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Large difference between Enghoff and Bohr dead space in ventilated infants with respiratory distress
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  • Masashi Zuiki,
  • Rika Kume,
  • Amane Matsuura,
  • Kohei Mitsuno,
  • Kazumasa Kitamura,
  • Takuyo Kanayama,
  • Hiroshi Komatsu
Masashi Zuiki
National Hospital Organisation Maizuru Medical Center

Corresponding Author:[email protected]

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Rika Kume
National Hospital Organisation Maizuru Medical Center
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Amane Matsuura
National Hospital Organisation Maizuru Medical Center
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Kohei Mitsuno
National Hospital Organisation Maizuru Medical Center
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Kazumasa Kitamura
National Hospital Organisation Maizuru Medical Center
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Takuyo Kanayama
National Hospital Organisation Maizuru Medical Center
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Hiroshi Komatsu
National Hospital Organisation Maizuru Medical Center
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Abstract

Background: Ventilated neonates with respiratory distress may show a ventilation-perfusion (V/Q) mismatch. Objective: To evaluate the difference between the Bohr (Vd,Bohr) and Enghoff (Vd,Enghoff) dead spaces in infants by using volumetric capnography (Vcap) based on ventilator graphics and capnograms. Methods: This study enrolled 46 ventilated infants (mean birth weight, 2239 ± 640 g; mean gestational age, 35.5 ± 3.3 weeks). We performed Vcap and calculated Vd,Bohr and Vd,Enghoff when arterial blood sampling was necessary for treatment. Each measurement was classified according to the severity of acute respiratory distress syndrome (ARDS) by using the Berlin definition: severe or moderate ARDS, ratio of partial pressure of oxygen to fraction of inspired oxygen (P/F ratio) ≤ 200; mild ARDS, 200 < P/F ratio ≤ 300; and non-ARDS, 300 < P/F ratio. Next, regression analysis was performed to evaluate the correlation between the P/F ratio and the difference between Vd,Enghoff and Vd,Bohr. Results: Median Vd,Enghoff/tidal volume (VT) was significantly higher in the ARDS groups (severe or moderate: 0.60 [IQR, 0.49–0.68]; mild: 0.50 [0.43-0.59]) than in the non-ARDS group (0.45 [0.36-0.56]). The ARDS groups showed a large difference between Vd,Enghoff and Vd,Bohr (severe or moderate: median, 0.23 [0.15-0.30]; mild: median, 0.14 [0.09-0.21] vs. control: median, 0.09 [0.06-0.13]). The regression analysis for the relationship between P/F ratio and Vd,Enghoff - Vd,Bohr showed a negative correlation (r = -0.55, p < 0.001). Conclusion: Ventilated neonates with respiratory distress showed a large difference between Vd,Enghoff and Vd,Bohr, possibly reflecting a low V/Q mismatch and right-to-left shunting.
10 Nov 2020Submitted to Pediatric Pulmonology
10 Nov 2020Submission Checks Completed
10 Nov 2020Assigned to Editor
15 Nov 2020Reviewer(s) Assigned
14 Dec 2020Review(s) Completed, Editorial Evaluation Pending
15 Dec 2020Editorial Decision: Revise Major
17 Jan 20211st Revision Received
18 Jan 2021Submission Checks Completed
18 Jan 2021Assigned to Editor
18 Jan 2021Reviewer(s) Assigned
07 Feb 2021Review(s) Completed, Editorial Evaluation Pending
08 Feb 2021Editorial Decision: Revise Minor
16 Mar 20212nd Revision Received
16 Mar 2021Reviewer(s) Assigned
16 Mar 2021Submission Checks Completed
16 Mar 2021Assigned to Editor
21 Mar 2021Review(s) Completed, Editorial Evaluation Pending
26 Mar 2021Editorial Decision: Accept