The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Early Oxygenation Index Improvement is Associated with Favorable Outcome of Acute Respiratory Distress Syndrome in Adults Receiving High Frequency Oscillatory Ventilation

Chun-Cheih Yang MD, John D. Davies RRT FAARC, Yuh-Chin T. Huang MD, Michael A. Gentile RRT FAARC, Ira M. Cheifetz MD FAARC, Neil R. MacIntyre MD, FAARC Duke University Medical Center Durham, NC

Background: Patients with acute respiratory distress syndrome (ARDS) often require escalating ventilatory support such as high-frequency oscillatory ventilation (HFOV). The purpose of this study is to evaluate the association of 30-day mortality and the average oxygenation index (OI) (mPaw × FiO2/PaO2) change between the 12th hour and 24th hour after initiation of HFOV in adults with ARDS.

Methods: We retrospectively reviewed ARDS patients managed with HFOV from March, 2001 to October, 2005.

Results: 75 adult patients with ARDS were treated with HFOV. All 75 patients had severe ARDS as evidenced by a pre-HFOV mean PaO2 / FiO2 ratio of 84 ± 27 mmHg, and an OI of 27.7 ± 12.9. The most common etiology of ARDS was pneumonia (44 patients). The mean (± SD) APACHE II score was 23.9 ± 6.1. The mean duration of conventional ventilation prior to HFOV was 4.2 ± 5.5 days. The 30-day mortality rate was 25.3%. The OI change (baseline OI - OI at 12-24 hours post-HFOV) was the only significant index between survivors and non-survivors (p = 0.002). Based on the receiver operating characteristic (ROC) curve, the OI change of ≥ 0.035 had specificity, sensitivity, positive predictive value and negative predictive value of 74%, 68%, 88% and 44%, respectively for predicting survival.

Conclusions: Improvement in OI from 12 to 24 hours after initiation of HFOV is associated with better survival. Monitoring OI during the first day of HFOV may identify a subgroup of patients who mostly likely would benefit from HFOV.


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