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Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study
BACKGROUND: Oxygenation index [OI = (MAP × FiO(2) × 100)/PaO(2)] assesses the severity of hypoxic respiratory failure. Oxygen saturation index [OSI = (MAP × FiO(2) × 100)/SpO(2)] is a noninvasive method to assesses the severity of hypoxic respiratory failure. Conventionally used PaO(2)/FiO(2) (P/F)...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Jaypee Brothers Medical Publishers
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626227/ https://www.ncbi.nlm.nih.gov/pubmed/37936792 http://dx.doi.org/10.5005/jp-journals-10071-24560 |
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author | Vadi, Sonali Suthar, Durga Sanwalka, Neha |
author_facet | Vadi, Sonali Suthar, Durga Sanwalka, Neha |
author_sort | Vadi, Sonali |
collection | PubMed |
description | BACKGROUND: Oxygenation index [OI = (MAP × FiO(2) × 100)/PaO(2)] assesses the severity of hypoxic respiratory failure. Oxygen saturation index [OSI = (MAP × FiO(2) × 100)/SpO(2)] is a noninvasive method to assesses the severity of hypoxic respiratory failure. Conventionally used PaO(2)/FiO(2) (P/F) ratio to measure the severity of ARDS requires arterial blood gas (ABG) sampling. It tenders limited prognostic information mandating the need for better markers. Oxygenation index (needs arterial sampling) and OSI (a noninvasive method) are substitutes to provide mortality information in ARDS patients. We evaluated the correlation between P/F, OI, and OSI in invasively ventilated COVID-19 ARDS patients (C-ARDS) and looked at its relationship with mortality. PATIENTS AND METHODS: A retrospective study of invasively ventilated C-ARDS >18 years of age managed in COVID ICU. Ventilator settings (FiO(2), mean airway pressure), pulse oximetry (SpO(2)), and ABG values (PaO(2)) were simultaneously noted at the time of sample collection. Patient outcomes (alive and deceased) were documented. Differences in parameters between survivors and nonsurvivors were assessed using independent sample t-test. Receiver operating characteristic (ROC) analysis with Youden's index was used to identify cutoff values to determine survival. RESULTS: A total of 1557 measurements for 203 patients were collected over the maximum duration of 21 days after ventilation. About 147 (72.4%) were males and 56 (27.6%) were females. On day one of ventilation, 161 (79.3%) had P/F ratio <200, 28 (13.8%) had P/F ratio between 200 and 300, and 14 (6.9%) had P/F ratio >300. There was a linear relationship between P/F ratio and OSI (r = −0.671), P/F and OI (r = −0.753), and OSI and OI (r = 0.893) (p < 0.001). After natural log transform, the correlation between these factors became stronger [P/F ratio and OSI (r = −0.797), PF and OI (r = −0.949), and OSI and OI (r = 0.902) (p < 0.001)]. About 74 (36.5%) patients survived. Survivors had significantly higher P/F ratio as compared with nonsurvivors (p < 0.05). Oxygen saturation index and OI were significantly lower in survivors as compared with nonsurvivors. Based on day-1 reading, a higher OSI (AUC = 0.719, 95% CI = 0.648–0.790) and OI (AUC = 0.752. 95% CI = 0.684–0.819) significantly can predict mortality. On the other hand, a higher P/F ratio can predict survival (AUC = 0.734, 95% CI = 0.664–0.805). P/F ratio of 160 on day 1 can predict survival. Oxygen saturation index values above 10.4% and OI above 13.5% were the cutoff derived for day 1 values to predict mortality. CONCLUSION: Noninvasive OSI can be used to assess the severity of hypoxic respiratory failure in C-ARDS without arterial access in resource-limited settings. Oxygen saturation index can noninvasively provide prognostic information in invasively ventilated C-ARDS patients. HOW TO CITE THIS ARTICLE: Vadi S, Suthar D, Sanwalka N. Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study. Indian J Crit Care Med 2023;27(11):801–805. |
format | Online Article Text |
id | pubmed-10626227 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Jaypee Brothers Medical Publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-106262272023-11-07 Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study Vadi, Sonali Suthar, Durga Sanwalka, Neha Indian J Crit Care Med Original Article BACKGROUND: Oxygenation index [OI = (MAP × FiO(2) × 100)/PaO(2)] assesses the severity of hypoxic respiratory failure. Oxygen saturation index [OSI = (MAP × FiO(2) × 100)/SpO(2)] is a noninvasive method to assesses the severity of hypoxic respiratory failure. Conventionally used PaO(2)/FiO(2) (P/F) ratio to measure the severity of ARDS requires arterial blood gas (ABG) sampling. It tenders limited prognostic information mandating the need for better markers. Oxygenation index (needs arterial sampling) and OSI (a noninvasive method) are substitutes to provide mortality information in ARDS patients. We evaluated the correlation between P/F, OI, and OSI in invasively ventilated COVID-19 ARDS patients (C-ARDS) and looked at its relationship with mortality. PATIENTS AND METHODS: A retrospective study of invasively ventilated C-ARDS >18 years of age managed in COVID ICU. Ventilator settings (FiO(2), mean airway pressure), pulse oximetry (SpO(2)), and ABG values (PaO(2)) were simultaneously noted at the time of sample collection. Patient outcomes (alive and deceased) were documented. Differences in parameters between survivors and nonsurvivors were assessed using independent sample t-test. Receiver operating characteristic (ROC) analysis with Youden's index was used to identify cutoff values to determine survival. RESULTS: A total of 1557 measurements for 203 patients were collected over the maximum duration of 21 days after ventilation. About 147 (72.4%) were males and 56 (27.6%) were females. On day one of ventilation, 161 (79.3%) had P/F ratio <200, 28 (13.8%) had P/F ratio between 200 and 300, and 14 (6.9%) had P/F ratio >300. There was a linear relationship between P/F ratio and OSI (r = −0.671), P/F and OI (r = −0.753), and OSI and OI (r = 0.893) (p < 0.001). After natural log transform, the correlation between these factors became stronger [P/F ratio and OSI (r = −0.797), PF and OI (r = −0.949), and OSI and OI (r = 0.902) (p < 0.001)]. About 74 (36.5%) patients survived. Survivors had significantly higher P/F ratio as compared with nonsurvivors (p < 0.05). Oxygen saturation index and OI were significantly lower in survivors as compared with nonsurvivors. Based on day-1 reading, a higher OSI (AUC = 0.719, 95% CI = 0.648–0.790) and OI (AUC = 0.752. 95% CI = 0.684–0.819) significantly can predict mortality. On the other hand, a higher P/F ratio can predict survival (AUC = 0.734, 95% CI = 0.664–0.805). P/F ratio of 160 on day 1 can predict survival. Oxygen saturation index values above 10.4% and OI above 13.5% were the cutoff derived for day 1 values to predict mortality. CONCLUSION: Noninvasive OSI can be used to assess the severity of hypoxic respiratory failure in C-ARDS without arterial access in resource-limited settings. Oxygen saturation index can noninvasively provide prognostic information in invasively ventilated C-ARDS patients. HOW TO CITE THIS ARTICLE: Vadi S, Suthar D, Sanwalka N. Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study. Indian J Crit Care Med 2023;27(11):801–805. Jaypee Brothers Medical Publishers 2023-11 /pmc/articles/PMC10626227/ /pubmed/37936792 http://dx.doi.org/10.5005/jp-journals-10071-24560 Text en Copyright © 2023; The Author(s). https://creativecommons.org/licenses/by-nc/4.0/© The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Original Article Vadi, Sonali Suthar, Durga Sanwalka, Neha Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study |
title | Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study |
title_full | Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study |
title_fullStr | Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study |
title_full_unstemmed | Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study |
title_short | Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study |
title_sort | correlation and prognostic significance of oxygenation indices in invasively ventilated adults (oxiva-cards) with covid-19-associated ards: a retrospective study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626227/ https://www.ncbi.nlm.nih.gov/pubmed/37936792 http://dx.doi.org/10.5005/jp-journals-10071-24560 |
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