Browse ATS 2021 Abstracts

HomeProgram ▶ Browse ATS 2021 Abstracts

ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Dead Space Fraction as Predictor of 28-Day Mortality in COVID-19 Patients

Session Title
A4455 - Dead Space Fraction as Predictor of 28-Day Mortality in COVID-19 Patients
Author Block: I. Oriaku1, N. Kaur1, H. Zhao2, F. Jaffe1, G. D'Alonzo1; 1Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA, United States, 2Department of Clinical Sciences at Lewis Katz School of Medicine at Temple University, Temple University Hospital, Philadelphia, PA, United States.
Rationale: Coronavirus Disease 2019 (COVID-19) is a highly contagious respiratory illness resulting from infection by SARS-CoV2. COVID-19 in its severe state results in respiratory failure requiring mechanical ventilation. Usual reasons for mechanical ventilation are a combination of hypoxemia and ventilatory failure resulting in hypercapnia. It has been shown in acute respiratory distress syndrome (ARDS) that dead space fraction predicts mortality. In the wake of COVID-19, there has been postulation that the respiratory failure resulting from this disease might be different from ARDS. In this study, we propose that the dead space fraction can predict mortality in patients with COVID- 19 respiratory failure requiring mechanical ventilation.Methods: This is a retrospective study in which 42 mechanically ventilated patients’ dead space at day 0, day 1, and day 3 were calculated. Dead space was estimated using Penn State estimates, rearranged Weir, and alveolar ventilation equation as was validated by Beitler et al. The two cohorts (alive and deceased) were compared using Chi-squared tests for categorical variables and 2-sample t-tests for continuous variables.Results: Of the 42 mechanically ventilated patients, majority (n=25, 60%) died. The demographics of the two cohorts were similar except for older age (68 vs. 56.47) and the presence of CKD (32% vs. 0%) which are both statistically higher in the deceased cohort. Dead space ventilation on day 3 of mechanical ventilation was found to predict 28-day mortality with a p-value of 0.045. The mean dead space on day 3 was statistically significantly different in the deceased cohort in contrast to the alive cohort (60.64 vs. 50.82). Fluid balance at day 3, D-dimer at day 0, and 1, Ferritin at day 0,1, and 3, Lactate dehydrogenase at day 0,1, and 3, were higher in the deceased cohort. Absolute lymphocyte count on day 3 was lower in the deceased group.Conclusion: Our study shows that higher dead space fraction is associated with higher 28-day mortality as has been previously shown in prior ARDS study. This study strengthens the data supporting dead space as a predictor of mortality in mechanically ventilated patients. It also raises several questions regarding the reason for elevated inflammatory markers as is seen here. Are these elevated inflammatory markers signals of progressive vasculopathy induced by the viral infection? Or are they elevated as a result of cytokine storm-like reaction in response to the act of intubation? These are questions we hope to answer as we continue further analysis of this patient population.