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A comparison of indices of respiratory failure in ventilated preterm infants
N V Subhedar1, A T Tan, E M Sweeney
1Neonatal Intensive Care Unit, Liverpool Women's Hospital, Liverpool, UK. mvsubhedar_lwh@yahoo.com
Insights
The oxygenation index (OI) and other respiratory failure indices effectively predict adverse outcomes in preterm infants. The OI is recommended for its simple calculation, aiding clinical decisions in neonatal respiratory care.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Preterm infants face significant risks of respiratory failure.
- Accurate prediction of adverse respiratory outcomes is crucial for timely intervention.
- Existing indices for respiratory failure require comparative analysis for optimal use.
Purpose of the Study:
- To compare the predictive performance of four key respiratory failure indices in preterm infants.
- To evaluate the alveolar-arterial oxygen tension difference (A-aDO(2)), arterial to alveolar oxygen tension ratio (a/A ratio), oxygenation index (OI), and fractional inspired oxygen concentration (FIO(2)).
Main Methods:
- Retrospective analysis of ventilated infants (<34 weeks gestation) within the first 24 hours of life.
- Utilized worst single index values and arterial blood gas data.
- Employed Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) to assess predictive accuracy for death from respiratory failure and chronic lung disease (CLD).
Main Results:
- The study included 155 preterm infants; 23% died from respiratory failure and 44% of survivors developed CLD.
- The a/A ratio demonstrated the highest predictive performance (AUC 0.88) for respiratory failure death.
- Demographic variables (gestational age, birth weight) showed comparable or better performance in predicting CLD/death compared to respiratory indices.
Conclusions:
- No significant difference was found between the a/A ratio, A-aDO(2), and OI in predicting adverse respiratory outcomes.
- The oxygenation index (OI) is recommended for clinical use due to its ease of calculation.
- Further research may explore combined use of indices and demographic factors for enhanced prediction.
Aim:
To compare indices of respiratory failure in terms of their ability to predict adverse respiratory outcomes in preterm infants. The indices evaluated were: (a) the alveolar-arterial oxygen tension difference (A-aDO(2)); (b) the ratio of arterial to alveolar oxygen tension (a/A ratio); (c) the oxygenation index (OI); (d) the fractional inspired oxygen concentration (FIO(2)).
Methods:
Details of respiratory support and arterial blood gas data in the first 24 hours of life were collected in ventilated infants below 34 weeks gestation. The worst single value of a particular index in the first 24 hours was chosen to quantify the severity of respiratory failure in each infant. Receiver operating characteristic curves were constructed and areas under the curve (AUC) calculated to compare the performance of the indices in predicting death from respiratory failure and/or the development of chronic lung disease (CLD).
Results:
A total of 155 preterm infants were studied, of whom 35 (23%) died primarily from respiratory failure and 53 of the 120 survivors (44%) developed CLD. The overall performance of the four indices in predicting death from respiratory failure ranged from 0. 77 (AUC for maximum FIO(2)) to 0.88 (AUC for minimum a/A ratio). The corresponding AUCs for gestational age and birth weight were 0.75 and 0.76 respectively. In contrast, demographic variables tended to perform better than indices of respiratory failure in predicting CLD/death.
Conclusions:
There was no evidence of a significant difference between the performance of the a/A ratio, A-aDO(2), and OI in predicting adverse respiratory outcomes. Use of the OI is recommended because of its ease of calculation.