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

Gustavo Adolfo Ospina-Tascón, Diego D.F. Bautista, Humberto H.J. Madriñán, Juan J.D. Valencia, William Bermúdez, Edgardo Quiñones, Luis Eduardo Calderón-Tapia, Glenn Hernandez, Alejandro Bruhn and Daniel De Backer

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Abstract: 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 (VCO2) and CO2 exhaled fraction (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

Keywords: Acute respiratory distress syndrome; Dead-space ventilation; Microcirculation; Microcirculatory blood flow; VD/VT; Ventilation/perfusion mismatch (search for similar items in EconPapers)
Date: 2020-12
New Economics Papers: this item is included in nep-gen
Note: SCOPUS: ar.j
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Published in: Annals of intensive care (2020) v.10 n° 1

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