Prognostic value of the novel P/FPE index to classify ARDS severity: A cohort study.

OBJECTIVE: To evaluate the impact of the novel P/FPE index to classify ARDS severity on mortality of patients with ARDS. DESIGN: A retrospective cohort study. SETTING: Twelve-bed medical and surgical intensive care unit from January 2018 to December 2020. PATIENTS: A total of 217 ARDS patients managed with invasive mechanical ventilation >48h. INTERVENTIONS: None. VARIABLES: ARDS severity on day 1 and day 3 was measured based on PaO2/FiO2 ratio and P/FPE index [PaO2/(FiO2×PEEP)]. Primary outcome was the hospital mortality. RESULTS: Hospital mortality rate was 59.9%. Relative to PaO2/FiO2 ratio, 31.8% of patients on day 1 and 77.0% on day 3 were reclassified into a different category of ARDS severity by P/FPE index. The level of PEEP was lower by P/FPE index-based ARDS severity classification than by using PaO2/FiO2 ratio. The performance for predicting mortality of P/FPE index was superior to PaO2/FiO2 ratio in term of AROC (day 1: 0.72 vs. 0.62; day 3: 0.87 vs. 0.68) and CORR (day 1: 0.370 vs. 0.213; day 3: 0.634 vs. 0.301). P/FPE index improved prediction of risk of death compared to PaO2/FiO2 ratio as showed by the qNRI (day 1: 72.0%, p<0.0001; day 3: 132.4%, p<0.0001) and IDI (day 1: 0.09, p<0.0001; day 3: 0.31, p<0.0001). CONCLUSIONS: Assessment of ARDS severity based on P/FPE index seems better than PaO2/FiO2 ratio for predicting mortality. The value of P/FPE index for clinical decision-making requires confirmation by randomized controlled trials.

Embarazo y enfermedades cardiovasculares / Preganancy and cardiovascular diseases

Se realizó una investigación en 150 embarazadas con enfermedades cardiovasculares asociadas, de un total de 1665 pacientes que tuvieron su parto en el período comprendido desde enero a diciembre de 1996, en el Hospital General Docente de Baracoa, lo que representó el 90

del total de ingresos. Indicadores como la edad, mostraron una moda de 24-27 años y como media, 26 años; la mujer primípara tuvo mayor incidencia que las de otro tipo de paridad. Las gestantes con hipertensión arterial crónica, estenosis mitral y comunicación interauricular, fueron las cardiopatías que prevalecieron. Predominaron los neonatos a término y los normopesos en las cardiopatías estudiadas. No hubo mortalidad perinatal ni materna en el período estudiado(AU)