Acute and Critical Care

  • 제33권4호
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  • Pages.222-229
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  • 2018
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  • 2586-6052(pISSN)
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  • 2586-6060(eISSN)
대한중환자의학회 (Korean Society of Critical Care Medicine)
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Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children

  • Kim, Soo Yeon (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Byuhree (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Choi, Sun Ha (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Jong Deok (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Sol, In Suk (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Min Jung (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Yoon Hee (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Kyung Won (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Sohn, Myung Hyun (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Kyu-Earn (Department of Pediatrics, Yonsei University College of Medicine)
  • 투고 : 2018.04.20
  • 심사 : 2018.08.27
  • 발행 : 2018.11.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS. Methods: Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality. Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001). Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

키워드

과제정보

연구 과제번호 : Development of Big Data Analytics Platform for Military Health Information

연구 과제 주관 기관 : Institute for Information & Communications Technology

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