Predictors of mortality in acute lung injury during the era of lung protective ventilation
Open Access
- 1 November 2008
- Vol. 63 (11), 994-998
- https://doi.org/10.1136/thx.2007.093658
Abstract
Background: Lung protective ventilation has been widely adopted for the management of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Consequently, ventilator associated lung injury and mortality have decreased. It is not known if this ventilation strategy changes the prognostic value of previously identified demographic and pulmonary predictors of mortality, such as respiratory compliance and the arterial oxygen tension to inspired oxygen fraction ratio (Pao2/Fio2). Methods: Demographic, clinical, laboratory and pulmonary variables were recorded in 149 patients with ALI/ARDS. Significant predictors of mortality were identified in bivariate analysis and these were entered into multivariate analysis to identify independent predictors of mortality. Results: Hospital mortality was 41%. In the bivariate analysis, 17 variables were significantly correlated with mortality, including age, APACHE II score and the presence of cirrhosis. Pulmonary parameters associated with death included Pao2/Fio2 and oxygenation index ((mean airway pressure×Fio2×100)÷Pao2). In unadjusted analysis, the odds ratio (OR) of death for Pao2/Fio2 was 1.57 (CI 1.12 to 3.04) per standard deviation decrease. However, in adjusted analysis, Pao2/Fio2 was not a statistically significant predictor of death, with an OR of 1.29 (CI 0.82 to 2.02). In contrast, oxygenation index (OI) was a statistically significant predictor of death in both unadjusted analysis (OR 1.89 (CI 1.28 to 2.78)) and in adjusted analysis (OR 1.84 (CI 1.13 to 2.99)). Conclusions: In this cohort of patients with ALI/ARDS, OI was an independent predictor of mortality, whereas Pao2/Fio2 was not. OI may be a superior predictor because it integrates both airway pressure and oxygenation into a single variable.This publication has 30 references indexed in Scilit:
- Oxygenation index for extracorporeal membrane oxygenation: is there predictive significance?Journal of Artificial Organs, 2007
- Incidence and Outcomes of Acute Lung InjuryThe New England Journal of Medicine, 2005
- Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2004
- Pulmonary Dead-Space Fraction as a Risk Factor for Death in the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2002
- Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2000
- The injury severity score—Importance and usesAnnals of Epidemiology, 1995
- Epidemiology of the Adult Respiratory Distress SyndromeSeminars in Respiratory and Critical Care Medicine, 1994
- A New Simplified Acute Physiology Score (SAPS II) Based on a European/North American Multicenter StudyJAMA, 1993
- A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter studyJAMA, 1993
- APACHE II-A Severity of Disease Classification SystemCritical Care Medicine, 1986