Predictive value of oxygenation index for outcomes in left-sided congenital diaphragmatic hernia

Ashley S. Bruns, Patricio E. Lau, Gurpreet S. Dhillon, Joseph Hagan, Joshua A. Kailin, George B. Mallory, Pablo Lohmann, Oluyinka O. Olutoye, Rodrigo Ruano, Caraciolo J. Fernandes

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background & objectives: Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. This study compares the efficacy of the highest oxygenation index in the first 48 h (HiOI) versus current prenatal indices to predict survival and morbidity. Methods: Medical records of 50 prenatally diagnosed, isolated, left-sided CDH patients treated from January 2011 to April 2016 were reviewed. Data abstracted included HiOI, lung to head ratio (LHR), observed to expected total fetal lung volume (O/E TFLV), percent liver herniation (%LH), 6 month survival, respiratory support at discharge, ventilator days and length of stay. Data were analyzed using parametric and nonparametric tests and regression analyses as appropriate. Results: HiOI was associated with significantly increased LOS (p < 0.001), respiratory support at discharge (p < 0.001), greater ventilator days (p = 0.001) and higher odds of death (p = 0.004) with risk of death increasing by 5% for every one-unit increase in OI. HiOI was statistically a better predictor of LOS than O/E TFLV (p = 0.007) and %LH (p = 0.02). Conclusions: In isolated, left-sided CDH patients, HiOI is associated with higher mortality, greater length of stay, more ventilator days and increased respiratory support at discharge. HiOI is a better predictor of length of stay than O/E TFLV and %LH. Type of study: Retrospective Study Level of evidence: II

Original languageEnglish (US)
Pages (from-to)1675-1680
Number of pages6
JournalJournal of Pediatric Surgery
Volume53
Issue number9
DOIs
StatePublished - Sep 1 2018

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Mechanical Ventilators
Length of Stay
Lung
Morbidity
Survival
Mortality
Medical Records
Retrospective Studies
Head
Regression Analysis
Congenital Diaphragmatic Hernias
Liver

Keywords

  • Congenital diaphragmatic hernia
  • Hypoxemic respiratory failure
  • Outcome
  • Oxygenation index
  • Pulmonary hypertension
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Bruns, A. S., Lau, P. E., Dhillon, G. S., Hagan, J., Kailin, J. A., Mallory, G. B., ... Fernandes, C. J. (2018). Predictive value of oxygenation index for outcomes in left-sided congenital diaphragmatic hernia. Journal of Pediatric Surgery, 53(9), 1675-1680. https://doi.org/10.1016/j.jpedsurg.2017.12.023

Predictive value of oxygenation index for outcomes in left-sided congenital diaphragmatic hernia. / Bruns, Ashley S.; Lau, Patricio E.; Dhillon, Gurpreet S.; Hagan, Joseph; Kailin, Joshua A.; Mallory, George B.; Lohmann, Pablo; Olutoye, Oluyinka O.; Ruano, Rodrigo; Fernandes, Caraciolo J.

In: Journal of Pediatric Surgery, Vol. 53, No. 9, 01.09.2018, p. 1675-1680.

Research output: Contribution to journalArticle

Bruns, AS, Lau, PE, Dhillon, GS, Hagan, J, Kailin, JA, Mallory, GB, Lohmann, P, Olutoye, OO, Ruano, R & Fernandes, CJ 2018, 'Predictive value of oxygenation index for outcomes in left-sided congenital diaphragmatic hernia', Journal of Pediatric Surgery, vol. 53, no. 9, pp. 1675-1680. https://doi.org/10.1016/j.jpedsurg.2017.12.023
Bruns, Ashley S. ; Lau, Patricio E. ; Dhillon, Gurpreet S. ; Hagan, Joseph ; Kailin, Joshua A. ; Mallory, George B. ; Lohmann, Pablo ; Olutoye, Oluyinka O. ; Ruano, Rodrigo ; Fernandes, Caraciolo J. / Predictive value of oxygenation index for outcomes in left-sided congenital diaphragmatic hernia. In: Journal of Pediatric Surgery. 2018 ; Vol. 53, No. 9. pp. 1675-1680.
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abstract = "Background & objectives: Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. This study compares the efficacy of the highest oxygenation index in the first 48 h (HiOI) versus current prenatal indices to predict survival and morbidity. Methods: Medical records of 50 prenatally diagnosed, isolated, left-sided CDH patients treated from January 2011 to April 2016 were reviewed. Data abstracted included HiOI, lung to head ratio (LHR), observed to expected total fetal lung volume (O/E TFLV), percent liver herniation ({\%}LH), 6 month survival, respiratory support at discharge, ventilator days and length of stay. Data were analyzed using parametric and nonparametric tests and regression analyses as appropriate. Results: HiOI was associated with significantly increased LOS (p < 0.001), respiratory support at discharge (p < 0.001), greater ventilator days (p = 0.001) and higher odds of death (p = 0.004) with risk of death increasing by 5{\%} for every one-unit increase in OI. HiOI was statistically a better predictor of LOS than O/E TFLV (p = 0.007) and {\%}LH (p = 0.02). Conclusions: In isolated, left-sided CDH patients, HiOI is associated with higher mortality, greater length of stay, more ventilator days and increased respiratory support at discharge. HiOI is a better predictor of length of stay than O/E TFLV and {\%}LH. Type of study: Retrospective Study Level of evidence: II",
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AU - Bruns, Ashley S.

AU - Lau, Patricio E.

AU - Dhillon, Gurpreet S.

AU - Hagan, Joseph

AU - Kailin, Joshua A.

AU - Mallory, George B.

AU - Lohmann, Pablo

AU - Olutoye, Oluyinka O.

AU - Ruano, Rodrigo

AU - Fernandes, Caraciolo J.

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N2 - Background & objectives: Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. This study compares the efficacy of the highest oxygenation index in the first 48 h (HiOI) versus current prenatal indices to predict survival and morbidity. Methods: Medical records of 50 prenatally diagnosed, isolated, left-sided CDH patients treated from January 2011 to April 2016 were reviewed. Data abstracted included HiOI, lung to head ratio (LHR), observed to expected total fetal lung volume (O/E TFLV), percent liver herniation (%LH), 6 month survival, respiratory support at discharge, ventilator days and length of stay. Data were analyzed using parametric and nonparametric tests and regression analyses as appropriate. Results: HiOI was associated with significantly increased LOS (p < 0.001), respiratory support at discharge (p < 0.001), greater ventilator days (p = 0.001) and higher odds of death (p = 0.004) with risk of death increasing by 5% for every one-unit increase in OI. HiOI was statistically a better predictor of LOS than O/E TFLV (p = 0.007) and %LH (p = 0.02). Conclusions: In isolated, left-sided CDH patients, HiOI is associated with higher mortality, greater length of stay, more ventilator days and increased respiratory support at discharge. HiOI is a better predictor of length of stay than O/E TFLV and %LH. Type of study: Retrospective Study Level of evidence: II

AB - Background & objectives: Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. This study compares the efficacy of the highest oxygenation index in the first 48 h (HiOI) versus current prenatal indices to predict survival and morbidity. Methods: Medical records of 50 prenatally diagnosed, isolated, left-sided CDH patients treated from January 2011 to April 2016 were reviewed. Data abstracted included HiOI, lung to head ratio (LHR), observed to expected total fetal lung volume (O/E TFLV), percent liver herniation (%LH), 6 month survival, respiratory support at discharge, ventilator days and length of stay. Data were analyzed using parametric and nonparametric tests and regression analyses as appropriate. Results: HiOI was associated with significantly increased LOS (p < 0.001), respiratory support at discharge (p < 0.001), greater ventilator days (p = 0.001) and higher odds of death (p = 0.004) with risk of death increasing by 5% for every one-unit increase in OI. HiOI was statistically a better predictor of LOS than O/E TFLV (p = 0.007) and %LH (p = 0.02). Conclusions: In isolated, left-sided CDH patients, HiOI is associated with higher mortality, greater length of stay, more ventilator days and increased respiratory support at discharge. HiOI is a better predictor of length of stay than O/E TFLV and %LH. Type of study: Retrospective Study Level of evidence: II

KW - Congenital diaphragmatic hernia

KW - Hypoxemic respiratory failure

KW - Outcome

KW - Oxygenation index

KW - Pulmonary hypertension

KW - Survival

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