Evaluation of Oxygen Saturation Index Compared With Oxygenation Index in Neonates With Hypoxemic Respiratory Failure

Muniraman, Hemananda; Song, Ashley; Ramanathan, Rangasamy; Fletcher, Kathryn L.; Kibe, Rutuja; Ding, Li; Lakshmanan, Ashwini; Biniwale, Manoj

doi:10.1001/jamanetworkopen.2019.1179

Cited by 81 publications

(98 citation statements)

References 21 publications

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“…OSI (ie, mean airway pressure Â F IO 2 Â 100/S pO 2 ) has a strong linear correlation with the oxygen index and had been validated as a noninvasive method for assessing the severity of respiratory illness in infants and children. [26][27][28] Recently, Muniraman et al 29 demonstrated that the oxygen index derived from OSI was strongly correlated (r ¼ 0.89) and may provide reliable assessment of respiratory failure on a 12 Collectively, these findings suggest that OSI is a useful metric for guiding interventions, evaluating treatment response, and identifying risk stratification in premature infants, and our results support these findings. Our data suggest that ductal patency confers a survival benefit because subjects who did not have a patent ductus arteriosus demonstrated a nearly 8-fold increase in mortality.…”

Section: Discussionsupporting

confidence: 82%

Mortality Risk Factors in Preterm Infants Treated with High-Frequency Jet Ventilation

et al. 2020

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BACKGROUND: High-frequency jet ventilation (HFJV) has been used in conjunction with conventional ventilation for premature infants with respiratory failure. We sought to identify parameters that were associated with mortality in subjects who underwent HFJV. METHODS: Subjects were enrolled if birthweight was^2,000 g and they were^34 weeks gestational age. Subjects were excluded if they received HFJV at the time of admission because we aimed to study subjects who failed conventional ventilation. Subject demographics, ventilator parameters, and laboratory data were extracted and analyzed. The Mann-Whitney U-test was used to assess differences in continuous variables, and the chi-square and Fisher exact tests were used for categorical variables between the groups. To assess variables that were predictive of mortality, we used both univariate and multivariate logistic regression analysis. Independent predictors of mortality were identified and used to create a multivariate risk score. Receiver operating characteristic curves were constructed to evaluate the predictive accuracy of the multivariate risk score. RESULTS: A total of 53 premature subjects (n 5 37 male) were studied, of whom 39 (74%) survived to discharge or transfer back to referring hospital. In the univariate model, female sex, older gestational age, higher birthweight, HFJV peak inspiratory pressure at 1 h, and oxygen saturation index at 4 h were associated with mortality. In the final multivariate logistic regression model, female sex (odds ratio 4.1, 95% CI 1.2-19.8, P 5 .044), closed ductus arteriosus (odds ratio 7.7, 95% CI 1.3-39.5, P 5 .016), and oxygen saturation index > 5.5 (odds ratio 6.0, 95% CI 1.5-28.3, P 5 .02) were independent predictors of mortality. CONCLUSIONS: We identified that oxygen saturation index > 5.5 after 4 h of HFJV, female sex, and closed ductus arteriosus were independent predictors of mortality.

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Section: Discussionsupporting

confidence: 82%

Mortality Risk Factors in Preterm Infants Treated with High-Frequency Jet Ventilation

et al. 2020

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“…In contrast to the oxygen saturation index (OSI; [FiO 2 × mean airway pressure]/SpO 2 ), the SpO 2 /FiO 2 ratio does not include the mean airway pressure. The OSI has been validated only in invasively ventilated patients in the first days of life [19][20][21] and none of the patients in this study received MV around doxapram start or during doxapram therapy. Integration of noninvasive pressure support could further improve therapy, although it is known to be an unreliable measure for the mean airway pressure in the lungs.…”

Section: Discussionmentioning

confidence: 99%

Use of Continuous Physiological Monitor Data to Evaluate Doxapram Therapy in Preterm Infants

et al. 2020

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Introduction: Evaluation of pharmacotherapy during intensive care treatment is commonly based on subjective, intermittent interpretations of physiological parameters. Real-time visualization and analysis may improve drug effect evaluation. We aimed to evaluate the effects of the respiratory stimulant doxapram objectively in preterm infants using continuous physiological parameters. Methods: In this longitudinal observational study, preterm infants who received doxapram therapy were eligible for inclusion. Physiological data (1 Hz) were used to assess respiration and to evaluate therapy effects. The oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio and the area under the 89% SpO2 curve (duration × saturation depth below target) were calculated as measures of hypoxemia. Regression analyses were performed in 1-h timeframes to discriminate therapy failure (intubation or death) from success (no intubation). Results: Monitor data of 61 patients with a median postmenstrual age (PMA) at doxapram initiation of 28.7 (IQR 27.6–30.0) weeks were available. The success rate of doxapram therapy was 56%. Doxapram pharmacodynamics were reflected in an increased SpO2 and SpO2/FiO2 ratio as well as a decrease in episodes with saturations below target (SpO2 <89%). The SpO2/FiO2 ratio, corrected for PMA and mechanical ventilation before therapy start, discriminated best between therapy failure and success (highest AUC ROC of 0.83). Conclusion: The use of continuous physiological monitor data enables objective and detailed interpretation of doxapram in preterm infants. The SpO2/FiO2 ratio is the best predictive parameter for therapy failure or success. Further implementation of real-time data analysis and treatment algorithms would provide new opportunities to treat newborns.

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“…The respiratory severity score (RSS = mean airway pressure (cmH 2 O) x FiO 2 ) and oxygen saturation index (OSI = MAP x FiO 2 × 100 ÷ SpO 2 ) were used to compare the pre-extubation respiratory conditions between the two groups [24, 25]. The RSS has been used to predict extubation readiness or the length of mechanical ventilation in preterm infants, and the OSI has been suggested to be a useful measurement to reliably assess the severity of respiratory conditions in preterm infants when the oxygen index is not available [26, 27].…”

Section: Methodsmentioning

confidence: 99%

Comparison of NIV-NAVA and NCPAP in facilitating extubation for very preterm infants

et al. 2019

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Background Various types of noninvasive respiratory modalities that lead to successful extubation in preterm infants have been explored. We aimed to compare noninvasive neurally adjusted ventilatory assist (NIV-NAVA) and nasal continuous positive airway pressure (NCPAP) for the postextubation stabilization of preterm infants. Methods This retrospective study was divided into two distinct periods, between July 2012 and June 2013 and between July 2013 and June 2014, because NIV-NAVA was applied beginning in July 2013. Preterm infants of less than 30 weeks GA who had been intubated with mechanical ventilation for longer than 24 h and were weaned to NCPAP or NIV-NAVA after extubation were enrolled. Ventilatory variables and extubation failure were compared after weaning to NCPAP or NIV-NAVA. Extubation failure was defined when infants were reintubated within 72 h of extubation. Results There were 14 infants who were weaned to NCPAP during Period I, and 2 infants and 16 infants were weaned to NCPAP and NIV-NAVA, respectively, during Period II. At the time of extubation, there were no differences in the respiratory severity score (NIV-NAVA 1.65 vs. NCPAP 1.95), oxygen saturation index (1.70 vs. 2.09) and steroid use before extubation. Several ventilation parameters at extubation, such as the mean airway pressure, positive end-expiratory pressure, peak inspiratory pressure, and FiO 2 , were similar between the two groups. SpO 2 and pCO 2 preceding extubation were comparable. Extubation failure within 72 h after extubation was observed in 6.3% of the NIV-NAVA group and 37.5% of the NCPAP group ( P = 0.041). Conclusions The data in the present showed promising implications for using NIV-NAVA over NCPAP to facilitate extubation.

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Evaluation of Oxygen Saturation Index Compared With Oxygenation Index in Neonates With Hypoxemic Respiratory Failure

Cited by 81 publications

References 21 publications

Mortality Risk Factors in Preterm Infants Treated with High-Frequency Jet Ventilation

Mortality Risk Factors in Preterm Infants Treated with High-Frequency Jet Ventilation

Use of Continuous Physiological Monitor Data to Evaluate Doxapram Therapy in Preterm Infants

Comparison of NIV-NAVA and NCPAP in facilitating extubation for very preterm infants

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