Comparison of PaO2/FiO2 (PF ratio) to SpO2/FiO2 (SF ratio) and OI to OSI for Predicting Short Term Outcomes in Children with Acute Hypoxemic Respiratory Distress: A Prospective Observational Study.

OBJECTIVES: To compare PaO2/FiO2 (PF ratio) to SpO2/FiO2 (SF ratio) and oxygenation index (OI) to oxygenation saturation index (OSI) for predicting short term outcomes [mortality, progression to ventilation and ventilator free days (VFD)] and compare trends of S/F and OSI in predicting early mortality in children with acute hypoxemic respiratory distress. METHODS: This prospective observational study included 200 consecutive children with acute hypoxemic respiratory distress. Serial PF and SF ratios calculated at 0, 6, 24 and 48 h were compared and their trends were utilized for prediction of 28 d mortality. Same was done in ventilated patients using OI and OSI. RESULTS: SF ratio at admission had a 72% sensitivity and 60% specificity while PF had a sensitivity of 78% and a specificity of 75% for prediction of mortality. The area under the curve (AUC) for SF ratio was 0.82 (CI: 0.688-0.915). Serial SF ratios accurately predicted mortality. OI had sensitivity of 92% and specificity of 95% in predicting 24 and 48 h mortality. OSI had 95% sensitivity and 92% specificity in predicting mortality with AUC 1.000 (CI- 1.00-1.00) at 24 and 48 h post ventilation. Serially increasing OI and OSI trends had an inverse correlation with VFDs (p <0.01). CONCLUSIONS: SF is a reliable surrogate for PF and a useful predictor of progression to ventilation and survival at discharge while OSI is a useful marker of worsening hypoxia and mortality in ventilated patients.

Deferasirox causing duodenal ulcer leading to upper gastrointestinal bleed and hemorrhagic shock in a child with beta-thalassemia major.

Iron chelators have significantly reduced the morbidity associated with iron overload and improved the quality of life in children with beta-thalassemia major. A 5-year-old female child with beta-thalassemia major on recurrent transfusions and oral chelation with deferasirox was brought with repeated episodes of frank hematemesis and progressive lethargy. Her evaluation revealed anemia, leukocytosis, and deranged liver function with coagulopathy. She was given red blood cell and plasma transfusions with liver supportive medication and proton-pump inhibitor (PPI) infusion. Her upper gastrointestinal endoscopy revealed multiple ulcers in all three parts of the duodenum, which in the absence of any other likely etiology were attributed to prolonged use of oral deferasirox. The child improved with the above-mentioned measures. Chelation therapy was withheld for 2 weeks and restarted at a lower dose using enteric-coated preparation while PPIs were given for 8 weeks. She showed sustained improvement and remained well on follow-up.