title: Sequential oxygenation index and organ dysfunction assessment within the first 3 days of mechanical ventilation predict the outcome of adult patients with severe acute respiratory failure.
abstract: OBJECTIVE
  To determine early predictors of outcomes of adult patients with severe acute respiratory failure.
  
  
  METHODS
  100 consecutive adult patients with severe acute respiratory failure were evaluated in this retrospective study. Data including comorbidities, Sequential Organ Failure Assessment (SOFA) score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II) score, PaO2, FiO2, PaO2/FiO2, PEEP, mean airway pressure (mPaw), and oxygenation index (OI) on the 1st and the 3rd day of mechanical ventilation, and change in OI within 3 days were recorded. Primary outcome was hospital mortality; secondary outcome measure was ventilator weaning failure.
  
  
  RESULTS
  38 out of 100 (38%) patients died within the study period. 48 patients (48%) failed to wean from ventilator. Multivariate analysis showed day 3 OI (P=0.004) and SOFA (P=0.02) score were independent predictors of hospital mortality. Preexisting cerebrovascular accident (CVA) (P=0.002) was the predictor of weaning failure. Results from Kaplan-Meier method demonstrated that higher day 3 OI was associated with shorter survival time (log-Rank test, P<0.001).
  
  
  CONCLUSIONS
  Early OI (within 3 days) and SOFA score were predictors of mortality in severe acute respiratory failure. In the future, prospective studies measuring serial OIs in a larger scale of study cohort is required to further consolidate our findings.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung 833, Taiwan.
authors.forename: Hsu-Ching
authors.initials: HC
authors.lastname: Kao
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Lai
authors.forename: Heui-Ling
authors.initials: HL
authors.lastname: Hung
authors.forename: Yu-Mu
authors.initials: YM
authors.lastname: Chen
authors.forename: Po-An
authors.initials: PA
authors.lastname: Chou
authors.forename: Chin-Chou
authors.initials: CC
authors.lastname: Wang
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lin
authors.forename: Wen-Feng
authors.initials: WF
authors.lastname: Fang
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063305:Organ Dysfunction Scores; D010100:Oxygen / Q000378:metabolism*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000378:metabolism / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods
chemical_list: D010100:Oxygen