Third-Day Oxygenation Index is an Excellent Predictor of Survival in Children Mechanically Ventilated for Acute Respiratory Distress Syndrome

Abstract

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.

Keywords:

• mortality
• respiration
• artificial
• prognosis
• intensive care units
• pediatric
• blood gas analysis
• survivors mortality of children mechanically ventilated for ARDS

Acknowledgments

University Children’s hospital in Belgrade, Serbia.

Disclosure

Prof. Dr. Davor Plavec reports grants, personal fees from GlaxoSmithKline; personal fees, non-financial support from Menarini, Philips, and Revenio; personal fees from Pliva, Boehringer Ingelheim, Belupo, Novartis, MSD, and Chiesi, outside the submitted work. The authors report no other conflicts of interest in this work.