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2008, Number 3

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Med Crit 2008; 22 (3)

Indexes of oxygenation as prognostic factory of ards early and late

Colín EV, Monares ZE, Sánchez CC, Elizalde GJJ, Poblano MM, Aguirre SJ, Martínez SJ

Language: Spanish
References: 17
Page: 131-142
PDF size: 190.33 Kb.


ABSTRACT

Introduction: ARDS remains a common reason for admission to the ICU. PaO2/FiO2 ratio is not a good predictor of mortality, but remains the most accepted index of oxygen exchange. We examined several index of oxygenation during the evolution of ARDS.
Methods: We studied 82 patients meeting criteria for ARDS. The patients were ventilated in volume-controlled mode with a tidal volume of 6 mL/kg body weight in ARDS net lung-protective protocol. Two groups were developed survivors (S) and non survivors (NS), age, gender, pulmonary etiology of ARDS, mechanical ventilation length days, oxygenation indexes they were gathered. A proposed index (PaO2/FIO2)/PEEP was calculated.
Results: PaO2 was not significant. The PaO2/FIO2 ratio in day one for NS 138 (105-178), for S 121(81-138) with a p 0.028, for the third day PaO2/FiO2 NS 177 (131-229), S 145(117-217), with a p 0.15, for the seventh day NS 158 (136-199) S 140 (115-186) p 0.18. For index (PaO2/FIO2)/PEEP day one NS 12.5 (7.9-25) S 10.7 (6.2-20.7) p 0.33. For the third day NS 15.6 (10.8-24.4) S 11.2 (8.4-14.7) p 0.010. For the seventh day NS 13.3 (10.8-27.5) S 10.6 (7.8-17.9) p 0.026. For the pulmonary ARDS subgroup PaO2 and PaO2/FiO2 ratio was not of utility in the prediction of mortality in days one, third and seventh. The index (PaO2/FiO2)/PEEP for the third day NS 16 (11.8-30.7) S 11.12 (8.2-14.4) p 0.05. In extra pulmonary ARDS only PaO2/FIO2 ratio day one was significant for predictive mortality NS 168 (124-191) S 121 (65-141) p 0.005. The best point of court for PaO2/FIO2 ratio day one was 143 sensibility (sen) 82% specificity (sp) 67% area under the curve (auc) 0.642, third day 152 sen 52% sp 67%, auc 0.606, seventh day 160 sen 47% sp 67% auc 0.618. For the (PaO2/FIO2)/PEEP third day 14.3 sen 67% sp 60% auc 0.630, seventh day 10.8 sen 60%, sp 79% auc 0.703.
Conclusion: The PaO2/FIO2 ratio in the day one is useful for predict mortality, but not in the subsequent days. The (PaO2/FiO2)/PEEP index is better predictor specially in the days third and seventh.


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