COVID-19: efficacy of prehospital pulse oximetry for early detection of silent hypoxemia

Quaresima, Valentina; Ferrari, Marco

doi:10.1186/s13054-020-03185-x

Cited by 26 publications

(21 citation statements)

References 8 publications

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“…Hospitalization is only an option if there is a medical need. Monitoring the blood oxygen level may be a meaningful way to remotely monitor individuals with mild COVID-19 21 . It could also be used for continuous monitoring of patients in the ICU with pneumonia, a common complication of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Digital oximetry biomarkers for assessing respiratory function: standards of measurement, physiological interpretation, and clinical use

et al. 2021

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Pulse oximetry is routinely used to non-invasively monitor oxygen saturation levels. A low oxygen level in the blood means low oxygen in the tissues, which can ultimately lead to organ failure. Yet, contrary to heart rate variability measures, a field which has seen the development of stable standards and advanced toolboxes and software, no such standards and open tools exist for continuous oxygen saturation time series variability analysis. The primary objective of this research was to identify, implement and validate key digital oximetry biomarkers (OBMs) for the purpose of creating a standard and associated reference toolbox for continuous oximetry time series analysis. We review the sleep medicine literature to identify clinically relevant OBMs. We implement these biomarkers and demonstrate their clinical value within the context of obstructive sleep apnea (OSA) diagnosis on a total of n = 3806 individual polysomnography recordings totaling 26,686 h of continuous data. A total of 44 digital oximetry biomarkers were implemented. Reference ranges for each biomarker are provided for individuals with mild, moderate, and severe OSA and for non-OSA recordings. Linear regression analysis between biomarkers and the apnea hypopnea index (AHI) showed a high correlation, which reached $$\overline R ^2 = 0.82$$ R ¯ 2 = 0.82 . The resulting python OBM toolbox, denoted “pobm”, was contributed to the open software PhysioZoo (physiozoo.org). Studying the variability of the continuous oxygen saturation time series using pbom may provide information on the underlying physiological control systems and enhance our understanding of the manifestations and etiology of diseases, with emphasis on respiratory diseases.

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Section: Discussionmentioning

confidence: 99%

Digital oximetry biomarkers for assessing respiratory function: standards of measurement, physiological interpretation, and clinical use

et al. 2021

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“…During the pandemic, a great deal of emphasis has been placed on so-called silent hypoxemia, which is characterized by a dissociation between SpO 2 and ventilatory dynamics [35,36]. The ventilatory response to hypoxemia is highly variable and is usually observed oin people who practically do not increase their ventilation when their oxygen decreases [7,8,37]. This unique pathophysiology of the disease could explain a decrease in the diagnostic accuracy of the ROX index when compared to SpO2/FiO2, though this could also be affected by an underestimated/incorrect evaluation of respiratory rates.…”

Section: Discussionmentioning

confidence: 99%

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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“…A pulse oximeter is a common and standard medical device used to noninvasively measure the arterial oxygen saturation level and respiratory function in patients [ 37 ]. Although it represents an accessible device, it is important to ensure that the used pulse oximeter has a high accuracy rate, especially in cases when patient SpO 2 is lower than 90% [ 38 ]. Constant monitoring of arterial oxygenation by pulse oximeter is a very good option to detect silent hypoxia.…”

Section: Diagnosis Of Silent Hypoxia Associated Covid-19 Patientsmentioning

confidence: 99%

Silent hypoxia in COVID-19: pathomechanism and possible management strategy

et al. 2021

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COVID-19: efficacy of prehospital pulse oximetry for early detection of silent hypoxemia

Cited by 26 publications

References 8 publications

Digital oximetry biomarkers for assessing respiratory function: standards of measurement, physiological interpretation, and clinical use

Digital oximetry biomarkers for assessing respiratory function: standards of measurement, physiological interpretation, and clinical use

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

Silent hypoxia in COVID-19: pathomechanism and possible management strategy

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