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Observational Study
. 2022 Sep;67(9):1075-1081.
doi: 10.4187/respcare.09854. Epub 2022 May 31.

Ventilatory Ratio Is a Valuable Prognostic Indicator in an Observational Cohort of Patients With ARDS

Emily R Siegel  1 , Hanjing Zhuo  2 , Pratik Sinha  3 , Alexander I Papolos  4 , Siyuan A Ni  5 , Kathryn Vessel  2 , Annika Belzer  2 , Emily B Minus  2 , Carolyn S Calfee  6 , Michael A Matthay  6 , Katherine D Wick  7
Affiliations
Observational Study

Ventilatory Ratio Is a Valuable Prognostic Indicator in an Observational Cohort of Patients With ARDS

Emily R Siegel et al. Respir Care. 2022 Sep.

Abstract

Background: How indices specific to respiratory compromise contribute to prognostication in patients with ARDS is not well characterized in general clinical populations. The primary objective of this study was to identify variables specific to respiratory failure that might add prognostic value to indicators of systemic illness severity in an observational cohort of subjects with ARDS.

Methods: Fifty subjects with ARDS were enrolled in a single-center, prospective, observational cohort. We tested the contribution of respiratory variables (oxygenation index, ventilatory ratio [VR], and the radiographic assessment of lung edema score) to logistic regression models of 28-d mortality adjusted for indicators of systemic illness severity (the Acute Physiology and Chronic Health Evaluation [APACHE] III score or severity of shock as measured by the number of vasopressors required at baseline) using likelihood ratio testing. We also compared a model utilizing APACHE III with one including baseline number of vasopressors by comparing the area under the receiver operating curve (AUROC).

Results: VR significantly improved model performance by likelihood ratio testing when added to APACHE III (P = .036) or the number of vasopressors at baseline (P = .01). Number of vasopressors required at baseline had similar prognostic discrimination to the APACHE III. A model including the number of vasopressors and VR (AUROC 0.77 [95% CI 0.64-0.90]) was comparable to a model including APACHE III and VR (AUROC 0.81 [95% CI 0.68-0.93]; P for comparison = .58.).

Conclusions: In this observational cohort of subjects with ARDS, the VR significantly improved discrimination for mortality when combined with indicators of severe systemic illness. The number of vasopressors required at baseline and APACHE III had similar discrimination for mortality when combined with VR. VR is easily obtained at the bedside and offers promise for clinical prognostication.

Keywords: ARDS; pulmonary dead space; pulmonary edema; ventilatory ratio.

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Conflict of interest statement

Dr Wick has received grant support from NIH, No. 5T32GM008440-24. The remaining authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flow chart.
Fig. 2.
Fig. 2.
Box plot of ventilatory ratio dichotomized by A: alive (n = 22) versus B: dead (n = 28) at day 28. Horizontal lines represent median; boxes represent upper and lower quartiles, and whiskers represent 1.5 times the interquartile range. Ventilatory ratio was significantly higher among nonsurvivors, P = .002 by Wilcoxon rank sum.
See this image and copyright information in PMC

References

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