Study on severity and outcome in children with acute respiratory distress syndrome by measurement of alveolar dead space fraction / 中国小儿急救医学

ABSTRACT

Objective To investigate the role of alveolar dead space fraction(ADSF) on the severity and outcome among children with acute respiratory distress syndrome ( ARDS). Methods Totally 20 chil-dren with ARDS in early stage were enrolled in this prospective study from December 2016 to November 2017 in PICU of Shengjing Hospital of China Medical University. According to the OI value,the cases were devided into mild-moderate group(4≤OI <16,n ＝12)and severe group (OI≥16,n ＝8). According to 28-day hospital mortality,the cases were devided into survival group(n＝11) and death group (n＝9). The general situation,PaCO2,PetCO2,oxygenation index(P/F,O/I) and 28-day hospital mortality were recorded and evaluated,and ADSF was measured by ADSF＝( PaCO2-PetCO2)/PaCO2. These variables were ana-lyzed by using student′s t-test,non-parametric test and ROC curve,to analyze the relationship between the severity of ARDS and ADSF,and the predictive value of the prognosis. Results (1) Compared with the mild-moderate group,the OI and ADSF of the severe group were significantly higher,and the P/F was signif-icantly lower(P<0. 05). (2)Compared with the survival group,the OI and ADSF of the death group were significantly higher,and the P/F was significantly lower(P<0. 05). (3)The area under the ROC judged by ADSF was 0. 690 (P<0. 05). If 0. 338 was as the critical value to evaluate the prognosis,the sensitivity and specificity for judging death were 0. 704 and 0. 634,respectively. The AUC of predicting the prognosis with OI was 0. 720 (P<0. 05). If 0. 348 was as the critical value to predict death,the sensitivity and specificity were 0.551 and 0.797,respectively. The area under the ROC judged by P/F was 0.256(P > 0.05). Conclusion The ADSF on early stage is higher in children with severe ARDS than those with mild to moderate ARDS. The ADSF on early stage is higher in death group than that in survival group. ADSF is of guiding significance in the prognosis of ARDS.