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Third-Day Oxygenation Index is an Excellent Predictor of Survival in Children Mechanically Ventilated for Acute
Snežana Rsovac1, Katarina Milošević1, Davor Plavec2,3
1Department of Pediatric and Neonatal Intensive Care, University Children's Hospital "Tiršova", Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Insights
The oxygenation index (OI) on day 3 is a highly accurate predictor of short-term mortality in children with acute respiratory distress syndrome (ARDS). This simple measure aids in assessing survival for mechanically ventilated pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Clinical Outcomes Research
Background:
- Acute respiratory distress syndrome (ARDS) is a critical condition in children requiring mechanical ventilation.
- Predicting outcomes in pediatric ARDS is essential for timely clinical decision-making.
- The oxygenation index (OI) is a potential marker for assessing respiratory function and prognosis.
Purpose of the Study:
- To evaluate the association between the oxygenation index (OI) and short-term mortality in pediatric patients with ARDS.
- To determine the prognostic value of OI in different age groups of children with ARDS.
- To assess the predictive accuracy of OI on different days of mechanical ventilation.
Main Methods:
- A cohort study included pediatric intensive care unit patients (age >30 days) diagnosed with ARDS and on mechanical ventilation.
- OI was calculated on day 1 and day 3 of mechanical ventilation.
- The association between OI and 28-day mortality was analyzed using logistic regression and receiver operating characteristic (ROC) curves.
Main Results:
- OI on day 3 demonstrated significant prognostic value for mortality (AUC=0.919, p=0.0001), with higher OI values in non-survivors.
- OI on day 1 did not show significant prognostic value for short-term mortality (AUC=0.634, p=0.056).
- No significant association was found between different modes of mechanical ventilation and patient outcomes.
Conclusions:
- The oxygenation index (OI) is a simple, accurate, and sensitive predictor of short-term survival in children with ARDS.
- OI on day 3 of mechanical ventilation is a valuable tool for prognostication in pediatric ARDS.
- OI can aid clinicians in assessing the likelihood of survival for mechanically ventilated children with ARDS.
Purpose:
The aim of this study was to assess the association between oxygenation index (OI) and outcome in children with acute respiratory distress syndrome (ARDS).
Patients And Methods:
Patients (age, >30 days) in the pediatric intensive care unit from April 2011 to March 2016 with ARDS and who were mechanically ventilated were included. Patients were divided into two age groups: infants (<12month) and older children. Lowest PaO2/FiO2 and SpO2/FiO2 ratios and highest mean airway pressure (MAP) were recorded on the first day of ARDS and after 72 h. OI was calculated on the first and third days of mechanical ventilation (MV) and its association with OI (first and third days) and short-term mortality evaluated at 28 days.
Results:
MV was initiated a mean of 2.3 days after admission (median, 1.0 day; maximum 14 days). The average MV duration for all patients was 11.8 (median, 7.0) days. Mean (95% confidence interval (CI)) OI values on the first day of MV were 14.17 (11.94-16.41), 12.72 (10.68-14.75), and 13.24 (11.73-14.74) for infants, older children, and all participants, respectively. In survivors (n=39) mean OI was 11.66 (9.64-13.68) compared with 15.22 (13.03-17.40) in non-survivors (n=31). Logistic regression analysis revealed that OI on day 3 had highly significant prognostic value for mortality (odds ratio, 256.5, 95% CI 27.1-2424, p<0.001), with an AUC of 0.919 (cut-off value, 17; positive predictive value, 0.905; negative predictive value, 0.964; p=0.0001). In contrast, OI on day 1 did not have significant prognostic value (AUC, 0.634; p=0.056) for short-term mortality. Different modes of MV were not significantly associated with outcome (p>0.05).
Conclusion:
OI is a simple, highly accurate, and sensitive predictor of the survival (short-term mortality) of children mechanically ventilated for ARDS.
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