Chest
Original Research: Critical CareOxygenation Saturation Index Predicts Clinical Outcomes in ARDS
Section snippets
Study Design
This trial was a nested retrospective cohort study of patients prospectively enrolled in the Validating Acute Lung Injury Markers for Diagnosis (VALID) study. Patients who were eligible for enrollment in VALID were ≥ 18 years old and admitted to the Vanderbilt University Medical Center medical, surgical, cardiovascular, or trauma ICU for at least 2 days. Full inclusion and exclusion criteria have been previously described elsewhere.24 Written informed consent was obtained at the time of
Patient Characteristics
A total of 329 patients met inclusion criteria for this study. Demographic characteristics and clinical data are described in Table 1. Predicted body weights were not available in the VALID study. Average tidal volume/kilogram (based on actual weight on day of diagnosis as we did not have height available for all patients to calculate ideal body weight) was 5.7 ± 1.9 cc/kg. The highest PEEP value on the day of ARDS diagnosis was 10 ± 4 cm H2O.
OI and OSI Are Strongly Correlated With Each Other
In this cohort of patients, OI and OSI were strongly
Discussion
In 329 adults with ARDS who were mechanically ventilated, the OSI was highly correlated with the OI. Both the OSI and the OI were independently associated with fewer VFDs, whereas the traditional metric for characterizing ARDS severity, Pao2/Fio2, was not. Among the ARDS severity measures analyzed, only OSI was significantly associated with mortality in this cohort. Furthermore, both OSI and OI were superior to the Pao2/Fio2 in prognostic performance. Based on analysis of receiver-operating
Conclusions
Measurement of the OSI on the day of ARDS diagnosis performed as well as the OI in predicting clinical outcomes, was simple to calculate and continuously available, and offered more prognostic information than traditional measures of ARDS severity such as Pao2/Fio2, while avoiding invasive arterial blood gas monitoring.
Acknowledgments
Author contributions: L. B. W. is the guarantor of this study and had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. K. D. served as principal author; K. D. and L. B. W. contributed to the study concept design and writing of the manuscript; and J. B. M., C. M. S., J. A. B., and C. W. contributed to data analysis and interpretation, study design, statistical
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2022, The Lancet Respiratory MedicineCitation Excerpt :The non-invasive OSI might have more prognostic validity than the arterial blood gas-based OI. In a retrospective observational study of 329 patients with ARDS, the OSI and OI were closely correlated with each other (ρ=0·862, p<0·001), but the OSI was independently associated with mortality when adjusted for age, sex, and severity of illness (adjusted OR for each 1-point increase in OSI 1·228, 95% CI 1·056–1·429, p=0·008), whereas the OI was not.9 These findings indicate that the OSI is both a good surrogate for the OI and potentially more sensitive for the severity of respiratory failure because it is calculated from the continuously available SpO2.
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2022, Respiratory InvestigationCitation Excerpt :When the cutoff value is 100 (19 studies [129,134–151]: N = 15,040), the integrated sensitivity was 0.43 (95% CI: 0.37–0.50) and integrated specificity was 0.70 (95% CI: 0.66–0.74). When the cutoff value was 200 (20 studies [129,134,135,137–150,152–154]: N = 15,489), the integrated sensitivity was 0.85 (95% CI: 0.81–0.88) and integrated specificity was 0.24 (95% CI: 0.21–0.29). In consideration of the risk of bias, inconsistency, and inaccuracy, the certainty of evidence was judged as “very low.”
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FUNDING/SUPPORT: This study was funded by the National Institutes of Health [grant HL103836], Courtney’s Race for the ARDS Cure, the Courtney Charneco Family, and the Vanderbilt Office of Medical Student Research.