通过氧储备指数对新生儿和小婴儿的 SpO 下降进行早期预警。

Early warning for SpO decrease by the oxygen reserve index in neonates and small infants.

机构信息

Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.

Biostatistician, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of Johannes Gutenberg University, Mainz, Germany.

出版信息

Paediatr Anaesth. 2023 Nov;33(11):923-929. doi: 10.1111/pan.14743. Epub 2023 Aug 8.

DOI:10.1111/pan.14743

PMID:37551627

Abstract

INTRODUCTION

Continuously assessing the oxygenation levels of patients to detect and prevent hypoxemia can be advantageous for safe anesthesia, especially in neonates and small infants. The oxygen reserve index (ORI) is a new parameter that can assess oxygenation through a relationship with arterial oxygen partial pressure (PaO ). The aim of this study was to examine whether the ORI provides a clinically relevant warning time for an impending SpO (pulse oximetry hemoglobin saturation) reduction in neonates and small infants.

METHODS

ORI and SpO were measured continuously in infants aged <2 years during general anesthesia. The warning time and sensitivity of different ORI alarms for detecting impending SpO decrease were calculated. Subsequently, the agreement of the ORI and PaO with blood gas analyses was assessed.

RESULTS

The ORI of 100 small infants and neonates with a median age of 9 months (min-max, 0-21 months) and weight of 8.35 kg (min-max, 2-13 kg) were measured. For the ORI/PaO correlation, 54 blood gas analyses were performed. The warning time and sensitivity of the preset ORI alarm during the entire duration of anesthesia were 84 s (25th-75th percentile, 56-102 s) and 55% (95% CI 52%-58%), and those during anesthesia induction were 63 s (40-82 s) and 56% (44%-68%), respectively. The positive predictive value of the preset ORI alarm were 18% (95% CI 17%-20%; entire duration of anesthesia) and 27% (95% CI 21%-35%; during anesthesia induction). The agreement of PaO intervals with the ORI intervals was poor, with a kappa of 0.00 (95% CI = [-0.18; 0.18]). The weight (p = .0129) and height (p = .0376) of the infants and neonates were correlated to the correct classification of the PaO interval with the ORI interval.

CONCLUSIONS

The ORI provided an early warning time for detecting an impending SpO decrease in small infants and neonates in the defined interval in this study. However, the sensitivity of ORI to forewarn a SpO decrease and the agreement of the ORI with PaO intervals in this real-life scenario were too poor to recommend the ORI as a useful early warning indicator for this age group.

摘要

简介

持续评估患者的氧合水平以检测和预防低氧血症有助于安全麻醉，尤其是在新生儿和小婴儿中。氧储备指数（ORI）是一种新的参数，可通过与动脉氧分压（PaO ）的关系来评估氧合情况。本研究旨在探讨 ORI 是否为新生儿和小婴儿即将发生的脉搏血氧饱和度（SpO ）降低提供了有临床意义的预警时间。

方法

在全身麻醉期间，连续测量 <2 岁婴儿的 ORI 和 SpO 。计算不同 ORI 警报检测即将发生的 SpO 降低的预警时间和敏感性。随后，评估 ORI 和 PaO 与血气分析的一致性。

结果

测量了 100 名年龄中位数为 9 个月（最小-最大，0-21 个月）、体重为 8.35kg（最小-最大，2-13kg）的小婴儿和新生儿的 ORI。对于 ORI/PaO 相关性，进行了 54 次血气分析。整个麻醉过程中预设 ORI 警报的预警时间和敏感性分别为 84s（25th-75th 百分位数，56-102s）和 55%（95%CI 52%-58%），麻醉诱导期间分别为 63s（40-82s）和 56%（44%-68%）。预设 ORI 警报的阳性预测值分别为 18%（95%CI 17%-20%；整个麻醉过程）和 27%（95%CI 21%-35%；麻醉诱导期间）。PaO 间隔与 ORI 间隔的一致性较差，kappa 值为 0.00（95%CI [0.18; 0.18]）。婴儿和新生儿的体重（p =.0129）和身高（p =.0376）与 PaO 间隔与 ORI 间隔的正确分类相关。