Microcirculatory dysfunction and dead-space ventilation in early ARDS: a hypothesis-generating observational study.

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dc.contributor.authorOspina-Tascón, G. A.
dc.contributor.authorHernández P., Glenn
dc.contributor.authorBruhn, Alejandro
dc.contributor.authorBautista Rincón, Diego F.
dc.contributor.authorMadriñán, H. J.
dc.contributor.authorValencia, J. D.
dc.contributor.authorBermúdez, W. F.
dc.contributor.authorQuiñones, Edgardo
dc.contributor.authorCalderón-Tapia, Luis E.
dc.contributor.authorDe Backer, D.
dc.date.accessioned2020-04-01T15:29:29Z
dc.date.available2020-04-01T15:29:29Z
dc.date.issued2020
dc.date.updated2020-03-29T01:03:21Z
dc.description.abstractAbstract Background Ventilation/perfusion inequalities impair gas exchange in acute respiratory distress syndrome (ARDS). Although increased dead-space ventilation (VD/VT) has been described in ARDS, its mechanism is not clearly understood. We sought to evaluate the relationships between dynamic variations in VD/VT and extra-pulmonary microcirculatory blood flow detected at sublingual mucosa hypothesizing that an altered microcirculation, which is a generalized phenomenon during severe inflammatory conditions, could influence ventilation/perfusion mismatching manifested by increases in VD/VT fraction during early stages of ARDS. Methods Forty-two consecutive patients with early moderate and severe ARDS were included. PEEP was set targeting the best respiratory-system compliance after a PEEP-decremental recruitment maneuver. After 60 min of stabilization, hemodynamics and respiratory mechanics were recorded and blood gases collected. VD/VT was calculated from the CO2 production ($$V_{{{\text{CO}}_{2} }}$$VCO2) and CO2 exhaled fraction ($$F_{{{\text{ECO}}_{2} }}$$FECO2) measurements by volumetric capnography. Sublingual microcirculatory images were simultaneously acquired using a sidestream dark-field device for an ulterior blinded semi-quantitative analysis. All measurements were repeated 24 h after. Results Percentage of small vessels perfused (PPV) and microcirculatory flow index (MFI) were inverse and significantly related to VD/VT at baseline (Spearman’s rho = − 0.76 and − 0.63, p < 0.001; R2 = 0.63, and 0.48, p < 0.001, respectively) and 24 h after (Spearman’s rho = − 0.71, and − 0.65; p < 0.001; R2 = 0.66 and 0.60, p < 0.001, respectively). Other respiratory, macro-hemodynamic and oxygenation parameters did not correlate with VD/VT. Variations in PPV between baseline and 24 h were inverse and significantly related to simultaneous changes in VD/VT (Spearman’s rho = − 0.66, p < 0.001; R2 = 0.67, p < 0.001). Conclusion Increased heterogeneity of microcirculatory blood flow evaluated at sublingual mucosa seems to be related to increases in VD/VT, while respiratory mechanics and oxygenation parameters do not. Whether there is a cause–effect relationship between microcirculatory dysfunction and dead-space ventilation in ARDS should be addressed in future research.
dc.identifier.citationAnnals of Intensive Care. 2020 Mar 24;10(1):35
dc.identifier.doi10.1186/s13613-020-00651-1
dc.identifier.urihttps://doi.org/10.1186/s13613-020-00651-1
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/28646
dc.issue.numeroNo. 35
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final11
dc.pagina.inicio1
dc.revistaAnnals of Intensive Carees_ES
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subjectAcute respiratory distress syndromees_ES
dc.subjectDead-space ventilationes_ES
dc.subjectVD/VTes_ES
dc.subjectVentilation/perfusion mismatches_ES
dc.subjectMicrocirculationes_ES
dc.subjectMicrocirculatory blood fowes_ES
dc.subject.ddc612.1
dc.subject.deweyMedicina y saludes_ES
dc.titleMicrocirculatory dysfunction and dead-space ventilation in early ARDS: a hypothesis-generating observational study.es_ES
dc.typeartículo
dc.volumenVol. 10
sipa.codpersvinculados98874
sipa.codpersvinculados741
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