The Use of the Oxygenation Stretch Index to Predict Outcomes in Mechanically Ventilated Patients With COVID-19 ARDS.
COVID-19
acute respiratory distress syndrome
outcome assessment
prognostic
Journal
Respiratory care
ISSN: 1943-3654
Titre abrégé: Respir Care
Pays: United States
ID NLM: 7510357
Informations de publication
Date de publication:
25 Nov 2023
25 Nov 2023
Historique:
pmc-release:
01
12
2024
medline:
27
11
2023
pubmed:
5
7
2023
entrez:
4
7
2023
Statut:
epublish
Résumé
In ARDS caused by COVID-19 pneumonia, appropriate adjustment of physiologic parameters based on lung stretch or oxygenation may optimize the ventilatory strategy. This study aims to describe the prognostic performance on 60-d mortality of single and composite respiratory variables in subjects with COVID-19 ARDS who are on mechanical ventilation with a lung-protective strategy, including the oxygenation stretch index combining oxygenation and driving pressure (ΔP). This single-center observational cohort study enrolled 166 subjects on mechanical ventilation and diagnosed with COVID-19 ARDS. We evaluated their clinical and physiologic characteristics. The primary study outcome was 60-d mortality. Prognostic factors were evaluated through receiver operating characteristic analysis, Cox proportional hazards regression model, and Kaplan-Meier survival curves. Mortality at day 60 was 18.1%, and hospital mortality was 22.9%. Oxygenation, ΔP, and composite variables were tested: oxygenation stretch index ([Formula: see text]/[Formula: see text] divided by ΔP) and ΔP × 4 + breathing frequency (f) (ΔP × 4 + f). At both day 1 and day 2 after inclusion, the oxygenation stretch index had the best area under the receiver operating characteristic curve (oxygenation stretch index on day 1 0.76 (95% CI 0.67-0.84) and on day 2 0.83 (95% CI 0.76-0.91) to predict 60-d mortality, although without significant difference from other indexes. In multivariable Cox regression, ΔP, [Formula: see text]/[Formula: see text], ΔP × 4 + f, and oxygenation stretch index were all associated with 60-d mortality. When dichotomizing the variables, ΔP ≥ 14, [Formula: see text]/[Formula: see text] ≤ 152 mm Hg, ΔP × 4 + f ≥ 80, and oxygenation stretch index < 7.7 showed lower 60-d survival probability. At day 2, after optimization of ventilatory settings, the subjects who persisted with the worse cutoff values for the oxygenation stretch index showed a lower probability of survival at 60 d compared with day 1; this was not the case for other parameters. The oxygenation stretch index, which combines [Formula: see text]/[Formula: see text] and ΔP, is associated with mortality and may be useful to predict clinical outcomes in COVID-19 ARDS.
Sections du résumé
BACKGROUND
BACKGROUND
In ARDS caused by COVID-19 pneumonia, appropriate adjustment of physiologic parameters based on lung stretch or oxygenation may optimize the ventilatory strategy. This study aims to describe the prognostic performance on 60-d mortality of single and composite respiratory variables in subjects with COVID-19 ARDS who are on mechanical ventilation with a lung-protective strategy, including the oxygenation stretch index combining oxygenation and driving pressure (ΔP).
METHODS
METHODS
This single-center observational cohort study enrolled 166 subjects on mechanical ventilation and diagnosed with COVID-19 ARDS. We evaluated their clinical and physiologic characteristics. The primary study outcome was 60-d mortality. Prognostic factors were evaluated through receiver operating characteristic analysis, Cox proportional hazards regression model, and Kaplan-Meier survival curves.
RESULTS
RESULTS
Mortality at day 60 was 18.1%, and hospital mortality was 22.9%. Oxygenation, ΔP, and composite variables were tested: oxygenation stretch index ([Formula: see text]/[Formula: see text] divided by ΔP) and ΔP × 4 + breathing frequency (f) (ΔP × 4 + f). At both day 1 and day 2 after inclusion, the oxygenation stretch index had the best area under the receiver operating characteristic curve (oxygenation stretch index on day 1 0.76 (95% CI 0.67-0.84) and on day 2 0.83 (95% CI 0.76-0.91) to predict 60-d mortality, although without significant difference from other indexes. In multivariable Cox regression, ΔP, [Formula: see text]/[Formula: see text], ΔP × 4 + f, and oxygenation stretch index were all associated with 60-d mortality. When dichotomizing the variables, ΔP ≥ 14, [Formula: see text]/[Formula: see text] ≤ 152 mm Hg, ΔP × 4 + f ≥ 80, and oxygenation stretch index < 7.7 showed lower 60-d survival probability. At day 2, after optimization of ventilatory settings, the subjects who persisted with the worse cutoff values for the oxygenation stretch index showed a lower probability of survival at 60 d compared with day 1; this was not the case for other parameters.
CONCLUSIONS
CONCLUSIONS
The oxygenation stretch index, which combines [Formula: see text]/[Formula: see text] and ΔP, is associated with mortality and may be useful to predict clinical outcomes in COVID-19 ARDS.
Identifiants
pubmed: 37402585
pii: respcare.10903
doi: 10.4187/respcare.10903
pmc: PMC10676243
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1683-1692Informations de copyright
Copyright © 2023 by Daedalus Enterprises.
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