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Higher Dead Space Is Associated With Increased Mortality in Critically Ill Children
Anoopindar K Bhalla1, Sanjay Belani, Dennis Leung
11Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 2Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Critical Care Medicine
|July 23, 2015
Summary
Increased dead space in mechanically ventilated children is linked to higher mortality. This finding, using end-tidal alveolar dead space fraction, may aid in pediatric critical care risk stratification.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Clinical Outcomes Research
Background:
- Elevated dead space is a known mortality predictor in adult respiratory failure.
- Evidence linking dead space to mortality in pediatric populations is less established.
Purpose of the Study:
- To investigate the association between dead space and mortality in mechanically ventilated children.
- To evaluate the utility of end-tidal alveolar dead space fraction as a prognostic marker.
Main Methods:
- Single-center retrospective review of 712 mechanically ventilated children with arterial catheters.
- Calculation of end-tidal alveolar dead space fraction ((PaCO2-PETCO2)/PaCO2) from arterial blood gases.
- Multivariate analysis controlling for oxygenation, inotropic support, and illness severity.
Main Results:
- Initial and Day 1 mean end-tidal alveolar dead space fraction were significantly associated with mortality (ORs 1.59-1.95).
- Associations remained significant after individual adjustments for oxygenation (PaO2/FIO2, OI), inotrope score, and PRISM III.
- Dead space was not independently associated with mortality when controlling for the combined severity of illness variables.
Conclusions:
- Increased dead space correlates with higher mortality in critically ill children.
- End-tidal alveolar dead space fraction may serve as a valuable bedside tool for risk stratification.
- Further research may refine its role alongside other severity indices.
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