Title: A cross-sectional study comparing the SpO2/FIO2 ratio with PaO2/FIO2 ratio in patients with ARDS

Authors: Dr Rachitha S, Dr Basanth Kumar S, Dr Gururaj V Gunda, Dr Tharunilatha A, Dr Preethi R Gandhi

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.127

Abstract

Background: ARDS is an acute hypoxemic respiratory failure whose early recognition is vital in implementing lung-protective ventilation strategy.PaO2/FiO2 (P/F) ratio is one of the parameters in ARDS diagnosis. This ratio is measured by arterial blood gas sampling. Since, this is an invasive procedure, this ratio can be substituted with Spo2/Fio2(S/F) ratio where SpO2 is measured by pulse oximetry. Therefore, SF ratio may be used as a reliable non-invasive alternative to the PF ratio.

Aims and Objectives: Deriving relationship between S/F and P/F ratios in ARDS patients and there by using S/F ratios as surrogate marker for P/F ratio.

Materials and Methods: 70 patients admitted in ICU of Kempegowda Institute of Medical Sciences and Research Centre, Bengaluru who met the criteria for ARDS, were intubated and receiving mechanical ventilation.

Results: Relationship between SF and PF ratio can be described by the regression equation SF =57+0.61 (P/F)[P <0.001].Based on this equation a PF ratio of 200 corresponds to an SF ratio of 181 [P <0.001]. The SF cut off 181 had 72% sensitivity and 81% specificity for the diagnosis of ARDS.

Conclusions: SF ratio is a reliable non-invasive surrogate for PF ratio for ARDS with the advantage of replacing invasive arterial blood sampling by non-invasive and continuously available pulse oximetry.

Keywords: ARDS, pulse oximetry, SpO2/FIO2 ratio, PaO2/FIO2 ratio.

References

  1. Powers AC, Niswender KD, Evans Molina C. Diabetes Mellitus. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J editors. Harrison's Principles of Internal Medicine, 20th ed. United States: McGraw-Hill Medical; 2018.p.2850-82
  2. Fishman AP, Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI. Fishman’s Pulmonary Diseases and Disorders, 4th edition.
  3. Neff TA. Routine oximetry. A fifth vital sign? Chest 1988; 94:22.
  4. Jensen LA, Onyskiw JE, Prasad NG. Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry in adults. Heart Lung 1998; 27:387–408
  5. Perkins GD, McAuley DF, Giles S, et al. Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation? Crit Care 2003; 7:R67
  6. Jubran A. Advances in respiratory monitoring during mechanical ventilation. Chest 1999; 116:1416–1425
  7. Young MP, Manning HL, Wilson DL, et al. Ventilation of patients with acute lung injury and acute respiratory distress syndrome: has new evidence changed clinical practice? Crit Care Med 2004; 32:1260–1265
  8. Rubenfeld GD, Cooper C, Carter G, et al. Barriers to providing lung-protective ventilation to patients with acute lung injury. Crit Care Med 2004; 32:1289–1293
  9. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270:2957–2963
  10. Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB. Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS. Chest 2007; 132(2):410-7. doi: 10.1378/chest.07-0617.
  11. Comparison of the Spo2/Fio2 Ratio and the Pao2/Fio2 Ratio in Patients with Acute Lung Injury or Acute Respiratory Distress Syndrome J Cardiovasc Thorac Res, 2015, 7(1), 28-31.

Corresponding Author

Dr Basanth Kumar S

Professor, Department of General Medicine, Kempegowda Institute of Medical Sciences and Research Centre, Bengaluru-560004