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Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate
Soo Yeon Kim1, Byuhree Kim1, Sun Ha Choi1
1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Insights
Reclassifying pediatric acute respiratory distress syndrome (PARDS) using oxygenation 24 hours after diagnosis improves outcome prediction. Oxygenation response is a key indicator of mortality risk in pediatric patients with PARDS.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Neonatology
Background:
- Pediatric acute respiratory distress syndrome (PARDS) diagnosis is pragmatic, based on initial hypoxia.
- Current diagnostic criteria may not fully capture prognostic information.
- Re-evaluating PARDS severity using updated metrics could enhance patient outcome prediction.
Purpose of the Study:
- To investigate if reclassifying PARDS based on oxygenation metrics 24 hours post-diagnosis improves prognostic ability.
- To compare the prognostic value of oxygenation changes versus pressure parameters in PARDS.
- To identify key indicators for mortality risk in pediatric patients with PARDS.
Main Methods:
- Retrospective analysis of 288 pediatric patients diagnosed with PARDS between 2010 and 2017.
- Comparison of initial PARDS classification with reclassification using data from 24 hours post-diagnosis.
- Investigation of changes in oxygenation and pressure parameters for prognostic value regarding mortality.
Main Results:
- PARDS severity showed significant variability within the first 24 hours, with 52.4% improving.
- Reclassification at 24 hours identified a severe group with significantly increased mortality risk (aOR 26.84, P=0.002).
- Changes in oxygenation (PaO2/FiO2) demonstrated superior discriminative power for mortality compared to pressure variables (AUC 0.701, P<0.001).
Conclusions:
- Reclassification of PARDS using 24-hour oxygenation metrics effectively stratifies patient outcomes.
- Early progress (within 24 hours) in PARDS is significantly associated with patient outcomes.
- Oxygenation response is the most discernible surrogate metric for predicting mortality in PARDS.
Background:
The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS.
Methods:
Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality.
Results:
PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001).
Conclusions:
Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.
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