Determination of PaO2/FiO2 after 24 h of invasive mechanical ventilation and 1PaO2/FiO2 at 24 h as predictors of survival in patients diagnosed with ARDS due to COVID-19

Hueda-Zavaleta M.; Copaja-Corzo C.; Miranda-Chávez B.; Flores-Palacios R.; Huanacuni-Ramos J.; Mendoza-Laredo J.; Minchón-Vizconde D.; de la Torre J.C.G.; Benites-Zapata V.A. · PeerJ (2022) · DOI: 10.7717/peerj.14290

Resumen

Introduction. Acute respiratory distress syndrome (ARDS) due to Coronavirus Disease 2019 (COVID-19) causes high mortality. The objective of this study is to determine whether the arterial pressure of oxygen/inspiratory fraction of oxygen (PaO2/FiO2) 24 h after invasive mechanical ventilation (IMV) and the difference between PaO2/FiO2 at 24 h after IMV and PaO2/FiO2 before admission to IMV (1PaO2/FiO2 24 h) are predictors of survival in patients with ARDS due to COVID-19. Methods. A retrospective cohort study was conducted that included patients with ARDS due to COVID-19 in IMV admitted to the intensive care unit (ICU) of a hospital in southern Peru from April 2020 to April 2021. The ROC curves and the Youden index were used to establish the cut-off point for PaO2/FiO2 at 24 h of IMV and 1PaO2/FiO2 at 24 h associated with mortality. The association with mortality was determined by Cox regression, calculating the crude (cHR) and adjusted (aHR) risk ratios, with their respective 95% confidence intervals (95% CI). Results. Two hundred patients were analyzed. The average age was 54.29 years, 79% were men, and 25.5% (n = 51) died. The cut-off point calculated for PaO2/FiO2 24 h after IMV and 1PaO2/FiO2 24 h was 222.5 and 109.5, respectively. Those participants with a value below the cut-off point of 1PaO2/FiO2 24 h and PaO2/FiO2 24 h after IMV had higher mortality, aHR = 3.32 (CI 95% [1.82–6.07]) and aHR = 2.87 (CI 95% [1.48–5.57]) respectively. Conclusion. PaO2/FiO2 24 h after IMV and 1PaO2/FiO2 24 h in patients diagnosed with ARDS due to COVID-19 on IMV were associated with higher hospital mortality. These findings are helpful to identify those patients with a higher risk of dying on admission to the ICU. © Copyright 2022 Hueda-Zavaleta et al.

Instituciones: Universidad Nacional Daniel Alcides Carrión; Universidad San Ignacio de Loyola; Universidad Privada de Tacna