Departamento de Paciente Crítico, Clínica Alemana de Santiago, Avenida Vitacura 5951, Vitacura, Santiago Zip Code 7650568, Chile; Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago Zip Code 7550000, Chile.
Departamento de Paciente Crítico, Clínica Alemana de Santiago, Avenida Vitacura 5951, Vitacura, Santiago Zip Code 7650568, Chile; Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago Zip Code 7550000, Chile.
J Crit Care. 2022 Oct;71:154095. doi: 10.1016/j.jcrc.2022.154095. Epub 2022 Jun 17.
To determine whether VDPhys/VT is associated with coagulation activation and outcomes.
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.
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/cmHO vs. 42[37-45] mL/cmHO, 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).
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.
确定 VDPhys/VT 是否与凝血激活和结局相关。
我们纳入了接受有创机械通气支持且使用容量测定二氧化碳描记术监测的 COVID-19 肺炎患者。测量在机械通气的前 24 小时内进行。主要终点是第 28 天存活出院的可能性。
共纳入 60 例患者，其中 25 例（42%）VDPhys/VT 较高（>57%）。与 VDPhys/VT 较低的患者相比，VDPhys/VT 较高的患者的急性生理学与慢性健康状况评分系统 II（APACHE II）更高（10[8-13] 分 vs. 8[6-9] 分，p = 0.002），呼吸系统静态顺应性更低（35[24-46] mL/cmH2O vs. 42[37-45] mL/cmH2O，p = 0.005），D-二聚体水平更高（1246[1050-1594] ng FEU/mL vs. 792[538-1159] ng FEU/mL，p = 0.001），而氧合指数（P/F 比值）无差异（157[112-226] vs. 168[136-226]，p = 0.719）。此外，D-二聚体水平与 VDPhys/VT 相关（r = 0.530，p < 0.001），但与 P/F 比值无关（r = -0.103，p = 0.433）。VDPhys/VT 较高的患者在第 28 天存活出院的可能性较低（32% vs. 71%，aHR = 3.393[1.161-9.915]，p = 0.026）。
在危重症 COVID-19 患者中，VDPhys/VT 增加与 D-二聚体水平升高和存活出院可能性降低相关。VDPhys/VT 的二分法可能有助于识别被 P/F 比值忽视的高危亚组患者。
