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Type: Artigo de periódico
Title: Relationship between physiologic deadspace/tidal volume ratio and gas exchange in infants with acute bronchiolitis on invasive mechanical ventilation
Author: Almeida-Junior, AA
da Silva, MTN
Almeida, CCB
Ribeiro, JD
Abstract: Objectives. To evaluate the association between deadspace/ tidal volume ratio (V-D/V-T) and gas exchange variables: PaO2, PacO(2), PaO2/FIO2, arterial/alveolar oxygen tension ratio (PaO2/PAO(2)), alveolar-arterial oxygen tension difference/arterial oxygen tension ratio (P(A-a)O-2/PaO2), carbon dioxide production (VCO2), ventilation index ([PaCO2 x peak inspiratory pressure x mechanical respiratory rate]/1000), and oxygenation index ([mean airway pressure x FIO2 x 100]/PaO2), all measured at an early stage in children with obstructive acute respiratory failure. Design: Prospective, cross-sectional, observational study. Setting: Pediatric intensive care unit, university hospital. Patients: Twenty-nine infants with acute bronchiolitis, defined according to clinical and radiologic criteria, Children with chronic pulmonary disease, neuromuscular disease, congenital cardiopathies, or hemodynamic instability were excluded. Interventions: Measurements were made between 24 and 72 hrs of mechanical ventilation using volumetric capnography and arterial blood gas analysis. Measurements and Main Results: The following variables significantly correlated with V-D/V-T, calculated using Spearman's correlation coefficient (r(s)): PaO2 (r(s) = -0.63, p < .001), PaO2/FIO2 (r(s) = -0.56, p = .002), PaO2/PAO(2) (r(s) = -0.46, p = .012), P(A-a)O-2/PaO2 (r(s) = 0.46, p =.012), PaCO2 (r(s) = 0.51, p = .005), VCO2 (r(s) = -0,62, p < .01), oxygenation index (r(s) = 0.48, p = .009), and ventilation index (r(s) = -0.53, p =.003). A statistically significant association was found between an increase in V-D/V-T and severity of lung injury, defined as PaO2/FIO2 < 200 (p =.03, Mann-Whitney). Conclusions: In the study population, V-D/V-T not only reflected ventilatory disorders, as is well recognized, but also was associated with disturbances of oxygenation. These results warrant further evaluation of the usefulness of serial measurement of V-D/V-T as a marker of disease severity in severe acute bronchiolitis and other causes of respiratory failure.
Subject: mechanical ventilation
acute bronchiolitis
pulmonary function
intensive care
deadspace volume
Country: EUA
Editor: Lippincott Williams & Wilkins
Citation: Pediatric Critical Care Medicine. Lippincott Williams & Wilkins, v. 8, n. 4, n. 372, n. 377, 2007.
Rights: fechado
Identifier DOI: 10.1097/01.PCC.0000269389.51189.A8
Date Issue: 2007
Appears in Collections:Unicamp - Artigos e Outros Documentos

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