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A novel oxygenation distension index (ODI): a driving pressure-based metric compared with the oxygenation index in
Ekin Soydan1, Gokhan Ceylan2, Ozlem Demirel3
1Pediatric Intensive Care Unit, Aydin Maternity and Children's Hospital, Ataturk Boulevard No:96, Center, Aydın, Turkey. dr-ekinsoydan@hotmail.com.
Insights
The new oxygenation distension index (ODI), using driving pressure, better reflects lung injury severity in pediatric ARDS than the standard oxygenation index (OI). ODI also improves 30-day mortality prediction in mechanically ventilated children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Medical Technology Assessment
Background:
- The standard oxygenation index (OI) for pediatric acute respiratory distress syndrome (PARDS) severity classification relies on mean airway pressure, which doesn't accurately reflect lung-distending forces.
- Driving pressure (DP) is a recognized determinant of lung strain and ventilator-induced lung injury.
Purpose of the Study:
- To develop and evaluate the oxygenation distension index (ODI) by replacing mean airway pressure with driving pressure in the OI formula.
- To compare the association of ODI and OI with lung injury markers and clinical outcomes in pediatric patients with PARDS.
Main Methods:
- An observational study included 56 children (1 month to 18 years) with PARDS requiring invasive mechanical ventilation.
- Lung ultrasound scores (LUS) and respiratory mechanics (PL, DPL, MP, MPL) were assessed.
- Associations between OI, ODI, lung injury markers, and 30-day mortality were analyzed.
Main Results:
- ODI showed stronger correlations with lung injury markers (LUS, PL, DPL, MP, MPL) than OI.
- ODI demonstrated higher discriminative performance for 30-day mortality (AUC 0.740) compared to OI (AUC 0.685).
Conclusions:
- The oxygenation distension index (ODI) more accurately reflects lung injury severity in PARDS by incorporating driving pressure.
- ODI improves the prediction of mortality in mechanically ventilated children with PARDS compared to the conventional oxygenation index.
Abstract:
The oxygenation index (OI) is widely used to assess disease severity in pediatric ARDS; however, it relies on mean airway pressure (Pmean), which does not reflect lung-distending forces relevant to ventilator-induced lung injury. Driving pressure (DP) is a determinant of lung strain. We developed and evaluated the oxygenation distension index (ODI) by substituting DP for Pmean in the OI formula. This observational study included children aged 1 month to 18 years with PARDS requiring ≥ 24 h of invasive mechanical ventilation in six centers. Lung ultrasound scores (LUS) and respiratory mechanics, including transpulmonary pressure (PL), transpulmonary driving pressure (DPL), mechanical power (MP), and transpulmonary mechanical power (MPL), were assessed 4-24 h after diagnosis according to PALICC-2 recommendations. Associations of OI and ODI with lung injury markers and clinical outcomes were analyzed. Among 56 patients, 41 (73%) had mild-to-moderate and 15 (27%) had severe PARDS. ODI demonstrated stronger correlations than OI with lung injury markers, including LUS (r = 0.818 vs. 0.501), PL (r = 0.779 vs. 0.697), DPL (r = 0.745 vs. 0.671), MP normalized to predicted body weight (r = 0.518 vs. 0.438), and MPL normalized to predicted body weight (r = 0.634 vs. 0.628). For 30-day mortality prediction, ODI showed higher discriminative performance than OI (AUC 0.740 [95% CI, 0.598-0.866] vs. 0.685 [95% CI, 0.535-0.835]; DeLong p = 0.040).
Conclusions:
By incorporating driving pressure, ODI more closely reflects lung injury severity than the conventional oxygenation index and improves discrimination for mortality in PARDS.
What Is Known:
• The oxygenation index is the standard metric used for severity classification in pediatric acute respiratory distress syndrome. • Driving pressure has been increasingly recognized as a key physiological determinant of lung injury and clinical outcomes in ARDS.
What Is New:
• A driving pressure-based oxygenation metric, the oxygenation distension index (ODI), shows stronger associations with established markers of lung injury than the conventional oxygenation index in PARDS. • ODI provides improved discrimination for 30-day mortality compared with the oxygenation index in mechanically ventilated children with PARDS.
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