Characteristics and management of mechanically ventilated patients in South Korea compared with other high-income Asian countries and regions

Tissue plasminogen activator for the treatment of adults with critical COVID-19: A pilot randomized clinical trial

SummaryBackgroundGeoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies.MethodsIn this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality.FindingsOf the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001).InterpretationDespite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status.FundingNo funding.

Comparison of short-term mortality between mechanically ventilated patients with COVID-19 and influenza in a setting of sustainable healthcare system

This paper explores the effect of human capital and technology on economic growth in Asian countries while considering economic development. The paper expands the Solow Growth model by further incorporating the import of machinery and equipment reflecting total factor productivity. Panel data for 30 Asian countries has been used over 1995-2015. Due to the endogeneity problem in human capital and other variables, the System Generalized Method of Moment (GMM) is used to address this problem. Empirical results reveal that human capital and technology have increased economic growth in the total sample of Asian countries. Furthermore, the sample has been disaggregated into high-income (HI) and low-income (LI) Asian countries. Our findings determine that human capital and technology are reflecting a positive and statistically significant role in enhancing economic growth in both samples of countries. However, the magnitude of the impact is high in HI Asian countries relative to LI Asian countries, respectively. When the import of machinery and equipment are replaced with patents, a positive and insignificant results are obtained for LI countries because these countries have lacked legal systems, but a positive and statistically significant relationship is observed for HI Asian countries.

PurposeThis study examines the causal relationship between information communication technology (ICT) and economic growth in high-income and middle-income Asian countries.Design/methodology/approachThis study utilises a high-quality data from 25 Asian countries from 2000 to 2018. This study presents the robustness results by employing panel cointegration and estimation procedures to account for the endogeneity and cross-sectional dependence issues.FindingsThe results illustrate that high-income Asian countries have achieved positive and significant economic development from high Internet penetration. Additionally, the middle-income countries have started to benefit from ICT Internet. The findings show that the telephone line and mobile phone penetration is highly capable of promoting economic growth in middle-income Asian countries.Practical implicationsIn high-income Asia countries, an appropriate ICT infrastructure policy will support feasible ICT penetration, which may drive the processes of economic development and innovation that contribute to economic growth. Moreover, in middle-income Asian countries, the establishment of better-quality ICT service and infrastructure is more critical. Policymakers should accommodate sufficient support to establish the ICT infrastructure and expand ICT penetration.Originality/valueThis study reveals that high-income Asian countries have been more proactive and effective than middle-income countries in embracing ICT to foster economic growth. Examining the case of high-income and middle-income Asian countries provides comprehensive insight for policymakers regarding the relevance of ICT in boosting economic growth through the advantages of technology expansion.

To investigate the effect of circadian heart rate variation on short-term and long-term mortality in intensive care unit (ICU) patients. A retrospective cohort study was conducted. A total of 32 536 ICU patients were recorded from 2001 to 2008 published by Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II v2.6) in April 2011. The circadian heart rate variation was defined as the ratio of mean nighttime (23:00 to 07:00) heart rate to mean daytime (07:00 to 23:00) heart rate. The 28-day mortality and 1-year mortality were defined as outcome events. The information such as age, gender, ethnicity, first sequential organ failure assessment (SOFA) score, first simplified acute physiology score I (SAPS I), usage of sedatives and catecholamines within 24 hours admission of ICU, clinical complications [hypertension, chronic obstructive pulmonary disease (COPD), diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.], and the complete heart rate records within 24 hours after ICU admission were collected. Cox proportional risk regression models were used to investigate the association between circadian heart rate variation and 28-day mortality and 1-year mortality in ICU patients. Besides, subgroup analysis was also performed in patients with different first SOFA scores. Totally 15 382 ICU patients in MIMIC-II database were enrolled, excluding the patients without heart rate records or death records, using pacemaker with arrhythmia, without SOFA or SAPS I score records. Finally, 9 439 patients were enrolled in the study cohort. (1) Cox regression analysis of the whole patient showed that the higher circadian heart rate variation was correlated with the increased 28-day mortality [hazard ratio (HR) = 1.613, 95% confidence interval (95%CI) was 1.338-1.943, P < 0.001] and 1-year mortality (HR = 1.573, 95%CI was 1.296-1.908, P < 0.001). After adjustment for demographic factors (age, gender and ethnicity), severity of illness (SOFA and SAPS I scores), clinical complications (hypertension, COPD, diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.), and influence of medications (sedatives and catecholamines), the night-day heart rate ratio was also correlated with 28-day mortality (HR = 1.256, 95%CI was 1.018-1.549, P = 0.033) and 1-year mortality (HR = 1.249, 95%CI was 1.010-1.545, P = 0.040). (2) According to the SOFA score (median value of 5), the patients were divided into two subgroups, in which 5 478 patients with SOFA score ≤ 5 and 3 961 patients with SOFA score > 5. Cox regression subgroup analysis showed that circadian heart rate variation was related with higher 28-day mortality (HR = 1.430, 95%CI was 1.164-1.756, P = 0.001) and 1-year mortality (HR = 1.393, 95%CI was 1.123-1.729, P = 0.003) in patients with SOFA score > 5. After adjustment for covariates, the 28-day mortality (HR = 1.279, 95%CI was 1.032-1.584, P = 0.025) and 1-year mortality (HR = 1.255, 95%CI was 1.010-1.558, P = 0.040) also increased with the increasing of night-day heart rate ratio in patients with SOFA score > 5. However, the relationships did not exist in patients with SOFA score ≤ 5. In ICU patients, the 28-day mortality and 1-year mortality increase with the higher circadian heart rate variation, which indicates that the circadian heart rate variation in ICU patients is positively correlated with the short-term and long-term mortality, especially in patients with relatively severe illness.

Background: Use of lower tidal volumes during mechanical ventilation is associated with reduced morbidity and mortality of Intensive Care Unit (ICU) patients with the Acute Respiratory Distress Syndrome (ARDS). Use of lower tidal volumes could also protect ICU patients without ARDS. While use of higher tidal volumes is strongly discouraged in ARDS patients, guidelines do not yet recommend on tidal volume size in patients not suffering from this complication, resulting in unwanted variable mechanical ventilation settings amongst ICU patients. Purpose: The present study aims to determine ventilation characteristics, including tidal volume size in intubated and mechanically ventilated patients in ICUs in Europe, Australia and the Americas. Ventilation characteristics and outcomes are compared among patients without ARDS, patients at risk for ARDS and patients with mild, moderate or severe ARDS. Methods: The ‘PRatice of VENTilation in critically ill patients without ARDS’ study (PRoVENT) is an international multicenter observational study in critically ill intubated and ventilated ICU patients by the PROVENet (PROtective VENtilation Network) investigators (http://www.provenet.eu/). At least 1,000 patients under invasive mechanical ventilation are included in a time window of 7 days, and followed up to the end of stay in ICU. The primary endpoint is the variability of tidal volume size in ventilated patients in ICUs in Europe, Australia and the Americas. Conclusion: PRoVENT is designed to investigate and compare tidal volume settings in patients without ARDS, patients at risk for ARDS, and patients with mild, moderate or severe ARDS, and to determine the impact of tidal volume size on important clinical endpoints, in particular patients without ARDS. PRoVENT shall provide information on ventilator settings that could be used in future trials of ventilation, especially in ICU patients without or at risk for ARDS (Trial Registration: NCT01868321).

To explore the evaluation value of sequential organ failure assessment (SOFA) score at different time points in the prognosis of patients with severe pneumonia combined with acute respiratory distress syndrome (ARDS). A retrospective cohort study method was conducted, including patients with severe pneumonia and ARDS admitted to the emergency intensive care unit (ICU) of General Hospital of Ningxia Medical University from January 2015 to December 2019. General clinical data such as gender, age, and the SOFA scores at 1, 2, 3, and 7 days after admission were recorded. According to the diagnostic test, the prognostic evaluation value of SOFA score in patients with severe pneumonia combined with ARDS at different time points and different ages was analyzed. A total of 88 cases were included in this study, eventually, 42 cases were survived and 46 cases died, the mortality was 52.27%. The age of the death group was significantly older than the survival group (years old: 60.67±14.66 vs. 51.91±15.97), the SOFA score at each time point were significantly higher than those in the survival group (9.83±3.50 vs. 7.54±2.67, 9.98±3.75 vs. 7.48±2.92, 10.84±4.14 vs. 7.23±2.94, 11.71±4.03 vs. 6.51±3.22, respectively at 1, 2, 3, 7 days after admission, all P < 0.01). The receiver operator characteristic curve (ROC curve) showed that the SOFA score at 1, 2, 3, and 7 days after admission had a certain predictive value for the prognosis of patients with severe pneumonia combined with ARDS (all P < 0.01), and with the prolong of ICU stay, the area under ROC curve (AUC) of SOFA score had gradually increased. On the 7th day after admission, the SOFA score had the highest sensitivity in predicting severe pneumonia combined with ARDS patients, which was 92.86%, and the specificity was the highest on the 3rd day after admission, which was 88.10%. The AUC in day 7 was significantly higher than day 2 (0.85 vs. 0.72), there was no statistically significant difference of AUC at other time points. After stratifying by age, the diagnostic of sensitivity, specificity, accuracy, and AUC of SOFA score for the prognosis had gradually increased, and the predictive value was better. However, only on day 3 after admission, the AUC of SOFA score was significantly higher than day 1 (0.80 vs. 0.77, P < 0.05), and there was no significant difference in AUC at other time points. In patients older than 60 years old, the AUC of the SOFA score predicting the prognosis of patients was relatively small on day 1 and day 2 (0.67, 0.68, respectively), the ability was poor. There was no statistically significant difference in the AUC of SOFA scores at each time point in evaluating the prognosis of patients. The trends over time of patients at different ages and time points showed that regardless of age, the SOFA scores of the patients in the death group showed an upward trend, while showed a downward trend in the survival group, the difference reached the largest on the 7th day after admission, and the death group was significantly higher than the survival group (age < 60 years old: 12.50 vs. 6.69; age ≥ 60 years old: 11.58 vs. 6.21). The initial SOFA score has a certain value in the evaluation of prognosis of severe pneumonia patients combined with ARDS, but the effect is poor for elderly patients.

Noninvasive ventilation during acute respiratory distress syndrome in patients with cancer: Trends in use and outcome

To approach the correlation between angiopoietin-2 (Ang-2) levels and degree of lung injury and prognosis and its clinical significance in patients with acute respiratory distress syndrome (ARDS). A prospective observation was conducted. Fifty-three ARDS patients admitted to Department of Critical Care Medicine of Third Affiliated Hospital of Anhui Medical University from January 2012 to March 2014 were enrolled. According to the criteria of the Berlin Definition of ARDS, the patients were divided into mild group (n=15), moderate group (n=22) and severe group (n=16). Meanwhile, ARDS patients were further divided into survival group(n=29) and non-survival group(n=24) according to 28-day outcomes. Twenty cases of non-ARDS patients were served as control. The acute physiology and chronic health evaluation II(APACHEII) score, sequential organ failure assessment (SOFA) score, oxygenation index (PaO₂/FiO₂), lung injury score (LIS) were recorded within 24 hours after admission. And the plasma levels of Ang-2, interleukin-6 (IL-6) and C-reaction protein (CRP) were measured. The independent risk factors of ARDS were analyzed by univariate and multivariable logistic regression. Receiver operating characteristic curve (ROC) was plotted to evaluate the value of Ang-2 in predicting ARDS. Compared with non-ARDS group, APACHEII score, SOFA score, LIS score, mortality were significantly increased, PaO2/FiO2 was significantly decreased, and plasma Ang-2, IL-6, CRP were significantly elevated [APACHEII score: 20.7 ± 5.0 vs. 14.1 ± 5.3, SOFA score: 7.7 ± 3.5 vs. 3.5 ± 2.1, LIS score: 1.69 ± 0.71 vs. 0.28 ± 0.27, PaO₂/FiO₂(mmHg, 1 mmHg = 0.133 kPa): 159.5 ± 61.3 vs. 394.0 ± 3.2, mortality: 45.3% (24/53) vs. 20.0% (4/20), Ang-2(μg/L): 4.73(2.59, 6.99)vs. 1.22 (0.61, 1.52), IL-6(ng/L): 56.50 (27.15, 139.90)vs. 13.05 (4.38, 15.55), CRP (mg/L): 95.75(41.74, 189.72) vs. 10.56 (3.92, 21.36), P<0.05 or P<0.01]. Each index increased or decreased more significantly with the aggravation of the disease. It was shown by correlation analysis that the plasma levels of Ang-2 was significantly positive correlated with IL-6 (r=0.468,P=0.000), CRP(r = 0.492, P = 0.000), APACHEII score (r = 0.560, P = 0.000), SOFA score (r = 0.508, P = 0.000) and LIS score (r = 0.588, P = 0.000), significantly negatively correlated with PaO2/FiO2 (r=-0.685,P=0.000). Factors, APACHEII score, LIS score, PaO2/FiO2, Ang-2 and IL-6 founded statistical significance in univariate analysis were analyzed using multivariable logistic regression. High APACHEII score at admission [odds ratio (OR) = 1.316, 95% confidence interval (95% CI) = 1.040-1.633, P = 0.022] and increased plasma Ang-2 levels (OR = 1.287, 95% CI = 1.041-1.760, P = 0.038) were the independent prognostic factors for the 28-day mortality in ARDS. The area under the ROC curve of Ang-2 was 0.964, the optimal critical value of Ang-2 was 1.79 μg/L, the specificity was 90.0%, and sensitivity was 92.5%. Plasma levels of Ang-2 was better in predicting ARDS than APACHEII score, SOFA score and IL-6. The plasma level of Ang-2 was significantly increased in patients with ARDS. The plasma level of Ang-2 was correlated with the severity of acute lung injury and had important prognosis evaluation.

BackgroundRisk factors affecting the prognosis of acute respiratory distress syndrome (ARDS) in adults were investigated. The aim was to identify new predictors for ARDS patient prognosis, including those with clinical, pathophysiological, and atypical immunodeficiency.MethodsARDS patients were retrospectively included. The patients were grouped and analysed according to different oxygenation index grades and prognosis, and factors influencing prognosis and survival were examined. Adolescent patients, patients with typical immunodeficiency and patients who died within 24 h after being diagnosed with ARDS were excluded. The predictive value for mortality was determined by Cox proportional hazard analysis.ResultsIn total, 201 patients who fulfilled the Berlin definition of ARDS were included. The severity of critical illness on the day of enrolment, as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score (P = 0.016), Sequential Organ Failure Assessment (SOFA) score (P = 0.027), and PaO2/FiO2 (P = 0.000), worsened from mild to severe ARDS cases. Compared with survivors, non-survivors were significantly older and had higher APACHE II and SOFA scores. Moreover, significantly lower lymphocyte/neutrophil ratios and leukocyte counts were found among non-survivors than survivors (P = 0.008, P = 0.012). A moderate positive correlation between the lymphocyte/neutrophil and PaO2/FiO2 ratios (P = 0.023) was observed. In predicting 100-day survival in patients with ARDS, the area under the curve (AUC) for the lymphocyte/neutrophil ratio was significantly higher than those for the PaO2/FiO2 ratio alone, body mass index (BMI) alone, and the lymphocyte count alone (P = 0.0062, 0.0001, and 0.0154). Age (per log10 years), BMI < 24, SOFA score, leukocyte count, and the lymphocyte/neutrophil ratio were independent predictors of 28-day mortality in ARDS patients. Additionally, ARDS patients with a lymphocyte/neutrophil ratio < 0.0537 had increased 28-day mortality rates (P = 0.0283). Old age affected both 28-day and 100-day mortality rates (P = 0.0064,0.0057).ConclusionsAge (per log10 years), BMI < 24, SOFA score, lymphocytes, and the lymphocyte/neutrophil ratio were independent predictors of 100-day mortality in patients with ARDS. The lymphocyte/neutrophil ratio may represent a potential molecular marker to evaluate atypical immunosuppression or impairment in patients with ARDS.

BackgroundEnabling community-led health initiatives will contribute to reducing the burdens on the healthcare system. Implementing such initiatives successfully in high and upper-middle income Asian countries is poorly understood and documented. We undertook a Rapid Review, systematically synthesising the evidence to develop implementation guidelines to address this gap.MethodsEligible studies focused on community movements or affiliated constructs in upper-middle and high-income Asian countries, conducted between 2014 and 2021. Studies were sought from either electronic databases – Cochrane and Campbell Collaboration, PubMed, Embase, CINAHL, SCOPUS, APA Psycinfo, Web of Science, Google Scholar – or recommendation from experts. Extraction was undertaken according to mid-level programme goals, termed Intermediate Results. These were conceptualized by a cross-disciplinary team and iteratively reworked as analysis progressed. Framework analysis was undertaken and structured according to the IRs. 28 studies (9 mixed methods, 9 quantitative, 7 qualitative and 3 case studies) were included and synthesised.ResultsThe MovEMENTs checklist and related strategies were elicited through the review. The six Intermediate Results include to: (1) Move the community to be recruited and retained (2) Engage capacity and build capability; (3) Maintain emotional resonance; (4) Embed participatory approaches; (5) Nurture network building and partnerships; (6) Team up to improve commissioning and funding structures. Sixteen strategies and related implementation guidelines underpinning the Intermediate Results are extracted from the evidence-base of included studies.ConclusionThe MovEMENTs for Health checklist is developed to serve as a guide for implementers and proposed to be adaptable to various contexts. The checklist should be tested, validated, and updated as a field tool.Trial registrationPROSPERO ID: CRD42023471832.

Treatment of Critically Ill Coronavirus Disease 2019 Patients With Adjunct Therapeutic Plasma Exchange: A Single-Center Retrospective Case Series

To explore the independent risk factors of acute respiratory distress syndrome (ARDS) in patients with sepsis, establish an early warning model, and verify the predictive value of the model based on synthetic minority oversampling technique (SMOTE) algorithm. A retrospective case-control study was conducted. 566 patients with sepsis who were admitted to Jinan People's Hospital from October 2016 to October 2022 were enrolled. General information, underlying diseases, infection sites, initial cause, severity scores, blood and arterial blood gas analysis indicators at admission, treatment measures, complications, and prognosis indicators of patients were collected. The patients were grouped according to whether ARDS occurred during hospitalization, and the clinical data between the two groups were observed and compared. Univariate and binary multivariate Logistic regression analysis were used to select the independent risk factors of ARDS during hospitalization in septic patients, and regression equation was established to construct the early warning model. Simultaneously, the dataset was improved using the SMOTE algorithm to build an enhanced warning model. Receiver operator characteristic curve (ROC curve) was drawn to validate the prediction efficiency of the model. 566 patients with sepsis were included in the final analysis, of which 163 developed ARDS during hospitalization and 403 did not. Univariate analysis showed that there were statistically significant differences in age, body mass index (BMI), malignant tumor, blood transfusion history, pancreas and peripancreatic infection, gastrointestinal tract infection, pulmonary infection as the initial etiology, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, albumin (Alb), blood urea nitrogen (BUN), mechanical ventilation therapy, septic shock and length of intensive care unit (ICU) stay between the two groups. Binary multivariate Logistic regression analysis showed that age [odds ratio (OR) = 3.449, 95% confidence interval (95%CI) was 2.197-5.414, P = 0.000], pulmonary infection as the initial etiology (OR = 2.309, 95%CI was 1.427-3.737, P = 0.001), pancreas and peripancreatic infection (OR = 1.937, 95%CI was 1.236-3.035, P = 0.004), septic shock (OR = 3.381, 95%CI was 1.890-6.047, P = 0.000), SOFA score (OR = 9.311, 95%CI was 5.831-14.867, P = 0.000) were independent influencing factors of ARDS during hospitalization in septic patients. An early warning model was established based on the above risk factors: P1 = -4.558+1.238×age+0.837×pulmonary infection as the initial etiology+0.661×pancreas and peripancreatic infection+1.218×septic shock+2.231×SOFA score. ROC curve analysis showed that the area under the ROC curve (AUC) of the model for ARDS during hospitalization in septic patients was 0.882 (95%CI was 0.851-0.914) with sensitivity of 79.8% and specificity of 83.4%. The dataset was improved based on the SMOTE algorithm, and the early warning model was rebuilt: P2 = -3.279+1.288×age+0.763×pulmonary infection as the initial etiology+0.635×pancreas and peripancreatic infection+1.068×septic shock+2.201×SOFA score. ROC curve analysis showed that the AUC of the model for ARDS during hospitalization in septic patients was 0.890 (95%CI was 0.867-0.913) with sensitivity of 85.3% and specificity of 79.1%. This result further confirmed that the early warning model constructed by the independent risk factors mentioned above had high predictive performance. Risk factors for the occurrence of ARDS during hospitalization in patients with sepsis include age, pulmonary infection as the initial etiology, pancreatic and peripancreatic infection, septic shock, and SOFA score. Clinically, the probability of ARDS in patients with sepsis can be assessed based on the warning model established using these risk factors, allowing for early intervention and improvement of prognosis.

To investigate the evaluation value of oxygenation index at different times of mechanical ventilation (MV) on the prognosis of patients with acute respiratory distress syndrome (ARDS). A retrospectively analysis was conducted. A total of 228 patients with ARDS admitted to Department of Emergency of China Medical University Affiliated First Hospital from February 2014 to June 2016 were enrolled. All patients underwent MV treatment, and recruitment maneuver (RM) was performed by pressure-controlled ventilation (PCV) 30 minutes after the implementation of the protective ventilation strategy. Arterial blood gas analysis was performed at MV immediately, after RM and at 6, 12, 24 hours of MV, and oxygenation index was calculated. Vital signs, laboratory data, ultrasonic echocardiography, sequential organ failure assessment (SOFA) score, duration of MV, and ventilator related parameters of patients were collected. The patients were divided into survivors and non-survivors according to the prognosis of 28 days. The survivors were subdivided into high and low oxygenation group (oxygenation index was ≥ 150 mmHg and < 150 mmHg, respectively, 1 mmHg = 0.133 kPa). Differences in clinical indicators between survivors and non-survivors were compared. The correlation between the oxygenation index after RM and the oxygenation index at each time after MV was analyzed by bivariate correlation analysis. Receiver operating characteristic (ROC) curve was plotted to analyze predictive value of oxygenation index measured at different times for the 28-day outcome of patients with ARDS. Among 228 patients, 99 patients died within 28 days, and 129 survived, with mortality rate of 43.4%. (1) The oxygenation index after RM and at 6, 12, 24 hours after MV in survivors and non-survivors showed a continuously increased tendency, which was significantly lower in non-survivors than that in survivors (all P < 0.05). There was no significant difference in the duration of MV between high oxygenation group and low oxygenation group at MV immediately and after RM, but the duration of MV in high oxygenation group was significantly shorter than that of the low oxygenation group at 6, 12, 24 hour of MV (all P < 0.01). (2) After ventilation for 24 hours, serum creatinine (SCr), brain natriuretic peptide (BNP), lactate (Lac), right ventricular internal diameter, and SOFA score in non-survivors were significantly higher than those of survivors, and arterial partial pressure of oxygen (PaO2), platelet (PLT) and right ventricular ejection fraction (RVEF) were significantly lower than those of survivors (all P < 0.05). (3) After 24 hours ventilation, positive end-expiratory pressure (PEEP), tidal volume (VT), and minute ventilation (VE) in non-survivors were significantly higher than those of survivors, and static compliance of thorax (Cdyn) was significantly lower than that of survivors (all P < 0.01). (4) It was shown by correlation analysis that the oxygenation index after RM was positively correlated with those at 6, 12, 24 hours of MV (r values were 0.856, 0.765, and 0.758, respectively, all P < 0.001). (5) It was shown by ROC curve that the area under the ROC curve (AUC) of the oxygenation index after RM for predicting 28-day prognosis was 0.688. When the cut-off value was 80.75 mmHg, the sensitivity was 97.7%, and the specificity was 42.4%, which could only be used for preliminary judgment of prognosis. The AUC of oxygenation index at 6, 12, 24 hours of MV for 28-day survival of ARDS patients were 0.719, 0.727, 0.754, respectively. When the cut-off values were 171.50, 192.14, and 161.75 mmHg, the sensitivity was 69.8%, 67.4%, 86.0%, and the specificity was 78.8%, 78.8%, and 63.6%, respectively. It indicated that the predictive value was higher, and no significant difference was found among the oxygenation index at different time points. The oxygenation index after the early stage of RM can preliminarily determine the prognosis of patients. The predictive value of oxygenation index after MV for 28-day survival of ARDS patients was higher, so the oxygenation index measured at 6 hours of MV may be considered to evaluate the prognosis of patients with ARDS.