Daniel Chilcote, Laura Mercer-Rosa, Yan Wang, Steven M. Kawut, Robert A. Berg, Nadir Yehya, Adam S. Himebauch
Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia.
United States
Pediatric Pulmonology
Pediatr Pulmonol 2023; 58: 559-565
DOI: 10.1002/ppul.26237
Abstract
Primary hypothesis: We hypothesized that higher alveolar dead space fraction (AVDSf) at pediatric acute respiratory distress syndrome (PARDS) onset would be associated with right ventricular (RV) systolic dysfunction within the first 24 h of PARDS.
Study design and methods: We performed a retrospective single-center cohort study of PARDS patients with clinically obtained echocardiograms within 24 h. Primary exposure was AVDSf at PARDS onset. Primary outcome was RV systolic dysfunction as defined by RV global longitudinal strain (GLS) (>-18%). Secondary outcomes included pulmonary hypertension (PH) and RV systolic dysfunction as defined by other echocardiogram parameters, and measures of oxygenation. Unadjusted and adjusted logistic and linear regression were used to investigate AVDSf associations with outcomes.
Results: Ninety-one patients were included: median age 6.2 years, 46% female, and 65% with moderate or severe PARDS. Median AVDSf was 0.2 (interquartile range [IQR] 0.0-0.3), 33% had RV dysfunction, and 21% had PH. Unadjusted and adjusted logistic regression showed no association between AVDSf and RV systolic dysfunction or PH by any echocardiographic measure, but unadjusted and adjusted linear regression did show an association between AVDSf and PaO2 /FiO2 .
Conclusion: AVDSf at PARDS onset was not associated with RV systolic dysfunction or PH within 24 h but was associated with PaO2 /FiO2 ratio and may be more reflective of pulmonary causes of ventilation-perfusion mismatch. Future investigations should focus on clarifying the clinical utility of AVDSf in relation to existing metrics throughout the course of PARDS.
Category
Class III. Pulmonary Hypertension Associated with Lung Disease
Right Heart Dysfunction Associated with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
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