Published ahead of print on April 7, 2005, doi:10.1164/rccm.200405-625OC Am. J. Respir. Crit. Care Med., Volume 172, Number 2, July 2005, 206-211 A more recent version of this article appeared on July 15, 2005
Submitted on May 14, 2004 Oxygenation Index Predicts Outcome in Children with Acute Hypoxemic Respiratory FailureDaniel Trachsel1,1 Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada, 2 Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada, 3 Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada * To whom correspondence should be addressed. E-mail: desmond.bohn{at}sickkids.ca.
To define outcome and time-dependence of predictors of outcome in pediatric acute hypoxemic respiratory failure (AHRF), 131 patients (age range 1 month to 18 years) were prospectively followed. Parametric models were used to describe time-related events, and competing risks analysis was performed for mortality estimates. Multiple logistic analysis was applied to describe time-related predictors of ventilation time and mortality. Overall mortality was 27%. Peak oxygenation index measured at any time point (p < 0.001, 91% reliability in bootstrapping, after inverse transformation) and PRISM score within the first 12 hours of mechanical ventilation (p < 0.001, 63% reliability in bootstrapping, after square transformation) were identified as independent predictors of mortality. Peak oxygenation index, younger age, and need for renal replacement therapy were significantly associated with a longer time to extubation. Although oxygenation index was less reliable as outcome predictor within the first 12 hours of intubation, it still predicted duration of mechanical ventilation. No clear-cut threshold of oxygenation index was identified which could accurately predict mortality. Survival was characterized by a peak rate of extubations at about 1 week with a more gradual decline thereafter, whereas death appeared as a constant risk over time, which exceeded chances of survival at about 4 weeks. Conclusions: Severity of oxygenation failure at any point in time during AHRF correlates with duration of mechanical ventilation and mortality. This is best reflected by oxygenation index which shows a direct correlation to outcome in a time-independent manner. Key words: mortality; respiratory distress syndrome; competing risks
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