Alveolar Dead Space as a Predictor of Severity and Reperfusion of Pulmonary Embolism_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HANWei , TANG Huaping , HAO Wanming , SUN Wenxin , LI Shuangbao

Department of Respiratory Medicine, East Hospital, Qingdao Municipal Hospital. Qingdao, Shandong, 266071, ChinaCorresponding Author: TANG Hua-ping, E-mail: qdthp@ 126. com;

Corresponding author：

Keywords：

Pulmonary embolism; Alveolar dead space fraction; Treatment; Perfusion

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Objective To assess the predictive value of alveolar dead space fraction ( ADSF) for severity and reperfusion of acute pulmonary embolism( APE) . Methods 39 consecutive patients with APE were enrolled in a perspective study from July 2004 to March 2007. All patients were divided into a large pulmonary embolism group ( LPE) and a small pulmonary embolism group ( SPE) based to the mass and location of the embolus. The patients of the LPE group received thrombolytic therapy and anticoagulation,while the patients of the SPE group received anticoagulation only. CTPA or lung scintigraphy was performed before and after treatment to confirm the resolve condition of the embolism after treatment. Pressure of endexpired carbon dioxide ( PETCO2 ) and blood gas analysis ( including PaCO2 ) were measured at the time of run-in and 30 days after treatment by bedside. ADSF was calculated by PET CO2 and PaCO2 . Results Among 39 APE patients, there were 18 patients in the LPE group, while 21 in the SPE group. The ADSF of the LPE group before treatment were higher than that of the SPE group ( 0. 34 ±0. 078 vs. 0. 18 ±0. 027,P lt;0. 05) . The ADSF decreased significantly after treatment in the patients with full reperfusion ( 0. 09 ±0. 04 vs. 0. 28 ±0. 11, P lt;0. 01) . Conclusion As a bedside test, ADSF can reflect the mass of embolism and the reperfusion condition, and is useful in monitoring the disease.

Citation： HANWei,TANG Huaping,HAO Wanming,SUN Wenxin,LI Shuangbao. Alveolar Dead Space as a Predictor of Severity and Reperfusion of Pulmonary Embolism. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(5): 520-522. doi: Copy

1.	肇冬梅, 章志丹, 朱然, 等. 住院肺血栓栓塞症患者32 年临床流行病学分析. 中国呼吸与危重监护杂志, 2006, 5: 345 -348.
2.	Kline JA, Israel EG, Michelson EA, et al. Diagnostic accuracy of a bedside D-dimer assay and alveolar dead-space measurement for rapid exclusion of pulmonary embolism: a multicenter study. JAMA,2001, 285 : 761-768.
3.	中华医学会呼吸病学分会. 肺血栓栓塞症的诊断与治疗指南( 草案) . 中华结核和呼吸杂志, 2001, 24: 259-264.
4.	Kline J, Meek S, Boudrow D, et al. Use of the alveolar dead space fraction ( VD/ VT) and plasma D-dimers to exclude acute pulmonary embolism in ambulatory patients. Acad Emerg Med, 1997, 4 : 856 -863.
5.	Rodger MA, Jones G, Rasuli P, et al. Steady-State End-Tidal Alveolar Dead Space Fraction and D-Dimer: Bedside Tests To Exclude Pulmonary Embolism. Chest, 2001, 120: 115-119.
6.	Nuckton TJ, Alonso JA, Kallet RH, et al. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med, 2002 , 346: 1281 -1286 .
7.	Moreira MM, Terzi RG, Carvalho CH, et al. Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism. Vasc Health Risk Manag, 2009 , 5: 9 -12 .

1. 肇冬梅, 章志丹, 朱然, 等. 住院肺血栓栓塞症患者32 年临床流行病学分析. 中国呼吸与危重监护杂志, 2006, 5: 345 -348.
2. Kline JA, Israel EG, Michelson EA, et al. Diagnostic accuracy of a bedside D-dimer assay and alveolar dead-space measurement for rapid exclusion of pulmonary embolism: a multicenter study. JAMA,2001, 285 : 761-768.
3. 中华医学会呼吸病学分会. 肺血栓栓塞症的诊断与治疗指南( 草案) . 中华结核和呼吸杂志, 2001, 24: 259-264.
4. Kline J, Meek S, Boudrow D, et al. Use of the alveolar dead space fraction ( VD/ VT) and plasma D-dimers to exclude acute pulmonary embolism in ambulatory patients. Acad Emerg Med, 1997, 4 : 856 -863.
5. Rodger MA, Jones G, Rasuli P, et al. Steady-State End-Tidal Alveolar Dead Space Fraction and D-Dimer: Bedside Tests To Exclude Pulmonary Embolism. Chest, 2001, 120: 115-119.
6. Nuckton TJ, Alonso JA, Kallet RH, et al. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med, 2002 , 346: 1281 -1286 .
7. Moreira MM, Terzi RG, Carvalho CH, et al. Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism. Vasc Health Risk Manag, 2009 , 5: 9 -12 .

Chinese Journal of Respiratory and Critical Care Medicine

Alveolar Dead Space as a Predictor of Severity and Reperfusion of Pulmonary Embolism

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