Association of Prehospital Oxygen Saturation to Inspired Oxygen Ratio With 1-, 2-, and 7-Day Mortality

Martin-Rodríguez, Francisco; López-Izquierdo, Raúl; Vegas, Carlos Del Pozo; Delgado-Benito, Juan F.; Ortega, Guillermo J.; Villamor, Miguel Ángel Castro; Sanz-García, Áncor

doi:10.1001/jamanetworkopen.2021.5700

Cited by 18 publications

(20 citation statements)

References 33 publications

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“…To our knowledge, this is the first multicenter, derivation-validation, progn hort study comparing the diagnostic accuracy of the SpO2/FiO2 ratio with the RO to predict IMV as a primary outcome in COVID-19 patients transferred by ambu an ED. In the current study, we found that the SpO2/FiO2 ratio had better accur Lastly, using previous SpO2/FiO2 ratio cutoff points considered for the determination of mortality risk groups (18), we assessed the percentages of IMV for each group; the high-risk group (50-100) presented 44%, the intermediate group (101-426) presented 25%, and the low risk group (427-476) presented 5% of patients on IMV.…”

Section: Discussionmentioning

confidence: 72%

“…To determine to what extent the ratio could be useful as a tool to predict outcomes, we have chosen to classify the patients into three groups, with SpO2/FiO2 cut-off points previously considered for the determination of mortality risk groups [18]. Our results show that we must carry out a closer study of intermediate (SpO2/FiO2 101-426) and high-risk (SpO2/FiO2 50-100) patients, as these groups represent an increased requirement for IMV (25% and 44%, respectively) as compared to the low-risk group (SpO2/FiO2: 427-476, with 5% of patients with IMV).…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, using previous SpO2/FiO2 ratio cutoff points considered for the de tion of mortality risk groups (18), we assessed the percentages of IMV for each gr high-risk group (50-100) presented 44%, the intermediate group (101-426) presen and the low risk group (427-476) presented 5% of patients on IMV.…”

Section: Spo2/fio2 Ratio and Age Associationmentioning

confidence: 99%

“…As an alternative, the SpO2/FiO2 ratio has been proposed. Both can be performed at any time and under any clinical conditions, both continuously and non-invasively [17,18].…”

Section: Introductionmentioning

confidence: 99%

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Role of SpO2/FiO2 Ratio and ROX Index in Predicting Early Invasive Mechanical Ventilation in COVID-19. A Pragmatic, Retrospective, Multi-Center Study

Iglesias¹,

Martin-Rodríguez

Ortega

et al. 2021

Biomedicines

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The ability of COVID-19 to compromise the respiratory system has generated a substantial proportion of critically ill patients in need of invasive mechanical ventilation (IMV). The objective of this paper was to analyze the prognostic ability of the pulse oximetry saturation/fraction of inspired oxygen ratio (SpO2/FiO2) and the ratio of SpO2/FiO2 to the respiratory rate–ROX index–as predictors of IMV in an emergency department in confirmed COVID-19 patients. A multicenter, retrospective cohort study was carried out in four provinces of Spain between March and November 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using a derivation sub-cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation sub-cohort. A total of 2040 patients were included in the study. The IMV rate was 10.1%, with an in-hospital mortality rate of 35.3%. The performance of the SpO2/FiO2 ratio was better than the ROX index–AUC = 0.801 (95% CI 0.746–0.855) and AUC = 0.725 (95% CI 0.652–0.798), respectively. In fact, a direct comparison between AUCs resulted in significant differences (p = 0.001). SpO2 to FiO2 ratio is a simple and promising non-invasive tool for predicting risk of IMV in patients infected with COVID-19, and it is realizable in emergency departments.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Spo2/fio2 Ratio and Age Associationmentioning

confidence: 99%

“…As an alternative, the SpO2/FiO2 ratio has been proposed. Both can be performed at any time and under any clinical conditions, both continuously and non-invasively [17,18].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Role of SpO2/FiO2 Ratio and ROX Index in Predicting Early Invasive Mechanical Ventilation in COVID-19. A Pragmatic, Retrospective, Multi-Center Study

Iglesias¹,

Martin-Rodríguez

Ortega

et al. 2021

Biomedicines

Self Cite

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“…The Berlin definition of the acute respiratory distress syndrome (ARDS)[ 1 ] is clinically useful as index of both organ dysfunction and severity of hypoxemia [ 2 , 3 ]. There is growing interest in non-invasive respiratory support for acute hypoxemic respiratory failure [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Limitations of the ARDS criteria during high-flow oxygen or non-invasive ventilation: evidence from critically ill COVID-19 patients

et al. 2022

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Background The ratio of partial pressure of arterial oxygen to inspired oxygen fraction (PaO2/FIO2) during invasive mechanical ventilation (MV) is used as criteria to grade the severity of respiratory failure in acute respiratory distress syndrome (ARDS). During the SARS-CoV2 pandemic, the use of PaO2/FIO2 ratio has been increasingly used in non-invasive respiratory support such as high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The grading of hypoxemia in non-invasively ventilated patients is uncertain. The main hypothesis, investigated in this study, was that the PaO2/FIO2 ratio does not change when switching between MV, NIV and HFNC. Methods We investigated respiratory function in critically ill patients with COVID-19 included in a single-center prospective observational study of patients admitted to the intensive care unit (ICU) at Uppsala University Hospital in Sweden. In a steady state condition, the PaO2/FIO2 ratio was recorded before and after any change between two of the studied respiratory support techniques (i.e., HFNC, NIV and MV). Results A total of 148 patients were included in the present analysis. We find that any change in respiratory support from or to HFNC caused a significant change in PaO2/FIO2 ratio. Changes in respiratory support between NIV and MV did not show consistent change in PaO2/FIO2 ratio. In patients classified as mild to moderate ARDS during MV, the change from HFNC to MV showed a variable increase in PaO2/FIO2 ratio ranging between 52 and 140 mmHg (median of 127 mmHg). This made prediction of ARDS severity during MV from the apparent ARDS grade during HFNC impossible. Conclusions HFNC is associated with lower PaO2/FIO2 ratio than either NIV or MV in the same patient, while NIV and MV provided similar PaO2/FIO2 and thus ARDS grade by Berlin definition. The large variation of PaO2/FIO2 ratio indicates that great caution should be used when estimating ARDS grade as a measure of pulmonary damage during HFNC.

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Novel Prehospital Phenotypes and Outcomes in Adult-Patients with Acute Disease

et al. 2022

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Association of Prehospital Oxygen Saturation to Inspired Oxygen Ratio With 1-, 2-, and 7-Day Mortality

Cited by 18 publications

References 33 publications

Role of SpO2/FiO2 Ratio and ROX Index in Predicting Early Invasive Mechanical Ventilation in COVID-19. A Pragmatic, Retrospective, Multi-Center Study

Role of SpO2/FiO2 Ratio and ROX Index in Predicting Early Invasive Mechanical Ventilation in COVID-19. A Pragmatic, Retrospective, Multi-Center Study

Limitations of the ARDS criteria during high-flow oxygen or non-invasive ventilation: evidence from critically ill COVID-19 patients

Novel Prehospital Phenotypes and Outcomes in Adult-Patients with Acute Disease

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