Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2∗10/FiO2∗PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome
Background. Conventionally, PaO2/FiO2 (P/F ratio) has been used to categorize severity of acute respiratory distress syndrome (ARDS) and prognostication of outcome. Recent literature has shown that incorporation of positive end-expiratory pressure (PEEP) into the P/F ratio (PaO2∗10/FiO2∗PEEP or P/FP...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2022/7871579 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832555169342029824 |
|---|---|
| author | Pratibha Todur Anitha Nileshwar Souvik Chaudhuri Nitin Gupta Srikant Natarajan Shwethapriya Rao |
| author_facet | Pratibha Todur Anitha Nileshwar Souvik Chaudhuri Nitin Gupta Srikant Natarajan Shwethapriya Rao |
| author_sort | Pratibha Todur |
| collection | DOAJ |
| description | Background. Conventionally, PaO2/FiO2 (P/F ratio) has been used to categorize severity of acute respiratory distress syndrome (ARDS) and prognostication of outcome. Recent literature has shown that incorporation of positive end-expiratory pressure (PEEP) into the P/F ratio (PaO2∗10/FiO2∗PEEP or P/FP∗10) has a much better prognostic ability in ARDS as compared to P/F ratio. The aim of this study was to correlate SpO2∗10/FiO2∗PEEP (S/FP∗10) to PaO2∗10/FiO2∗PEEP (P/FP∗10) and evaluate the utility of S/FP∗10 as a reliable noninvasive indicator of oxygenation in ARDS to avoid repeated arterial blood sampling. Aim. To evaluate if pulse oximetry is a reliable indicator of oxygenation in ARDS patients by calculating SpO2∗10/FiO2∗PEEP (S/FP∗10). The primary objective was to determine the correlation of S/FP∗10 to P/FP∗10 ratio in ARDS patients. The secondary objective was to determine the cut-off value of S/FP∗10 ratio to predict severe ARDS and survival. Methods. Patients aged 18–80 years on invasive mechanical ventilation (MV) diagnosed with ARDS as defined by the Berlin definition were included. The values of PaO2, FiO2, and SpO2 were collected at three different time points. They were at baseline, i.e., after intubation and initiation of MV (within one hour of intubation), day one (1–24 hours of MV), and day three (48–72 hours of MV). The primary outcome was survival at the end of intensive care unit (ICU) stay. Results. A total of 85 patients with ARDS on invasive MV were included. The data points were obtained at baseline, day one, and day three of MV. S/FP∗10 ratio has an excellent correlation to P/FP∗10 ratio at baseline and day three of invasive MV (r = 0.831 and 0.853, respectively; p<0.001) and has a strong correlation on day one of invasive MV (r = 0.733, p<0.001). S/FP∗10 ratio ≤116 at baseline has excellent discriminant function to be categorized as severe ARDS as per Berlin definition (AUC: 0.925, p<0.001, 90% sensitivity, 93% specificity, CI: [0.862–0.988]). The increase in S/FP∗10 ratio by ≥64.40 from baseline to day three of MV is a good predictor of survival (AUC: 0.877, p<0.001, 73.5% sensitivity, 97% specificity, CI: [0.803–0.952]). Conclusion. S/FP∗10 has a strong correlation to P/FP∗10 in ARDS patients. S/FP∗10 ≤116 has an excellent discriminant function to be categorized as severe ARDS. The S/FP∗10 ratio on day three of MV and the change in S/FP∗10 ratio from baseline and day one to day three of MV are good predictors of survival in ARDS patients. This trial is registered with CTRI/2020/04/024940. |
| format | Article |
| id | doaj-art-2314a4b900664f918ee54a446e4c1373 |
| institution | Kabale University |
| issn | 2090-1313 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-2314a4b900664f918ee54a446e4c13732025-02-03T05:49:20ZengWileyCritical Care Research and Practice2090-13132022-01-01202210.1155/2022/7871579Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2∗10/FiO2∗PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress SyndromePratibha Todur0Anitha Nileshwar1Souvik Chaudhuri2Nitin Gupta3Srikant Natarajan4Shwethapriya Rao5Department of Respiratory TherapyDepartment of AnaesthesiologyDepartment of Critical Care MedicineDepartment of Infectious DiseasesDepartment of Oral Pathology & MicrobiologyDepartment of Critical Care MedicineBackground. Conventionally, PaO2/FiO2 (P/F ratio) has been used to categorize severity of acute respiratory distress syndrome (ARDS) and prognostication of outcome. Recent literature has shown that incorporation of positive end-expiratory pressure (PEEP) into the P/F ratio (PaO2∗10/FiO2∗PEEP or P/FP∗10) has a much better prognostic ability in ARDS as compared to P/F ratio. The aim of this study was to correlate SpO2∗10/FiO2∗PEEP (S/FP∗10) to PaO2∗10/FiO2∗PEEP (P/FP∗10) and evaluate the utility of S/FP∗10 as a reliable noninvasive indicator of oxygenation in ARDS to avoid repeated arterial blood sampling. Aim. To evaluate if pulse oximetry is a reliable indicator of oxygenation in ARDS patients by calculating SpO2∗10/FiO2∗PEEP (S/FP∗10). The primary objective was to determine the correlation of S/FP∗10 to P/FP∗10 ratio in ARDS patients. The secondary objective was to determine the cut-off value of S/FP∗10 ratio to predict severe ARDS and survival. Methods. Patients aged 18–80 years on invasive mechanical ventilation (MV) diagnosed with ARDS as defined by the Berlin definition were included. The values of PaO2, FiO2, and SpO2 were collected at three different time points. They were at baseline, i.e., after intubation and initiation of MV (within one hour of intubation), day one (1–24 hours of MV), and day three (48–72 hours of MV). The primary outcome was survival at the end of intensive care unit (ICU) stay. Results. A total of 85 patients with ARDS on invasive MV were included. The data points were obtained at baseline, day one, and day three of MV. S/FP∗10 ratio has an excellent correlation to P/FP∗10 ratio at baseline and day three of invasive MV (r = 0.831 and 0.853, respectively; p<0.001) and has a strong correlation on day one of invasive MV (r = 0.733, p<0.001). S/FP∗10 ratio ≤116 at baseline has excellent discriminant function to be categorized as severe ARDS as per Berlin definition (AUC: 0.925, p<0.001, 90% sensitivity, 93% specificity, CI: [0.862–0.988]). The increase in S/FP∗10 ratio by ≥64.40 from baseline to day three of MV is a good predictor of survival (AUC: 0.877, p<0.001, 73.5% sensitivity, 97% specificity, CI: [0.803–0.952]). Conclusion. S/FP∗10 has a strong correlation to P/FP∗10 in ARDS patients. S/FP∗10 ≤116 has an excellent discriminant function to be categorized as severe ARDS. The S/FP∗10 ratio on day three of MV and the change in S/FP∗10 ratio from baseline and day one to day three of MV are good predictors of survival in ARDS patients. This trial is registered with CTRI/2020/04/024940.http://dx.doi.org/10.1155/2022/7871579 |
| spellingShingle | Pratibha Todur Anitha Nileshwar Souvik Chaudhuri Nitin Gupta Srikant Natarajan Shwethapriya Rao Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2∗10/FiO2∗PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome Critical Care Research and Practice |
| title | Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2∗10/FiO2∗PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome |
| title_full | Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2∗10/FiO2∗PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome |
| title_fullStr | Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2∗10/FiO2∗PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome |
| title_full_unstemmed | Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2∗10/FiO2∗PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome |
| title_short | Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2∗10/FiO2∗PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome |
| title_sort | utility of pulse oximetry oxygen saturation spo2 with incorporation of positive end expiratory pressure spo2∗10 fio2∗peep for classification and prognostication of patients with acute respiratory distress syndrome |
| url | http://dx.doi.org/10.1155/2022/7871579 |
| work_keys_str_mv | AT pratibhatodur utilityofpulseoximetryoxygensaturationspo2withincorporationofpositiveendexpiratorypressurespo210fio2peepforclassificationandprognosticationofpatientswithacuterespiratorydistresssyndrome AT anithanileshwar utilityofpulseoximetryoxygensaturationspo2withincorporationofpositiveendexpiratorypressurespo210fio2peepforclassificationandprognosticationofpatientswithacuterespiratorydistresssyndrome AT souvikchaudhuri utilityofpulseoximetryoxygensaturationspo2withincorporationofpositiveendexpiratorypressurespo210fio2peepforclassificationandprognosticationofpatientswithacuterespiratorydistresssyndrome AT nitingupta utilityofpulseoximetryoxygensaturationspo2withincorporationofpositiveendexpiratorypressurespo210fio2peepforclassificationandprognosticationofpatientswithacuterespiratorydistresssyndrome AT srikantnatarajan utilityofpulseoximetryoxygensaturationspo2withincorporationofpositiveendexpiratorypressurespo210fio2peepforclassificationandprognosticationofpatientswithacuterespiratorydistresssyndrome AT shwethapriyarao utilityofpulseoximetryoxygensaturationspo2withincorporationofpositiveendexpiratorypressurespo210fio2peepforclassificationandprognosticationofpatientswithacuterespiratorydistresssyndrome |