Document Detail


Higher pulmonary dead space may predict prolonged mechanical ventilation after cardiac surgery.
MedLine Citation:
PMID:  19382217     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Children undergoing congenital heart surgery are at risk for prolonged mechanical ventilation and length of hospital stay. We investigated the prognostic value of pulmonary dead space fraction as a non-invasive, physiologic marker in this population. In a prospective, cross-sectional study, we measured pulmonary dead space fraction in 52 intubated, pediatric patients within 24 hr postoperative from congenital heart surgery. Measurements were obtained with a bedside, non-invasive cardiac output (NICO) monitor (Respironics Novametrix, Inc., Wallingford, CT). Median pulmonary dead space fraction was 0.46 (25-75% IQR 0.34-0.55). Pulmonary dead space fraction significantly correlated with duration of mechanical ventilation and length of hospital stay in the entire cohort (r(s) = 0.51, P = 0.0002; r(s) = 0.51, P = 0.0002) and in the subset of patients without residual intracardiac shunting (r(s) = 0.45, P = 0.008; r(s) = 0.49, P = 0.004). In a multivariable logistic regression model, pulmonary dead space fraction remained an independent predictor for prolonged mechanical ventilation in the presence of cardiopulmonary bypass time and ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (OR 2.2; 95% CI 1.14-4.38; P = 0.02). The area under the receiver operator characteristic curve for this model was 0.91. Elevated pulmonary dead space fraction is associated with prolonged mechanical ventilation and hospital stay in pediatric patients who undergo surgery for congenital heart disease and has additive predictive value in identifying those at risk for longer duration of mechanical ventilation. Pulmonary dead space may be a useful prognostic tool for clinicians in patients who undergo congenital heart surgery.
Authors:
Thida Ong; Regan B Stuart-Killion; Brian M Daniel; Laura B Presnell; Hanjing Zhuo; Michael A Matthay; Kathleen D Liu
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pediatric pulmonology     Volume:  44     ISSN:  1099-0496     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-27     Completed Date:  2009-08-03     Revised Date:  2014-09-22    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  457-63     Citation Subset:  IM    
Copyright Information:
(c) 2009 Wiley-Liss, Inc.
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures / adverse effects
Child, Preschool
Cross-Sectional Studies
Female
Heart Defects, Congenital / surgery*
Humans
Infant
Infant, Newborn
Length of Stay
Male
Odds Ratio
Postoperative Care*
Predictive Value of Tests
ROC Curve
Regression Analysis
Respiration, Artificial*
Respiratory Dead Space / physiology*
Grant Support
ID/Acronym/Agency:
HL051856/HL/NHLBI NIH HHS; KL2RR024130/RR/NCRR NIH HHS; R37 HL051856/HL/NHLBI NIH HHS; R37 HL051856-14/HL/NHLBI NIH HHS
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