{"title":"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。","authors":"","doi":"10.1016/j.medin.2024.05.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Design</h3><div>Observational study of a historical cohort in an university hospital in Medellin, Colombia.</div></div><div><h3>Participants</h3><div>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.</div></div><div><h3>Main variables of interest</h3><div>VD/VT, CMV, VR, demographic data, oxygenation index, and ventilatory parameters.</div></div><div><h3>Results</h3><div>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; <em>P</em> <!-->=<!--> <!-->0.046), age (HR: 1.024; 95% CI: 1.014-1.034; <em>P</em><<!--> <!-->0.001), and SOFA score at onset (HR: 1.036; 95% CI: 1.001-1.07; <em>P</em> <!-->=<!--> <!-->0.017).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"\",\"doi\":\"10.1016/j.medin.2024.05.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>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.</div></div><div><h3>Design</h3><div>Observational study of a historical cohort in an university hospital in Medellin, Colombia.</div></div><div><h3>Participants</h3><div>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.</div></div><div><h3>Main variables of interest</h3><div>VD/VT, CMV, VR, demographic data, oxygenation index, and ventilatory parameters.</div></div><div><h3>Results</h3><div>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; <em>P</em> <!-->=<!--> <!-->0.046), age (HR: 1.024; 95% CI: 1.014-1.034; <em>P</em><<!--> <!-->0.001), and SOFA score at onset (HR: 1.036; 95% CI: 1.001-1.07; <em>P</em> <!-->=<!--> <!-->0.017).</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":49268,\"journal\":{\"name\":\"Medicina Intensiva\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medicina Intensiva\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0210569124001943\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicina Intensiva","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0210569124001943","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
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
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.
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).