 VD/VT (≥ 0.60) in early ARDS is associated with higher mortality. Measuring VD/VT may be useful in identifying ARDS patients at increased risk of death who are enrolled into a therapeutic trial. [ABSTRACT FROM AUTHOR]
Databáze:	Supplemental Index
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