Scheeren T W L, Belda F J, Perel A
Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain.
J Clin Monit Comput. 2018 Jun;32(3):379-389. doi: 10.1007/s10877-017-0049-4. Epub 2017 Aug 8.
Supplemental oxygen is administered in the vast majority of patients in the perioperative setting and in the intensive care unit to prevent the potentially deleterious effects of hypoxia. On the other hand, the administration of high concentrations of oxygen may induce hyperoxia that may also be associated with significant complications. Oxygen therapy should therefore be precisely titrated and accurately monitored. Although pulse oximetry has become an indispensable monitoring technology to detect hypoxemia, its value in assessing the oxygenation status beyond the range of maximal arterial oxygen saturation (SpO ≥97%) is very limited. In this hyperoxic range, we need to rely on blood gas analysis, which is intermittent, invasive and sometimes delayed. The oxygen reserve index (ORI) is a new continuous non-invasive variable that is provided by the new generation of pulse oximeters that use multi-wavelength pulse co-oximetry. The ORI is a dimensionless index that reflects oxygenation in the moderate hyperoxic range (PaO 100-200 mmHg). The ORI may provide an early alarm when oxygenation deteriorates well before any changes in SpO occur, may reflect the response to oxygen administration (e.g., pre-oxygenation), and may facilitate oxygen titration and prevent unintended hyperoxia. In this review we describe this new variable, summarize available data and preliminary experience, and discuss its potential clinical utilities in the perioperative and intensive care settings.
在围手术期和重症监护病房的绝大多数患者中，都会给予补充氧气以预防缺氧可能产生的有害影响。另一方面，高浓度氧气的使用可能会导致高氧血症，这也可能与严重并发症相关。因此，氧疗应精确滴定并准确监测。尽管脉搏血氧饱和度测定法已成为检测低氧血症不可或缺的监测技术，但其在评估动脉血氧饱和度最大值（SpO₂≥97%）范围之外的氧合状态时价值非常有限。在这个高氧范围内，我们需要依靠血气分析，而血气分析是间歇性的、有创的，有时还会有延迟。氧储备指数（ORI）是一种新的连续无创变量，由使用多波长脉搏共血氧测定法的新一代脉搏血氧仪提供。ORI是一个无量纲指数，反映中度高氧范围（动脉血氧分压100 - 200 mmHg）内的氧合情况。当氧合恶化且在SpO₂出现任何变化之前，ORI可能会发出早期警报，可能反映对氧疗的反应（如预给氧），并可能有助于氧滴定，防止意外的高氧血症。在这篇综述中，我们描述了这个新变量，总结了现有数据和初步经验，并讨论了其在围手术期和重症监护环境中的潜在临床应用。
