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Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children

 Soo Yeon Kim  ;  Byuhree Kim  ;  Sun Ha Choi  ;  Jong Deok Kim  ;  In Suk Sol  ;  Min Jung Kim  ;  Yoon Hee Kim  ;  Kyung Won Kim  ;  Myung Hyun Sohn  ;  Kyu-Earn Kim 
 ACUTE AND CRITICAL CARE, Vol.33(4) : 222-229, 2018 
Journal Title
Issue Date
acute respiratory distress syndrome ; mortality ; pediatrics ; risk assessment
Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a
pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to
determine whether reclassification using oxygenation metrics 24 hours after diagnosis could
provide prognostic ability for outcomes in PARDS.
Methods: Two hundred and eighty-eight pediatric patients admitted between January 1,
2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively
analyzed. Reclassification based on data measured 24 hours after diagnosis was compared
with the initial classification, and changes in pressure parameters and oxygenation were
investigated for their prognostic value with respect to mortality.
Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an
improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or
died. Multivariate analysis revealed that mortality risk significantly increased for the severe
group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds
ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in
pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation
(arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed
statistically better discriminative power for mortality (area under the receiver operating characteristic
curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001).
Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours after
diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was
significantly associated with outcomes in PARDS, and oxygenation response was the most
discernable surrogate metric for mortality.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Won(김경원) ORCID logo https://orcid.org/0000-0003-4529-6135
Kim, Kyu Earn(김규언)
Kim, Min Jung(김민정) ORCID logo https://orcid.org/0000-0002-5634-9709
Kim, Soo Yeon(김수연) ORCID logo https://orcid.org/0000-0003-4965-6193
Kim, Yoon Hee(김윤희) ORCID logo https://orcid.org/0000-0002-2149-8501
Kim, Jong Deok(김종덕)
Sol, In Suk(설인숙) ORCID logo https://orcid.org/0000-0003-2470-9682
Sohn, Myung Hyun(손명현) ORCID logo https://orcid.org/0000-0002-2478-487X
Choi, Sun Ha(최선하)
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