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[Oxygen extraction as a predictor of mortality in patients on high frequency ventilation]
J A García-Hernández1, A Vázquez Florido, A I Martínez-López
1Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Infantil Universitario Virgen del Rocío, Seville, Spain. garcier@gmail.com
Insights
High frequency oscillatory ventilation (HFOV) in children with respiratory failure improved hemodynamics. A 12-hour predictive model using end-tidal O2 and central venous O2 saturation accurately identified mortality risk.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Hemodynamic Monitoring
Context:
- High frequency oscillatory ventilation (HFOV) is used for pediatric respiratory failure.
- Potential adverse effects on cardiac output require investigation.
- Hemodynamic monitoring is crucial during HFOV.
Purpose:
- To analyze hemodynamic changes during HFOV in children.
- To identify predictors of mortality in this population.
- To develop a predictive model for mortality.
Summary:
- 48 children with hypoxemia-driven respiratory failure were studied prospectively.
- HFOV improved pH, mean arterial pressure, and venous saturation, while decreasing venous pressure and oxygen extraction.
- Mortality predictors at 24 hours included FiO2, PaO2/FiO2, oxygenation index, shunt, pH, CVP, MAP, SvO2, and O2 extraction.
Impact:
- HFOV demonstrates beneficial hemodynamic effects in pediatric respiratory failure.
- A predictive model using end-tidal CO2 (EtCO2) and central venous oxygen saturation (SvO2) at 12 hours achieved 92.3% accuracy in predicting mortality.
- This model offers a valuable tool for early risk stratification and management decisions.
Introduction:
The high frequency oscillatory ventilation (HFOV) may reduce cardiac output. The haemodynamics were analysed and predictors of mortality identified.
Patients And Methods:
A total of 48 children with respiratory failure undergoing HFOV between January 2003 and December 2010 were included. The study design was prospective, observational, and descriptive. Inclusion criteria were based on the existence of hypoxemia. The variables studied were: arterial and central venous pressure, arterial pH, venous saturation and oxygen extraction ratio, with determinations performed prior to HFOV, during, and before turning to conventional ventilation. Prognostic factors were identified by bivariate analysis and a predictive model of mortality was developed.
Results:
The mean age was 21 [4 to 72] months. On admission, PRISM scales and Murray were 33 and 2.8, PaO(2)/FiO(2) of 61 and oxygenation index of 35. After HFOV an increase in pH (P<.001), mean arterial pressure (P<.001) and venous saturation, and decreased venous pressure and O(2) extraction (P<.001), was obtained. The prognostic factors of mortality at 24 hours after starting HFOV were: FiO(2), PaO(2)/FiO(2), oxygenation index, shunt, pH, central venous pressure and mean arterial pressure, venous saturation, and O(2) extraction. The model developed at 12 hours, consisting of EtO(2) and SvcO(2) was able to predict death with a probability of 92.3%.
Conclusions:
HFOV improves haemodynamics. The model at 12 hours is the best predictor of death.
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