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ORIGINAL RESEARCHCRITICAL CARE MEDICINEPulmonary Dead Space Fraction and Pulmonary Artery Systolic Pressure as Early Predictors of Clinical Outcome in Acute Lung Injury
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Study Design and Patient Selection
This was a prospective observational cohort study conducted in the ICU of a tertiary care university hospital. The protocol was approved by the Institutional Committee on Human Research, and informed consent was obtained from the patients or their surrogates. All patients with ALI admitted to the adult ICU of Moffitt-Long Hospital at the University of California San Francisco between December 2004 and May 2006 were eligible for the study. Inclusion criteria were age ≥ 18 years, positive
Baseline Characteristics
A total of 42 patients with ALI were enrolled in the study (23 women and 19 men; mean age, 62 ± 17 years). Of the 42 patients enrolled, 15 patients (36%) died and 27 patients (64%) survived. The demographics, etiology of ALI, and comorbidities are summarized in Table 1. Baseline physiologic variables are summarized in Table 2. Systolic PA pressure measurements were successfully obtained in 39 of the 42 patients. Three patients had an incomplete tricuspid regurgitation jet despite agitated
Discussion
Abnormalities of pulmonary blood flow and progressive and irreversible obstruction of the microvasculature35 resulting in pulmonary hypertension678 are one of the hallmarks of ALI, first described by Zapol and Snider28 in 1977. Several subsequent studies91011 using right-heart catheterization in patients with ARDS have confirmed that PA hypertension is common and can be associated with poor prognosis. However, these early studies examined PA pressure at varying points after the onset of ARDS,
References (40)
- et al.
Biventricular volumes and function in patients with adult respiratory distress syndrome ventilated with PEEP
Chest
(1983) - et al.
Cardiovascular alterations in the adult respiratory distress syndrome
Am J Med
(1982) - et al.
Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients
J Am Coll Cardiol
(1985) - et al.
Saline contrast enhancement of tricuspid regurgitant jets detected by Doppler color flow imaging
Am J Cardiol
(1990) - et al.
Are low tidal volumes safe?
Chest
(1990) - et al.
The adult respiratory distress syndrome: a report of survival and modifying factors
Chest
(1992) - et al.
Vascular obstruction causes pulmonary hypertension in severe acute respiratory failure
Chest
(1977) Right ventricular stroke-work: an index of distribution of pulmonary perfusion in acute respiratory failure
Chest
(1983)- et al.
The acute respiratory distress syndrome
N Engl J Med
(2000) - et al.
Incidence and outcomes of acute lung injury
N Engl J Med
(2005)
Early bedside detection of pulmonary vascular occlusion during acute respiratory failure
Am Rev Respir Dis
Alterations of the gas exchange apparatus in adult respiratory insufficiency associated with septicemia
Am Rev Respir Dis
The pulmonary vascular lesions of the adult respiratory distress syndrome
Am J Pathol
Effects of dopamine on cardiopulmonary function and left ventricular volumes in patients with acute respiratory failure
Am Rev Respir Dis
Pulmonary and systemic haemodynamic disorders in the adult respiratory distress syndrome
Intensive Care Med
Pulmonary hypertension in acute respiratory failure
Crit Care Med
Hemodynamic profile in severe ARDS: results of the European Collaborative ARDS Study
Intensive Care Med
Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome
N Engl J Med
The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination
Am J Respir Crit Care Med
Physiologically based indices of volumetric capnography in patients receiving mechanical ventilation
Eur Respir J
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This research was supported in part by National Heart, Lung, and Blood Institute grants HL74005 and HL58156, and also KL2RR024130 from the National Center for Research Studies.
The authors have no conflicts of interest to disclose.