Pulmonary Dead-Space Fraction as a Risk Factor for Death in the Acute Respiratory Distress Syndrome

• Published in: The New England journal of medicine Vol. 346; no. 17; pp. 1281 - 1286
• Main Authors: Nuckton, Thomas J, Alonso, James A, Kallet, Richard H, Daniel, Brian M, Pittet, Jean-François, Eisner, Mark D, Matthay, Michael A
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 25.04.2002
• Subjects: Acquired Immunodeficiency Syndrome - complications; Biological and medical sciences; Humans; Logistic Models; Medical sciences; Middle Aged; Mortality; Pneumology; Positive-Pressure Respiration; Prospective Studies; Respiratory Dead Space; Respiratory diseases; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - classification; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - physiopathology; Respiratory system : syndromes and miscellaneous diseases; Respiratory therapy; Risk Factors; Sepsis - complications; Severity of Illness Index; Human; Lung disease; Prognosis; Adult respiratory distress syndrome; Respiratory disease; Mortality; Risk factor; Respiratory dead space
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa012835

Pulmonary dead space, the fraction of ventilation that is wasted, is greater than normal in patients with the acute respiratory distress syndrome who are undergoing mechanical ventilation. This study found that when the dead-space fraction was measured early in the course of the syndrome, higher values were independently associated with an increased risk of death. The acute respiratory distress syndrome is an important cause of acute respiratory failure and has a high mortality rate. 1 – 5 Despite 30 years of research into the causes and consequences of the acute respiratory distress syndrome, efforts to identify a reliable, pulmonary-specific risk factor for death have been disappointing. Variables that are independently associated with mortality are qualitative or not specific to abnormalities of pulmonary pathophysiology, such as sepsis, nonpulmonary organ system dysfunction, age, and cirrhosis. 4 – 7 Although indexes of hypoxemia, such as the partial pressure of arterial oxygen (PaO 2 ), the fraction of inspired oxygen (FiO 2 ), . . .