Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk

Purpose Requiring PaO 2 /FiO 2 ratio (PF) to define ARDS may bias towards children with cardiovascular dysfunction and hypoxemia. We sought to evaluate (1) the Berlin definition of ARDS in children using PF; (2) the effect of substituting SpO 2 /FiO 2 (SF) ratio; (3) differences between patients wit...

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Bibliographic Details
Published in:Intensive care medicine 2015-01, Vol.41 (1), p.94-102
Main Authors: Khemani, Robinder G., Rubin, Sarah, Belani, Sanjay, Leung, Dennis, Erickson, Simon, Smith, Lincoln S., Zimmerman, Jerry J., Newth, Christopher J. L.
Format: Article
Language:English
Subjects:
Acute Lung Injury - diagnosis
Acute Lung Injury - physiopathology
Adolescent
Anesthesiology
Blood Gas Analysis
Catheters
Child
Child, Preschool
Critical Care Medicine
Electronic health records
Emergency Medicine
Female
Hospital Mortality
Humans
Illnesses
Infant
Intensive
Intensive care
Intensive Care Units, Pediatric
Male
Medicine
Medicine & Public Health
Mortality
Ostomy
Oximetry
Pain Medicine
Pediatric Original
Pediatrics
Pneumology/Respiratory System
Predictive Value of Tests
Pulse oximetry
Respiration, Artificial
Respiratory distress syndrome
Respiratory Function Tests
Retrospective Studies
Risk Factors
Severity of Illness Index
Ventilators
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Summary:Purpose Requiring PaO 2 /FiO 2 ratio (PF) to define ARDS may bias towards children with cardiovascular dysfunction and hypoxemia. We sought to evaluate (1) the Berlin definition of ARDS in children using PF; (2) the effect of substituting SpO 2 /FiO 2 (SF) ratio; (3) differences between patients with and without arterial blood gases; and (4) the ability of SpO 2 and PaO 2 indices to discriminate ICU mortality. Methods Single center retrospective review (3/2009–4/2013) of mechanically ventilated (MV) children. Initial values for PF, SF, oxygenation index (OI), and oxygen saturation index (OSI) after intubation and average values on day 1 of MV were analyzed against ICU mortality, subgrouped by Berlin severity categories. Results Of the 1,833 children included, 129 met Berlin PF ARDS criteria (33 % mortality); 312 met Berlin SF ARDS criteria (22 % mortality). Children with a PaO 2 on day 1 of MV had higher mortality and severity of illness, were older, and had more vasoactive-inotropic infusions ( p  
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-014-3486-2