Analysis of ventilatory ratio as a novel method to monitor ventilatory adequacy at the bedside

“…1,2,9 For adults with ARDS, Sinha et al recently suggested the ventilatory ratio (VR) as a marker of dead space that can be calculated using routinely available clinical data without any measures of capnography. [10][11][12] VR in adults is defined as:…”

Section: Introductionmentioning

confidence: 99%

The Association Between Ventilatory Ratio and Mortality in Children and Young Adults

et al. 2020

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BACKGROUND: The ventilatory ratio (VR) is a dead-space marker associated with mortality in mechanically ventilated adults with ARDS. The end-tidal alveolar dead space fraction (AVDSf) has been associated with mortality in children. However, AVDSf requires capnography measurements, whereas VR does not. We sought to examine the prognostic value of VR, in comparison to AVDSf, in children and young adults with acute hypoxemic respiratory failure. METHODS: We conducted a retrospective study of prospectively collected data from 180 mechanically ventilated children and young adults with acute hypoxemic respiratory failure. VR was calculated as (minute ventilation 3 P aCO 2)/(age-adjusted predicted minute ventilation 3 37.5). AVDSf was calculated as ðP aCO 2 2 P ETCO 2 Þ=P aCO 2. RESULTS: VR and AVDSf had a moderate correlation (rho 0.31, P < .001). VR was similar between survivors at 1.22 (interquartile range [IQR] 1.0-1.52) and nonsurvivors at 1.30 (IQR 0.96-1.95) (P 5 .2). AVDSf was lower in survivors at 0.12 (IQR 0.03-0.23) than nonsurvivors at 0.24 (IQR 0.13-0.33) (P < .001). In logistic regression and competing risk regression analyses, VR was not associated with mortality or rate of extubation at any given time (competing risk death; all P > .3). An AVDSf in the highest 2 quartiles, in comparison to the lowest quartile (AVDSf < 0.06), was associated with higher mortality after adjustment for oxygenation index and severity of illness (AVDSf 6 0.15-0.26: odds ratio 3.58, 95% CI 1.02-12.64, P 5 .047, and AVDSf 6 0.26: odds ratio 3.91 95% CI-1.03-14.83, P 5 .045). At any given time after intubation, a child with an AVDSf 6 0.26 was less likely to be extubated than a child with an AVDSf < 0.06, after adjustment for oxygenation index and severity of illness (AVDSf 6 0.26: subdistribution hazard ratio 0.55, 95% CI 0.33-0.94, P 5 .03). CONCLUSIONS: VR should not be used for prognostic purposes in children and young adults. AVDSf added prognostic information to the severity of oxygenation defect and overall severity of illness in children and young adults, consistent with previous research.

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“…Dead space could be measured at the bedside with the ventilatory ratio, an index that is associated with higher mortality in ARDS. (10) The strength of this study lies in its relatively large sample size that includes a diverse study population in children. In addition, the study bene ts from the availability of plasma samples from multiple time points and a well curated collection of data elements.…”

Section: Discussionmentioning

confidence: 99%

Thrombomodulin is Associated with Increased Mortality and Organ Failure in Mechanically Ventilated Children with Acute Respiratory Failure: A Prospective Observational Study.

Monteiro

Flori

Dahmer

et al. 2021

Preprint

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BACKGROUNDAcute respiratory failure (ARF) can progress to acute respiratory distress syndrome (ARDS) and death. Biomarkers such as soluble thrombomodulin (sTM), implicated in pulmonary vascular injury, may allow for risk stratification and prognostic enrichment in ARF.METHODSThis was a prospective observational study of 432 patients aged 2 weeks - 17 years requiring invasive mechanical ventilation. It was ancillary to the multicenter clinical trial, Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE). After consent, patients had up to 3 plasma samples collected at 24-hour intervals within 5 days after intubation. sTM was assayed by ELISA. Hazard ratio (HR) for 90-day mortality was determined by cox regression. Mixed effect models (MEM) were used to test for association with extrapulmonary multiorgan failure (MOF) and oxygenation index (OI). Age, race, sex and PRISM-III scores were used as confounding variables for multivariable analyses.RESULTSsTM values ranged from 16.6 to 670.9 ng/ml within 5 days after intubation. Higher sTM was associated with increased 90-day mortality (n=432, adjusted HR= 1.003, p=0.02) and worse OI in the first 5 days after intubation (n=252, Estimate = 0.02, p<0.01). Both initial and slope of sTM were associated with increased extrapulmonary MOF in unadjusted and adjusted analyses (Intercept, Estimate=0.003, p<0.0001; and slope, Estimate=0.01, p=0.0009, n= 386). CONCLUSIONSPlasma sTM are associated with mortality, severity of ARDS extrapulmonary MOF in children with ARF. This suggests a role of vascular injury in pathogenesis of ARF and provide potential application for targeted therapies. TRIAL REGISTRATIONNCT00814099

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Analysis of ventilatory ratio as a novel method to monitor ventilatory adequacy at the bedside

Cited by 28 publications

References 18 publications

Ventilatory Mechanics in Early vs Late Intubation in a Cohort of Coronavirus Disease 2019 Patients With ARDS

Ventilatory Mechanics in Early vs Late Intubation in a Cohort of Coronavirus Disease 2019 Patients With ARDS

The Association Between Ventilatory Ratio and Mortality in Children and Young Adults

Thrombomodulin is Associated with Increased Mortality and Organ Failure in Mechanically Ventilated Children with Acute Respiratory Failure: A Prospective Observational Study.

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