Related Experiment Video
Updated: Oct 7, 2025
How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
Published on: August 19, 2020
Low Inadequate Oxygen Delivery Index is Associated with Decreased Cardiac Arrest Risk in High-Risk Pediatric ICU
Maya Dewan1,2,3,4, David S Cooper1,5, Ken Tegtmeyer1,2
1Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH.
Insights
Clinician concern combined with the Inadequate Oxygen Delivery Index (IDO2) can help identify high-risk pediatric intensive care unit patients. This approach improves system efficiency by reducing the number of patients needing evaluation for clinical deterioration.
Area of Science:
- Pediatric critical care medicine
- Physiological monitoring
- Clinical decision support systems
Background:
- Identifying high-risk patients in the Pediatric Intensive Care Unit (PICU) is crucial for timely intervention.
- Clinician concern is a primary method for escalating patient care.
- Existing methods may lack precision in predicting critical events.
Purpose of the Study:
- To evaluate the Inadequate Oxygen Delivery Index (IDO2) as a tool to identify high-risk PICU patients.
- To determine if IDO2 can refine predictions made by clinician concern.
- To assess the impact of IDO2 on the efficiency of clinical deterioration detection.
Main Methods:
- Prospective observational cohort study in a single PICU (February 2017 - May 2020).
- Collected mean calculated IDO2 in 12-hour increments for 3,087 patients.
- Analyzed data for clinical deterioration and cardiopulmonary resuscitation (CPR) events during 'watcher periods'.
Main Results:
- Over 24,505 periods, 224 clinical deterioration events occurred, with 48 being CPR events.
- Adding a mean IDO2 threshold (<5) during pre-watcher periods reduced the number needed to evaluate for deterioration from 43 to 38.
- The addition of IDO2 did not alter the prediction of CPR events but improved efficiency for other deteriorations.
Conclusions:
- Physiologic monitor data, like IDO2, can enhance clinician-activated situation awareness systems.
- Integrating IDO2 can decrease the number needed to alert, improving overall system efficiency.
- This approach supports more targeted and efficient patient monitoring in the PICU.
Objectives:
To evaluate the Inadequate Oxygen Delivery Index (IDO2) in the PICU to identify patients labeled as high risk by clinician concern who will not experience a cardiac arrest.
Design Setting And Participants:
Prospective observational cohort study in a single PICU from February 1, 2017, to May 20, 2020. All mean calculated IDO2 was collected for patients in 12-hour increments.
Measurements And Main Results:
We monitored 3,087 patients over 24,505 12-hour periods. Four thousand seventeen were watcher periods-12-hour period following watcher determination to watch for clinical deterioration. Overall, there were 224 clinical deterioration events of which 21% (n = 48) were cardiopulmonary resuscitation (CPR) events. Twenty-three CPR events (48%) and 93 clinical deteriorationevents (42%) occurred during 4,017 watcher periods. Following addition of a mean IDO2 threshold less than 5 during the prewatcher period, 23 CPR events (48%) and 77 clinical deterioration events (34%) occurred during 2,958 watcher periods. Using clinical concern alone, the number needed to evaluate for CPR events was 167 watcher periods for each single CPR event and 43 watcher periods for each clinical deterioration event. With the addition of a mean IDO2 less than 5, the number needed to evaluate decreased to 125 and 38, respectively, with no change in the prediction of CPR events.
Conclusions:
The use of physiologic monitor data can be applied to clinician-activated situation awareness systems to decrease the number needed to alert and improve system efficiency.
Related Concept Videos
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:23Acute Respiratory Failure-IV
01:21Cardiopulmonary Resuscitation I: Adult
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management