This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bohn, D. Articles by Nakagawa, S. Search for Related Content PubMed Articles by Bohn, D. Articles by Nakagawa, S.

Oxygenation Index as a Predictor of Outcome in Children with Acute Hypoxemic Respiratory Failure

We thank Dr. Mathur and Mr. Bullock for their interest in our study of outcome in pediatric acute hypoxemic respiratory failure (AHRF) (1). Ventilation strategy in these patients aimed at minimizing peak airway pressures and oxygen toxicity, allowing for low tidal volumes, permissive hypercapnia, and lower oxygen partial pressures (2). No bedside compliance measurements were made; instead, positive end-expiratory pressures were continuously adjusted to optimize tidal volumes, with the aim of reducing peak airway pressures and fraction of inspired oxygen. As stated, the institution of high-frequency oscillatory ventilation (HFOV) was done at the attending physician's discretion, and four patients dying on the ventilator succumbed while on HFOV.

The pediatric risk of mortality (PRISM) score assessed within the 12 hours of mechanical ventilation was a significant predictor of outcome, its mean differing between survivors and nonsurvivors (16 ± 7 vs. 22 ± 11, p < 0.001). As expected, no clear threshold could be identified that discriminated between survival and death, reflecting the heterogeneous pattern as to how pediatric AHRF evolves over time. Our study focused on the impact of the severity of oxygenation failure on outcome; this proved to independently affect prognosis. As discussed in the article, multiorgan failure certainly played an important role both in those dying with Pa_O2 equal to or less than 50 mm Hg and those with Pa_O2 values greater than 50 mm Hg. Ventilatory parameters over the last 24 hours before death were not statistically different between these two groups, leading us to state that any threshold of Pa_O2 incompatible with survival is arbitrary and likely differs independently of overall organ integrity. The pediatric logistic organ dysfunction (PELOD) score was not validated until 2003 (3), when data collection for this study had been completed. Improved insight into the role of multiorgan dysfunction might be expected if such a scoring is being performed serially during the entire observational period.

Desmond Bohn, Daniel Trachsel, Brian McCrindle and Satoshi Nakagawa

The Hospital for Sick Children, Toronto, Ontario, Canada

FOOTNOTES

Conflict of Interest Statement: None of the authors have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Trachsel D, McCrindle BW, Nakagawa S, Bohn D. Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure. Am J Respir Crit Care Med 2005;172:206–211.[Abstract/Free Full Text]
2. Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301–1308.[Abstract/Free Full Text]
3. Leteurtre S, Martinot A, Duhamel A, Proulx F, Grandbastien B, Cotting J, Gottesman R, Joffe A, Pfenninger J, Hubert P, et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003;362:192–197.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bohn, D. Articles by Nakagawa, S. Search for Related Content PubMed Articles by Bohn, D. Articles by Nakagawa, S.