BACKGROUND: Estimates for dead space ventilation have been shown to be independently associated with an increased risk of mortality in the acute respiratory distress syndrome and small case series of COVID-19-related ARDS.METHODS: Secondary analysis from the PRoVENT-COVID study. The PRoVENT-COVID is a national, multicenter, retrospective observational study done at 22 intensive care units in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The aim was to quantify the dynamics and determine the prognostic value of surrogate markers of wasted ventilation in patients with COVID-19-related ARDS.RESULTS: A total of 927 consecutive patients admitted with COVID-19-related ARDS were included in this study. Estimations of wasted ventilation such as the estimated dead space fraction (by Harris-Benedict and direct method) and ventilatory ratio were significantly higher in non-survivors than survivors at baseline and during the following days of mechanical ventilation (p < 0.001). The end-tidal-to-arterial PCO2 ratio was lower in non-survivors than in survivors (p < 0.001). As ARDS severity increased, mortality increased with successive tertiles of dead space fraction by Harris-Benedict and by direct estimation, and with an increase in the VR. The same trend was observed with decreased levels in the tertiles for the end-tidal-to-arterial PCO2 ratio. After adjustment for a base risk model that included chronic comorbidities and ventilation- and oxygenation-parameters, none of the dead space estimates measured at the start of ventilation or the following days were significantly associated with 28-day mortality.CONCLUSIONS: There is significant impairment of ventilation in the early course of COVID-19-related ARDS but quantification of this impairment does not add prognostic information when added to a baseline risk model.TRIAL REGISTRATION: ISRCTN04346342. Registered 15 April 2020. Retrospectively registered.
MULTIFILE
Background: Estimates for dead space ventilation have been shown to be independently associated with an increased risk of mortality in the acute respiratory distress syndrome and small case series of COVID-19-related ARDS. Methods: Secondary analysis from the PRoVENT-COVID study. The PRoVENT-COVID is a national, multicenter, retrospective observational study done at 22 intensive care units in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The aim was to quantify the dynamics and determine the prognostic value of surrogate markers of wasted ventilation in patients with COVID-19-related ARDS. Results: A total of 927 consecutive patients admitted with COVID-19-related ARDS were included in this study. Estimations of wasted ventilation such as the estimated dead space fraction (by Harris–Benedict and direct method) and ventilatory ratio were significantly higher in non-survivors than survivors at baseline and during the following days of mechanical ventilation (p < 0.001). The end-tidal-to-arterial PCO2 ratio was lower in non-survivors than in survivors (p < 0.001). As ARDS severity increased, mortality increased with successive tertiles of dead space fraction by Harris–Benedict and by direct estimation, and with an increase in the VR. The same trend was observed with decreased levels in the tertiles for the end-tidal-to-arterial PCO2 ratio. After adjustment for a base risk model that included chronic comorbidities and ventilation- and oxygenation-parameters, none of the dead space estimates measured at the start of ventilation or the following days were significantly associated with 28-day mortality. Conclusions: There is significant impairment of ventilation in the early course of COVID-19-related ARDS but quantification of this impairment does not add prognostic information when added to a baseline risk model. Trial registration: ISRCTN04346342. Registered 15 April 2020. Retrospectively registered.
Aim. This study aims to identify ways that allow studying how intellectually impaired persons showing challenging behaviour interact with space, without impacting their daily lives. Back-ground. Research about space that better suits these persons’ needs is challenging to conduct, since they may have difficulties expressing themselves verbally and are extremely sensitive to-wards sensory stimuli. Therefore, researchers collecting data may be disturbing and intrusive, and requires great caution. Tapping into existing data may be a promising alternative. Residential care organisations routinely collect data about residents during their regular work processes, such as personal information and incident registration. Also useful may be routinely collected spatial data, such as drawings and repair reports. This study explores how routinely collected data (RCD) can provide insight into how residents interact with space, without impacting their daily lives. Methods. We reflect on the possibilities of using RCD (related to resident or space) based on explorations in the context of a case study at a Dutch very-intensive-care facility. The data were analysed to identify general patterns, such as locations with a high density of incidents/repairs and verified initial findings by member checking with staff. Results. The RCD analysed provide a basic and relevant insight into incidents and repairs connected to challenging behaviour. However, most data were neither complete or relevant for analysis. Therefore, we dis-cussed the RCD were with staff and only then it was possible to draw conclusions regarding relevance of RCD and the residents-space interactions. Conclusions. Only in conjunction with an ex-tended approach on member checking the use of RCD seems relevant. RCD have little meaning of their own. But the combination of RCD with member checking seems to provide insight into the interaction between residents and space, without interfering with the residents’ daily lives.