McGuire W Cameron, Pearce Alex K, Elliott Ann R, Fine Janelle M, West John B, Crouch Daniel R, Prisk G Kim, Malhotra Atul
UC San Diego Health Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology 9500 Gilman Drive, Mail Code 7381, La Jolla, CA 92093, USA.
J Clin Med. 2023 Sep 26;12(19):6203. doi: 10.3390/jcm12196203.
The COVID-19 pandemic magnified the importance of gas exchange abnormalities in early respiratory failure. Pulse oximetry (SpO) has not been universally effective for clinical decision-making, possibly because of limitations. The alveolar gas monitor (AGM100) adds exhaled gas tensions to SpO to calculate the oxygen deficit (OD). The OD parallels the alveolar-to-arterial oxygen difference (AaDO) in outpatients with cardiopulmonary disease. We hypothesized that the OD would discriminate between COVID-19 patients who require hospital admission and those who are discharged home, as well as predict need for supplemental oxygen during the index hospitalization.
Patients presenting with dyspnea and COVID-19 were enrolled with informed consent and had OD measured using the AGM100. The OD was then compared between admitted and discharged patients and between patients who required supplemental oxygen and those who did not. The OD was also compared to SpO for each of these outcomes using receiver operating characteristic (ROC) curves.
Thirty patients were COVID-19 positive and had complete AGM100 data. The mean OD was significantly ( = 0.025) higher among those admitted 50.0 ± 20.6 (mean ± SD) vs. discharged 27.0 ± 14.3 (mean ± SD). The OD was also significantly ( < 0.0001) higher among those requiring supplemental oxygen 60.1 ± 12.9 (mean ± SD) vs. those remaining on room air 25.2 ± 11.9 (mean ± SD). ROC curves for the OD demonstrated very good and excellent sensitivity for predicting hospital admission and supplemental oxygen administration, respectively. The OD performed better than an SpO threshold of <94%.
The AGM100 is a novel, noninvasive way of measuring impaired gas exchange for clinically important endpoints in COVID-19.
新型冠状病毒肺炎（COVID-19）大流行凸显了早期呼吸衰竭时气体交换异常的重要性。脉搏血氧饱和度（SpO）在临床决策中并非普遍有效，可能是由于存在局限性。肺泡气体监测仪（AGM100）通过将呼出气体张力与SpO相结合来计算氧亏（OD）。在患有心肺疾病的门诊患者中，OD与肺泡-动脉血氧分压差（AaDO）相似。我们假设OD能够区分需要住院治疗的COVID-19患者和可出院回家的患者，以及预测在首次住院期间是否需要补充氧气。
纳入有呼吸困难症状且确诊COVID-19的患者，并获得其知情同意，使用AGM100测量其OD。然后比较入院患者与出院患者之间以及需要补充氧气的患者与不需要补充氧气的患者之间的OD。还使用受试者工作特征（ROC）曲线将OD与SpO针对上述每种结果进行比较。
30例患者COVID-19检测呈阳性且有完整的AGM100数据。入院患者的平均OD显著更高（P = 0.025），分别为50.0±20.6（均值±标准差）与出院患者的27.0±14.3（均值±标准差）。需要补充氧气的患者的OD也显著更高（P < 0.0001），分别为60.1±12.9（均值±标准差）与呼吸室内空气的患者的25.2±11.9（均值±标准差）。OD的ROC曲线分别对预测住院和补充氧气给药显示出非常好和极好的敏感性。OD的表现优于SpO阈值<94%。
AGM100是一种用于测量COVID-19中具有临床重要意义终点的气体交换受损情况的新型非侵入性方法。
