https://doi.org/10.4081/monaldi.2024.2840
Prognostic value of the oxygenation index measured during mechanical ventilation and weaning. A retrospective cohort study
Submitted: November 2, 2023
Accepted: April 30, 2024
Published: July 23, 2024
Accepted: April 30, 2024
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PDF_EARLY VIEW: 93
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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The aim of this study was to investigate the predictive value of the ratio of oxygen saturation (ROX) index calculated during mechanical ventilation (MV) and the weaning period in evaluating readiness to weaning and the success of the spontaneous breathing trial (SBT), extubation, and mortality. We also compared the results of the ROX index calculated with partial arterial oxygen pressure (PaO2), arterial oxygen saturation (SaO2%), and probe oxygen saturation (SpO2%). In this retrospective cohort study, the ROX index was calculated by SpO2%, PaO2, and SaO2% separately using the ROX index formula (PaO2 or SaO2 or SpO2 /FiO2)/respiratory rate. ROX was calculated during the first three days of MV treatment and the weaning period daily (SBT). Positive end-expiratory pressure and peak inspiratory pressure values were also recorded during these measurements. These ROX values were used to analyze whether they predict weaning readiness, SBT, extubation failure (EF), and mortality. The study included 107 mechanically ventilated patients. Weaning could be tried in 64 (60%) of the 107 patients; 44 (69%) of the 64 patients succeeded, and extubation was performed. 19 (43%) of 44 patients had EF. ROX values calculated with PaO2 during MV and SBT predicted readiness to wean, EF, and mortality better than ROX values calculated with SaO2 and SpO2. ROX values calculated with PaO2 during the third day of MV had the highest sensitivity and specificity for EF (sensitivity: 81%, specificity: 70% for the ROX<11 value). The results of this study suggest that the calculation of ROX index, not only with SpO2% but also with arterial blood gas PaO2 and SaO2% values, may be helpful in predicting the weaning readiness evaluation, SBT, and extubation success and mortality. Further studies with more patients are necessary to verify and standardize these results.
Stefan MS, Shieh MS, Pekow PS, et al. Epidemiology and outcomes of acute respiratory failure in the United States, 2001 to 2009: a national survey. J Hosp Med 2013;8:76-82.
DOI: https://doi.org/10.1002/jhm.2004
Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998;158:489-93.
DOI: https://doi.org/10.1164/ajrccm.158.2.9711045
Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24.
DOI: https://doi.org/10.1164/ajrccm.149.3.7509706
Demiselle J, Calzia E, Hartmann C, et al. Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients. Ann Intensive Care 2021;11:88.
DOI: https://doi.org/10.1186/s13613-021-00872-y
Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Crit Care 2016;35:200-5.
DOI: https://doi.org/10.1016/j.jcrc.2016.05.022
Roca O, Caralt B, Messika J, et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med 2019;199:1368-76.
DOI: https://doi.org/10.1164/rccm.201803-0589OC
Suliman LA, Abdelgawad TT, Farrag NS, Abdelwahab HW. Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia. Adv Respir Med 2021;89:1-7.
DOI: https://doi.org/10.5603/ARM.a2020.0176
Pandharipande PP, Shintani AK, Hagerman HE, et al. Derivation and validation of Spo2/Fio2 ratio to impute for Pao2/Fio2 ratio in the respiratory component of the Sequential Organ Failure Assessment score. Crit Care Med 2009;37:1317-21.
DOI: https://doi.org/10.1097/CCM.0b013e31819cefa9
Van de Louw A, Cracco C, Cerf C, et al. Accuracy of pulse oximetry in the intensive care unit. Intensive Care Med 2001;27:1606-13.
DOI: https://doi.org/10.1007/s001340101064
Perkins GD, McAuley DF, Giles S, et al. Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation?. Crit Care 2003;7:R67-71.
DOI: https://doi.org/10.1186/cc2339
Jubran A, Tobin MJ. Reliability of pulse oximetry in titrating supplemental oxygen therapy in ventilator-dependent patients. Chest 1990;97:1420-25.
DOI: https://doi.org/10.1378/chest.97.6.1420
Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 2000;161:1530-36.
DOI: https://doi.org/10.1164/ajrccm.161.5.9905102
Macintyre NR, Cook DJ, Ely EW Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians, the American Association for Respiratory Care, and the American College of Critical Care Medicine. Chest 2001;120:375S-95S.
DOI: https://doi.org/10.1378/chest.120.6_suppl.375S
Akella P, Voigt LP, Chawla S. To wean or not to wean: a practical patient focused guide to ventilator weaning. J Intensive Care Med 2022;37:1417-25.
DOI: https://doi.org/10.1177/08850666221095436
Haas CF, Loik PS. Ventilator discontinuation protocols. Respir Care 2012;57:1649-62.
DOI: https://doi.org/10.4187/respcare.01895
Nemer SN, Barbas CS. Predictive parameters for weaning from mechanical ventilation. J Bras Pneumol 2011;37:669-79.
DOI: https://doi.org/10.1590/S1806-37132011000500016
Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29:1033-56.
DOI: https://doi.org/10.1183/09031936.00010206
Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995;332:345-50.
DOI: https://doi.org/10.1056/NEJM199502093320601
Vallverdú I, Calaf N, Subirana M, et al. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med 1998;158:1855-62.
DOI: https://doi.org/10.1164/ajrccm.158.6.9712135
Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8.
DOI: https://doi.org/10.1056/NEJM200005043421801
Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-54.
DOI: https://doi.org/10.1056/NEJM199802053380602
Matthay MA, Arabi Y, Arroliga AC, et al. A new global definition of acute respiratory distress syndrome. Am J Respir Crit Care Med 2024;209:37-47.
DOI: https://doi.org/10.1164/rccm.202303-0558WS
Rice TW, Wheeler AP, Bernard GR, et al. Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS. Chest 2007;132:410-17.
DOI: https://doi.org/10.1378/chest.07-0617
Rodriguez M, Thille AW, Boissier F, et al. Predictors of successful separation from high-flow nasal oxygen therapy in patients with acute respiratory failure: a retrospective monocenter study. Ann Intensive Care 2019;9:101.
DOI: https://doi.org/10.1186/s13613-019-0578-8
Artacho Ruiz R, Artacho Jurado B, Caballero Güeto F, et al. Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure. Med Intensiva 2021;45:80-7.
DOI: https://doi.org/10.1016/j.medine.2019.07.008
Andrade Filho PH, Brasil ESA, Costa LG, et al. Prediction of extubation failure in COVID-19. Respir Care 2021;66:1323-29.
DOI: https://doi.org/10.4187/respcare.08564
Guzatti NG, Klein F, Oliveira JA, et al. Predictive factors of extubation failure in COVID-19 mechanically ventilated patients. J Intensive Care Med 2022;37:1250-55.
DOI: https://doi.org/10.1177/08850666221093946
Jubran A, Mathru M, Dries D, Tobin MJ. Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 1998;158:1763-69.
DOI: https://doi.org/10.1164/ajrccm.158.6.9804056
Lee CU, Jo YH, Lee JH, et al. The index of oxygenation to respiratory rate as a prognostic factor for mortality in Sepsis. Am J Emerg Med 2021;45:426-32.
DOI: https://doi.org/10.1016/j.ajem.2020.09.052
Ethics Approval
This study was approved by the Gazi University Clinical Research Ethics Committee (date: 14.06.2021; decision No: 546).How to Cite
Eriş, Esra, Ayshan Mammadova, Ayşe Taşçı Kara, Aydın Atasoy, Zeynep Sena Solmaz, and Gül Gürsel. 2024. “Prognostic Value of the Oxygenation Index Measured During Mechanical Ventilation and Weaning. A Retrospective Cohort Study”. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2024.2840.
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