Abstract
Purpose
To determine whether VDPhys/VT is associated with coagulation activation and outcomes.
Materials and methods
We enrolled patients with COVID-19 pneumonia who were supported by invasive mechanical ventilation and were monitored using volumetric capnography. Measurements were performed during the first 24 h of mechanical ventilation. The primary endpoint was the likelihood of being discharge alive on day 28.
Results
Sixty patients were enrolled, of which 25 (42%) had high VDPhys/VT (>57%). Patients with high vs. low VDPhys/VT had higher APACHE II (10[8-13] vs. 8[6-9] points, p = 0.002), lower static compliance of the respiratory system (35[24–46] mL/cmH2O vs. 42[37–45] mL/cmH2O, p = 0.005), and higher D-dimer levels (1246[1050–1594] ng FEU/mL vs. 792[538–1159] ng FEU/mL, p = 0.001), without differences in P/F ratio (157[112–226] vs. 168[136–226], p = 0.719). Additionally, D-dimer levels correlated with VDPhys/VT (r = 0.530, p < 0.001), but not with the P/F ratio (r = −0.103, p = 0.433). Patients with high VDPhys/VT were less likely to be discharged alive on day 28 (32% vs. 71%, aHR = 3.393[1.161–9.915], p = 0.026).
Conclusions
In critically ill COVID-19 patients, increased VDPhys/VT was associated with high D-dimer levels and a lower likelihood of being discharged alive. Dichotomic VDPhys/VT could help identify a high-risk subgroup of patients neglected by the P/F ratio.
【저자키워드】 COVID-19, D-dimer, Respiratory dead space, Volumetric capnography, 【초록키워드】 mechanical ventilation, Pneumonia, discharge, Coagulation, outcomes, Critically ill, Patient, Respiratory system, COVID-19 patients, D-dimer level, Invasive mechanical ventilation, primary endpoint, APACHE II, Activation, static compliance, help, P/F ratio, material, volumetric, measurement, likelihood, Result, enrolled, identify, performed, supported, less, determine, correlated, discharged, patients with COVID-19, subgroup of patient, 【제목키워드】 ARDS, outcome, Coagulation, Activation, Increased,