Clinical Focus

  • Pediatric Critical Care Medicine

Academic Appointments

Professional Education

  • Fellowship: Stanford University Cardiovascular Intensive Care (CVICU) Fellowship (2024) CA
  • Fellowship: Children's Hospital Los Angeles Pediatric Critical Care Fellowship (2022) CA
  • Medical Education: University of California Davis School of Medicine (2016) CA
  • Board Certification: American Board of Pediatrics, Pediatric Critical Care Medicine (2022)
  • Residency: UC Irvine Pediatrics Residency (2019) CA
  • Board Certification: American Board of Pediatrics, Pediatrics (2019)

Contact

  • Academic
    ariyac@stanford.edu
    University - Academic staff Department: Pediatrics - Cardiology Position: Clinical Assistant Professor
  • Clinical (Primary)  Pediatric Cardiology 725 Welch Rd Ste 325 Palo Alto, CA 94304 (650) 497-8422 (fax)

Additional Clinical Info

Additional Info

  • Mail Code: 5580

All Publications

  • The end-tidal alveolar dead space fraction for risk stratification during the first week of invasive mechanical ventilation: an observational cohort study. Critical care (London, England) Bhalla, A. K., Chau, A., Khemani, R. G., Newth, C. J. 2023; 27 (1): 54

    Abstract

    BACKGROUND: The end-tidal alveolar dead space fraction (AVDSf=[PaCO2-PETCO2]/PaCO2) is a metric used to estimate alveolar dead space. Higher AVDSf on the first day of mechanical ventilation is associated with mortality and fewer ventilator-free days. It is not clear if AVDSf is associated with length of ventilation in survivors, how AVDSf performs for risk stratification beyond the first day of ventilation, or whether AVDSf adds predictive value to oxygenation (oxygenation index [OI]) or severity of illness (Pediatric Risk of Mortality [PRISM III]) markers.METHODS: Retrospective single-center observational cohort study of children and young adults receiving invasive mechanical ventilation. In those with arterial or capillary blood gases, AVDSf was calculated at the time of every blood gas for the first week of mechanical ventilation.RESULTS: There were 2335 children and young adults (median age 5.8years [IQR 1.2, 13.2]) enrolled with 8004 analyzed AVDSf values. Higher AVDSf was associated with mortality and longer length of ventilation in survivors throughout the first week of ventilation after controlling for OI and PRISM III. Higher OI was not associated with increased mortality until≥48h of ventilation after controlling for AVDSf and PRISM III. When using standardized variables, AVDSf effect estimates were generally higher than OI for mortality, whereas OI effect estimates were generally higher than AVDSf for the length of ventilation in survivors. An AVDSf>0.3 was associated with a higher mortality than an AVDSf<0.2 within each pediatric acute respiratory distress syndrome severity category. The maximum AVDSf within 12h of intensive care unit admission demonstrated good risk stratification for mortality (AUC 0.768 [95% CI 0.732, 0.803]). AVDSf did not improve mortality risk stratification when added to PRISM III but did improve mortality risk stratification when added to the gas exchange components of PRISM III (minimum 12-h PaO2 and maximum 12-h PCO2) (p<0.00001).CONCLUSIONS: AVDSf is associated with mortality and length of ventilation in survivors throughout the first week of invasive mechanical ventilation. Some analyses suggest AVDSf may better stratify mortality risk than OI, whereas OI may better stratify risk for prolonged ventilation in survivors than AVDSf.

    View details for DOI 10.1186/s13054-023-04339-3

    View details for PubMedID 36759925