Dataset Information

Prognostic classification based on P/F and PEEP in invasively ventilated ICU patients with hypoxemia-insights from the MARS study.

ABSTRACT:

Background

Outcome prediction in patients with acute respiratory distress syndrome (ARDS) greatly improves when patients are reclassified based on predefined arterial oxygen partial pressure to fractional inspired oxygen ratios (PaO₂/FiO₂) and positive end-expiratory pressure (PEEP) cutoffs 24?h after the initial ARDS diagnosis. The aim of this study was to test whether outcome prediction improves when patients are reclassified based on predefined PaO₂/FiO₂ and PEEP cutoffs 24?h after development of mild hypoxemia while not having ARDS.

Methods

Post hoc analysis of a large prospective, multicenter, observational study that ran in the ICUs of two academic hospitals in the Netherlands between January 2011 and December 2013. Patients were classified into four groups using predefined cutoffs for PaO₂/FiO₂ (250?mmHg) and PEEP (5?cm H₂O), both at onset of hypoxemia and after 24?h: PaO₂/FiO₂ ? 250?mmHg and PEEP < 6?cm H₂O (group I), PaO₂/FiO₂ ? 250?mmHg and PEEP ? 6?cm H₂O (group II), PaO₂/FiO₂ < 250?mmHg and PEEP < 6?cm H₂O (group III), and PaO₂/FiO₂ < 250?mmHg and PEEP ? 6?cm H₂O (group IV), to look for trend association with all-cause in-hospital mortality, the primary outcome. Secondary outcome were ICU- and 90-day mortality, and the number of ventilator-free days or ICU-free days and alive at day 28.

Results

The analysis included 689 consecutive patients. All-cause in-hospital mortality was 35%. There was minimal variation in mortality between the four groups at onset of hypoxemia (33, 36, 38, and 34% in groups I to IV, respectively; P = 0.65). Reclassification after 24?h resulted in a strong trend with increasing mortality from group I to group IV (31, 31, 37, and 48% in groups I to IV, respectively; P < 0.01). Similar trends were found for the secondary endpoints.

Conclusions

Reclassification using PaO₂/FiO₂ and PEEP cutoffs after 24?h improved classification for outcome in invasively ventilated ICU patients with hypoxemia not explained by ARDS, compared to classification at onset of hypoxemia.

Trial registration

ClinicalTrials.gov identifier: NCT01905033. Registered on July 11, 2013. Retrospectively registered.

SUBMITTER: Simonis FD

PROVIDER: S-EPMC7746417 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Prognostic classification based on P/F and PEEP in invasively ventilated ICU patients with hypoxemia-insights from the MARS study.

Simonis Fabienne D FD Schouten Laura R A LRA Cremer Olaf L OL Ong David S Y DSY Amoruso Gabriele G Cinella Gilda G Schultz Marcus J MJ Bos Lieuwe D LD

Intensive care medicine experimental 20201218 Suppl 1

<h4>Background</h4>Outcome prediction in patients with acute respiratory distress syndrome (ARDS) greatly improves when patients are reclassified based on predefined arterial oxygen partial pressure to fractional inspired oxygen ratios (PaO<sub>2</sub>/FiO<sub>2</sub>) and positive end-expiratory pressure (PEEP) cutoffs 24 h after the initial ARDS diagnosis. The aim of this study was to test whether outcome prediction improves when patients are reclassified based on predefined PaO<sub>2</sub>/Fi ...[more]

PMID: 33336322

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Project description:BACKGROUND:Information is limited regarding the prevalence, management, and outcome of hypoxemia among intensive care unit (ICU) patients. We assessed the prevalence and severity of hypoxemia in ICU patients and analyzed the management and outcomes of hypoxemic patients. METHODS:This is a multinational, multicenter, 1-day point prevalence study in 117 ICUs during the spring of 2016. All patients hospitalized in an ICU on the day of the study could be enrolled. Hypoxemia was defined as a PaO2/FiO2 ratio???300 mmHg and classified as mild (PaO2/FiO2 between 300 and 201), moderate (PaO2/FiO2 between 200 and 101), and severe (PaO2/FiO2???100 mmHg). RESULTS:Of 1604 patients included, 859 (54%, 95% CI 51-56%) were hypoxemic, 51% with mild (n?=?440), 40% with moderate (n?=?345), and 9% (n?=?74) with severe hypoxemia. Among hypoxemic patients, 61% (n?=?525) were treated with invasive ventilation, 10% (n?=?84) with non-invasive ventilation, 5% (n?=?45) with high-flow oxygen therapy, 22% (n?=?191) with standard oxygen, and 1.6% (n?=?14) did not receive oxygen. Protective ventilation was widely used in invasively ventilated patients. Twenty-one percent of hypoxemic patients (n?=?178) met criteria for acute respiratory distress syndrome (ARDS) including 65 patients (37%) with mild, 82 (46%) with moderate, and 31 (17%) with severe ARDS. ICU mortality was 27% in hypoxemic patients and significantly differed according to severity: 21% in mild, 26% in moderate, and 50% in patients with severe hypoxemia, p?<?0.001. Multivariate Cox regression identified moderate and severe hypoxemia as independent factors of ICU mortality compared to mild hypoxemia (adjusted hazard ratio 1.38 [1.00-1.90] and 2.65 [1.69-4.15], respectively). CONCLUSIONS:Hypoxemia affected more than half of ICU patients in this 1-day point prevalence study, but only 21% of patients had ARDS criteria. Severity of hypoxemia was an independent risk factor of mortality among hypoxemic patients. Trial registration NCT 02722031.

Dataset Information

Prognostic classification based on P/F and PEEP in invasively ventilated ICU patients with hypoxemia-insights from the MARS study.

Background

Methods

Results

Conclusions

Trial registration

Publications

Prognostic classification based on P/F and PEEP in invasively ventilated ICU patients with hypoxemia-insights from the MARS study.

Similar Datasets

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