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Aşar S, Rahim F, Rahimi P, Acicbe Ö, Tontu F, Çukurova Z. Novel Oxygenation and Saturation Indices for Mortality Prediction in COVID-19 ARDS Patients: The Impact of Driving Pressure and Mechanical Power. J Intensive Care Med 2024; 39:595-608. [PMID: 38179691 PMCID: PMC11092301 DOI: 10.1177/08850666231223498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Background: The oxygenation index (OI) and oxygen saturation index (OSI) are proven mortality predictors in pediatric and adult patients, traditionally using mean airway pressure (Pmean). We introduce novel indices, replacing Pmean with DP (ΔPinsp), MPdyn, and MPtot, assessing their potential for predicting COVID-19 acute respiratory distress syndrome (ARDS) mortality, comparing them to traditional indices. Methods: We studied 361 adult COVID-19 ARDS patients for 7 days, collecting ΔPinsp, MPdyn, and MPtot, OI-ΔPinsp, OI-MPdyn, OI-MPtot, OSI-ΔPinsp, OSI-MPdyn, and OSI-MPtot. We compared these in surviving and non-surviving patients over the first 7 intensive care unit (ICU) days using Mann-Whitney U test. Logistic regression receiver operating characteristic (ROC) analysis assessed AUC and CI values for ICU mortality on day three. We determined cut-off values using Youden's method and conducted multivariate Cox regression on parameter limits. Results: All indices showed significant differences between surviving and non-surviving patients on the third day of ICU care. The AUC values of OI-ΔPinsp were significantly higher than those of P/F and OI-Pmean (P values .0002 and <.0001, respectively). Similarly, AUC and CI values of OSI-ΔPinsp and OSI-MPdyn were significantly higher than those of SpO2/FiO2 and OSI-Pmean values (OSI-ΔPinsp: P < .0001, OSI-MPdyn: P values .047 and .028, respectively). OI-ΔPinsp, OSI-ΔPinsp, OI-MPdyn, OSI-MPdyn, OI-MPtot, and OSI-MPtot had AUC values of 0.72, 0.71, 0.69, 0.68, 0.66, and 0.64, respectively, with cut-off values associated with hazard ratios and P values of 7.06 (HR = 1.84, P = .002), 8.04 (HR = 2.00, P ≤ .0001), 7.12 (HR = 1.68, P = .001), 5.76 (HR = 1.70, P ≤ .0001), 10.43 (HR = 1.52, P = .006), and 10.68 (HR = 1.66, P = .001), respectively. Conclusions: Critical values of all indices were associated to higher ICU mortality rates and extended mechanical ventilation durations. The OI-ΔPinsp, OSI-ΔPinsp, and OSI-MPdyn indices displayed the strongest predictive capabilities for ICU mortality. These novel indices offer valuable insights for intensivists in the clinical management and decision-making process for ARDS patients.
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Affiliation(s)
- Sinan Aşar
- Department of Anesthesiology and Reanimation, Bakırköy Dr SadiKonuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatih Rahim
- Department of Industrial Engineering, Koç University, Istanbul, Turkey
| | - Payam Rahimi
- Department of Anesthesiology and Reanimation, Bakırköy Dr SadiKonuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özlem Acicbe
- Department of Anesthesiology and Reanimation, Şişli HamidiyeEtfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Furkan Tontu
- Department of Anesthesiology and Reanimation, Ağrı Training and Research Hospital, Ağrı, Turkey
| | - Zafer Çukurova
- Department of Anesthesiology and Reanimation, Bakırköy Dr SadiKonuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Chiumello D, Fioccola A. Recent advances in cardiorespiratory monitoring in acute respiratory distress syndrome patients. J Intensive Care 2024; 12:17. [PMID: 38706001 PMCID: PMC11070081 DOI: 10.1186/s40560-024-00727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Recent advances on cardiorespiratory monitoring applied in ARDS patients undergoing invasive mechanical ventilation and noninvasive ventilatory support are available in the literature and may have potential prognostic implication in ARDS treatment. MAIN BODY The measurement of oxygen saturation by pulse oximetry is a valid, low-cost, noninvasive alternative for assessing arterial oxygenation. Caution must be taken in patients with darker skin pigmentation, who may experience a greater incidence of occult hypoxemia. Dead space surrogates, which are easy to calculate, have important prognostic implications. The mechanical power, which can be automatically computed by intensive care ventilators, is an important parameter correlated with ventilator-induced lung injury and outcome. In patients undergoing noninvasive ventilatory support, the use of esophageal pressure can measure inspiratory effort, avoiding possible delays in endotracheal intubation. Fluid responsiveness can also be evaluated using dynamic indices in patients ventilated at low tidal volumes (< 8 mL/kg). In patients ventilated at high levels of positive end expiratory pressure (PEEP), the PEEP test represents a valid alternative to passive leg raising. There is growing evidence on alternative parameters for evaluating fluid responsiveness, such as central venous oxygen saturation variations, inferior vena cava diameter variations and capillary refill time. CONCLUSION Careful cardiorespiratory monitoring in patients affected by ARDS is crucial to improve prognosis and to tailor treatment via mechanical ventilatory support.
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Affiliation(s)
- Davide Chiumello
- Department of Health Sciences, University of Milan, Milan, Italy.
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan, Via Di Rudinì 9, Milan, Italy.
- Coordinated Research Center on Respiratory Failure, University of Milan, Milan, Italy.
| | - Antonio Fioccola
- Department of Health Sciences, University of Milan, Milan, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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Wu SH, Kor CT, Chi SH, Li CY. Categorizing Acute Respiratory Distress Syndrome with Different Severities by Oxygen Saturation Index. Diagnostics (Basel) 2023; 14:37. [PMID: 38201346 PMCID: PMC10795683 DOI: 10.3390/diagnostics14010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The oxygen saturation index (OSI), defined by FIO2/SpO2 multiplied by the mean airway pressure, has been reported to exceed the Berlin definition in predicting the mortality of acute respiratory distress syndrome (ARDS). The OSI has served as an alternative to the Berlin definition in categorizing pediatric ARDS. However, the use of the OSI for the stratification of adult ARDS has not been reported. A total of 379 invasively ventilated adult ARDS patients were retrospectively studied. The ARDS patients were classified into three groups by their incidence rate of mortality: mild (OSI < 14.69), moderate (14.69 < OSI < 23.08) and severe (OSI > 23.08). OSI-based categorization was highly correlated with the Berlin definition by a Kendall's tau of 0.578 (p < 0.001). The Kaplan-Meier curves of the three OSI-based groups were significantly different (p < 0.001). By the Berlin definition, the hazard ratio for 28-day mortality was 0.58 (0.33-1.05) and 0.95 (0.55-1.67) for the moderate and severe groups, respectively (compared to the mild group). In contrast, the corresponding hazard ratio was 1.01 (0.69-1.47) and 2.39 (1.71-3.35) for the moderate and severe groups defined by the OSI. By multivariate analysis, OSI-based severe ARDS was independently associated with 28-D or 90-D mortality. In conclusion, we report the first OSI-based stratification for adult ARDS and find that it serves well as an alternative to the Berlin definition.
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Affiliation(s)
- Shin-Hwar Wu
- Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua 50006, Taiwan;
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 50006, Taiwan
| | - Shu-Hua Chi
- Section of Respiratory Therapy, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 50006, Taiwan; (S.-H.C.); (C.-Y.L.)
| | - Chun-Yu Li
- Section of Respiratory Therapy, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 50006, Taiwan; (S.-H.C.); (C.-Y.L.)
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Jagiasi BG. Noninvasive Oxygenation Indices: New Tools for Resource-limited Settings? Indian J Crit Care Med 2023; 27:784-785. [PMID: 37936800 PMCID: PMC10626234 DOI: 10.5005/jp-journals-10071-24583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
How to cite this article: Jagiasi BG. Noninvasive Oxygenation Indices: New Tools for Resource-limited Settings? Indian J Crit Care Med 2023;27(11):784-785.
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Affiliation(s)
- Bharat G Jagiasi
- Department of Critical Care, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
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Wick KD, Matthay MA, Ware LB. Pulse oximetry for the diagnosis and management of acute respiratory distress syndrome. Lancet Respir Med 2022; 10:1086-1098. [PMID: 36049490 PMCID: PMC9423770 DOI: 10.1016/s2213-2600(22)00058-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/30/2022] [Accepted: 02/10/2022] [Indexed: 02/07/2023]
Abstract
The diagnosis of acute respiratory distress syndrome (ARDS) traditionally requires calculation of the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) using arterial blood, which can be costly and is not possible in many resource-limited settings. By contrast, pulse oximetry is continuously available, accurate, inexpensive, and non-invasive. Pulse oximetry-based indices, such as the ratio of pulse-oximetric oxygen saturation to FiO2 (SpO2/FiO2), have been validated in clinical studies for the diagnosis and risk stratification of patients with ARDS. Limitations of the SpO2/FiO2 ratio include reduced accuracy in poor perfusion states or above oxygen saturations of 97%, and the potential for reduced accuracy in patients with darker skin pigmentation. Application of pulse oximetry to the diagnosis and management of ARDS, including formal adoption of the SpO2/FiO2 ratio as an alternative to PaO2/FiO2 to meet the diagnostic criterion for hypoxaemia in ARDS, could facilitate increased and earlier recognition of ARDS worldwide to advance both clinical practice and research.
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Affiliation(s)
- Katherine D Wick
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine and Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Todur P, Nileshwar A, Chaudhuri S, Gupta N, Natarajan S, Rao S, Tisherman SA. Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2 10/FiO2 PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome. Crit Care Res Pract 2022; 2022:1-10. [PMID: 36111248 PMCID: PMC9470362 DOI: 10.1155/2022/7871579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Conventionally, PaO2/FiO2 (P/F ratio) has been used to categorize severity of acute respiratory distress syndrome (ARDS) and prognostication of outcome. Recent literature has shown that incorporation of positive end-expiratory pressure (PEEP) into the P/F ratio (PaO2
10/FiO2
PEEP or P/FP
10) has a much better prognostic ability in ARDS as compared to P/F ratio. The aim of this study was to correlate SpO2
10/FiO2
PEEP (S/FP
10) to PaO2
10/FiO2
PEEP (P/FP
10) and evaluate the utility of S/FP
10 as a reliable noninvasive indicator of oxygenation in ARDS to avoid repeated arterial blood sampling. Aim. To evaluate if pulse oximetry is a reliable indicator of oxygenation in ARDS patients by calculating SpO2
10/FiO2
PEEP (S/FP
10). The primary objective was to determine the correlation of S/FP
10 to P/FP
10 ratio in ARDS patients. The secondary objective was to determine the cut-off value of S/FP
10 ratio to predict severe ARDS and survival. Methods. Patients aged 18–80 years on invasive mechanical ventilation (MV) diagnosed with ARDS as defined by the Berlin definition were included. The values of PaO2, FiO2, and SpO2 were collected at three different time points. They were at baseline, i.e., after intubation and initiation of MV (within one hour of intubation), day one (1–24 hours of MV), and day three (48–72 hours of MV). The primary outcome was survival at the end of intensive care unit (ICU) stay. Results. A total of 85 patients with ARDS on invasive MV were included. The data points were obtained at baseline, day one, and day three of MV. S/FP
10 ratio has an excellent correlation to P/FP
10 ratio at baseline and day three of invasive MV (r = 0.831 and 0.853, respectively;
) and has a strong correlation on day one of invasive MV (r = 0.733,
). S/FP
10 ratio ≤116 at baseline has excellent discriminant function to be categorized as severe ARDS as per Berlin definition (AUC: 0.925,
, 90% sensitivity, 93% specificity, CI: [0.862–0.988]). The increase in S/FP
10 ratio by ≥64.40 from baseline to day three of MV is a good predictor of survival (AUC: 0.877,
, 73.5% sensitivity, 97% specificity, CI: [0.803–0.952]). Conclusion. S/FP
10 has a strong correlation to P/FP
10 in ARDS patients. S/FP
10 ≤116 has an excellent discriminant function to be categorized as severe ARDS. The S/FP
10 ratio on day three of MV and the change in S/FP
10 ratio from baseline and day one to day three of MV are good predictors of survival in ARDS patients. This trial is registered with CTRI/2020/04/024940.
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Ortiz G, Bastidas A, Garay-Fernández M, Lara A, Benavides M, Rocha E, Buitrago A, Díaz G, Ordóñez J, Reyes LF. Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level. Med Intensiva 2022; 46:501-507. [PMID: 36057441 DOI: 10.1016/j.medine.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/04/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN Ambispective descriptive multicenter cohort study. SETTING Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS None. VARIABLES Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.
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Affiliation(s)
- G Ortiz
- Pulmonary Medicine, Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Bastidas
- School of Medicine, Universidad de la Sabana, Clínica Universidad de La Sabana, Chía, Colombia.
| | - M Garay-Fernández
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Lara
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - M Benavides
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - E Rocha
- Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Buitrago
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - G Díaz
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - J Ordóñez
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - L F Reyes
- School of Medicine, Universidad de la Sabana, Clínica Universidad de La Sabana, Chía, Colombia
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Zaccagnini G, Berni A, Pieralli F. Correlation of non-invasive oxygenation parameters with paO2/FiO2 ratio in patients with COVID-19 associated ARDS. Eur J Intern Med 2022; 96:117-119. [PMID: 34987012 PMCID: PMC8687749 DOI: 10.1016/j.ejim.2021.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Giacomo Zaccagnini
- COVID-19 High Care Unit, University Hospital Careggi, Largo Brambilla 3, Firenze 50139, Italy.
| | - Andrea Berni
- Medicina Interna 3, University Hospital Careggi, Largo Brambilla 3, Firenze 50139, Italy
| | - Filippo Pieralli
- COVID-19 High Care Unit, University Hospital Careggi, Largo Brambilla 3, Firenze 50139, Italy
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Abstract
Background Acute hypoxemic respiratory failure (AHRF) is a major factor for increased mortality in the intensive care unit (ICU). We hypothesized that the noninvasive index SpO2/FiO2 (SF) ratio can be used as a surrogate to invasive index PaO2/FiO2 (PF) as SF ratio correlates with PF ratio in all modes of oxygen supplementation. Patients and methods Patients with acute respiratory failure admitted to the intensive care unit were enrolled in this retrospective cross-sectional study. Fraction of inspired oxygen (FiO2), method of oxygen supplementation, and partial pressure of arterial oxygen (PaO2) were noted from the ABG reports in the medical records. The corresponding SpO2 was noted from the nurse's chart. The calculated SF and PF ratios were recorded, and correlation between the same was noted in different methods of oxygen administration. Results A total of 300-sample data were collected. Pearson's correlation was used to quantify the relationship between the variables. The study showed a positive correlation, r = 0.66 (p <0.001), between PF ratio and SF ratio. SF threshold values were 285 and 323 for corresponding PF values of 200 and 300 with a sensitivity and specificity in the range of 70 to 80%. In addition, SF and PF could also be used interchangeably irrespective of the mode of oxygen supplementation, as the median values of PF ratio (p = 0.06) and SF ratio (p = 0.88) were not statistically significant. Conclusion In patients with AHRF, the noninvasive SF ratio can be used as a surrogate to invasive index PF in all modes of oxygen supplementation. How to cite this article Babu S, Abhilash KPP, Kandasamy S, Gowri M. Association between SpO2/FiO2 Ratio and PaO2/FiO2 Ratio in Different Modes of Oxygen Supplementation. Indian J Crit Care Med 2021;25(9):1001–1005.
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Affiliation(s)
- Sheetal Babu
- Surgical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Subramani Kandasamy
- Division of Critical Care and Surgical ICU, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
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Roozeman JP, Mazzinari G, Serpa Neto A, Hollmann MW, Paulus F, Schultz MJ, Pisani L. Prognostication using SpO 2/FiO 2 in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study. J Crit Care 2021; 68:31-37. [PMID: 34872014 PMCID: PMC8641962 DOI: 10.1016/j.jcrc.2021.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/02/2021] [Accepted: 11/13/2021] [Indexed: 12/19/2022]
Abstract
Background The SpO2/FiO2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO2/FiO2 for mortality in patients with ARDS due to COVID–19. Methods This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID–19. The primary endpoint was 28–day mortality. Results In 869 invasively ventilated patients, 28–day mortality was 30.1%. The SpO2/FiO2 on day 1 had no prognostic value. The SpO2/FiO2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO2/FiO2 on day 2 (OR, 0.66 [95%–CI 0.46–0.96]) and on day 3 (OR, 0.70 [95%–CI 0.51–0.96]) were associated with 28–day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76–0.79]). The measured PaO2/FiO2 and the PaO2/FiO2 calculated from SpO2/FiO2 were strongly correlated (Spearman's r = 0.79). Conclusions In this cohort of patients with ARDS due to COVID–19, the SpO2/FiO2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28–day mortality. The SpO2/FiO2 is a useful metric for risk stratification in invasively ventilated COVID–19 patients.
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Affiliation(s)
- Jan-Paul Roozeman
- Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands.
| | - Guido Mazzinari
- Department of Anesthesiology, Hospital Universitario la Fe, Valencia, Spain; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria Valencia, Spain
| | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Luigi Pisani
- Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy; Department of Anesthesiology and Intensive Care Medicine, Miulli Regional Hospital, Acquaviva delle Fonti, Italy
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Mahale N, Godavarthy P, Marreddy S, Gokhale SD, Funde P, Rajhans PA, Akole PV, Pawar B, Bhurke B, Dalvi P, Marudwar P, Gugale S, Shahane MS, Kshirsagar SN, Jog SA. Intravenous Methylene Blue as a Rescue Therapy in the Management of Refractory Hypoxia in COVID-19 ARDS Patients: A Case Series. Indian J Crit Care Med 2021; 25:934-938. [PMID: 34733037 PMCID: PMC8559741 DOI: 10.5005/jp-journals-10071-23905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: To describe the clinical outcomes of hypoxic coronavirus disease 2019 (COVID-19) patients treated with intravenous methylene blue (MB) in a tertiary care hospital. Materials and methods: We conducted a case series of 50 patients with hypoxic COVID-19 treated with intravenous MB admitted to our hospital between June 01 and September 10, 2020. Intravenous MB was administered as rescue therapy in dosage of 1 mg/kg body weight, with a maximum of five doses, to patients with high oxygen requirements (SpO2/FiO2 <200) apart from the standard of care after obtaining G6PD levels. Data were abstracted from multiple electronic data sources or patient charts to provide information on patient characteristics, clinical and laboratory variables and outcomes. Results: The median age of the patients was 53.3 (range 25–74 years) and most patients (74%) were men. About 68% of patients had pre-existing comorbidity. Median SpO2/FiO2 ratio progressively improved from 132.5 (predose) to 284 before the terminal event (death or discharge), ventilator-free days, and decrease in the proinflammatory biochemical parameter was significantly higher after the second dose of MB. A total of six patients out of 50 required invasive mechanical ventilation (IMV). Thirty patients were discharged with a recovery rate of 60%, while 20 patients succumbed to the illness. There was no major side effect or adverse event reported in any of the patients. Conclusion: MB due to its polypharmacological action against SARS‐CoV‐2, an inexpensive and widely available drug with minimal side effects, has a significant potential in the treatment of COVID-19. How to cite this article: Mahale N, Godavarthy P, Marreddy S, Gokhale SD, Funde P, Rajhans PA, et al. Intravenous Methylene Blue as a Rescue Therapy in the Management of Refractory Hypoxia in COVID-19 ARDS Patients: A Case Series. Indian J Crit Care Med 2021;25(8):934–938.
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Affiliation(s)
- Nilesh Mahale
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Purushotham Godavarthy
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Srinath Marreddy
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Snehal D Gokhale
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Pradip Funde
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Prasad A Rajhans
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Prasad V Akole
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Balasaheb Pawar
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Bhagyashri Bhurke
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Pradip Dalvi
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Prasanna Marudwar
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Shradha Gugale
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Manasi S Shahane
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Sarang N Kshirsagar
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Sameer A Jog
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
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12
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Lohano PD, Baloch SH, Gowa MA, Raza SJ, Soomro L, Nawaz H. Correlation Between the Ratio of Oxygen Saturation to Fraction of Inspired Oxygen and the Ratio of Partial Pressure of Oxygen to Fraction of Inspired Oxygen in Detection and Risk Stratification of Pediatric Acute Respiratory Distress Syndrome. Cureus 2021; 13:e18353. [PMID: 34725605 PMCID: PMC8555751 DOI: 10.7759/cureus.18353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To measure the correlation between the ratio of oxygen saturation to fraction of inspired oxygen [SpO2/FiO2 (SF)] and the ratio of partial pressure of oxygen to fraction of inspired oxygen [PaO2/FiO2 (PF)] among children diagnosed with acute respiratory distress syndrome (ARDS). Methodology: A cross-sectional study was conducted at the pediatric intensive care unit (PICU), National Institute of Child Health (NICH), Karachi, a tertiary care government hospital, from November 2020 to July 2021. One hundred twenty children (of either gender) having the age range of 2 months to 16 years, admitted to PICU with acute onset of respiratory distress, were included in the study. We measured SpO2, PaO2, FiO2 and calculated SF and PF ratios. SPSS (version 23) (Armonk, NY: IBM Corp) was used to analyze data, and the Spearmen's correlation test was applied to measure the relationship between SF and PF ratios. Results: A total of 120 children were included, the mean age was 40.58±38.88 months and 67 (55.8%) were males. The mean FiO2 was 76.33%, the mean PaO2 and SpO2 were 100.35 mmHg and 94.37%, respectively. The mean PF ratio was 156.34, and the mean SF ratio was 156.45. There was a strong correlation between the SF ratio and the PF ratio (r=0.688; p=0.001). Conclusion: This study has shown that there is a strong correlation between the SF and PF ratios, and a statistically substantial agreement has been observed.
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Affiliation(s)
- Pooja D Lohano
- Pediatric Medicine, National Institute of Child Health, Karachi, PAK
| | - Sadam H Baloch
- Pediatric Medicine, National Institute of Child Health, Karachi, PAK
| | - Murtaza A Gowa
- Pediatric Critical Care, National Institute of Child Health, Karachi, PAK
| | - Syed J Raza
- Pediatrics and Endocrinology, National Institute of Child Health, Karachi, PAK
| | - Lareb Soomro
- Pediatric Medicine, Civil Hospital, Hyderabad, PAK
| | - Hira Nawaz
- Pediatric Medicine, National Institute of Child Health, Karachi, PAK
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13
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Kwizera A, Kateete DP, Ssenyonga R, Nakiyingi L, Nakibuuka J, Namata C, Mwanje A, Okello E, Kabatoro D, Kiwanuka N, Bollinger RC, Tumwine J, Summers C. Acute Respiratory Distress Syndrome in an African Intensive Care Unit Setting: A Prospective Study of Prevalence and Outcomes. Ann Am Thorac Soc 2021. [PMID: 34666632 DOI: 10.1513/AnnalsATS.202103-270RL] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Ortiz G, Bastidas A, Garay-Fernández M, Lara A, Benavides M, Rocha E, Buitrago A, Díaz G, Ordóñez J, Reyes LF. Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level. Med Intensiva 2021; 46:S0210-5691(21)00100-5. [PMID: 34167826 DOI: 10.1016/j.medin.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/09/2021] [Accepted: 05/04/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN Ambispective descriptive multicenter cohort study. SETTING Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS None. VARIABLES Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.
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Affiliation(s)
- G Ortiz
- Pulmonary Medicine, Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Bastidas
- School of Medicine, Universidad de la Sabana, Clínica Universidad de La Sabana, Chía, Colombia.
| | - M Garay-Fernández
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Lara
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - M Benavides
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - E Rocha
- Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Buitrago
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - G Díaz
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - J Ordóñez
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - L F Reyes
- School of Medicine, Universidad de la Sabana, Clínica Universidad de La Sabana, Chía, Colombia
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15
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Stilma W, Åkerman E, Artigas A, Bentley A, Bos LD, Bosman TJC, de Bruin H, Brummaier T, Buiteman-Kruizinga LA, Carcò F, Chesney G, Chu C, Dark P, Dondorp AM, Gijsbers HJH, Gilder ME, Grieco DL, Inglis R, Laffey JG, Landoni G, Lu W, Maduro LMN, McGready R, McNicholas B, de Mendoza D, Morales-Quinteros L, Nosten F, Papali A, Paternoster G, Paulus F, Pisani L, Prud’homme E, Ricard JD, Roca O, Sartini C, Scaravilli V, Schultz MJ, Sivakorn C, Spronk PE, Sztajnbok J, Trigui Y, Vollman KM, van der Woude MCE. Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers. Am J Trop Med Hyg 2021; 104:1676-1686. [PMID: 33705348 PMCID: PMC8103477 DOI: 10.4269/ajtmh.20-1445] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/28/2021] [Indexed: 01/03/2023] Open
Abstract
Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6-12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.
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Affiliation(s)
- Willemke Stilma
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands;,Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, The Netherlands;,Address correspondence to Willemke Stilma, Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands. E-mail:
| | - Eva Åkerman
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden;,Function of Perioperative Medicine and Intensive Care, Department of Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Antonio Artigas
- Department of Intensive Care, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, Spain;,Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Andrew Bentley
- Acute Intensive Care Unit, Manchester University NHS Foundation, Manchester, United Kingdom;,Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lieuwe D. Bos
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
| | - Thomas J. C. Bosman
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
| | - Hendrik de Bruin
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
| | - Tobias Brummaier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand;,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Laura A. Buiteman-Kruizinga
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands;,Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Francesco Carcò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gregg Chesney
- Division of Emergency Medicine-Critical Care, Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
| | - Cindy Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand;,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul Dark
- Critical Care Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom;,Division of Infection, Immunity and Respiratory Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom;,Humanitarian and Conflict Response Institute, University of Manchester, Manchester, United Kingdom
| | - Arjen M. Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;,Faculty of Tropical Medicine, Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Harm J. H. Gijsbers
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Domenico L. Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;,Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Rebecca Inglis
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, University of Oxford, Vientiane, Lao People’s Democratic Republic
| | - John G. Laffey
- Department of Anaesthesia and Intensive Care, MedicineGalway University Hospitals, Galway, Ireland;,School of Medicine, Disciplines of Anaesthesia and Intensive Care Medicine, National University of Ireland, Galway, Ireland
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy;,School of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Weihua Lu
- Department of Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Lisa M. N. Maduro
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand;,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Bairbre McNicholas
- Department of Anaesthesia and Intensive Care, MedicineGalway University Hospitals, Galway, Ireland
| | - Diego de Mendoza
- Intensive Care Department, Hospital Universitari Sagrat Cor. Grupo Quironsalud, Barcelona, Spain;,Emergency Department, Hospital Universitari Sagrat Cor. Grupo Quironsalud, Barcelona, Spain;,Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Morales-Quinteros
- Intensive Care Department, Hospital Universitari Sagrat Cor. Grupo Quironsalud, Barcelona, Spain;,Institut d’ Investigacio I Innovacio Parc Taulí I3PT, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand;,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Alfred Papali
- Division of Pulmonary and Critical Medicine, Atrium Health, Charlotte, North Carolina;,School of Medicine, University of Maryland, Baltimore, Maryland
| | - Gianluca Paternoster
- Department of Cardiovascular Anaesthesia and ICU, San Carlo Hospital, Potenza, Italy
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands;,Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, The Netherlands
| | - Luigi Pisani
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands;,Faculty of Tropical Medicine, Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand;,Section of Operational Research, Doctors with Africa CUAMM, Padova, Italy
| | - Eloi Prud’homme
- Intensive Care Unit, Détresse Respiratoire Infections Sévères, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Jean-Damien Ricard
- DMU ESPRIT-Enseignements et Soins de Proximité, Recherche, Innovation et Territoires, Université de Paris, Paris, France;,Infection, Antimicrobiens, Modélisation, Evolution (IAME), Université de Paris, Paris, France;,Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique – Hôpitaux de Paris, Colombes, France
| | - Oriol Roca
- Servei de Medicina Intensiva, Hospital Vall d’Hebron, Barcelona, Spain
| | - Chiara Sartini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Scaravilli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands;,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;,Faculty of Tropical Medicine, Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Chaisith Sivakorn
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Peter E. Spronk
- Expertise Center for Intensive Care Rehabilitation Apeldoorn, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands
| | - Jaques Sztajnbok
- Intensive Care Unit, Instituto de Infectologia Emilio Ribas, São Paulo, Brazil
| | - Youssef Trigui
- Service des Maladies Respiratoires, Centre Hospitalier D’Aix-en-Provence, Aix-en-Provence, France
| | - Kathleen M. Vollman
- Clinical Nurse Specialist/Critical Care Consultant, Advancing Nursing LLC, Northville, Michigan
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16
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Martín-Rodríguez F, López-Izquierdo R, Castro-Villamor MA, Martín-Conty JL, Herrero-Antón RM, Del Pozo-Vegas C, Guillén-Gil D, Dueñas-Laita A. A predictive model for serious adverse events in adults with acute poisoning in prehospital and hospital care. Aust Crit Care 2021; 34:209-216. [PMID: 33067102 DOI: 10.1016/j.aucc.2020.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/01/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to design a risk model with variables determined before hospital arrival to predict the risk of serious adverse events in patients with acute poisoning. METHODS A preliminary prospective, multicentre cohort study of adults with prehospital diagnosis of acute intoxication was conducted. The study was carried out in the Public Health System of the Community of Castilla-Leon (Spain), including seven advanced life support units and five hospitals, between April 1, 2018, and June 30, 2019. People aged >18 years with a main prehospital diagnosis of acute poisoning admitted to a referral hospital on advanced life support were included. The main outcome measure was prehospital and hospital serious adverse events in patients with acute poisoning. RESULTS We included 221 patients, with a median age of 47 years (interquartile range: 33-61). The most frequent cause of poisoning was psychopharmaceuticals (111 cases, 49.8%): 38 (17.2%) patients had a serious adverse event, with a hospital mortality of 4.1% (nine cases) in the 30 days after the index event. The final model included age ≥65 years (odds ratio [OR]: 9.59, 95% confidence interval [CI]: 3.48-26.45; p < 0.001), oxygen saturation/fraction of inspired oxygen index ≤300 (OR: 15.03, 95% CI: 5.74-39.33; p < 0.001), and point-of-care lactate ≥4 mmol/L (OR: 7.68, 95% CI: 2.88-20.45; p < 0.001). The poisoning Early Warning Score was constructed from these three variables, and 1 point was assigned to each variable. The area under the curve of the score was 0.896 (95% CI: 0.82-0.96; p < 0.001). CONCLUSIONS The poisoning Early Warning Score may help in decision-making and promote early identification of high-risk patients with acute poisoning in the prehospital context.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Life Support, Emergency Medical Services, Valladolid, Spain; School of Medicine, Universidad de Valladolid, Avda. Ramón y Cajal, 7, 47005, Valladolid, Spain.
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain.
| | - Miguel A Castro-Villamor
- School of Medicine, Universidad de Valladolid, Avda. Ramón y Cajal, 7, 47005, Valladolid, Spain.
| | - José L Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla La Mancha, Avda. Real Fábrica de Seda, S/n, 45600, Talavera de La Reina, Spain.
| | - Rosa M Herrero-Antón
- Emergency Department, Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente, 182, 37007, Salamanca, Spain.
| | - Carlos Del Pozo-Vegas
- Emergency Department, Hospital Clínico Universitario, Avda. Ramón y Cajal, 3, 47003, Valladolid, Spain.
| | - David Guillén-Gil
- Advanced Life Support of Burgos, Emergency Medical Services, Paseo Hospital Militar, 24, 47007, Valladolid, Spain.
| | - Antonio Dueñas-Laita
- Toxicology Department, Hospital Universitario Rio Hortega, Valladolid. School of Medicine, Universidad de Valladolid, Avda. Ramón y Cajal, 7, 47005, Valladolid, Spain.
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17
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Fukuda Y, Tanaka A, Homma T, Kaneko K, Uno T, Fujiwara A, Uchida Y, Suzuki S, Kotani T, Sagara H. Utility of SpO2/FiO2 ratio for acute hypoxemic respiratory failure with bilateral opacities in the ICU. PLoS One 2021; 16:e0245927. [PMID: 33493229 PMCID: PMC7833145 DOI: 10.1371/journal.pone.0245927] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
Acute hypoxemic respiratory failure (AHRF) with bilateral opacities causes fatalities in the intensive care unit (ICU). It is often difficult to identify the causes of AHRF at the time of admission. The SpO2 to FiO2 (S/F) ratio has been recently used as a non-invasive and alternative marker of the PaO2/FiO2 (P/F) ratio in acute respiratory failure. This retrospective cohort study was conducted from October 2010 to March 2019 at the Showa University Hospital, Tokyo, Japan. We enrolled 94 AHRF patients who had bilateral opacities and received mechanical ventilation in ICU to investigate their prognostic markers including S/F ratio. Significant differences were observed for APACHE II, S/F ratio, PaO2/FiO2 (P/F) ratio, and ventilator-free-days at day 28 for ICU mortality, and for age, S/F ratio, P/F ratio, duration of mechanical ventilation, and ventilator-free days at day 28 for hospital mortality. Multivariate logistic regression analysis showed that the S/F ratio was significantly and independently associated with the risk of death during in ICU (p = 0.003) and hospitalization (p = 0.002). The area under the receiver operating characteristic curves (AUC) based on the S/F ratio were significantly greater than those based on simplified acute physiology score (SAPS) II and sequential organ failure assessment (SOFA) for ICU mortality (0.785 in S/F ratio vs. 0.575 in SAPS II, p = 0.012; 0.785 in S/F ratio vs 0.594 in SOFA, p = 0.021) and for hospital mortality (0.701 in S/F ratio vs. 0.502 in SAPS II, p = 0.012; 0.701 in S/F ratio vs. 0.503 in SOFA, p = 0.005). In the subanalysis for bacterial pneumonia and interstitial lung disease groups, the AUC based on the S/F ratio was the greatest among all prognostic markers, including APACHE II, SAPS II, and SOFA. The S/F ratio may be a useful and noninvasive predictive prognostic marker for acute hypoxemic respiratory failure with bilateral opacities in the ICU.
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Affiliation(s)
- Yosuke Fukuda
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Akihiko Tanaka
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Tetsuya Homma
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Keisuke Kaneko
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Tomoki Uno
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Akiko Fujiwara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Yoshitaka Uchida
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Shintaro Suzuki
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Toru Kotani
- Department of Intensive Care Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
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Pisani L, Algera AG, Serpa Neto A, Ahsan A, Beane A, Chittawatanarat K, Faiz A, Haniffa R, Hashemian SM, Hashmi M, Imad HA, Indraratna K, Iyer S, Kayastha G, Krishna B, Ling TL, Moosa H, Nadjm B, Pattnaik R, Sampath S, Thwaites L, Tun NN, Mohd Yunos N, Grasso S, Paulus F, Gama de Abreu M, Pelosi P, Day N, White N, Dondorp AM, Schultz MJ, For The PRoVENT-iMiC Investigators Moru And The Prove Network, Adhikari A, Akaraborworn O, Akhtar A, Alam AKMS, Ali SM, Arumoli J, Asaduzzaman M, Azauddin SNS, Banik D, Bhuiyan SR, Bhurayanontachai R, Chatmongkolchart S, Das S, Das SS, De Silva K, Dilhani YAH, Dissanayake L, Dongre A, Dorasamy D, Duong Bich T, Dutta ML, Edirisooriya M, Farooq A, Fernando M, Gunaratne A, Hamid T, Hanif S, Hasan MS, Hayat M, Hossain M, Hussain T, Idrees F, Jamaluddin MFH, Joseph S, Juntaping K, Kamal S, Karmaker P, Kasi CK, Kassim M, Khaskheli S, Khatoon SN, Khoundabi B, Kongpolprom N, Kudavidanage B, Lam Mihn Y, Malekmohammad M, Mat Nor MB, Mathanalagan S, Memon I, Mithraratne N, Mobasher M, Mondol MK, Mostafa Kamal AH, Nath RK, Navasakulpong A, Nazneed S, Nguyen Thi Thanh H, Nguyen Van K, Nooraei N, Othman Jailani MI, Pangeni R, Petnak T, Pilimatalawwe C, Pinto V, Piriyapatsom A, Pornsuriyasak P, Qadeer A, Raessi Estabragh R, Rahman Chowdhury MA, Ranatunge K, Rehman AU, Reza ST, Roy S, Roy P, Rungruanghiranya S, Salim M, Samaranayake U, Samarasinghe L, Sarkar SA, Shah J, Sigera C, Silachamroon U, Singhatas P, Sultana R, Surasit K, Taher SM, Tai LL, Tajarernmuang P, Tangsujaritvijit V, Taohid TM, Taqi A, Thilakasiri K, Thungtitigul P, Trongtrakul K, Vaas M, Voon CM, Vu Quoc D, Zarudin N. Epidemiological Characteristics, Ventilator Management, and Clinical Outcome in Patients Receiving Invasive Ventilation in Intensive Care Units from 10 Asian Middle-Income Countries (PRoVENT-iMiC): An International, Multicenter, Prospective Study. Am J Trop Med Hyg 2021; 104:1022-1033. [PMID: 33432906 PMCID: PMC7941813 DOI: 10.4269/ajtmh.20-1177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/22/2020] [Indexed: 01/05/2023] Open
Abstract
Epidemiology, ventilator management, and outcome in patients receiving invasive ventilation in intensive care units (ICUs) in middle-income countries are largely unknown. PRactice of VENTilation in Middle-income Countries is an international multicenter 4-week observational study of invasively ventilated adult patients in 54 ICUs from 10 Asian countries conducted in 2017/18. Study outcomes included major ventilator settings (including tidal volume [V T] and positive end-expiratory pressure [PEEP]); the proportion of patients at risk for acute respiratory distress syndrome (ARDS), according to the lung injury prediction score (LIPS), or with ARDS; the incidence of pulmonary complications; and ICU mortality. In 1,315 patients included, median V T was similar in patients with LIPS < 4 and patients with LIPS ≥ 4, but lower in patients with ARDS (7.90 [6.8-8.9], 8.0 [6.8-9.2], and 7.0 [5.8-8.4] mL/kg Predicted body weight; P = 0.0001). Median PEEP was similar in patients with LIPS < 4 and LIPS ≥ 4, but higher in patients with ARDS (five [5-7], five [5-8], and 10 [5-12] cmH2O; P < 0.0001). The proportions of patients with LIPS ≥ 4 or with ARDS were 68% (95% CI: 66-71) and 7% (95% CI: 6-8), respectively. Pulmonary complications increased stepwise from patients with LIPS < 4 to patients with LIPS ≥ 4 and patients with ARDS (19%, 21%, and 38% respectively; P = 0.0002), with a similar trend in ICU mortality (17%, 34%, and 45% respectively; P < 0.0001). The capacity of the LIPS to predict development of ARDS was poor (ROC AUC of 0.62, 95% CI: 0.54-0.70). In Asian middle-income countries, where two-thirds of ventilated patients are at risk for ARDS according to the LIPS and pulmonary complications are frequent, setting of V T is globally in line with current recommendations.
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Affiliation(s)
- Luigi Pisani
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Anna Geke Algera
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Ary Serpa Neto
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Areef Ahsan
- Department of Critical Care, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Abigail Beane
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Abul Faiz
- Dev Care Foundation, Dhaka, Bangladesh.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rashan Haniffa
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Seyed MohammadReza Hashemian
- Chronic Respiratory Diseases Research Center (CRDRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Madiha Hashmi
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Hisham Ahmed Imad
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kanishka Indraratna
- Department of Anaesthesia and Intensive Care, Sri Jayewardenepura General Hospital, Colombo, Sri Lanka
| | - Shivakumar Iyer
- Department of Medicine, Bharati Vidyapeeth Medical College, Pune, India
| | - Gyan Kayastha
- Department of Internal Medicine, Patan Academy of Health Science, Kathmandu, Nepal
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, India
| | - Tai Li Ling
- Department of Anaesthesia and Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Hassan Moosa
- Department of Intensive Care, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - Behzad Nadjm
- National Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | | | - Sriram Sampath
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, India
| | - Louise Thwaites
- Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ni Ni Tun
- Medical Action Myanmar, Naypyidaw, Myanmar
| | - Nor'azim Mohd Yunos
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Malaysia
| | - Salvatore Grasso
- Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Marcelo Gama de Abreu
- Pulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,San Martino Policlinico Hospital - IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Nick Day
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nick White
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Arjen M Dondorp
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Marcus J Schultz
- Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A) Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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van Meenen DMP, Serpa Neto A, Paulus F, Merkies C, Schouten LR, Bos LD, Horn J, Juffermans NP, Cremer OL, van der Poll T, Schultz MJ; MARS Consortium. The predictive validity for mortality of the driving pressure and the mechanical power of ventilation. Intensive Care Med Exp 2020; 8:60. [PMID: 33336298 DOI: 10.1186/s40635-020-00346-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022] Open
Abstract
Background Outcome prediction in critically ill patients under invasive ventilation remains extremely challenging. The driving pressure (ΔP) and the mechanical power of ventilation (MP) are associated with patient-centered outcomes like mortality and duration of ventilation. The objective of this study was to assess the predictive validity for mortality of the ΔP and the MP at 24 h after start of invasive ventilation. Methods This is a post hoc analysis of an observational study in intensive care unit patients, restricted to critically ill patients receiving invasive ventilation for at least 24 h. The two exposures of interest were the modified ΔP and the MP at 24 h after start of invasive ventilation. The primary outcome was 90-day mortality; secondary outcomes were ICU and hospital mortality. The predictive validity was measured as incremental 90-day mortality beyond that predicted by the Acute Physiology, Age and Chronic Health Evaluation (APACHE) IV score and the Simplified Acute Physiology Score (SAPS) II. Results The analysis included 839 patients with a 90-day mortality of 42%. The median modified ΔP at 24 h was 15 [interquartile range 12 to 19] cm H2O; the median MP at 24 h was 206 [interquartile range 145 to 298] 10−3 J/min/kg predicted body weight (PBW). Both parameters were associated with 90-day mortality (odds ratio (OR) for 1 cm H2O increase in the modified ΔP, 1.05 [95% confidence interval (CI) 1.03 to 1.08]; P < 0.001; OR for 100 10−3 J/min/kg PBW increase in the MP, 1.20 [95% CI 1.09 to 1.33]; P < 0.001). Area under the ROC for 90-day mortality of the modified ΔP and the MP were 0.70 [95% CI 0.66 to 0.74] and 0.69 [95% CI 0.65 to 0.73], which was neither different from that of the APACHE IV score nor that of the SAPS II. Conclusions In adult patients under invasive ventilation, the modified ΔP and the MP at 24 h are associated with 90 day mortality. Neither the modified ΔP nor the MP at 24 h has predictive validity beyond the APACHE IV score and the SAPS II.
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Kwizera A, Nakibuuka J, Nakiyingi L, Sendagire C, Tumukunde J, Katabira C, Ssenyonga R, Kiwanuka N, Kateete DP, Joloba M, Kabatoro D, Atwine D, Summers C. Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality. BMJ Open Respir Res 2020; 7:7/1/e000719. [PMID: 33148779 PMCID: PMC7643509 DOI: 10.1136/bmjresp-2020-000719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/24/2020] [Accepted: 09/18/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Limited data exist on the epidemiology of acute hypoxaemic respiratory failure (AHRF) in low-income countries (LICs). We sought to determine the prevalence of AHRF in critically ill adult patients admitted to a Ugandan tertiary referral hospital; determine clinical and treatment characteristics as well as assess factors associated with mortality. MATERIALS AND METHODS We conducted a prospective observational study at the Mulago National Referral and Teaching Hospital in Uganda. Critically ill adults who were hospitalised at the emergency department and met the criteria for AHRF (acute shortness of breath for less than a week) were enrolled and followed up for 90 days. Multivariable analyses were conducted to determine the risk factors for death. RESULTS A total of 7300 patients was screened. Of these, 327 (4.5%) presented with AHRF. The majority (60 %) was male and the median age was 38 years (IQR 27-52). The mean plethysmographic oxygen saturation (SpO2) was 77.6% (SD 12.7); mean SpO2/FiO2 ratio 194 (SD 32) and the mean Lung Injury Prediction Score (LIPS) 6.7 (SD 0.8). Pneumonia (80%) was the most common diagnosis. Only 6% of the patients received mechanical ventilatory support. In-hospital mortality was 77% with an average length of hospital stay of 9.2 days (SD 7). At 90 days after enrolment, the mortality increased to 85%. Factors associated with mortality were severity of hypoxaemia (risk ratio (RR) 1.29 (95% CI 1.15 to 1.54), p=0.01); a high LIPS (RR 1.79 (95% CI 1.79 1.14 to 2.83), p=0.01); thrombocytopenia (RR 1.23 (95% CI 1.11 to 1.38), p=0.01); anaemia (RR 1.15 (95% CI 1.01 to 1.31), p=0.03) ; HIV co-infection (RR 0.84 (95% CI 0.72 to 0.97), p=0.019) and male gender (RR 1.15 (95% CI 1.01 to 1.31) p=0.04). CONCLUSIONS The prevalence of AHRF among emergency department patients in a tertiary hospital in an LIC was low but was associated with very high mortality. Pneumonia was the most common cause of AHRF. Mortality was associated with higher severity of hypoxaemia, high LIPS, anaemia, HIV co-infection, thrombocytopenia and being male.
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Affiliation(s)
- Arthur Kwizera
- Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jane Nakibuuka
- Intensive Care, Mulago National Referral Hospital, Kampala, Uganda
| | - Lydia Nakiyingi
- Internal Medicine, Makerere University Faculty of Medicine, Kampala, Uganda
| | - Cornelius Sendagire
- Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Janat Tumukunde
- Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Catherine Katabira
- Respiratory medicine department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Ronald Ssenyonga
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Patrick Kateete
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Joloba
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daphne Kabatoro
- Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Diana Atwine
- Office of the permanent secretary, Republic of Uganda Ministry of Health, Kampala, Uganda
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21
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Xu C, Jiang DW, Qiu WY, Zhou YX, Chen LW, Hong GL, Zhao GJ, Lu ZQ. Arterial oxygen pressure targets in critically ill patients: Analysis of a large ICU database. Heart Lung 2020; 50:220-225. [PMID: 33143913 DOI: 10.1016/j.hrtlng.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Providing supplemental oxygen is common in the management of critically ill patients, yet the optimal oxygen regimen remains unclear. OBJECTIVES To explore the optimal range of PaO2 in critically ill patients. METHODS This is a retrospective study conducted in the Medical Information Mart for Intensive Care III (MIMIC-III) database. The patients with a least 48 h of oxygen therapy were included. Nonlinear regression was used to analyze the association between PaO2 and mortality. We derived an optimal range of PaO2 and evaluated the association between the proportion of PaO2 measurements within this range and mortality. RESULTS In total, 8401 patients were included in the study. A J-shaped relationship was observed between median PaO2 and hospital mortality. Compared with the reference group of 100-120 mmHg, patients with values of 80-100 mmHg and 120-140 mmHg had higher hospital mortality (adjusted odds ratio [aOR], 1.23; 95% CI, 1.05-1.43 and 1.29; 95%CI, 1.08-1.54, respectively). Similarly, mortality rates were significantly higher for PaO2 <80 mmHg and ≥140 mmHg (aOR, 1.97; 95%CI, 1.58-2.45 and 1.42; 95%CI, 1.19-1.69, respectively). Patients spent a greater proportion of time within 100-120 mmHg tended to have a lower mortality rate. CONCLUSION Among critically ill patients, the relationship between median PaO2 and hospital mortality was J-shaped. The lowest rates of mortality was observed in those with PaO2 levels within 100 to 120 mmHg.
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Affiliation(s)
- Chang Xu
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Dan-Wei Jiang
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Wei-Yong Qiu
- Department of Intensive Care Unit, Yiwu Hospital Affiliated to Wenzhou Medical University, Yiwu 322000, PR China
| | - Yan-Xue Zhou
- Department of Nephrology, Yiwu Hospital Affiliated to Wenzhou Medical University, Yiwu 322000, PR China
| | - Long-Wang Chen
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Guang-Liang Hong
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Guang-Ju Zhao
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China.
| | - Zhong-Qiu Lu
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China.
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Rahmani H, Davoudi-Monfared E, Nourian A, Nabiee M, Sadeghi S, Khalili H, Abbasian L, Ghiasvand F, Seifi A, Hasannezhad M, Ghaderkhani S, Mohammadi M, Yekaninejad MS. Comparing outcomes of hospitalized patients with moderate and severe COVID-19 following treatment with hydroxychloroquine plus atazanavir/ritonavir. ACTA ACUST UNITED AC 2020; 28:625-34. [PMID: 32857301 DOI: 10.1007/s40199-020-00369-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The role of the antiviral therapy in treatment of COVID-19 is still a matter to be investigated. Also efficacy and safety of antiviral regimens were not compared according severity of the disease. In this study the efficacy and safety of hydroxychloroquine plus atazanavir/ritonavir was compared in patients with moderate and severe COVID-19. METHODS We prospectively evaluated the clinical outcomes of 213 patients with COVID-19 during the hospitalization course and up to 56 days after the hospital discharge. The disease was categorized to moderate and severe based on the severity of pneumonia and peripheral oxygen saturation (SpO2). The patients received the national treatment protocol containing hydroxychloroquine (400 mg BD in first day and then 200 mg BD) plus atazanavir/ritonavir (300/100 mg daily) for 7 days. Main outcomes included discharge rates at day 7, 14 and 28, 28-day mortality, rate of intensive care unit (ICU) admission and intubation, length of hospital and ICU stay and incidence of adverse events. RESULTS The mean (SD) age of patients was 60(14) years and 53% were male. According to WHO definition, 51.64% and 48.36% of the patients had moderate (SpO2 ≥ 90%) and severe disease (SpO2 < 90%) at baseline, respectively. The discharge rate of the moderate group was significantly higher than the severe group at day 7, 14 and 28 (HR = 0.49; 95% CI: 0.35-0.69, p = < 0.001 at day 7, HR = 0.48; 95% CI: 0.35-0.66, p = < 0.001 at day 14 and HR = 0.49; 95% CI: 0.36-0.67, p = < 0.001at day 28). The 28-day mortality of the severe group was six times higher than the moderate group (HR = 6.00; 95% CI: 2.50-14.44), p = < 0.001). The need of admission in ICU for the severe group and the moderate group was 37.86% and 18.18% of the patients. Length of hospital stay was significantly shorter in the moderate group in comparison with the severe group (5 ± 4 vs. 8 ± 6 days, p < 0.001). Patients in the moderate group experienced the serious adverse events and complications less than the severe group. The discharged patients were followed up to 56 days after discharge. Some of the patients complained of symptoms such as exertional dyspnea, weakness and new-onset hair loss. CONCLUSION Our study did not support the use of hydroxychloroquine plus atazanavir/ritonavir in patients who had SpO2 < 90% at the time of hospital admission. SpO2 was the only predictor of clinical outcomes (duration of hospital stay, discharge from the hospital and mortality) in patients treated with hydroxychloroquine plus atazanavir/ritonavir.
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Palmer E, Post B, Klapaukh R, Marra G, MacCallum NS, Brealey D, Ercole A, Jones A, Ashworth S, Watkinson P, Beale R, Brett SJ, Young JD, Black C, Rashan A, Martin D, Singer M, Harris S. The Association between Supraphysiologic Arterial Oxygen Levels and Mortality in Critically Ill Patients. A Multicenter Observational Cohort Study. Am J Respir Crit Care Med 2020; 200:1373-1380. [PMID: 31513754 PMCID: PMC6884048 DOI: 10.1164/rccm.201904-0849oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: There is conflicting evidence on harm related to exposure to supraphysiologic PaO2 (hyperoxemia) in critically ill patients. Objectives: To examine the association between longitudinal exposure to hyperoxemia and mortality in patients admitted to ICUs in five United Kingdom university hospitals. Methods: A retrospective cohort of ICU admissions between January 31, 2014, and December 31, 2018, from the National Institute of Health Research Critical Care Health Informatics Collaborative was studied. Multivariable logistic regression modeled death in ICU by exposure to hyperoxemia. Measurements and Main Results: Subsets with oxygen exposure windows of 0 to 1, 0 to 3, 0 to 5, and 0 to 7 days were evaluated, capturing 19,515, 10,525, 6,360, and 4,296 patients, respectively. Hyperoxemia dose was defined as the area between the PaO2 time curve and a boundary of 13.3 kPa (100 mm Hg) divided by the hours of potential exposure (24, 72, 120, or 168 h). An association was found between exposure to hyperoxemia and ICU mortality for exposure windows of 0 to 1 days (odds ratio [OR], 1.15; 95% compatibility interval [CI], 0.95–1.38; P = 0.15), 0 to 3 days (OR 1.35; 95% CI, 1.04–1.74; P = 0.02), 0 to 5 days (OR, 1.5; 95% CI, 1.07–2.13; P = 0.02), and 0 to 7 days (OR, 1.74; 95% CI, 1.11–2.72; P = 0.02). However, a dose–response relationship was not observed. There was no evidence to support a differential effect between hyperoxemia and either a respiratory diagnosis or mechanical ventilation. Conclusions: An association between hyperoxemia and mortality was observed in our large, unselected multicenter cohort. The absence of a dose–response relationship weakens causal interpretation. Further experimental research is warranted to elucidate this important question.
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Affiliation(s)
- Edward Palmer
- Bloomsbury Institute of Intensive Care Medicine.,INFORM-lab, London, United Kingdom
| | - Benjamin Post
- INFORM-lab, London, United Kingdom.,Department of Critical Care, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | - Roman Klapaukh
- Research Software Development Group, Research IT Services, and.,INFORM-lab, London, United Kingdom
| | - Giampiero Marra
- Department of Statistical Science, University College London, London, United Kingdom
| | - Niall S MacCallum
- Bloomsbury Institute of Intensive Care Medicine.,INFORM-lab, London, United Kingdom.,Department of Critical Care and
| | - David Brealey
- Bloomsbury Institute of Intensive Care Medicine.,INFORM-lab, London, United Kingdom.,Department of Critical Care and
| | - Ari Ercole
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Andrew Jones
- Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Ashworth
- Division of Critical Care, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Peter Watkinson
- Critical Care Research Group (Kadoorie Centre), Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Richard Beale
- Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.,Centre for Human Applied Physiological Science, King's College London, London, United Kingdom
| | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; and
| | - J Duncan Young
- Critical Care Research Group (Kadoorie Centre), Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Claire Black
- INFORM-lab, London, United Kingdom.,Therapies and Rehabilitation, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Daniel Martin
- Division of Surgery and Interventional Science and.,Critical Care Unit, Royal Free Hospital, London, United Kingdom
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine.,Department of Critical Care and
| | - Steve Harris
- Bloomsbury Institute of Intensive Care Medicine.,INFORM-lab, London, United Kingdom.,Department of Critical Care and
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Yang P, Wu T, Yu M, Chen F, Wang C, Yuan J, Xu J, Zhang G. A new method for identifying the acute respiratory distress syndrome disease based on noninvasive physiological parameters. PLoS One 2020; 15:e0226962. [PMID: 32023257 PMCID: PMC7001976 DOI: 10.1371/journal.pone.0226962] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022] Open
Abstract
Early diagnosis and prevention play a crucial role in the treatment of patients with ARDS. The definition of ARDS requires an arterial blood gas to define the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2 ratio). However, many patients with ARDS do not have a blood gas measured, which may result in under-diagnosis of the condition. Using data from MIMIC-III Database, we propose an algorithm based on patient non-invasive physiological parameters to estimate P/F levels to aid in the diagnosis of ARDS disease. The machine learning algorithm was combined with the filter feature selection method to study the correlation of various noninvasive parameters from patients to identify the ARDS disease. Cross-validation techniques are used to verify the performance of algorithms for different feature subsets. XGBoost using the optimal feature subset had the best performance of ARDS identification with the sensitivity of 84.03%, the specificity of 87.75% and the AUC of 0.9128. For the four machine learning algorithms, reducing a certain number of features, AUC can still above 0.8. Compared to Rice Linear Model, this method has the advantages of high reliability and continually monitoring the development of patients with ARDS.
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Affiliation(s)
- Pengcheng Yang
- Institute of Medical Support, Academy of Military Sciences, Tianjin, China
| | - Taihu Wu
- Institute of Medical Support, Academy of Military Sciences, Tianjin, China
| | - Ming Yu
- Institute of Medical Support, Academy of Military Sciences, Tianjin, China
| | - Feng Chen
- Institute of Medical Support, Academy of Military Sciences, Tianjin, China
| | - Chunchen Wang
- Department of Aerospace Medicine, Air Force Military Medical University, Xi’an, China
| | - Jing Yuan
- Institute of Medical Support, Academy of Military Sciences, Tianjin, China
| | - Jiameng Xu
- Institute of Medical Support, Academy of Military Sciences, Tianjin, China
| | - Guang Zhang
- Institute of Medical Support, Academy of Military Sciences, Tianjin, China
- * E-mail:
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Adams JY, Rogers AJ, Schuler A, Marelich GP, Fresco JM, Taylor SL, Riedl AW, Baker JM, Escobar GJ, Liu VX. Association Between Peripheral Blood Oxygen Saturation (SpO 2)/Fraction of Inspired Oxygen (FiO 2) Ratio Time at Risk and Hospital Mortality in Mechanically Ventilated Patients. Perm J 2020; 24:19.113. [PMID: 32069205 DOI: 10.7812/tpp/19.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Acute respiratory failure requiring mechanical ventilation is a leading cause of mortality in the intensive care unit. Although single peripheral blood oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) ratios of hypoxemia have been evaluated to risk-stratify patients with acute respiratory distress syndrome, the utility of longitudinal SpO2/FiO2 ratios is unknown. OBJECTIVE To assess time-based SpO2/FiO2 ratios ≤ 150-SpO2/FiO2 time at risk (SF-TAR)-for predicting mortality in mechanically ventilated patients. METHODS Retrospective, observational cohort study of mechanically ventilated patients at 21 community and 2 academic hospitals. Association between the SF-TAR in the first 24 hours of ventilation and mortality was examined using multivariable logistic regression and compared with the worst recorded isolated partial pressure of arterial oxygen/fraction of inspired oxygen (P/F) ratio. RESULTS In 28,758 derivation cohort admissions, every 10% increase in SF-TAR was associated with a 24% increase in adjusted odds of hospital mortality (adjusted odds ratio = 1.24; 95% confidence interval [CI] = 1.23-1.26); a similar association was observed in validation cohorts. Discrimination for mortality modestly improved with SF-TAR (area under the receiver operating characteristic curve [AUROC] = 0.81; 95% CI = 0.81-0.82) vs the worst P/F ratio (AUROC = 0.78; 95% CI = 0.78-0.79) and worst SpO2/FiO2 ratio (AUROC = 0.79; 95% CI = 0.79-0.80). The SF-TAR in the first 6 hours offered comparable discrimination for hospital mortality (AUROC = 0.80; 95% CI = 0.79-0.80) to the 24-hour SF-TAR. CONCLUSION The SF-TAR can identify ventilated patients at increased risk of death, offering modest improvements compared with single SpO2/FiO2 and P/F ratios. This longitudinal, noninvasive, and broadly generalizable tool may have particular utility for early phenotyping and risk stratification using electronic health record data in ventilated patients.
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Affiliation(s)
- Jason Y Adams
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Davis, Sacramento
| | - Angela J Rogers
- Division of Pulmonary and Critical Care Medicine, Stanford University, CA
| | | | | | | | - Sandra L Taylor
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Albert W Riedl
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | | | | | - Vincent X Liu
- Division of Research, Kaiser Permanente, Oakland, CA
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Abstract
PURPOSE OF REVIEW The burden of critical illness in low-income and middle-income countries (LMICs) is substantial. A better understanding of critical care outcomes is essential for improving critical care delivery in resource-limited settings. In this review, we provide an overview of recent literature reporting on critical care outcomes in LMICs. We discuss several barriers and potential solutions for a better understanding of critical care outcomes in LMICs. RECENT FINDINGS Epidemiologic studies show higher in-hospital mortality rates for critically ill patients in LMICs as compared with patients in high-income countries (HICs). Recent findings suggest that critical care interventions that are effective in HICs may not be effective and may even be harmful in LMICs. Little data on long-term and morbidity outcomes exist. Better outcomes measurement is beginning to emerge in LMICs through decision support tools that report process outcome measures, studies employing mobile health technologies with community health workers and the development of context-specific severity of illness scores. SUMMARY Outcomes from HICs cannot be reliably extrapolated to LMICs, so it is important to study outcomes for critically ill patients in LMICs. Specific challenges to achieving meaningful outcomes studies in LMICs include defining the critically ill population when few ICU beds exist, the resource-intensiveness of long-term follow-up, and the need for reliable severity of illness scores to interpret outcomes. Although much work remains to be done, examples of studies overcoming these challenges are beginning to emerge.
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Li J, Harnois LJ, Markos B, Roberts KM, Homoud SA, Liu J, Mirza S, Vines D. Epoprostenol Delivered via High Flow Nasal Cannula for ICU Subjects with Severe Hypoxemia Comorbid with Pulmonary Hypertension or Right Heart Dysfunction. Pharmaceutics 2019; 11:pharmaceutics11060281. [PMID: 31207936 PMCID: PMC6631264 DOI: 10.3390/pharmaceutics11060281] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/20/2022] Open
Abstract
Inhaled epoprostenol (iEPO) has been utilized to improve oxygenation in mechanically ventilated subjects with severe hypoxemia, but the evidence for iEPO via high-flow nasal cannula (HFNC) is rare. Following approval by the institutional review board, this retrospective cohort study evaluated subjects who received iEPO via HFNC for more than 30 min to treat severe hypoxemia comorbid with pulmonary hypertension or right heart dysfunction between July 2015 and April 2018. A total of 11 subjects were enrolled in the study of whom 4 were male (36.4%), age 57.5 ± 22.1 years, and APACHE II score at ICU admission was 18.5 ± 5.7. Ten subjects had more than three chronic heart or lung comorbidities; seven of them used home oxygen. After inhaling epoprostenol, subjects' SpO2/FIO2 ratio improved from 107.5 ± 26.3 to 125.5 ± 31.6 (p = 0.026) within 30-60 min. Five subjects (45.5%) had SpO2/FIO2 improvement >20%, which was considered as a positive response. Heart rate, blood pressure, and respiratory rate were not significantly different. Seven subjects did not require intubation, and seven subjects were discharged home. This retrospective study demonstrated the feasibility of iEPO via HFNC in improving oxygenation. Careful titration of flow while evaluating subjects' response may help identify responders and avoid delaying other interventions. This study supports the need for a larger prospective randomized control trial to further evaluate the efficacy of iEPO via HFNC in improving outcomes.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL 60130, USA.
| | - Lauren J Harnois
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL 60130, USA.
| | - Bethelhem Markos
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL 60130, USA.
| | - Keith M Roberts
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL 60130, USA.
| | - Salma Al Homoud
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL 60130, USA.
| | - Jing Liu
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL 60130, USA.
| | - Sara Mirza
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL 60130, USA.
| | - David Vines
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL 60130, USA.
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