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  • Title: Prediction equation to estimate dead space to tidal volume fraction correlates with mortality in critically ill patients.
    Author: Vender RL, Betancourt MF, Lehman EB, Harrell C, Galvan D, Frankenfield DC.
    Journal: J Crit Care; 2014 Apr; 29(2):317.e1-3. PubMed ID: 24581935.
    Abstract:
    OBJECTIVE: The measurement of dead space to tidal volume fraction (Vd/Vt) using various methodologies has been shown to be a reliable predictor of mortality in critically ill patients. In this study, we evaluated the correlation of a validated equation using clinically available information to predict calculation of Vd/Vt with clinically relevant outcome parameters in patients requiring mechanical ventilation. METHODS: Calculations of Vd/Vt were obtained based upon a previously published prediction equation for dead space ventilation fraction: Vd/Vt = 0.320 + 0.0106 (Paco2--end-tidal carbon dioxide measurement) + 0.003 (respiratory rate per minute) + 0.0015 (age in years) on study days 1, 3 to 4, 6 to 9, and 14 after initiation of mechanical ventilation in adult patients who satisfied 1 of the 3 study defined diseases: (1) acute bacterial pneumonia, (2) acute respiratory distress syndrome, or (3) cystic fibrosis. RESULTS: Using the final/last available time point calculation of Vd/Vt, a significant difference was observed between survivors and nonsurvivors both in relation to mean and median values (56.5% vs 71.2% and 56.0% vs 65.0%, respectively). In addition, sequential analyses of Vd/Vt calculations over time also demonstrated a statistically significant difference between survivors and nonsurvivors for days 6 to 9. CONCLUSION: In this study-specific population of critically ill patients, the prediction equation of Vd/Vt using clinically available parameters correlates with mortality. In addition, we provide a simple method to estimate Vd/Vt that can be potentially applicable to all critically ill intensive care unit patients.
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