Alveolar dead space as a predictor of severity of pulmonary embolism

Jeffrey Kline, Anita K. Kubin, Manish M. Patel, Edward J. Easton, Rawle A. Seupal

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objective: To determine whether the alveolar dead space volume (V(D)alv), expressed as a percentage of the alveolar tidal volume (V(D)alv/V(T)alv), can predict the degree of vascular occlusion caused by pulmonary embolism (PE). Methods: Fifty-three subjects with suspected PE were prospectively studied. Pulmonary embolism was diagnosed in 33 by high- probability ventilation/perfusion (V/Q) scan (n = 19) or by pulmonary arteriography (PAG, n = 14). Pulmonary embolism was excluded by PAG in 20 subjects. The V(D)alv/V(T)alv was determined from volumetric capnography and arterial blood gas analysis, which permits measurement of the physiologic dead space, V(D)phys (mL) = [(PaCO2 - PeCO2)/PaCO2] · tidal volume. Airway dead space (V(D)aw) was subtracted to yield the alveolar dead space [(V(D)phys - V(D)aw) = V(D)alv (mL)]; the percentage of alveolar volume occupied by alveolar dead space per breath = V(D)alv/V(T)alv · 100%. Percentage perfusion defect was determined from V/Q scans by a radiologist blinded to other data. Regression analysis was performed to show correlation between V(D)alv/V(T)alv and defect on V/Q scan or systolic pulmonary arterial pressure (SPAP). Results: For subjects with PE, the mean perfusion defect on lung scan was 38 + 22%; the mean V(D)alv = 208 ± 115 mL, V(T)alv = 452 ± 251 mL, and V(D)alv/V(T)alv = 43 ± 18%. Regression of V(D)alv/V(T)alv vs perfusion defect yielded r2 = 0.41. Regression of V(D)alv/V(T)alv vs pulmonary artery pressures yielded r2 = 0.59. For subjects without PE, V(D)alv/V(T)alv = 27 ± 14% and V(D)alv = 89 ± 66 mL. Conclusions: The V(D)alv/V(T)alv correlates with the lung perfusion defect and the pulmonary artery pressures in subjects with PE. These findings show the potential for V(D)alv/V(T)alv to quantify the embolic burden of PE.

Original languageEnglish (US)
Pages (from-to)611-617
Number of pages7
JournalAcademic Emergency Medicine
Volume7
Issue number6
StatePublished - Jun 2000
Externally publishedYes

Fingerprint

Pulmonary Embolism
Perfusion
Lung
Tidal Volume
Pulmonary Artery
Capnography
Pressure
Blood Gas Analysis
Blood Vessels
Angiography
Arterial Pressure
Regression Analysis

Keywords

  • Capnography
  • Diagnosis
  • Physiologic dead space
  • Pulmonary embolism
  • Thromboembolism
  • Thrombolysis

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Kline, J., Kubin, A. K., Patel, M. M., Easton, E. J., & Seupal, R. A. (2000). Alveolar dead space as a predictor of severity of pulmonary embolism. Academic Emergency Medicine, 7(6), 611-617.

Alveolar dead space as a predictor of severity of pulmonary embolism. / Kline, Jeffrey; Kubin, Anita K.; Patel, Manish M.; Easton, Edward J.; Seupal, Rawle A.

In: Academic Emergency Medicine, Vol. 7, No. 6, 06.2000, p. 611-617.

Research output: Contribution to journalArticle

Kline, J, Kubin, AK, Patel, MM, Easton, EJ & Seupal, RA 2000, 'Alveolar dead space as a predictor of severity of pulmonary embolism', Academic Emergency Medicine, vol. 7, no. 6, pp. 611-617.
Kline J, Kubin AK, Patel MM, Easton EJ, Seupal RA. Alveolar dead space as a predictor of severity of pulmonary embolism. Academic Emergency Medicine. 2000 Jun;7(6):611-617.
Kline, Jeffrey ; Kubin, Anita K. ; Patel, Manish M. ; Easton, Edward J. ; Seupal, Rawle A. / Alveolar dead space as a predictor of severity of pulmonary embolism. In: Academic Emergency Medicine. 2000 ; Vol. 7, No. 6. pp. 611-617.
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abstract = "Objective: To determine whether the alveolar dead space volume (V(D)alv), expressed as a percentage of the alveolar tidal volume (V(D)alv/V(T)alv), can predict the degree of vascular occlusion caused by pulmonary embolism (PE). Methods: Fifty-three subjects with suspected PE were prospectively studied. Pulmonary embolism was diagnosed in 33 by high- probability ventilation/perfusion (V/Q) scan (n = 19) or by pulmonary arteriography (PAG, n = 14). Pulmonary embolism was excluded by PAG in 20 subjects. The V(D)alv/V(T)alv was determined from volumetric capnography and arterial blood gas analysis, which permits measurement of the physiologic dead space, V(D)phys (mL) = [(PaCO2 - PeCO2)/PaCO2] · tidal volume. Airway dead space (V(D)aw) was subtracted to yield the alveolar dead space [(V(D)phys - V(D)aw) = V(D)alv (mL)]; the percentage of alveolar volume occupied by alveolar dead space per breath = V(D)alv/V(T)alv · 100{\%}. Percentage perfusion defect was determined from V/Q scans by a radiologist blinded to other data. Regression analysis was performed to show correlation between V(D)alv/V(T)alv and defect on V/Q scan or systolic pulmonary arterial pressure (SPAP). Results: For subjects with PE, the mean perfusion defect on lung scan was 38 + 22{\%}; the mean V(D)alv = 208 ± 115 mL, V(T)alv = 452 ± 251 mL, and V(D)alv/V(T)alv = 43 ± 18{\%}. Regression of V(D)alv/V(T)alv vs perfusion defect yielded r2 = 0.41. Regression of V(D)alv/V(T)alv vs pulmonary artery pressures yielded r2 = 0.59. For subjects without PE, V(D)alv/V(T)alv = 27 ± 14{\%} and V(D)alv = 89 ± 66 mL. Conclusions: The V(D)alv/V(T)alv correlates with the lung perfusion defect and the pulmonary artery pressures in subjects with PE. These findings show the potential for V(D)alv/V(T)alv to quantify the embolic burden of PE.",
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AU - Kubin, Anita K.

AU - Patel, Manish M.

AU - Easton, Edward J.

AU - Seupal, Rawle A.

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N2 - Objective: To determine whether the alveolar dead space volume (V(D)alv), expressed as a percentage of the alveolar tidal volume (V(D)alv/V(T)alv), can predict the degree of vascular occlusion caused by pulmonary embolism (PE). Methods: Fifty-three subjects with suspected PE were prospectively studied. Pulmonary embolism was diagnosed in 33 by high- probability ventilation/perfusion (V/Q) scan (n = 19) or by pulmonary arteriography (PAG, n = 14). Pulmonary embolism was excluded by PAG in 20 subjects. The V(D)alv/V(T)alv was determined from volumetric capnography and arterial blood gas analysis, which permits measurement of the physiologic dead space, V(D)phys (mL) = [(PaCO2 - PeCO2)/PaCO2] · tidal volume. Airway dead space (V(D)aw) was subtracted to yield the alveolar dead space [(V(D)phys - V(D)aw) = V(D)alv (mL)]; the percentage of alveolar volume occupied by alveolar dead space per breath = V(D)alv/V(T)alv · 100%. Percentage perfusion defect was determined from V/Q scans by a radiologist blinded to other data. Regression analysis was performed to show correlation between V(D)alv/V(T)alv and defect on V/Q scan or systolic pulmonary arterial pressure (SPAP). Results: For subjects with PE, the mean perfusion defect on lung scan was 38 + 22%; the mean V(D)alv = 208 ± 115 mL, V(T)alv = 452 ± 251 mL, and V(D)alv/V(T)alv = 43 ± 18%. Regression of V(D)alv/V(T)alv vs perfusion defect yielded r2 = 0.41. Regression of V(D)alv/V(T)alv vs pulmonary artery pressures yielded r2 = 0.59. For subjects without PE, V(D)alv/V(T)alv = 27 ± 14% and V(D)alv = 89 ± 66 mL. Conclusions: The V(D)alv/V(T)alv correlates with the lung perfusion defect and the pulmonary artery pressures in subjects with PE. These findings show the potential for V(D)alv/V(T)alv to quantify the embolic burden of PE.

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