Won-Il Choi1, Esmeralda Shehu2, So Yeon Lim3, Shin Ok Koh4, Kyeongman Jeon3, Sungwon Na4, Chae-Man Lim5, Young-Joo Lee6, Seok Chan Kim7, Ick Hee Kim8, Je Hyeong Kim9, Jae Yeol Kim10, Jaemin Lim11, Chin Kook Rhee7, Sunghoon Park12, Ho Cheol Kim13, Jin Hwa Lee14, Ji Hyun Lee15, Jisook Park16, Younsuck Koh5, Gee Young Suh17. 1. Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea. 2. Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea; Department of Internal Medicine, Regional Hospital of Durres, Albania. 3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. 5. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 6. Department of Anesthesiology, Aju University College of Medicine, Suwon, Republic of Korea. 7. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea. 8. Department of Surgery, Chungju hospital, School of Medicine, Konkuk University, Chungju, Republic of Korea. 9. Division of Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea. 10. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea. 11. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Gangneung Asan Hospital, Gangneung, University of Ulsan Medical College of Medicine, Gangneung, Republic of Korea. 12. Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea. 13. Division of Pulmonary and Critical Care Medicine, Department of Medicine, College of Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea. 14. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea. 15. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bundang CHA hospital CHA university, Seongnam, Republic of Korea. 16. Department of Multimedia, Seoul Women's University, Seoul, Republic of Korea. 17. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: suhgy@skku.edu.
Abstract
PURPOSE: This study described the acute hypoxemic respiratory failure (AHRF) population and identified potential modifiable markers of outcome. METHODS: A prospective, multicenter study was performed in 22 intensive care units (ICUs). The clinical outcomes of patients with acute respiratory distress syndrome (ARDS) were compared to the outcomes in patients with non-ARDS AHRF, and a propensity score matched analysis was performed. RESULTS: A total 837 patients with an arterial oxygen tension/fraction of inspired oxygen ratio (Pao2/Fio2) less than 300 mm Hg on ICU admission were included. Of these, 163 patients met the criteria defining ARDS, whereas the remaining 674 patients who had unilateral or no pulmonary opacities were classified as non-ARDS AHRF. Baseline Pao2/Fio2 ratio, thrombocytopenia, increased positive end-expiratory pressure (PEEP) were significantly associated with the 60-day mortality in hypoxemic respiratory failure after multivariate analysis. However, ARDS was not associated with increased 60-day mortality when independent predictors for the 60-day mortality and propensity score were controlled. In the case-control study, the 60-day mortality rate was 38.6% in the ARDS group and 32.3% in the non-ARDS AHRF group. In both patients with ARDS and non-ARDS AHRF, the mortality rate increased proportionally to a lower baseline Pao2/Fio2. CONCLUSION: Lower baseline oxygenation (Pao2/Fio2) is a poor prognostic marker in acute hypoxemic respiratory failure.
PURPOSE: This study described the acute hypoxemic respiratory failure (AHRF) population and identified potential modifiable markers of outcome. METHODS: A prospective, multicenter study was performed in 22 intensive care units (ICUs). The clinical outcomes of patients with acute respiratory distress syndrome (ARDS) were compared to the outcomes in patients with non-ARDS AHRF, and a propensity score matched analysis was performed. RESULTS: A total 837 patients with an arterial oxygen tension/fraction of inspired oxygen ratio (Pao2/Fio2) less than 300 mm Hg on ICU admission were included. Of these, 163 patients met the criteria defining ARDS, whereas the remaining 674 patients who had unilateral or no pulmonary opacities were classified as non-ARDS AHRF. Baseline Pao2/Fio2 ratio, thrombocytopenia, increased positive end-expiratory pressure (PEEP) were significantly associated with the 60-day mortality in hypoxemic respiratory failure after multivariate analysis. However, ARDS was not associated with increased 60-day mortality when independent predictors for the 60-day mortality and propensity score were controlled. In the case-control study, the 60-day mortality rate was 38.6% in the ARDS group and 32.3% in the non-ARDS AHRF group. In both patients with ARDS and non-ARDS AHRF, the mortality rate increased proportionally to a lower baseline Pao2/Fio2. CONCLUSION: Lower baseline oxygenation (Pao2/Fio2) is a poor prognostic marker in acute hypoxemic respiratory failure.
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