![]() Individual patient data from 940 ARDS patients were analyzed. ![]() The present study is a post hoc analysis of a prospective observational cohort study of ICUs of two tertiary care hospitals in the Netherlands. This study aimed to compare various methods for dead space estimation and the ventilatory ratio in patients with acute respiratory distress syndrome (ARDS) and to determine their independent values for predicting death at day 30. Finally we describe the indices currently available to track ventilatory efficiency at the bedside.Indirect indices for measuring impaired ventilation, such as the estimated dead space fraction and the ventilatory ratio, have been shown to be independently associated with an increased risk of mortality. The potential reasons that have led to the variable being under-used are also examined. Described are the various clinical applications of deadspace measurements in the critically unwell. This review revisits the physiological concepts and methods of measuring deadspace. Thus making it more accessible and easy to monitor and study in large groups of patients, factors which have perhaps resulted in its under-utilisation in critical care. Several indices have been described that either predict deadspace or track ventilatory efficiency at the bedside. Recently though there has been a resurgence of interest in ventilatory efficiency. Deadspace and with it ventilatory efficiency has been largely forgotten. Yet indices of oxygenation seem to be the mainstay when instigating or fine-tuning ventilatory strategies. Since its first description by Bohr in the late 19th century to the current use of single-breath test for volumetric CO(2), our understanding of the physiological deadspace has vastly improved. Measuring deadspace ventilation should be the most reliable method of monitoring ventilatory efficiency in mechanically ventilated patients. ![]() Problems with ventilatory efficiency results in abnormal CO(2) clearance. ![]()
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