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Research ArticleOriginal Research Article

FIO2 Trajectory as a Pragmatic Intermediate Marker in Acute Hypoxic Respiratory Failure

Sarah J Chalmers, Yewande E Odeyemi, Amos Lal, Heyi Li, Ryan D Frank, Ognjen Gajic and Hemang Yadav
Respiratory Care October 2021, 66 (10) 1521-1530; DOI: https://doi.org/10.4187/respcare.09053
Sarah J Chalmers
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic–Rochester, Rochester, Minnesota.
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  • For correspondence: [email protected]
Yewande E Odeyemi
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic–Rochester, Rochester, Minnesota.
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Amos Lal
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic–Rochester, Rochester, Minnesota.
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Heyi Li
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic–Rochester, Rochester, Minnesota.
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Ryan D Frank
Division of Biomedical Statistics and Informatics, Mayo Clinic–Rochester, Rochester, Minnesota.
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Ognjen Gajic
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic–Rochester, Rochester, Minnesota.
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Hemang Yadav
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic–Rochester, Rochester, Minnesota.
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Abstract

BACKGROUND: Several markers of oxygenation are used as prognostic markers in acute hypoxemic respiratory failure. Real-world use is limited by the need for invasive measurements and unreliable availability in the electronic health record. A pragmatic, reliable, and accurate marker of acute hypoxemic respiratory failure is needed to facilitate epidemiologic studies, clinical trials, and shared decision-making with patients. Embedded Image is easily obtained at the bedside and from the electronic health record. The Embedded Image trajectory may be a valuable marker of recovery in patients with acute hypoxemic respiratory failure.

METHODS: This was a historical cohort study of adult subjects admitted to an ICU with acute hypoxemic respiratory failure secondary to community-acquired pneumonia and/or ARDS.

RESULTS: Our study included 2,670 subjects. Embedded Image and Embedded Image were consistently more available than was Embedded Image in the electronic health record: (Embedded Image vs Embedded Image vs Embedded Image : 100 vs 100 vs 72.8% on day 1, and 100 vs 99 vs 21% on day 5). A worsening Embedded Image trajectory was associated with reduced ventilator-free days. From days 2 to 5, every increase in Embedded Image by 10% from the previous day was associated with fewer ventilator-free days (on day 2: adjusted mean –1.25 [95% CI –1.45 to –1.05] d, P < .001). The Embedded Image trajectory also provided prognostic information. On days 3 – 5, an increase in Embedded Image from the previous day was associated with increased ventilator-free days (on day 3: adjusted mean 2.09 (95% CI 1.44–2.74) d; P < .001). Embedded Image models did not add predictive information compared with models with Embedded Image alone (on day 2: adjusted Embedded Image vs Embedded Image R2 0.122 vs 0.119; and on day 3: 0.153 vs 0.163).

CONCLUSIONS: Embedded Image and Embedded Image are pragmatic and readily available intermediate prognostic markers in acute hypoxic respiratory failure. The Embedded Image trajectory in the first 5 d of ICU admission provided important prognostic information (ventilator-free days). Although the Embedded Image trajectory was also associated with ventilator-free days, it did not provide more information than the Embedded Image trajectory alone.

  • acute hypoxic respiratory failure
  • electronic health record
  • hypoxia
  • pneumonia
  • acute respiratory distress syndrome
  • prognosis

Footnotes

  • Correspondence: Sarah J Chalmers MD, Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail: chalmers.sarah{at}mayo.edu
  • See the Related Editorial on Page 1636

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • This study was supported by a grant from the Mayo Clinic Critical Care and Research Committee, which did not play a role in the study design, implementation, or analysis of this study or in production of this manuscript. This project was supported by Clinical and Translational Science Award grant UL1 TR002377 from the National Center for Advancing Translational Science. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (10)
Respiratory Care
Vol. 66, Issue 10
1 Oct 2021
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FIO2 Trajectory as a Pragmatic Intermediate Marker in Acute Hypoxic Respiratory Failure
Sarah J Chalmers, Yewande E Odeyemi, Amos Lal, Heyi Li, Ryan D Frank, Ognjen Gajic, Hemang Yadav
Respiratory Care Oct 2021, 66 (10) 1521-1530; DOI: 10.4187/respcare.09053

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FIO2 Trajectory as a Pragmatic Intermediate Marker in Acute Hypoxic Respiratory Failure
Sarah J Chalmers, Yewande E Odeyemi, Amos Lal, Heyi Li, Ryan D Frank, Ognjen Gajic, Hemang Yadav
Respiratory Care Oct 2021, 66 (10) 1521-1530; DOI: 10.4187/respcare.09053
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Keywords

  • acute hypoxic respiratory failure
  • electronic health record
  • hypoxia
  • pneumonia
  • Acute Respiratory Distress Syndrome
  • prognosis

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