Reference values for oxygen saturation from sea level to the highest human habitation in the Andes in acclimatised persons

Rojas-Camayo, Jose; Mejía, Christian R.; Callacondo, David; Dawson, Jennifer A; Posso, Margarita; Galván, César; Davila-Arango, Nadia; Bravo, Erick Anibal; Loescher, Viky Y; Padilla-Deza, Magaly Milagros; Rojas-Valero, Nora; Velasquez-Chavez, Gary; Clemente, José C.; Alva-Lozada, Guisela; Quispe-Mauricio, Angel; Bardalez, Silvana; Subhi, Rami

doi:10.1136/thoraxjnl-2017-210598

Cited by 60 publications

(51 citation statements)

References 9 publications

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“…This statistical model is therefore highly dependent on the data included in the modelling process. This is illustrated by the observed mismatch between this model and the empirical data sets obtained by Rojas-Camayo et al [13] as well as our own data collection in the IHIP-2 trial. On the one hand, the statistical model was built using aggregated data collected from mixed populations while using pulse oximeters with partially unknown specifications.…”

Section: Discussionmentioning

confidence: 67%

“…to avoid extrapolation errors. Instead of the LMS method used by Rojas-Camayo et al [13], we reported the centiles of their data with a lowess smoother. To visualise the difference between the various hypoxemia thresholds that have been proposed, we graphically compared the altitude-adaptive abnormal SpO 2 threshold, the statistical hypoxemia threshold, and the WHO definition for oxygen administration (90%) with the 2.5 th centile (lowess smoothed) reported by Rojas-Camayo et al [13].…”

Section: Discussionmentioning

confidence: 99%

“…In a very recent prospective study, Rojas-Camayo et al recorded SpO 2 from 6289 subjects in the Peruvian Andes across 15 altitudes (154 m -5100 m a.s.l.) [13]. They reported the 2.5 th , 10 th , 25 th , 50 th , 75 th , 90 th and 97.5 th centile of the data, but neither did provide a descriptive model thereof, nor suggested an abnormal threshold.…”

Section: Related Workmentioning

confidence: 95%

“…, the threshold from Subhi et al [14] is derived from the 2.5 th centile of observations obtained from literature review (dotted grey line), the 90% threshold from the WHO guideline is a result of a working group consensus (thick continuous grey line) and the 2.5 th centile from Rojas-Camayo et al [13] originates from a prospectively collected paediatric sample in the Preruvian Andes (dashed line).…”

Section: Figure 3: Comparison O Proposedf Hypoxemia Thresholds That Wmentioning

confidence: 99%

“…While reference values for healthy children living up to 5100 m a.s.l. have been reported over the past 25 years [8]- [13], the distribution of SpO 2 values for sick children is less clear. Furthermore, previous studies have not been able to conclusively answer at which SpO 2 levels oxygen should be administered at altitude or in limited settings.…”

Section: Introductionmentioning

confidence: 98%

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Physiologically driven, altitude-adaptive model for the interpretation of pediatric oxygen saturation at altitudes above 2000 m a.s.l

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Tüshaus

Zhang

et al. 2018

Preprint

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21Measuring peripheral oxygen saturation (SpO2) with pulse oximeters at the point of care is widely established. 22However, since SpO2 is dependent on ambient atmospheric pressure, the distribution of SpO2 values in populations 23 living above 2000 m a.s.l. is largely unknown. Here, we propose and evaluate a computer model to predict SpO2 24 values for pediatric permanent residents living between 0 and 4000 m a.s.l. Based on a sensitivity analysis of 25 oxygen transport parameters, we created an altitude-adaptive SpO2 model that takes physiological adaptation of 26 permanent residents into account. From this model, we derived an altitude-adaptive abnormal SpO2 threshold 27 using patient parameters from literature. We compared the obtained model and threshold against a previously 28 proposed threshold derived statistically from data and two empirical datasets independently recorded from 29 Peruvian children living at altitudes up to 4100 m a.s.l. Our model followed the trends of empirical data, with the 30 empirical data having a narrower healthy SpO2 range below 2000 m a.s.l., but the medians did never differ more 31 than 2.29% across all altitudes. Our threshold estimated abnormal SpO2 in only 17 out of 5981 (0.3%) healthy 32 recordings, whereas the statistical threshold returned 95 (1.6%) recordings outside the healthy range. The strength 33 of our parametrised model is that it is rooted in physiology-derived equations and enables customisation. 34 Furthermore, as it provides a reference SpO2, it could assist practitioners in interpreting SpO2 values for diagnosis, 35 prognosis, and oxygen administration at higher altitudes. 36 New & Noteworthy 37 Our model describes the altitude-dependent decrease of SpO2 in healthy pediatric residents based on physiological 38 equations and can be adapted based on measureable clinical parameters. The proposed altitude-specific abnormal 39 SpO2 threshold might be more appropriate than rigid guidelines for administering oxygen that currently are only 40 available for sea level patients. We see this as a starting point to discuss and adapt oxygen administration 41 guidelines. 42 65 abnormal SpO2 threshold. The physiology-backed altitude-adaptive model describes SpO2 values of healthy 66 children living permanently at altitudes up to 4000 m a.s.l. With this model, we aim to provide a better 67 understanding of healthy SpO2 values at altitudes above 2000 m a.s.l. for healthy children. The altitude-adaptive 68 abnormal SpO2 threshold is obtained by setting the model parameters to abnormal values found in hypoxemic 69 patients. We evaluate these results with a novel dataset obtained from healthy children living in the rural Andes 70 of Peru. 71 2011. 426 22.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Related Workmentioning

confidence: 95%

Section: Figure 3: Comparison O Proposedf Hypoxemia Thresholds That Wmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Physiologically driven, altitude-adaptive model for the interpretation of pediatric oxygen saturation at altitudes above 2000 m a.s.l

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Tüshaus

Zhang

et al. 2018

Preprint

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The relationship between altitude and BMI varies across low‐ and middle‐income countries

Maxfield,

Hadley,

Hruschka

2024

American J Hum Biol

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ObjectivesStudies suggest that living at high altitude decreases obesity risk, but this research is limited to single‐country analyses. We examine the relationship between altitude and body mass index (BMI) among women living in a diverse sample of low‐ and middle‐income countries.Materials and MethodsUsing Demographic and Health Survey data from 1 583 456 reproductive age women (20–49 years) in 54 countries, we fit regression models predicting BMI and obesity by altitude controlling for a range of demographic factors—age, parity, breastfeeding status, wealth, and education.ResultsA mixed‐effects model with country‐level random intercepts and slopes predicts an overall −0.162 kg/m2 (95% CI −0.220, −0.104) reduction in BMI and lower odds of obesity (OR 0.90, 95% CI 0.87, 0.95) for every 200 m increase in altitude. However, countries vary dramatically in whether they exhibit a negative or positive association between altitude and BMI (34 countries negative, 20 positive). Mixed findings also arise when examining odds of obesity.DiscussionWe show that past findings of declining obesity risk with altitude are not universal. Increasing altitude predicts slightly lower BMIs at the global level, but the relationship within individual countries varies in both strength and direction.

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Effect of altitude on COVID-19 mortality rate and case incidence in Peru, the country with the highest cumulative mortality rate worldwide

Castillo-Uribe,

Cucho-Vásquez,

Contreras-León

et al. 2023

J Public Health (Berl.)

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Reference values for oxygen saturation from sea level to the highest human habitation in the Andes in acclimatised persons

Cited by 60 publications

References 9 publications

Physiologically driven, altitude-adaptive model for the interpretation of pediatric oxygen saturation at altitudes above 2000 m a.s.l

Physiologically driven, altitude-adaptive model for the interpretation of pediatric oxygen saturation at altitudes above 2000 m a.s.l

The relationship between altitude and BMI varies across low‐ and middle‐income countries

Effect of altitude on COVID-19 mortality rate and case incidence in Peru, the country with the highest cumulative mortality rate worldwide

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