Asociación de fracción de espacio muerto con la mortalidad en pacientes con síndrome de dificultad respiratoria aguda por COVID-19: Un estudio observacional de una cohorte histórica

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva Pub Date : 2024-11-01 DOI:10.1016/j.medin.2024.05.007

Carlos Carvajal , Nelson Darío Giraldo Ramirez , Andrés David de la Hoz Castro , Carlos Guillermo Vidal Vargas , Hemel Antonio Pacheco , David Fernández Sánchez , Laura Vannesa González Salazar , Silvia Stella Romero Otta , Silvia Vergara Jaimes , Juan Fernando Bolívar Ospina , Juliana Correa Céspedes , Alejandro Narváez Orozco , Jorge Hernando Donado , Carlos Alberto Cadavid , Gisela de la Rosa

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引用次数: 0

Abstract

Objective

To assess the association between dead space fraction (VD/VT) measured through time capnography, corrected minute volume (CMV), and ventilation ratio (VR) with clinical outcomes in COVID-19 patients requiring invasive mechanical ventilation.

Design

Observational study of a historical cohort in an university hospital in Medellin, Colombia.

Participants

Patients aged 15 and above with confirmed COVID-19 diagnosis admitted to the ICU requiring mechanical ventilation; interventions: measurement of VD/VT, CMV, and VR in COVID-19 patients.

Main variables of interest

VD/VT, CMV, VR, demographic data, oxygenation index, and ventilatory parameters.

Results

During the study period, 1,047 COVID-19 patients on mechanical ventilation were analyzed, of whom 446 (42%) died. Deceased patients exhibited a higher prevalence of advanced age and obesity, elevated Charlson index, higher APACHE II and SOFA scores, as well as an increase in VD/VT ratio (0.27 in survivors and 0.31 in deceased) and minute ventilation volume on the first day of mechanical ventilation. Multivariate analysis revealed independent associations with in-hospital mortality, higher VD/VT (HR: 1.24; 95% CI: 1.003-1.525; P = 0.046), age (HR: 1.024; 95% CI: 1.014-1.034; P< 0.001), and SOFA score at onset (HR: 1.036; 95% CI: 1.001-1.07; P = 0.017).

Conclusions

VD/VT demonstrated an association with mortality in COVID-19 ARDS patients on mechanical ventilation. These findings suggest that VD/VT measurement may serve as a severity marker for the disease.

查看原文本刊更多论文

通过 COVID-19 分析死腔分数与急性呼吸窘迫综合征患者死亡率的关系：一项历史队列观察研究。

目的评估通过时间式毛细血管通气图测量的死腔分数（VD/VT）、校正分钟容量（CMV）和通气比（VR）与需要进行有创机械通气的 COVID-19 患者的临床预后之间的关系。主要关注变量VD/VT、CMV、VR、人口统计学数据、氧合作用指数和通气参数。结果在研究期间，分析了 1047 名接受机械通气的 COVID-19 患者，其中 446 人（42%）死亡。死亡患者的高龄和肥胖比例较高，Charlson 指数升高，APACHE II 和 SOFA 评分较高，机械通气第一天的 VD/VT 比值（存活者为 0.27，死亡者为 0.31）和分钟通气量也有所增加。多变量分析显示，与院内死亡率、较高的VD/VT（HR：1.24；95% CI：1.003-1.525；P = 0.046）、年龄（HR：1.024；95% CI：1.014-1.034；P<；0.001）和发病时的 SOFA 评分（HR：1.036；95% CI：1.001-1.07；P = 0.017）。结论VD/VT 显示与 COVID-19 ARDS 机械通气患者的死亡率有关。这些研究结果表明，VD/VT 测量可作为疾病严重程度的标志。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medicina Intensiva CRITICAL CARE MEDICINE-

CiteScore

2.70

自引率

20.00%

发文量

146

审稿时长

33 days

期刊介绍： Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).