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Carboxyhemoglobin and Survival Outcome in Patients with Acute Respiratory Distress Syndrome
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A5074 - Carboxyhemoglobin and Survival Outcome in Patients with Acute Respiratory Distress Syndrome
Author Block: W. Hsia1, M. Kunsoruska1, B. Jafari2; 1Internal Medicine, University of California, Irvine, Orange, CA, United States, 2Pulmonary,Critical Care, University of California-Irvine, Long Beach, CA, United States.
Introduction: Arterial carboxyhemoglobin level (COHb) was previously studied in critically ill and septic patients. Past studies revealed higher mortality in intensive care unit (ICU) patients with lower minimum and higher maximum COHb level after cardiothoracic surgery. Additionally, Funk et al. observed average COHb level to be marginally lower in septic patients who died in the medical ICU. No prior studies have examined the correlation between arterial COHb level and survival in patients with acute respiratory distress syndrome (ARDS). This study, therefore, aims to determine the correlation between levels of COHb and mortality in ICU patients with ARDS. Method: A Retrospective, observational study was conducted in a medical ICU in California. Patients with ARDS were identified using the Berlin criteria. Arterial blood gas prior to intubation, on day 1 of intubation, and prior to extubation/terminal extubation were obtained. Arterial COHb levels and ICU mortality were evaluated descriptively via Microsoft® Excel followed by two-tailed T test using SPSS®. Primary outcome was defined as COHb level between survivors and non-survivors. Secondary outcome being ICU length of stay, number of days intubated, and all-cause mortality. Results: A total of 656 patient charts were reviewed. Among reviewed patients, 31 patients met the inclusion criteria. Of those, 20 died and 11 survived. Higher COHb levels were observed in non-survivors prior to death compare to survivors (P=0.054, 95% CI: -0.82 to 0.01). Amongst non-survivors, a statistically significant upward trend was noted on COHb level from day 1 of intubation to prior to terminal extubation/death (1.09% to 1.47%; P=0.036; 95% CI: -0.73 to -0.03). On the contrary, the survivor group had no significant different between the COHb level from day 1 of intubation to prior to extubation (1.02% to 1.06%; P=0.82; 95% CI: -0.45 to 0.36). Conclusion: Patients with ARDS in the medical ICU who did not survive had higher arterial COHb compare to survivors. COHb level increased significantly from day 1 of intubation to the time of death amongst non-survivors. The study, therefore, suggests a positive correlation between COHb level and mortality in patients with ARDS.
Author Block: W. Hsia1, M. Kunsoruska1, B. Jafari2; 1Internal Medicine, University of California, Irvine, Orange, CA, United States, 2Pulmonary,Critical Care, University of California-Irvine, Long Beach, CA, United States.
Introduction: Arterial carboxyhemoglobin level (COHb) was previously studied in critically ill and septic patients. Past studies revealed higher mortality in intensive care unit (ICU) patients with lower minimum and higher maximum COHb level after cardiothoracic surgery. Additionally, Funk et al. observed average COHb level to be marginally lower in septic patients who died in the medical ICU. No prior studies have examined the correlation between arterial COHb level and survival in patients with acute respiratory distress syndrome (ARDS). This study, therefore, aims to determine the correlation between levels of COHb and mortality in ICU patients with ARDS. Method: A Retrospective, observational study was conducted in a medical ICU in California. Patients with ARDS were identified using the Berlin criteria. Arterial blood gas prior to intubation, on day 1 of intubation, and prior to extubation/terminal extubation were obtained. Arterial COHb levels and ICU mortality were evaluated descriptively via Microsoft® Excel followed by two-tailed T test using SPSS®. Primary outcome was defined as COHb level between survivors and non-survivors. Secondary outcome being ICU length of stay, number of days intubated, and all-cause mortality. Results: A total of 656 patient charts were reviewed. Among reviewed patients, 31 patients met the inclusion criteria. Of those, 20 died and 11 survived. Higher COHb levels were observed in non-survivors prior to death compare to survivors (P=0.054, 95% CI: -0.82 to 0.01). Amongst non-survivors, a statistically significant upward trend was noted on COHb level from day 1 of intubation to prior to terminal extubation/death (1.09% to 1.47%; P=0.036; 95% CI: -0.73 to -0.03). On the contrary, the survivor group had no significant different between the COHb level from day 1 of intubation to prior to extubation (1.02% to 1.06%; P=0.82; 95% CI: -0.45 to 0.36). Conclusion: Patients with ARDS in the medical ICU who did not survive had higher arterial COHb compare to survivors. COHb level increased significantly from day 1 of intubation to the time of death amongst non-survivors. The study, therefore, suggests a positive correlation between COHb level and mortality in patients with ARDS.
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