Ventilation index and outcome in children with acute respiratory distress syndrome

Abstract

The purpose of this investigation was to determine the predictive value of the ventilation index (VI) in children with acute respiratory distress syndrome (ARDS). We performed a 10‐year retrospective chart review of children who were admitted to the Pediatric Intensive Care Unit with a diagnosis of ARDS. Acute respiratory distress syndrome was defined as acute onset of diffuse, bilateral pulmonary infiltrates of noncardiac origin, and severe hypoxemia, defined as the ratio of the arterial partial pressure of oxygen to the fraction of inspired oxygen of <200 and a positive end expiratory pressure of 6 cmH2O or greater. Records of daily arterial blood gas results and ventilator settings were reviewed, and the ventilation index (VI = partial pressure of arterial CO2 × peak airway pressure × respiratory rate/1,000) was calculated each time the measurements were made. These values were correlated with outcome (survival or nonsurvival). The VI was not different at the time of diagnosis of ARDS in the patients who lived, compared with those who subsequently died. However, by 3 to 5 days after study entry, the VI of nonsurvivors was significantly higher than for survivors (P < 0.05). The VI for survivors remained between 30 and 35 throughout the study period, whereas the VI of nonsurvivors continued to increase with time. A VI of >65 predicted death with a specificity and positive predictive value of >90% on days 3 through 9. We conclude that the VI provides a reliable prognostic marker in children with ARDS, and its increase above 65 indicates a need for orderly intervention with alternative modalities of care. Pediatr Pulmonol. 1998; 26:125–128. © 1998 Wiley‐Liss, Inc.

Monocyte Interleukin‐12 Production Is Inversely Related to Duration of Respiratory Failure in Respiratory Syncytial Virus Bronchiolitis

“…The correlation between mean VI and duration of mechanical ventilation is consistent with the findings of Paret et al [3], who demonstrated the prognostic value of VI for children with ARDS at days 3-5 after initiation of mechanical ventilation. Our results show that the mean VI during the first 24 h after initiation of mechanical ventilation corresponds with duration of mechanical ventilation.…”

“…VI was calculated every 8 h during the first 24 h of mechanical ventilation, starting 8 h after initiation of mechanical ventilation. VI was defined as the product of partial pressure of arterial CO 2 (mm Hg) ϫ peak airway pressure (cm H 2 O) ϫ respiratory rate (breaths per minute) divided by 1000 [3]. The mean VI was defined as the arithmetic mean of the VIs at 8, 16, and 24 h after initiation of mechanical ventilation.…”

Acute lung injury in pediatric intensive care in Australia and New Zealand–A prospective, multicenter, observational study*

“…This has not been a consistent finding in the literature, however, with many studies showing no correlation between indexes of respiratory severity and mortality (20,22,30,41,42).…”

Daily practice of mechanical ventilation in Italian pediatric intensive care units: A prospective survey*

“…This is a low rate if compared with the 43% observed in adult patients with ARDS (compared pooled mortality over 72 studies) (20) and in other pediatric studies. It has been estimated that ARDS accounts for 1% to 4% of all pediatric intensive care unit admissions, approximately 8% to 10% of patients requiring MV (6,21), and ARDS has an estimated mortality between 20% and 75% (22)(23)(24)(25)(26)(27)(28)(29). We should consider that as many as 43% of children with ARDS in the PALISI study had a secondary diagnosis of bronchiolitis that has a low mortality rate (6,30).…”