Penggunaan Ventilatory Ratio dan Alveolar Dead Space Fraction sebagai Prediktor Mortalitas pada Pasien COVID-19 dengan Acute Respiratory Distress Syndrome
Abstract
Pada pasien COVID-19 dengan ARDS terjadi gangguan oksigenasi dan ventilasi. Menurut kriteria Berlin ARDS, oksigenasi diukur dengan PaO2/FiO2, namun tidak mengukur ventilasi alveolar yang diukur dengan dead space yang dapat terjadi akibat kondisi, seperti kerusakan endotel, mikrotrombus, dan penggunaan ventilator yang berlebih. Tujuan penelitian ini menganalisis penggunaan ventilatory ratio (VR) dan dead space fraction (Vd/Vt) sebagai prediktor mortalitas pasien COVID-19 ARDS. Penelitian ini adalah analitik kohort retrospektif. Data dikumpulkan dari rekam medik pasien COVID-19 yang dirawat di RIK RSUD Dr. Soetomo periode Juni–September 2020 dengan teknik total sampling terhadap subjek yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Data yang dikumpulkan adalah nilai VR dan Vd/Vt (diambil dari data laboratorium), kondisi klinis pasien dan pengaturan ventilator 24 jam pertama setelah terintubasi. Penelitian ini didapatkan 77 dari 80 subjek yang memenuhi kriteria. Nilai VR berhubungan dengan mortalitas secara signifikan dengan nilai p 0,001; cut off 1,84; sensitivitas 84,2%; spesifisitas 85%; RR 30,22; CI 95%: 7,31–124,89. Vd/Vt dan mortalitas menunjukkan hubungan yang signifikan terhadap mortalitas dengan nilai p 0.001. Uji analisis Spearman VR dengan Vd/Vt didapatkan hasil korelasi yang kuat dengan koefisien korelasi 0,704 dan p 0,001. Simpulan, nilai VR dan Vd/Vt dapat digunakan sebagai prediktor mortalitas pasien COVID-19 dengan ARDS dan keduanya mempunyai korelasi yang kuat. VR dapat menggantikan Vd/Vt.
Use of Ventilatory Ratio and Alveolar Dead Space Fraction as Predictorz of Mortality in Covid-19 Patients with Acute Respiratory Distress Syndrome
COVID-19 with ARDS experience impaired oxygenation and ventilation. In Berlin ARDS criteria, oxygenation is measured by PaO2 /FiO2, but does not measure alveolar ventilation, which is measured through the dead space produced in this conditions, such as endothelial damage, microthrombus, and excessive use of entilator. The purpose of this study was to analyze the use of ventilatory ratio (VR) and dead space fraction (Vd/Vt) as predictors of mortality in patients with COVID-19 ARDS. This study was a retrospective cohort analytic study one medical records of COVID-19 patients treated in an inpatient unit of a referral hospital in Indonesia. The ethical clearance was obtained from the Health Research Ethics Committee of Dr. Soetomo Hospital, Indonesia. Data were collected through total sampling of medical records that met the inclusion and exclusion criteria. The VR and Vd/Vt scores were collected from the laboratory data, patient clinical condition, and ventilator setting 24 hours after intubation. Of all medical records screened, 77 out of 80 samples met the criteria. VR was significantly associated with mortality with a p value of 0.001 (cut-off point:1.84, sensitivity: 84.2%, specificity: 85%, RR: 30.22, and 95%, CI: 7.31–124.89). Similarly, Vd/Vt and mortality showed a significant relationship with mortality with a p value of 0.001 (cut-off: 0.25, sensitivity: 85%, specificity: 86%, RR: 34.71, 95% CI: 8.24–146.05). The Spearman analysis test between VR and Vd/Vt showed a strong correlation with a correlation coefficient of 0,704 and p 0,001. Thus, VR and Vd/Vt can be used as predictors of mortality in COVID-19 patients with ARDS and because both have a strong correlation. VR can also substitute Vd/Vt.
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Huang C, Wang Y, Li X, Ren L, Zhao J, Cao B, dkk. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it, World Health Organization, (diunduh 5 April 2020). Tersedia dari: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, dkk. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9.
Wu C, Chen X, Cai Y, Xia J, Zhou X, Song Y, dkk. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–43.
Quinteros-Morales L, Schultz MJ, Bringué J, Calfee CS, Camprubí M, Cremer OL, dkk. Estimated dead space fraction and the ventilatory ratio are associated with mortality in early ARDS. Ann Intens Care. 2019;9(1):128.
Nuckton T, Alonso J, Kallet R, Daniel B, Pittet J, Eisner M, dkk. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. New Eng J Med. 2002;346(17):1281–6.
Liu X, Liu X, Xu Y, Xu Z, Huang Y, Chen S, dkk. Ventilatory ratio in hypercapnic mechanically ventilated patients with covid-19–associated acute respiratory distress syndrome. Am J Respirat Crit Care Med. 2020;201(10):1297–9.
Bohr C. Uber die Lungeatmung [in German]. Skand Arch Physiol. 1891;(2):236–8.
Kline J, Meek S, Boudrow D, Warner D, Colucciello S. Use of the alveolar dead space fraction (vd/vt) and plasma d-dimers to exclude acute pulmonary embolism in ambulatory patients. Academic Emerg Med. 1997;4(9):856–63.
Sinha P, Calfee CS, Beitler JR, Soni N, Ho K, Matthay MA, dkk. Physiologic analysis and clinical performance of the ventilatory ratio in acute respiratory distress syndrome. Am J Respirat Crit Care Med. 2019;199(3):333–41.
Gibson PG, Qin L, Puah SH. COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS. Med J Australia. 2020;213(2):54–6.e1.
Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, dkk. LUNG SAFE investigators, & ESICM trials group; epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800.
Huang Y, Lu Y, Huang YM, Wang M, Ling W, Sui Y, dkk. Obesity in patients with COVID-19: a systematic review and meta-analysis. Metabolism: Clin Exper. 2020;113: 154378.
Yue Z, Qing Y, Jingwei C, Bingzi D, Wenshan, Lv, Liyan S, dkk. Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease. A systematic review and meta-analysis, Intern J Infect Dis. 2019;99:47–56,
Petersson J, Glenny R. Gas exchange and ventilation–perfusion relationships in the lung. Euro Respirat J. 2014;44(4):1023–41.
Rodger M. Steady-state end-tidal alveolar dead space measure and d-dimer. Chest. 2010;121(4):1373–4.
Zhang YJ, Gao XJ, Li ZB, Wang ZY, Feng QS, Yin CF, dkk. Comparison of the pulmonary dead-space fraction derived from ventilator volumetric capnography and a validated equation in the survival prediction of patients with acute respiratory distress syndrome. Chinese J Traumatol Zhonghua Chuang Shang Za Zhi. 2016;19(3):141–5.
Sinha P, Fauvel NJ, Singh S, Soni N. Ventilatory ratio: a simple bedside measure of ventilation. Br J Anaesth. 2009;102(5): 692–7.
Enghoff, H. Volumen inefficax. Bemerkungen zur Frage des sch€adlichen Raumes. Uppsala L€akareforen Forhandl. 1938;44:191–218.
Sinha P, Sanders RD, Soni N, Vukoja MK, Gajic O. Acute respiratory distress syndrome: the prognostic value of ventilatory ratio--a simple bedside tool to monitor ventilatory efficiency. Am J Respirat Crit Care Med. 2013;187(10):1150–3.
DOI: https://doi.org/10.15851/jap.v9n1.2274
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