Nonlinear Imputation of Pao2/Fio2 From Spo2/Fio2 Among Patients With Acute Respiratory Distress Syndrome

Brown, Samuel M.; Grissom, Colin K.; Moss, Marc; Rice, Todd W.; Schoenfeld, David; Hou, Peter C.; Thompson, B. Taylor; Brower, Roy G.

doi:10.1016/j.chest.2016.01.003

Cited by 149 publications

(122 citation statements)

References 34 publications

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“…In a large, retrospective study of patients with ARDS enrolled in three clinical trials,(12) we demonstrated that a non-linear imputation based on the Ellis inversion(13) of the Severinghaus equation(14) outperformed linear and log-linear imputation methods, observations which complemented prior studies of non-intubated patients with pneumonia. (15–18) To externally validate these retrospective observations, we undertook a prospective study, with attention to patient characteristics that might affect the accuracy of imputation.…”

Section: Introductionmentioning

confidence: 68%

“…Because imputation is considered to be most accurate for SpO 2 ≤ 96%, based on the sigmoidal shape of the hemoglobin-oxygen dissociation curve(14) and our prior empirical observations,(12) we separately analyzed ABGs with an associated SpO 2 ≤ 96%. Because PIO 2 (partial pressure of inspired oxygen) varies by both FIO 2 and barometric pressure, we adjusted PaO 2 /FIO 2 ratios at the Utah site (altitude ~1300m) by the ratio of local to sea level barometric pressure (0.845).…”

Section: Methodsmentioning

confidence: 99%

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Nonlinear Imputation of Pao 2/Fio 2 From Spo 2/Fio 2 Among Mechanically Ventilated Patients in the ICU: A Prospective, Observational Study

Brown

Duggal

Hou

et al. 2017

Critical Care Medicine

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Objectives In the contemporary intensive care unit (ICU), mechanically ventilated patients may not have arterial blood gas (ABG) measurements available at relevant timepoints. Severity criteria often depend on ABG results. Retrospective studies suggest that non-linear imputation of PaO2/FIO2 from SpO2/FIO2 is accurate, but this has not been established prospectively among mechanically ventilated ICU patients. The objective was to validate the superiority of non-linear imputation of PaO2/FIO2 among mechanically ventilated patients and understand what factors influence the accuracy of imputation. Design Simultaneous SpO2, oximeter characteristics, receipt of vasopressors, and skin pigmentation were recorded at the time of a clinical ABG. ARDS criteria were recorded. For each imputation method, we calculated both imputation error and the area under the curve (AUC) for patients meeting criteria for ARDS (PaO2/FIO2≤300) and moderate-severe ARDS (PaO2/FIO2≤150). Setting Nine hospitals within the Prevention and Early Treatment of Acute Lung Injury network. Patients We prospectively enrolled 703 mechanically ventilated patients admitted to the emergency departments or ICUs of participating study hospitals. Interventions None. Measurements and Main Results We studied 1034 ABGs from 703 patients; 650 ABGs were associated with SpO2≤96%. Non-linear imputation had consistently lower error than other techniques. Among all patients, non-linear had a lower error (p<0.001) and higher (p<0.001) AUC (0.87; 95% CI 0.85–0.90) for PaO2/FIO2 ≤300 than linear/log-linear (0.80; 95%CI 0.76–0.83) imputation. All imputation methods better identified moderate-severe ARDS (PaO2/FIO2 ≤150); non-linear imputation remained superior (p<0.001). For PaO2/FiO2≤150, the sensitivity and specificity for non-linear imputation were 0.87 (95% CI 0.83–0.90) and 0.91 (95% CI 0.88–0.93) respectively. Skin pigmentation and receipt of vasopressors were not associated with imputation accuracy. Conclusions In mechanically ventilated patients, non-linear imputation of PaO2/FIO2 from SpO2/FIO2 appears accurate, especially for moderate-severe hypoxemia. Linear and log-linear imputation cannot be recommended.

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Section: Introductionmentioning

confidence: 68%

Section: Methodsmentioning

confidence: 99%

Nonlinear Imputation of Pao 2/Fio 2 From Spo 2/Fio 2 Among Mechanically Ventilated Patients in the ICU: A Prospective, Observational Study

Brown

Duggal

Hou

et al. 2017

Critical Care Medicine

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“…Posterior LUS 9 ± 2 10 ± 3 9 ± 2 0.87 assessed by the SpO 2 /FiO 2 ratio, which is probably less accurate than the PaO 2 levels in ARDS patients [34]. The sample is monocentric and only 19 patients were included, limiting the interpretation of these results.…”

Section: Oxygenation Response To Ppmentioning

confidence: 90%

Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Haddam

Zieleskiewicz

Parratte³

et al. 2016

Intensive Care Med

108

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“…When an arterial line was not present, PaO2 was imputed from SpO2 ≤97% according to a log-linear equation (22). Finally, we measured associations between day 1 cytokines and three biomarkers of endothelial injury (Ang-2, vWF, and sTM) (13, 14).…”

Section: Methodsmentioning

confidence: 99%

Incorporating Inflammation into Mortality Risk in Pediatric Acute Respiratory Distress Syndrome

Zinter

Orwoll

Spicer

et al. 2017

Critical Care Medicine

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Objective In pediatric ARDS, lung injury is mediated by immune activation and severe inflammation. Therefore, we hypothesized that patients with elevated pro- and anti-inflammatory cytokines would have higher mortality rates and that these biomarkers could improve risk-stratification of poor outcomes. Design Multicenter prospective observational study. Setting We enrolled patients from 5 academic PICUs between 2008–2015. Patients Patients were 1 month to 18 years old, used noninvasive or invasive ventilation, and met the American European Consensus Conference definition of ARDS. Interventions None. Methods Eight pro-inflammatory and anti-inflammatory cytokines were measured on ARDS day 1 and correlated with mortality, ICU morbidity as measured by survivor PELOD score, and biomarkers of endothelial injury, including angiopoietin-2, von Willebrand Factor, and soluble thrombomodulin. Measurements & Main Results We measured biomarker levels in 194 patients, including 38 ARDS nonsurvivors. IL-6, IL-8, IL-10, IL-18, and TNF-R2 were each strongly associated with all-cause mortality, multiple markers of ICU morbidity, and endothelial injury. A multiple logistic regression model incorporating OI, IL-8, and TNF-R2 was superior to a model of OI alone in predicting the composite outcome of mortality or severe morbidity (AUROC 0.77 [0.70–0.83] vs. 0.70 [0.62–0.77], p=0.042). Conclusions In pediatric ARDS, pro- and anti-inflammatory cytokines are strongly associated with mortality, ICU morbidity, and biochemical evidence of endothelial injury. These cytokines significantly improve the ability of the OI to discriminate risk of mortality or severe morbidity and may allow for identification and enrollment of high-risk subgroups for future studies.

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Nonlinear Imputation of Pao2/Fio2 From Spo2/Fio2 Among Patients With Acute Respiratory Distress Syndrome

Cited by 149 publications

References 34 publications

Nonlinear Imputation of Pao 2/Fio 2 From Spo 2/Fio 2 Among Mechanically Ventilated Patients in the ICU: A Prospective, Observational Study

Nonlinear Imputation of Pao 2/Fio 2 From Spo 2/Fio 2 Among Mechanically Ventilated Patients in the ICU: A Prospective, Observational Study

Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Incorporating Inflammation into Mortality Risk in Pediatric Acute Respiratory Distress Syndrome

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