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

Snežana Rsovac; Katarina Milošević; Davor Plavec; Dušan Todorović; Ljiljana Šćepanović

doi:10.2147/RMHP.S253545

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

Risk Manag Healthc Policy. 2020 Sep 24:13:1739-1746. doi: 10.2147/RMHP.S253545. eCollection 2020.

Authors

Snežana Rsovac¹, Katarina Milošević¹, Davor Plavec^{2

3}, Dušan Todorović⁴, Ljiljana Šćepanović⁴

Affiliations

¹ Department of Pediatric and Neonatal Intensive Care, University Children's Hospital "Tiršova", Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
² Srebrnjak Children's Hospital, Zagreb, Croatia.
³ Medical Faculty Osijek, JJ Strossmayer University of Osijek, Osijek, Croatia.
⁴ Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

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