Low Inadequate Oxygen Delivery Index is Associated with Decreased Cardiac Arrest Risk in High-Risk Pediatric ICU Patients

Abstract

OBJECTIVES:. To evaluate the Inadequate Oxygen Delivery Index (IDO2) in the PICU to identify patients labeled as high risk by clinician concern who will not experience a cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS:. Prospective observational cohort study in a single PICU from February 1, 2017, to May 20, 2020. All mean calculated IDO2 was collected for patients in 12-hour increments. MEASUREMENTS AND MAIN RESULTS:. We monitored 3,087 patients over 24,505 12-hour periods. Four thousand seventeen were watcher periods—12-hour period following watcher determination to watch for clinical deterioration. Overall, there were 224 clinical deterioration events of which 21% (n = 48) were cardiopulmonary resuscitation (CPR) events. Twenty-three CPR events (48%) and 93 clinical deteriorationevents (42%) occurred during 4,017 watcher periods. Following addition of a mean IDO2 threshold less than 5 during the prewatcher period, 23 CPR events (48%) and 77 clinical deterioration events (34%) occurred during 2,958 watcher periods. Using clinical concern alone, the number needed to evaluate for CPR events was 167 watcher periods for each single CPR event and 43 watcher periods for each clinical deterioration event. With the addition of a mean IDO2 less than 5, the number needed to evaluate decreased to 125 and 38, respectively, with no change in the prediction of CPR events. CONCLUSIONS:. The use of physiologic monitor data can be applied to clinician-activated situation awareness systems to decrease the number needed to alert and improve system efficiency.