Pulmonary dead space fraction and pulmonary artery systolic pressure as early predictors of clinical outcome in acute lung injury

Chest. 2007 Sep;132(3):836-42. doi: 10.1378/chest.07-0409. Epub 2007 Jun 15.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Pulmonary Wedge Pressure*
  • Respiration, Artificial
  • Respiratory Dead Space*
  • Respiratory Distress Syndrome / mortality*
  • Respiratory Distress Syndrome / physiopathology*
  • Respiratory Distress Syndrome / therapy
  • Survival Rate
  • Systole
  • Treatment Outcome