Physiological dead space ventilation, disease severity and outcome in ventilated patients with hypoxaemic respiratory fa
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LETTER
Physiological dead space ventilation, disease severity and outcome in ventilated patients with hypoxaemic respiratory failure due to coronavirus disease 2019 Francesco Vasques1, Barnaby Sanderson1, Federico Formenti2,4, Manu Shankar‑Hari1,3 and Luigi Camporota1,2* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, The severity of acute hypoxemic respiratory failure (AHRF) in Coronavirus Disease 2019 (COVID-19) correlates correlates poorly with lung weight and lung mechanics, leading to the proposal of phenotypes that may be associated with similar degree of hypoxaemia but different lung volume, weight, and compliance [1]. The alteration of the pulmonary vascular tone and immune thrombosis of the alveolar capillaries [2] may account for these pathophysiological characteristics and for the high physiological dead space observed in these patients. To describe estimated indices of physiological dead space—and their association with respiratory mechanics, severity of hypoxaemia, biomarkers, and outcomes—we performed a retrospective analysis of adult patients with COVID-19 respiratory failure requiring mechanical ventilation in four medical Intensive Care Units (ICU) within Guy’s and St Thomas’ NHS Trust—London, UK (Ethics reference: 10,796). We used the recorded values at the time of worst P aO2/ FiO2 observed on the day of critical care admission. Continuous variables were compared using Mann–Whitney *Correspondence: [email protected] 1 Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners, St Thomas’ Hospital, 1st Floor East Wing, Westminster Bridge Road, London SE1 7EH, UK Full author information is available at the end of the article
Luigi Camporota and Manu Shankar-Hari are to be considered joint last (senior) authors.
U test. This cohort included 213 patients (73% males), mean (95%CI) age 56 (54–57) years, and P aO2/FiO2 128 (121–135) mmHg. When subdivided in four groups based on cut-off P aO2/FiO2 of 150 mmHg and compliance of 40 mL/cmH2O; 72% (n = 154) had PaO2/ FiO2
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