Wong et al identified risk factors for increased mortality in a pediatric patient with the acute respiratory distress syndrome (ARDS). These can help to identify a patient who may benefit from more aggressive management. The authors are from KK Women's and Children's Hospital (Singapore), Duke-NUS Graduate School of Medicine (Singapore), and Universidade Federal de Sao Paulo in Brazil.
Patient selection: 1 day to 16 years
Shared Parameter
Uses PaO2
Uses SpO2
FIO2
P/F ratio
S/F ratio
FIO2 and MAP
OI (oxygenation index)
OSI (oxygen saturation index)
Index
Not ALI
ALI
ARDS
P/F ratio
> 300
200 to 300
< 200 (moderate), < 100 (severe)
S/F ratio
> 253
212 to 253
< 212
oxygenation index
< 5.3
5.3 to 8.1
> 8.1
oxygen saturation index
< 6.5
6.5 to 7.8
> 7.8
Values of the indices at baseline did not identify survivors or non-survivors. The P/F ratio and oxygenation index identified survivors at 24 hours. All 4 indices identified survivors at day 3 and 7.
The P/F and S/F ratio in survivors show a steady increase from the initial values while non-survivors show little or no change. Values in survivors are higher than non-survivors at each stage.
The OI and OSI indices show a steady decrease from the initial value in survivors but show little or no change in non-survivors. Values of survivors are lower than those of non-survivors at each stage.
Other predictors for mortality:
(1) an underlying comorbid condition
(2) multi-organ dysfunction
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