模拟长时间现场救治和地面及高空后送期间，无创 SpO2/FiO2 比值可替代 PaO2/FiO2 比值。
Noninvasive SpO2/FiO2 ratio as surrogate for PaO2/FiO2 ratio during simulated prolonged field care and ground and high-altitude evacuation.
机构信息
From the Autonomous Reanimation and Evacuation Research Program (AREVA, Extramural DOD Affiliated Research Laboratory) (A.I.B., D.W., J.J., B.B., T.R., J.H.C., G.H.), The Geneva Foundation, Tacoma, Washington; Morsani College of Medicine (A.I.B., T.R.), University of South Florida, Tampa, Florida; U.S. Army Institute of Surgical Research (A.I.B., D.W., B.B., T.R., J.H.C., L.C.C.), JBSA Ft. Sam Houston, Texas; U.S. Army Medical Research and Development Command (M.D.), Ft. Detrick, Maryland; Division of Traumatology (J.C.), Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery (J.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; and San Antonio Military Medical Center (V.S.), JBSA Ft. Sam Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2020 Aug;89(2S Suppl 2):S126-S131. doi: 10.1097/TA.0000000000002744.
BACKGROUND
Diagnosis of lung injury requires invasive blood draws to measure oxygen tension in blood. This capability is nonexistent in austere settings and during prolonged field care (PFC), that is, medical care characterized by inability to evacuate casualties from the point of injury for up to 72 hours. We analyzed pulse-oximeter-derived noninvasive SpO2 and assessed the SpO2/FiO2 ratio (SFR) as a surrogate for the PaO2/FiO2 ratio (PFR), an accepted marker of lung function. We hypothesized that SFR is a suitable surrogate for PFR in a data set from animal models of combat-relevant trauma, PFC, and aeromedical evacuation.
METHODS
Data from anesthetized swine (N = 30) subjected to combat relevant trauma, resuscitation, and critical care interventions were analyzed. Pairwise correlations and Bland-Altman and regression analyses were performed to compare PFR and SFR, based on averaged SpO2 values obtained from two monitoring devices.
RESULTS
We performed 683 pairwise correlations. SpO2/FiO2 ratio was numerically higher than PFR with a 313 cutoff values for acute respiratory distress syndrome (ARDS) (PFR ≥300). Sensitivity/specificity for detection of mild ARDS was 75%/73% with a 200 to 300 PFR range corresponding to 252 to 312 SFR range. For moderate ARDS, sensitivity/specificity was 61%/93% with a 100 to 200 PFR range corresponding to 191 to 251 SFR range. For severe ARDS, sensitivity/specificity was 49%/97% with a 0 to 100 PFR range corresponding to 0 to 190 SFR range. For all groups, areas under the receiver operating characteristic curves ranged from 0.76 to 0.98.
CONCLUSION
SpO2/FiO2 ratio is a useful surrogate for PFR when arterial blood gas testing is not available during dynamically changing physiologic conditions, for example, during austere conditions, PFC, or aeromedical evacuation, and may permit early detection of casualties in need of lung-specific life-saving interventions. Studies in critically ill humans are warranted.
背景
诊断肺损伤需要进行有创性血液采集以测量血液中的氧分压。在恶劣环境和长时间现场救治（PFC）中，这种能力是不存在的，即医疗救治的特点是无法将伤员从受伤地点撤离长达 72 小时。我们分析了脉搏血氧仪衍生的无创 SpO2，并评估了 SpO2/FiO2 比值（SFR）作为肺功能的替代指标，即接受的 PaO2/FiO2 比值（PFR）的替代指标。我们假设 SFR 是一个适合在与战斗相关的创伤、PFC 和航空医疗后送的动物模型数据集中替代 PFR 的指标。
方法
分析了接受与战斗相关的创伤、复苏和重症监护干预的麻醉猪的数据（N=30）。进行了成对相关性分析、Bland-Altman 和回归分析，以比较基于两个监测设备获得的平均 SpO2 值的 PFR 和 SFR。
结果
我们进行了 683 次成对相关性分析。SpO2/FiO2 比值数值高于 PFR，急性呼吸窘迫综合征（ARDS）的截断值为 313（PFR≥300）。轻度 ARDS 的检测灵敏度/特异性为 75%/73%，对应于 200 至 300 PFR 范围的 252 至 312 SFR 范围。对于中度 ARDS，灵敏度/特异性为 61%/93%，对应于 100 至 200 PFR 范围的 191 至 251 SFR 范围。对于重度 ARDS，灵敏度/特异性为 49%/97%，对应于 0 至 100 PFR 范围的 0 至 190 SFR 范围。对于所有组，受试者工作特征曲线下面积范围为 0.76 至 0.98。
结论
在动态变化的生理条件下，例如在恶劣条件下、PFC 或航空医疗后送中，当无法进行动脉血气检测时，SpO2/FiO2 比值是 PFR 的有用替代指标，可能允许早期发现需要进行肺部特定救生干预的伤员。需要在危重症患者中进行研究。
Zotero 插件