![]() We approximated dead space ventilation using the equation V D/ V T ≈ P aCO 2× V′ E. ![]() According to Enghoff's method, physiological dead space ventilation is calculated with the equation V D/ V T = ( P aCO 2− P ECO 2)/ P aCO 2 (where V D is the dead space volume, V T is the tidal volume, P aCO 2 is the arterial carbon dioxide tension and P ECO 2 is the expired carbon dioxide tension), which in the absence of capnography can be approximated to the ventilatory ratio ( P aCO 2× V′ E)/(predicted body weight×100×37.5). The primary outcome of our study was the change in dead space ventilation after rt-PA. If a patient received repeat doses of rt-PA separated by >48 h, both data sets were included. Exclusion criteria included rt-PA administration in a peri-cardiac arrest period or unavailability of minute ventilation ( V′ E) or arterial blood gas. Inclusion criteria were a positive COVID-19 PCR test, Berlin criteria for ARDS and treatment with rt-PA. The study was approved by the Rutgers institutional review board (IRB #Pro2020000766). The objective of this study was to determine whether rt-PA administration decreases dead space ventilation in patients with COVID-19.Ĭharts from COVID-19-positive patients admitted to the intensive care unit at Robert Wood Johnson University Hospital, New Brunswick, NJ, USA, between 24 March 2020 and were retrospectively reviewed. ![]() ![]() Thus far, no clinical trials have been completed to evaluate the use of recombinant tissue-type plasminogen activator (rt-PA) to treat COVID-19. This has prompted the use of therapeutic anticoagulation and thrombolytics. Part of the pathophysiology of COVID-19-induced ARDS is explained by increased dead space ventilation from pulmonary microthrombi this is supported by the existence of alveolar capillary microthrombi found on autopsies. In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as the causative agent for coronavirus disease 2019 (COVID-19), a clinical syndrome with high incidence of acute respiratory distress syndrome (ARDS). ![]()
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