ABSTRACT
OBJECTIVE: To assess the correlation of dead space fraction (VD/VT) measured through time capnography, corrected minute volume (CMV) and ventilation ratio (VR) with clinical outcomes in COVID-19 patients requiring invasive mechanical ventilation. DESIGN: Observational study of a historical cohort. SETTING: University hospital in Medellin, Colombia. PARTICIPANTS: Patients aged 15 and above with a confirmed COVID-19 diagnosis admitted to the ICU and requiring mechanical ventilation. INTERVENTIONS: Measurement of VD/VT, CMV, and VR in COVID-19 patients. MAIN VARIABLES OF INTEREST: VD/VT, CMV, VR, demographic data, oxygenation indices and ventilatory parameters. RESULTS: During the study period, 1047 COVID-19 patients on mechanical ventilation were analyzed, of whom 446 (42%) died. Deceased patients exhibited a higher prevalence of advanced age and obesity, elevated Charlson index, higher APACHE II and SOFA scores, as well as an increase in VD/VT ratio (0.27 in survivors and 0.31 in deceased) and minute ventilation volume on the first day of mechanical ventilation. The multivariate analysis revealed independent associations to in-hospital mortality, higher VD/VT (HR 1.24; 95%CI 1.003-1.525; p = 0.046), age (HR 1.024; 95%CI 1.014-1.034; p < 0.001), and SOFA score at onset (HR: 1.036; 95%CI: 1.001-1.07; p = 0.017). CONCLUSIONS: VD/VT demonstrated an association with mortality in COVID-19 patients with ARDS on mechanical ventilation. These findings suggest that VD/VT measurement may serve as a severity marker for the disease.
ABSTRACT
Introducción: Se presenta el caso clínico de un varón de 15 años con fracturas de huesos cortos del pie derecho como consecuencia de un accidente de tránsito. Tras 24 h de evolución, ingresa con disnea, desaturación, pico febril objetivo y posterior desarrollo de insuficiencia respiratoria. Ante la sospecha clínica de síndrome de embolia grasa, se solicita una angiotomografía pulmonar que confirma el diagnóstico. Se trata de una entidad inusual en pacientes con este tipo de fractura. El tratamiento inicial consistió en vigilancia estrecha en la unidad de cuidados intensivos, medidas de soporte con oxígeno suplementario, terapia res-piratoria y manejo quirúrgico de las fracturas. La evolución clínica del paciente fue adecuada y el cuadro respiratorio se resolvió por completo. Conclusiones: El síndrome de embolia grasa secundario a fracturas de huesos cortos es un cuadro infrecuente; por lo tanto, es preciso tener un alto grado de sospecha diagnóstica, no solo en los escenarios más comunes, sino también en este tipo de contextos inusuales y retadores, que permita su identificación temprana y, de esta forma, implementar un manejo oportuno y generar un impacto favorable en los desenlaces clínicos y en la disminución del riesgo de secuelas a largo plazo. Nivel de Evidencia: IV
Introduction: We present the clinical case of a 15-year-old male who sustained fractures to the short bones of his right foot as a result of a traffic accident. After 24 hours of evolution, he was admitted for dyspnea, desaturation, an objective febrile peak, and the development of respiratory failure. Given the clinical suspicion of fat embolism syndrome, pulmonary angiotomography was requested, which confirmed the diagnosis. This is a rare finding in patients with this type of fracture. The initial treatment included close monitoring in the intensive care unit, supportive measures such as supplemental oxygen, respiratory therapy, and surgical fracture management. The patient's clinical progression was adequate, and the respiratory condition resolved completely. Conclusion: Fat embolism syndrome resulting from short bone fractures is a rare condition; therefore, it is necessary to have a high level of diagnostic suspicion, not only in the most common scenarios, but also in these unusual and challenging contexts, which allows for its early detection and, as a result, timely management, which has a positive impact on clinical outcomes and reduces the risk of long-term sequelae. Level of Evidence: IV