Oxygenation Index, Adjusted Oxygenation Index and Saturation Index in Coronavirus Disease 2019 (COVID-19) Patients
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Rationale: The mean airway pressure (MAP) and indices incorporating MAP applied on adults withacute respiratory distress syndrome (ARDS) reflect tissue oxygenation and are, thus, associatedwith patients%27 outcomes. The purpose of this study was to investigate the association betweenmortality and MAP values, oxygenation index (OI), adjusted oxygenation index (AOI), and saturationindex (OSI) in coronavirus disease 19 (COVID-19) patients undergoing invasive mechanicalventilation (IMV). Methods: Retrospective study of 994 adult COVID-19 patients admitted to ourhospital between March 2020 and February 2022. Patients with IMV were identified, and arterialblood gas results and registers of ventilator settings were obtained. Fractions of inspired oxygen(FiO2), mean airway pressure (MAP), oxygen saturation (SpO2), and arterial pressure of oxygen(PaO2) were recorded. The cohort was divided into patients that survived and patients that did not.The OI (OI=[(MAP)× FiO2 × 100/PaO2]), OSI (OSI= [FIO2 x MAP x 100)/ SpO2]) and AOI (AOI = OI age) were calculated in each group at 24, 48 and 72 hours after mechanical ventilation wasinitiated. The primary outcome was survival to hospital discharge. Descriptive statistics, Mann-Whitney U, and binomial regression methods were utilized to ascertain statistical significance.Results:157 mechanically ventilated patients were included in this cohort. 105 (66.9%25) patientswere male. Age was 62.8 years ± 12.8 years. 136 patients (86.6%25) died. There was no differencein gender, age, or BMI when comparing survivors and non-survivors. At 24 hours, MAP, OI, AOI, andOSI were statistically lower in survivors. At 48 hours, MAP and OI were not statistically differentbetween survivors and non-survivors, and only OSI was significantly different. At 72 hours, neitherMAP nor AOI demonstrated to be different in survivors vs non-survivors. However, both OI and OSIwere significantly lower in survivors (Table). On binomial regression for risk of death, OI >14.99 onday 1 had an odds ratio (OR) of 3.59 (95%25CI 1.36, 9.52; p=0.01), AOI >89.99 on day 1 of 4.33(95%25CI 1.38, 13.69; p=0.012), OSI >15.99 on day 1 of 5.05 (95%25CI 1.84,13.91; p=0.002), MAP>15.00 on day 1 of 5.07 (95%25CI 1.62-15.87; p=0.005), and OSI >13.99 on day 3 of 3.20 (95%25CI1.19,8.99; p=0.024). Conclusions: When measured in the first 24 hours, all parameters wereassociated with higher in-hospital mortality. In patients who survived hospital discharge, only OSIwas persistently lower when calculated 24, 48, and 72 hours after mechanical ventilation wasstarted.
