Oxygenation Index, Oxygen Saturation Index vs PaO2/FiO2 *PEEP: A Secondary Analysis of OXIVA-CARDS Study.

IF 1.5 Q3 CRITICAL CARE MEDICINE
Sonali Mr Vadi, Neha Sanwalka, Durga Suthar
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引用次数: 0

Abstract

Background: The classification of Berlin definition is based on the PaO2/FiO2 ratio, which has been found to have a poor association with mortality. Airway pressures reflect lung compliance and the settings of mechanical ventilators. In this study, we aimed to investigate the change in the severity of COVID-19-associated acute respiratory distress syndrome (ARDS) classification using [PaO2/FiO2 × PEEP] (P/FP) ratio compared to the traditional P/F ratio, and whether the P/FP ratio improves the predictive validity of in-hospital mortality.

Methods: Our study sample included patients from the OXIVA-CARDS study. In this secondary analysis, we examined the oxygenation index and oxygen saturation index in relation to the P/FP ratio, as well as the risk of P/FP in mortality. We used Pearson's correlation to assess the relationships between various parameters. Receiver operating characteristic analysis with Youden's index was used to compare the prognostic value of the oxygenation index (OI), oxygen saturation index (OSI), P/F ratio, P/FP ratio, and SaO2/FiO2 ratio for predicting overall mortality. Multiple logistic regression was also performed to determine the impact of mean airway pressure (Pmean), S/F ratio, OI, and P/FP ratio on mortality.

Results: A total of 201 patients (with 1543 measurements) were included in the analysis. Overall, 522 (34%) were reclassified into either more or less severe categories. Patients who were classified as having severe ARDS based on the P/FP ratio had significantly lower P/FP ratio, oxygenation index, and A-a O2 gradient as compared to those classified as having severe ARDS based on the P/F ratio (p < 0.05) at all levels of ARDS severity. On multivariate regression analysis, only the OI significantly impacted mortality (p < 0.05).

Conclusion: We observed that the oxygen index and oxygen saturation index were more sensitive than the PaO2/FiO2 ratio and P/FP ratio. Additionally, only the oxygenation index had a significant impact on mortality. By including airway pressures in the calculation of the OI, its predictive ability is enhanced compared to using the S/F ratio, P/F ratio, or P/FP ratio.

Highlights: The sensitivity of mortality by including Pmean is higher as compared to when only PEEP is taken into consideration. P/FP is a weak predictor of mortality as compared to OI and OSI.

How to cite this article: Vadi SMR, Sanwalka N, Suthar D. Oxygenation Index, Oxygen Saturation Index vs PaO2/FiO2 *PEEP: A Secondary Analysis of OXIVA-CARDS Study. Indian J Crit Care Med 2024;28(10):917-922.

氧合指数、氧饱和度指数与 PaO2/FiO2 *PEEP:OXIVA-CARDS 研究的二次分析。
背景:柏林定义的分类以 PaO2/FiO2 比率为基础,而 PaO2/FiO2 比率与死亡率关系不大。气道压力反映了肺顺应性和机械呼吸机的设置。在本研究中,我们旨在探讨与传统的 P/F 比值相比,使用[PaO2/FiO2×PEEP](P/FP)比值对 COVID-19 相关急性呼吸窘迫综合征(ARDS)严重程度进行分类的变化,以及 P/FP 比值是否能提高院内死亡率的预测有效性:我们的研究样本包括 OXIVA-CARDS 研究的患者。在这项二次分析中,我们研究了氧合指数和血氧饱和度指数与 P/FP 比值的关系,以及 P/FP 在死亡率中的风险。我们使用皮尔逊相关性来评估各种参数之间的关系。使用Youden指数的接收者操作特征分析比较了氧合指数(OI)、血氧饱和度指数(OSI)、P/F比值、P/FP比值和SaO2/FiO2比值在预测总死亡率方面的预后价值。此外,还进行了多元逻辑回归,以确定平均气道压(Pmean)、S/F 比值、OI 和 P/FP 比值对死亡率的影响:共有 201 名患者(1543 次测量)被纳入分析。总计有 522 人(34%)被重新分类为较严重或较不严重的类别。根据 P/FP 比值被归类为重度 ARDS 的患者与根据 P/F 比值被归类为重度 ARDS 的患者相比,在所有 ARDS 严重程度级别上,P/FP 比值、氧合作用指数和 A-a 氧梯度都明显较低(P < 0.05)。在多变量回归分析中,只有氧合指数对死亡率有显著影响(P < 0.05):我们观察到,氧合指数和氧饱和度指数比 PaO2/FiO2 比值和 P/FP 比值更敏感。此外,只有氧合指数对死亡率有显著影响。与使用 S/F 比值、P/F 比值或 P/FP 比值相比,在计算氧饱和指数时加入气道压力可提高其预测能力:亮点:与仅考虑 PEEP 相比,将 Pmean 计算在内对死亡率的敏感性更高。与 OI 和 OSI 相比,P/FP 对死亡率的预测作用较弱:Vadi SMR, Sanwalka N, Suthar D. 氧合指数、氧饱和度指数与 PaO2/FiO2 *PEEP:OXIVA-CARDS 研究的二次分析。Indian J Crit Care Med 2024;28(10):917-922.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.50
自引率
10.00%
发文量
299
期刊介绍: Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.
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