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First published online on June 15, 2007
Chest, doi:10.1378/chest.07-0409
doi:10.1378/chest.07-0409
(Chest. 2007; 132:836-842)
© 2007 American College of Chest Physicians
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Pulmonary Dead Space Fraction and Pulmonary Artery Systolic Pressure as Early Predictors of Clinical Outcome in Acute Lung Injury*

Magda Cepkova, MD; Vineet Kapur, MD; Xiushui Ren, MD; Thomas Quinn, MD; Hanjing Zhuo, MD, MPH; Elyse Foster, MD; Kathleen D. Liu, MD, PhD and Michael A. Matthay, MD

* From the Cardiovascular Research Institute (Drs. Zhuo and Matthay), and the Departments of Medicine (Drs. Ren, Foster, and Liu) and Anesthesia, (Drs. Cepkova, Kapur, and Quinn), University of California, San Francisco, San Francisco, CA.

Correspondence to: Michael A. Matthay, MD, Critical Care Medicine, 505 Parnassus Ave, Room M-917, San Francisco, CA 94143-0624; e-mail: Michael.matthay{at}ucsf.edu

Abstract

Study objective: The primary objective of this study was to test whether an elevated systolic pulmonary artery (PA) pressure or an elevated pulmonary dead space fraction (VD/VT) in early acute lung injury (ALI) is associated with poor clinical outcomes in the era of lung-protective ventilation.

Design: Prospective observational cohort study.

Setting: ICUs of a university hospital.

Patients: Forty-two patients with ALI receiving mechanical ventilation.

Measurements: PA pressure was measured noninvasively using transthoracic echocardiography. VD/VT was measured by volumetric capnography (NICO Cardiopulmonary Management System; Novametrix; Wallingford, CT).

Main results: There was no difference in the mean systolic PA pressure in patients who died compared to those who survived (43 ± 9 mm Hg vs 41 ± 9 mm Hg, p = 0.54) [mean ± SD]. In contrast to the PA systolic pressure, VD/VT was significantly higher in patients who died compared to those who survived (0.61 ± 0.09 vs 0.53 ± 0.10, p = 0.02). Similarly, VD/VT was higher in patients with < 7 ventilator-free days during the first 28 days after enrollment compared to those with > 7 ventilator-free days (0.61 ± 0.08 vs 0.52 ± 0.11, p = 0.008).

Conclusion: In the era of lung-protective ventilation, systolic PA pressure early in the course of ALI is elevated but not predictive of outcome. However, elevated VD/VT in early ALI is associated with increased mortality and with fewer ventilator-free days.

Key Words: acute lung injury • ARDS • pulmonary dead space fraction • systolic pulmonary artery pressure • transthoracic echocardiography






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