36
views
0
recommends
+1 Recommend
1 collections
    0
    shares

      International Journal of COPD (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on pathophysiological processes underlying Chronic Obstructive Pulmonary Disease (COPD) interventions, patient focused education, and self-management protocols. Sign up for email alerts here.

      39,063 Monthly downloads/views I 2.893 Impact Factor I 5.2 CiteScore I 1.16 Source Normalized Impact per Paper (SNIP) I 0.804 Scimago Journal & Country Rank (SJR)

      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Can dead space fraction predict the length of mechanical ventilation in exacerbated COPD patients?

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Chronic obstructive pulmonary disease (COPD) is a condition in which there is limited airflow during expiration (exhaling, or breathing out) that is not fully reversible and usually worsens over time. The disease is estimated to kill more than 100,000 Americans each year, and costs related to care of patients with COPD are significant. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. Laboratory tests indicate elevated CO 2 levels, gradual reduction of the levels of oxygen and pH in arterial blood, and a consequent rise in the dead space fraction (DSF) of the lungs.

          Objective

          Patients with COPD exacerbation represent a large portion of those artificially ventilated. In an attempt to develop a prognostic tool for length of treatment, we compared the proportion of DSF to the length of mechanical ventilation (MV).

          Methods

          This study included 73 patients admitted to the intensive care unit (ICU) where they received MV due to exacerbation of COPD. Each patient’s arterial blood gases (ABG) were measured upon admission. PeCO 2 was tested using a Datex S/5 instrument. Subsequently, DSF was calculated using the Bohr equation. Statistical data was analyzed using SPSS software.

          Results

          Patients included in the study were ventilated from 6 to 160 hours (average 40 ± 47). In addition to ABG measurements, PeCO 2 (expired CO 2) levels were measured and DSF calculated for each patient. DSF values varied from 0.21 to 0.76 (average 0.119 ± 0.489). No correlation was found between DSF and length of artificial ventilation.

          Conclusion

          Evaluation of DSF does not provide a factor in estimating the length of treatment for patients with acute respiratory failure due to COPD exacerbation.

          Most cited references19

          • Record: found
          • Abstract: not found
          • Article: not found

          Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Chronic obstructive pulmonary disease.

            P Barnes (2000)
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome.

              No single pulmonary-specific variable, including the severity of hypoxemia, has been found to predict the risk of death independently when measured early in the course of the acute respiratory distress syndrome. Because an increase in the pulmonary dead-space fraction has been described in observational studies of the syndrome, we systematically measured the dead-space fraction early in the course of the illness and evaluated its potential association with the risk of death. The dead-space fraction was prospectively measured in 179 intubated patients, a mean (+/-SD) of 10.9+/-7.4 hours after the acute respiratory distress syndrome had developed. Additional clinical and physiological variables were analyzed with the use of multiple logistic regression. The study outcome was mortality before hospital discharge. The mean dead-space fraction was markedly elevated (0.58+/-0.09) early in the course of the acute respiratory distress syndrome and was higher among patients who died than among those who survived (0.63+/-0.10 vs. 0.54+/-0.09, P<0.001). The dead-space fraction was an independent risk factor for death: for every 0.05 increase, the odds of death increased by 45 percent (odds ratio, 1.45; 95 percent confidence interval, 1.15 to 1.83; P=0.002). The only other independent predictors of an increased risk of death were the Simplified Acute Physiology Score II, an indicator of the severity of illness (odds ratio, 1.06; 95 percent confidence interval, 1.03 to 1.08; P<0.001) and quasistatic respiratory compliance (odds ratio, 1.06; 95 percent confidence interval, 1.01 to 1.10; P=0.01). Increased dead-space fraction is a feature of the early phase of the acute respiratory distress syndrome. Elevated values are associated with an increased risk of death.
                Bookmark

                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2009
                2009
                29 November 2009
                : 4
                : 437-441
                Affiliations
                [1 ] Specialist in Internal Medicine and Nephrology, Department of Internal Medicine B, Ziv Medical Center, Safed-Israel
                [2 ] Director of Respiratory Intensive Care Unit, Western Galilee Hospital, Nahariya, Israel
                Author notes
                Correspondence: Raymond Farah, Herzel St. 122/7 Nahariya 22448, Department Head of Internal Medicine B, Ziv Medical Center, PO Box 1008, Safed 13110, Israel, Tel +972 4 682 8946, Fax +972 4 682 8116, Email raymond.f@ 123456ziv.health.gov.il
                Article
                copd-4-437
                10.2147/COPD.S7509
                2793072
                20037683
                b9bbb385-2a57-47df-8018-7c83df06258d
                © 2009 Farah and Makhoul, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                Categories
                Original Research

                Respiratory medicine
                dead space,weaning,mechanical ventilation,copd
                Respiratory medicine
                dead space, weaning, mechanical ventilation, copd

                Comments

                Comment on this article