Acute Crit Care.  2018 Nov;33(4):222-229. 10.4266/acc.2018.00136.

Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children

Affiliations
  • 1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea. kwkim@yuhs.ac
  • 2Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea.
  • 3Sowha Children's Hospital, Seoul, Korea.

Abstract

BACKGROUND
The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS.
METHODS
Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality.
RESULTS
PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P < 0.001).
CONCLUSIONS
Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

Keyword

acute respiratory distress syndrome; mortality; pediatrics; risk assessment

MeSH Terms

Anoxia
Child*
Classification
Diagnosis*
Humans
Mortality
Multivariate Analysis
Odds Ratio
Oxygen*
Partial Pressure
Pediatrics
Respiratory Distress Syndrome, Adult*
Retrospective Studies
Risk Assessment
ROC Curve
Oxygen
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