Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury*
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- 1 April 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 40 (4), 1309-1316
- https://doi.org/10.1097/ccm.0b013e31823bc61b
Abstract
Given pulse oximetry is increasingly substituting for arterial blood gas monitoring, noninvasive surrogate markers for lung disease severity are needed to stratify pediatric risk. We sought to validate prospectively the comparability of SpO2/Fio2 to PaO2/Fio2 and oxygen saturation index to oxygenation index in children. We also sought to derive a noninvasive lung injury score. Prospective, multicentered observational study in six pediatric intensive care units. One hundred thirty-seven mechanically ventilated children with SpO2 80% to 97% and an indwelling arterial catheter. Simultaneous blood gas, pulse oximetry, and ventilator settings were collected. Derivation and validation data sets were generated, and linear mixed modeling was used to derive predictive equations. Model performance and fit were evaluated using the validation data set. One thousand one hundred ninety blood gas, SpO2, and ventilator settings from 137 patients were included. Oxygen saturation index had a strong linear association with oxygenation index in both derivation and validation data sets, given by the equation oxygen saturation index = 2.76 1 0.547*oxygenation index (derivation). 1/SpO2/Fio2 had a strong linear association with 1/PaO2/Fio2 in both derivation and validation data sets given by the equation 1/SpO2/Fio2 = 0.00232 1 0.443/PaO2/Fio2 (derivation). SpO2/Fio2 criteria for acute respiratory distress syndrome and acute lung injury were 221 (95% confidence interval 215–226) and 264 (95% confidence interval 259–269). Multivariate models demonstrated that oxygenation index, serum pH, and Paco2 were associated with oxygen saturation index (p < .05); and 1/PaO2/Fio2, mean airway pressure, serum pH, and Paco2 were associated with 1/SpO2/Fio2 (p < .05). There was strong concordance between the derived noninvasive lung injury score and the original pediatric modification of lung injury score with a mean difference of 20.0361 α0.264 sd. Lung injury severity markers, which use SpO2, are adequate surrogate markers for those that use PaO2 in children with respiratory failure for SpO2 between 80% and 97%. They should be used in clinical practice to characterize risk, to increase enrollment in clinical trials, and to determine disease prevalence. (Crit Care Med 2012; 40:–1316)Keywords
This publication has 17 references indexed in Scilit:
- Acute lung injury in children: Therapeutic practice and feasibility of international clinical trials*Pediatric Critical Care Medicine, 2010
- Characteristics of Children Intubated and Mechanically Ventilated in 16 PICUsSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2009
- Effect of tidal volume in children with acute hypoxemic respiratory failureIntensive Care Medicine, 2009
- Acute lung injury in pediatric intensive care in Australia and New Zealand–A prospective, multicenter, observational study*Pediatric Critical Care Medicine, 2007
- Oxygenation Index Predicts Outcome in Children with Acute Hypoxemic Respiratory FailureAmerican Journal of Respiratory and Critical Care Medicine, 2005
- Effect of Prone Positioning on Clinical Outcomes in Children With Acute Lung InjuryJAMA, 2005
- Pediatric Acute Lung InjuryAmerican Journal of Respiratory and Critical Care Medicine, 2005
- Effect of Exogenous Surfactant (Calfactant) in Pediatric Acute Lung InjuryA Randomized Controlled TrialJAMA, 2005
- Pulmonary Dead-Space Fraction as a Risk Factor for Death in the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2002
- An Expanded Definition of the Adult Respiratory Distress SyndromeAmerican Review of Respiratory Disease, 1988