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Bedside estimates of dead space using end-tidal CO(2) are independently associated with mortality in ARDS

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 CO(2) (arterial-ET difference), a surrogate for dead space fraction, would predict mor...

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Autores principales: Lecompte-Osorio, Paola, Pearson, Steven D., Pieroni, Cole H., Stutz, Matthew R., Pohlman, Anne S., Lin, Julie, Hall, Jesse B., Htwe, Yu M., Belvitch, Patrick G., Dudek, Steven M., Wolfe, Krysta, Patel, Bhakti K., Kress, John P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442447/
https://www.ncbi.nlm.nih.gov/pubmed/34526077
http://dx.doi.org/10.1186/s13054-021-03751-x
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author Lecompte-Osorio, Paola
Pearson, Steven D.
Pieroni, Cole H.
Stutz, Matthew R.
Pohlman, Anne S.
Lin, Julie
Hall, Jesse B.
Htwe, Yu M.
Belvitch, Patrick G.
Dudek, Steven M.
Wolfe, Krysta
Patel, Bhakti K.
Kress, John P.
author_facet Lecompte-Osorio, Paola
Pearson, Steven D.
Pieroni, Cole H.
Stutz, Matthew R.
Pohlman, Anne S.
Lin, Julie
Hall, Jesse B.
Htwe, Yu M.
Belvitch, Patrick G.
Dudek, Steven M.
Wolfe, Krysta
Patel, Bhakti K.
Kress, John P.
author_sort Lecompte-Osorio, Paola
collection PubMed
description 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 CO(2) (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 ((P(a)CO(2)–P(ET)CO(2))/P(a)CO(2)) 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 CO(2) (ETCO(2)) difference is an independent predictor of mortality in patients with ARDS.
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spelling pubmed-84424472021-09-15 Bedside estimates of dead space using end-tidal CO(2) are independently associated with mortality in ARDS Lecompte-Osorio, Paola Pearson, Steven D. Pieroni, Cole H. Stutz, Matthew R. Pohlman, Anne S. Lin, Julie Hall, Jesse B. Htwe, Yu M. Belvitch, Patrick G. Dudek, Steven M. Wolfe, Krysta Patel, Bhakti K. Kress, John P. Crit Care Research 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 CO(2) (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 ((P(a)CO(2)–P(ET)CO(2))/P(a)CO(2)) 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 CO(2) (ETCO(2)) difference is an independent predictor of mortality in patients with ARDS. BioMed Central 2021-09-15 /pmc/articles/PMC8442447/ /pubmed/34526077 http://dx.doi.org/10.1186/s13054-021-03751-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Lecompte-Osorio, Paola
Pearson, Steven D.
Pieroni, Cole H.
Stutz, Matthew R.
Pohlman, Anne S.
Lin, Julie
Hall, Jesse B.
Htwe, Yu M.
Belvitch, Patrick G.
Dudek, Steven M.
Wolfe, Krysta
Patel, Bhakti K.
Kress, John P.
Bedside estimates of dead space using end-tidal CO(2) are independently associated with mortality in ARDS
title Bedside estimates of dead space using end-tidal CO(2) are independently associated with mortality in ARDS
title_full Bedside estimates of dead space using end-tidal CO(2) are independently associated with mortality in ARDS
title_fullStr Bedside estimates of dead space using end-tidal CO(2) are independently associated with mortality in ARDS
title_full_unstemmed Bedside estimates of dead space using end-tidal CO(2) are independently associated with mortality in ARDS
title_short Bedside estimates of dead space using end-tidal CO(2) are independently associated with mortality in ARDS
title_sort bedside estimates of dead space using end-tidal co(2) are independently associated with mortality in ards
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442447/
https://www.ncbi.nlm.nih.gov/pubmed/34526077
http://dx.doi.org/10.1186/s13054-021-03751-x
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