The Predicting Ability of Serum Phosphorus to Assess the Duration of Mechanical Ventilation in Critically Ill Patients

Talakoub, Reihanak; Bahrami, Mahshid; Honarmand, Azim; Abbasi, Saeed; Gerami, Hamideh

The Predicting Ability of Serum Phosphorus to Assess the Duration of Mechanical Ventilation in Critically Ill Patients

Document Type : Original Article

Authors

Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: No previous study exists to evaluate serum phosphorus (Ph) level as a predictor of the need to mechanical ventilation (MV). This study was designed to determine the predictive ability of admission serum Ph level on MV in patients admitted in Intensive Care Unit (ICU). Materials and Methods: This prospective study was conducted on 100 patients (>16 years old), admitted to our ICU over 1-year. Patients were classified into two groups according to the days of the need to MV. Group A: Patients who required equal or <5 days MV, and Group B: Patients who required more than 5 days of MV. We measured total serum Ph concentrations at the times of ICU admission, connecting to the ventilator and weaning from the ventilator. Results: There were significant differences between serum Ph concentration on admission to ICU (Group A: 3.39 ± 0.39 mg/dl, Group B: 2.89 ± 0.31 mg/dl, P < 0.001), at the time of connecting to ventilator (Group A: 2.49 ± 0.38 mg/dl, Group B: 2.25 ± 0.26 mg/dl, P = 0.004) and weaning from ventilator (Group A: 3.42 ± 0.33 mg/dl, Group B: 2.98 ± 0.34 mg/dl, P < 0.001) between two groups. Duration of ICU stay in Group A was 6.08 ± 1.48 days and in Group B was 15.35 ± 6.45, this difference was significant (P < 0.001). We found the best cut-off point of 3.07 for serum Ph concentration to predict the longer duration of MV.Conclusion: According to the results of our study, hypophosphatemia may increase the need to MV. Therefore, monitoring serum Ph level is a good prognostic factor to predict the need to ventilation.

Keywords

References

1.	Oud L. Transient hypoxic respiratory failure in a patient with severe hypophosphatemia. Med Sci Monit 2009;15:CS49-53.
2.	al-Ghamdi SM, Cameron EC, Sutton RA. Magnesium deficiency: Pathophysiologic and clinical overview. Am J Kidney Dis 1994;24:737-52.
3.	Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29:1033-56.
4.	Lermitte J, Garfield M. Weaning from mechanical ventilation. Contin Educ Anaesth 2005;5:113-117.
5.	Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29:1033-56.
6.	Tobin MJ. Mechanical ventilation. N Engl J Med 1994;330:1056-61.
7.	Smith RA. Principles of Mechanical Ventilation. Text Book of Critical Care. Philadelphia (PA): W.B. Sanders; 1995. p. 858-67.
8.	Safavi M, Honarmand A. Admission hypomagnesemia impact on mortality or morbidity in critically ill patients. Middle East J Anaesthesiol 2007;19:645-60.
9.	Arend W, Drazan J, Larusso N, Armitage J, Clemmons D. Renal Diseases, Goldman's Cecils Medicine. Philadelphia: Elsevier Publication; 2008. p. 839-40.
10.	Amanzadeh J, Reilly RF Jr. Hypophosphatemia: An evidence-based approach to its clinical consequences and management. Nat Clin Pract Nephrol 2006;2:136-48.
11.	Brunelli SM, Goldfarb S. Hypophosphatemia: Clinical consequences and management. J Am Soc Nephrol 2007;18:1999-2003.
12.	Doig GS, Bellomo R, Simson F, Hegarty C, Egi M, Sweetman EA, et al. Hypophosphatemia occurs early in ICU stay and associated with increased duration of mechanical ventilation and ICU and hospital stay. Am J Respir Crit Care Med: 2009;179:23-9.
13.	Alsumrain MH, Jawad SA, Imran NB, Riar S, DeBari VA, Adelman M. Association of hypophosphatemia with failure-to-wean from mechanical ventilation. Ann Clin Lab Sci 2010;40:144-8.
14.	Grewal Y, Ong PH, Badara M, Chanda A, Balasingham SH, Diovertiprono MV, et al. Incidence and consequences of hypophosphatemia in critically ill patients. Am J Respir Crit Care Med 2011;183.A5824.
15.	Jaber S, Petrof BJ, Jung B, Chanques G, Berthet JP, Rabuel C, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med 2011;183:364-71.
16.	McNeil BJ, Hanley JA. Statistical approaches to the analysis of receiver operating characteristic (ROC) curves. Med Decis Making 1984;4:137-50.
17.	Moor DJ, Rosh AJ. Hypophosphatemia. Emedicine. Available from: http://www.emedicine.medscape.com/article/767955-overview.[Last updated on 2009 Sep 22].
18.	Meyer AA, Messick WJ, Young P, Baker CC, Fakhry S, Muakkassa F, et al. Prospective comparison of clinical judgment and APACHE II score in predicting the outcome in critically ill surgical patients. J Trauma 1992;32:747-53.
19.	Patel U, Sriram K. Acute respiratory failure due to refeeding syndrome and hypophosphatemia induced by hypocaloric enteral nutrition. Nutrition 2009;25:364-7.
20.	Dooley J, Fegley A. Laboratory monitoring of mechanical ventilation. Crit Care Clin 2007;23:135-48, vii.
21.	Honarmand A, Safavi M, Moradi D. The use of infection probability score and sequential organ failure assessment scoring systems in predicting mechanical ventilation requirement and duration. Ulus Travma Acil Cerrahi Derg 2009;15:440-7.
22.	Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, et al. Quantification of organ dysfunction: Seeking standardization. Crit Care Med 1998;26:1767-8.

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