Respiratory failure & ventilation
The end-tidal alveolar dead space fraction for risk stratification during the first week of invasive mechanical ventilation: an observational cohort study
Authors' conclusion
AVDSf is associated with mortality and length of ventilation in survivors throughout the first week of invasive mechanical ventilation.
Study context
- Population
- Children and young adults receiving invasive mechanical ventilation with arterial or capillary blood gases8,004 AVDSf values analysed
- Participants
- 2,335 children
- Outcome
- Association of AVDSf with mortality and length of ventilation in survivors
- Follow-up
- First week of mechanical ventilation
Methodological detailssingle-centre, observational
- Single-centre
- Observational
Main finding
As reported in the abstract
Mortality and length of ventilation in survivors · first week of ventilation
- Higher AVDSf associated with mortality and longer length of ventilation in survivors throughout the first week, after controlling for OI and PRISM III
- With standardized variables, AVDSf effect estimates generally higher than OI for mortality; OI generally higher than AVDSf for length of ventilation in survivors
Observational data: associations, not effects.
Further findings
OI and mortality
- Higher OI not associated with increased mortality until ≥ 48 h of ventilation, after controlling for AVDSf and PRISM III
Mortality by pediatric ARDS severity category
- AVDSf > 0.3 associated with higher mortality than AVDSf < 0.2 within each pediatric ARDS severity category
Mortality risk stratification by maximum AVDSf within 12 h of ICU admission
- AUC
- 0.768 (95% CI 0.732, 0.803)
Added value of AVDSf for mortality risk stratification
- No improvement when added to PRISM III
- Improved when added to gas exchange components of PRISM III (minimum 12-h PaO2 and maximum 12-h PCO2), p < 0.00001
Original publication
The end-tidal alveolar dead space fraction for risk stratification during the first week of invasive mechanical ventilation: an observational cohort study. Crit Care. Published 9 February 2023. doi:10.
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