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Modern medicine combines the traditional approach to treat syndromes with recent advances in translational research to improve understanding of the pathophysiology of the patient response. Integration of biomarkers with routinely measured clinical variables may offer information on how patients respond to a treatment and their final outcome.1 Therefore, integration and understanding the different pathophysiological information of critical illness will improve treatment decisions and outcomes at bedside.
In patients with ARDS, an elevated measured pulmonary dead space, measured as deadspace to tidal volume ratio (VD/VT) is a predictor of death and is one of the respiratory physiomarkers independently associated with mortality.2-5 However, determination of dead space at the bedside requires extra equipment for the measurement of the PCO2 in mixed expired air, which is a limitation for its routine clinical use. Other ventilator efficiency indices using partial pressure of end-tidal CO2 as a function of PaCO2 also have value to predict optimal recruitment,6 greater likelihood of weaning from venovenous extracorporeal membrane oxygenation (ECMO),7 or to be independently associated with mortality risk8,9 although their implementation is not generalized. Since CO2 is highly more diffusible across tissues than oxygen, impaired CO2 excretion reflects profound vascular and alveolar injury.
In recent years, the ventilatory ratio (VR), an index of impaired efficiency of ventilation, has been proposed as an easily acquired bedside index of impaired ventilation that can be computed using routinely measured …
Correspondence: Lluís Blanch MD PhD, Critical Care Department, Parc Tauli Universitary Hospital, Sabadell, Spain; Institut d'Investigació i Innovació Parc Taulí, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain. E-mail: lblanch{at}tauli.cat
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