A comparison of indices of respiratory failure in ventilated preterm infants
N V Subhedar, A T Tan, E M Sweeney, N J Shaw
Neonatal Intensive
Care Unit, Liverpool Women's Hospital, Liverpool, UK
Correspondence to: Dr Subhedar, Neonatal Intensive Care Unit, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK email: nvsubhedar_lwh{at}yahoo.com
Accepted 24 March 2000
AIM
To compare indices
of respiratory failure in terms of their ability to predict adverse
respiratory outcomes in preterm infants. The indices evaluated were:
(a) the alveolar-arterial oxygen tension difference (A-aDO2);
(b) the ratio of arterial to alveolar oxygen tension (a/A ratio); (c) the oxygenation
index (OI); (d) the fractional inspired
oxygen concentration (FIO2).
METHODSDetails of
respiratory support and arterial blood gas data in the first 24 hours
of life were collected in ventilated infants below 34 weeks gestation.
The worst single value of a particular index in the first 24 hours was
chosen to quantify the severity of respiratory failure in each infant.
Receiver operating characteristic curves were constructed and areas
under the curve (AUC) calculated to compare the performance of the
indices in predicting death from respiratory failure and/or the
development of chronic lung disease (CLD).
RESULTSA total of 155 preterm infants were studied, of whom 35 (23%) died primarily from
respiratory failure and 53 of the 120 survivors (44%) developed CLD.
The overall performance of the four indices in predicting death from
respiratory failure ranged from 0.77 (AUC for maximum
FIO2) to 0.88 (AUC for minimum a/A ratio). The corresponding AUCs for gestational age and birth weight were 0.75 and
0.76 respectively. In contrast, demographic variables tended to perform
better than indices of respiratory failure in predicting CLD/death.
CONCLUSIONSThere was
no evidence of a significant difference between the performance of the
a/A ratio, A-aDO2, and OI in predicting adverse respiratory outcomes. Use of the OI is recommended because of its ease
of calculation.
Keywords: respiratory distress syndrome; infant; premature; respiratory insufficiency; lung; arterial blood gas
© 2000 by Archives of Disease in Childhood
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