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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. 
is easily obtained at the bedside and from the electronic health record. The 
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. 
and 
were consistently more available than was 
in the electronic health record: (
vs 
vs 
: 100 vs 100 vs 72.8% on day 1, and 100 vs 99 vs 21% on day 5). A worsening 
trajectory was associated with reduced ventilator-free days. From days 2 to 5, every increase in 
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 
trajectory also provided prognostic information. On days 3 – 5, an increase in 
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). 
models did not add predictive information compared with models with 
alone (on day 2: adjusted 
vs 
R2 0.122 vs 0.119; and on day 3: 0.153 vs 0.163).
CONCLUSIONS: 
and 
are pragmatic and readily available intermediate prognostic markers in acute hypoxic respiratory failure. The 
trajectory in the first 5 d of ICU admission provided important prognostic information (ventilator-free days). Although the 
trajectory was also associated with ventilator-free days, it did not provide more information than the 
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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