Increased Ratio of Dead Space to Tidal Volume in Subjects With Inhalation Injury. 2020

Thomas Granchi, and Ashley Lemere, and Neil Mashruwala, and Colette Galet, and Kathleen S Romanowski
Department of Surgery, Acute Care Surgery Division, University of Iowa Hospitals & Clinic, Iowa City, Iowa. tgranch@emory.edu.

BACKGROUND Inhalation injury increases morbidity and mortality in burn patients. Patients with inhalation injury present with large differences between end-tidal CO2 pressure and [Formula: see text], an indirect measure of dead space. We aimed to investigate the relationships between increased dead space and inhalation injury outcomes. METHODS This retrospective study included 51 adult subjects with burns and inhalation injuries. Demographics, size of burns, length of stay, ventilator days, blood gas results, end-tidal CO2 pressure, presence of ventilator-associated pneumonia, and mortality data were collected. Modified Baux scores and ratios of alveolar dead space to alveolar tidal volume ([Formula: see text]/[Formula: see text]) were calculated. Independent t tests were used to compare mean [Formula: see text]/[Formula: see text] of survivors to that of subjects who died and between subjects with and without pneumonia. The relationships between [Formula: see text]/[Formula: see text] and ventilator days or modified Baux score were assessed with bivariate correlation analysis. RESULTS Our population had a mean age of 52 y and an average burn size of 17.5%. The average length of stay and ventilator days were 12 d and 3.8 d, respectively. The mean modified Baux score was 87. The mean [Formula: see text]/[Formula: see text] was 0.38. Ten subjects died, and 6 subjects had pneumonia. The [Formula: see text]/[Formula: see text] of survivors was significantly smaller for survivors than for subjects who died (0.34 vs 0.52, P = .03). No significant difference was observed between subjects with and without pneumonia (0.36 vs 0.47, P = .26). [Formula: see text]/[Formula: see text] correlated significantly with modified Baux score (r = .524, P < .001). CONCLUSIONS Alveolar dead space ([Formula: see text]/[Formula: see text]) is easily calculated from [Formula: see text] and end-tidal CO2 pressure and may be useful in assessing severity of inhalation injury, the patient's prognosis, and the patient's response to treatment.

UI MeSH Term Description Entries
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D012137 Respiratory System The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. Respiratory Tract,Respiratory Systems,Respiratory Tracts,System, Respiratory,Tract, Respiratory
D002056 Burns Injuries to tissues caused by contact with heat, steam, chemicals (BURNS, CHEMICAL), electricity (BURNS, ELECTRIC), or the like. Burn
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D013990 Tidal Volume The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. Tidal Volumes,Volume, Tidal,Volumes, Tidal

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