海拔 2600 米以上行有创机械通气患者校正 PaO2/FiO2 和 SpO2/FiO2 的相关性和有效性。

Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level.

机构信息

Pulmonary Medicine, Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia.

School of Medicine, Universidad de la Sabana, Clínica Universidad de La Sabana, Chía, Colombia.

出版信息

Med Intensiva (Engl Ed). 2022 Sep;46(9):501-507. doi: 10.1016/j.medine.2021.05.010.

DOI:10.1016/j.medine.2021.05.010

PMID:36057441

Abstract

OBJECTIVE

To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude.

DESIGN

Ambispective descriptive multicenter cohort study.

SETTING

Two intensive care units (ICU) from Colombia at 2600m a.s.l.

PATIENTS OR PARTICIPANTS

Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019.

INTERVENTIONS

None.

VARIABLES

Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated.

RESULTS

The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001).

CONCLUSIONS

At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.

摘要

目的

建立高海拔地区机械通气患者动脉血气 PaO2/FiO2 与无创方法（线性、非线性、对数推测 PaO2/FiO2 和 SpO2/FiO2）之间的相关性和有效性。

设计

前瞻性描述性多中心队列研究。

地点

哥伦比亚两个海拔 2600 米的重症监护病房（ICU）。

患者或参与者

纳入 2016 年 6 月至 2019 年 6 月期间至少接受 24 小时机械通气的年龄大于 18 岁的连续危重症患者。

干预措施

无。

变量

分析的变量包括人口统计学、生理指标、实验室检查、氧合指数和临床情况。使用非线性、线性和对数公式从 SpO2 计算 PaO2，并同时根据严重低氧血症诊断计算 SpO2/FiO2。计算了组内相关系数、ROC 曲线下面积、灵敏度、特异性、阳性预测值、阴性预测值、阳性和阴性似然比。

结果

通过动脉血气获得的 PaO2/FiO2 与通过所提出的一种方法（线性、非线性和对数公式）获得的 PaO2/FiO2 以及通过 SpO2/FiO2 测量的 PaO2/FiO2 之间的相关性较高（大于 0.77，p<0.001）。不同的推测方法和 SpO2/FiO2 在严重低氧血症患者（PaO2/FiO2 <150）中具有相似的诊断性能。PaO2/FiO2 线性推测 AUC ROC 为 0.84（95%CI 0.81-0.87，p<0.001），PaO2/FiO2 对数推测 AUC ROC 为 0.84（95%CI 0.80-0.87，p<0.001），PaO2/FiO2 非线性推测 AUC ROC 为 0.82（95%CI 0.79-0.85，p<0.001），SpO2/FiO2 血氧测定 AUC ROC 为 0.84（95%CI 0.81-0.87，p<0.001）。