Xia Yan, Xu Qiancheng, Guo Zhiyuan, Zhang Huijuan, Cao Yingya, Qi Yupeng, Chen Qun, Lu Weihua
Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, Anhui, China.
Anhui Province Clinical Research Center for Critical Care Medicine (Respiratory Disease), Wuhu, Anhui, China.
J Intensive Med. 2024 Aug 8;5(1):51-57. doi: 10.1016/j.jointm.2024.06.002. eCollection 2025 Jan.
The purpose is to formulate a modified screening protocol for acute respiratory distress syndrome (ARDS) in patients with respiratory support based on saturation of pulse oximetry (SpO) and inspired oxygen concentration (FiO).
This prospective observational study was conducted from August to October 2020 at the Department of Critical Care Medicine of Yijishan Hospital Affiliated with Wannan Medical College. All patients admitted during the study period and required arterial blood gas analysis and electrocardiogram monitoring were included in this study. Patients with contraindications to arterial puncture, methemoglobinemia, carbon monoxide poisoning, and other factors that could affect data collection were excluded. The demographic and clinical data, immediate percutaneous SpO, FiO, arterial oxygen partial pressure (PaO), and respiratory rate were recorded; and the SpO/FiO ratio (SFR) and PaO/FiO ratio (PFR) values were calculated according to the above information. The patients were divided into two cohorts by random number table: the establishment cohort and the verification cohort. In the established part, data were divided into group H and group N according to whether SpO >97 %. For group H (SpO ≤97 %), the regression equation was established between SFR and PFR. For group N (SpO >97 %), the correlation between each observation data and PFR was analyzed. Then, a new diagnostic process was established, and the reliability was verified with the Berlin definition set as the gold standard for diagnosis and classification.
There were 341 patients were included. Among them, 161 patients were used to establish the model, and 180 patients were used to verify the validity of the model. In this new diagnosis progress, when SpO ≤97 %, if SFR ≤352, ARDS may exist; when SpO >97 %, if FiO >39 %, there may be ARDS. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of the new diagnosis progress for ARDS were 91.1 %, 76.7 %, 89.6 %, 79.6 %, and 83.9 %, respectively.
The SpO/FiO ratio demonstrates notable sensitivity and specificity in diagnosing ARDS, presenting as a credible alternative to PFR. Chinese Clinical Trial Registry Identifier: ChiCTR2000029217.
目的是基于脉搏血氧饱和度（SpO）和吸入氧浓度（FiO）制定一种适用于接受呼吸支持患者的急性呼吸窘迫综合征（ARDS）改良筛查方案。
这项前瞻性观察性研究于2020年8月至10月在皖南医学院弋矶山医院重症医学科进行。纳入研究期间所有入院且需要进行动脉血气分析和心电图监测的患者。排除有动脉穿刺禁忌证、高铁血红蛋白血症、一氧化碳中毒以及其他可能影响数据收集的因素的患者。记录人口统计学和临床数据、即时经皮SpO、FiO、动脉血氧分压（PaO）和呼吸频率；并根据上述信息计算SpO/FiO比值（SFR）和PaO/FiO比值（PFR）值。通过随机数字表将患者分为两个队列：建立队列和验证队列。在建立部分，根据SpO是否>97%将数据分为H组和N组。对于H组（SpO≤97%），建立SFR与PFR之间的回归方程。对于N组（SpO>97%），分析各观察数据与PFR之间的相关性。然后，建立新的诊断流程，并以柏林定义作为诊断和分类的金标准验证其可靠性。
共纳入341例患者。其中，161例患者用于建立模型，180例患者用于验证模型的有效性。在这个新的诊断流程中，当SpO≤97%时，如果SFR≤352，则可能存在ARDS；当SpO>97%时，如果FiO>39%，则可能存在ARDS。新诊断流程对ARDS的敏感性、特异性、阴性预测值、阳性预测值和准确性分别为91.1%、76.7%、89.6%、79.6%和83.9%。
SpO/FiO比值在诊断ARDS方面表现出显著的敏感性和特异性，是PFR的可靠替代指标。中国临床试验注册标识符：ChiCTR2000029217。
