Takagi Toshishige, Fujii Tomoko, Nakamura Sae, Tsutsumi Yusuke, Uezono Shoichi
Department of Intensive Care, Jikei University Hospital, Tokyo, Japan.
Department of Intensive Care, Jikei University Hospital, Tokyo, Japan.
Chest. 2025 Mar 18. doi: 10.1016/j.chest.2025.03.006.
Oxygen administration is often guided by pulse oximeter readings. However, inaccuracies have been reported, particularly in patients with darker skin tones. During the COVID-19 pandemic, racial and ethnic disparities in hypoxemia detection emerged, with studies showing a higher incidence of hidden hypoxemia in Black and Hispanic patients. However, limited data exist regarding the Asian population.
How accurate are oxygen saturation (Spo) readings in Asian patients with critical illness, and what factors contribute to discrepancies with arterial oxygen saturation (Sao)?
We conducted a single-center observational study in an ICU at a tertiary care hospital in Japan, including all adult patients admitted from October 2013 through September 2021. We collected data from electronic records and analyzed for agreement between Spo and Sao using modified Bland-Altman plots. We performed multivariable regression analysis to identify factors associated with Spo-Sao differences. We used cubic splines to model associations between the differences and mortality. To further explore potential mechanisms of dissociation, subgroups of patients with chronic dialysis and sepsis were analyzed.
Clinical data from 10,698 patients admitted to the ICU were analyzed. The mean bias between Spo and Sao was -1.2%, with the largest discrepancies occurring 24.7 hours after ICU admission. Hidden hypoxemia (Sao < 88%, Spo ≥ 88%) occurred in 0.8% of patients, and serious hidden hypoxemia (Spo ≥ 92%) occurred in 0.6% of patients. Overestimation of Sao was associated with high creatinine levels, particularly among patients with chronic hemodialysis, whereas underestimation was associated with sepsis, mechanical ventilation, and signs of impaired systemic perfusion. We observed a U-shaped relation between the Spo and Sao differences and mortality, indicating a nonlinear association.
Our results show that dissociation between Spo and Sao in Asian patients in the ICU was small; however, overestimation and underestimation were associated with increased mortality risk, particularly among patients with chronic hemodialysis or impaired peripheral perfusion.
氧疗通常由脉搏血氧饱和度仪读数指导。然而，已报告存在读数不准确的情况，尤其是在肤色较深的患者中。在新冠疫情期间，低氧血症检测中出现了种族和民族差异，研究表明黑人和西班牙裔患者中隐匿性低氧血症的发生率更高。然而，关于亚洲人群的数据有限。
重症亚洲患者的血氧饱和度（Spo）读数有多准确，哪些因素导致其与动脉血氧饱和度（Sao）存在差异？
我们在日本一家三级医院的重症监护病房进行了一项单中心观察性研究，纳入2013年10月至2021年9月期间收治的所有成年患者。我们从电子记录中收集数据，并使用改良的布兰德-奥特曼图分析Spo和Sao之间的一致性。我们进行多变量回归分析以确定与Spo - Sao差异相关的因素。我们使用三次样条函数对差异与死亡率之间的关联进行建模。为进一步探讨分离的潜在机制，对慢性透析和脓毒症患者亚组进行了分析。
对10698例入住重症监护病房的患者的临床数据进行了分析。Spo和Sao之间的平均偏差为 -1.2%，入住重症监护病房后24.7小时差异最大。0.8%的患者出现隐匿性低氧血症（Sao < 88%，Spo≥88%），0.6%的患者出现严重隐匿性低氧血症（Spo≥92%）。Sao的高估与高肌酐水平相关，尤其是在慢性血液透析患者中，而低估与脓毒症、机械通气及全身灌注受损迹象相关。我们观察到Spo和Sao差异与死亡率之间呈U形关系，表明存在非线性关联。
我们的结果表明，重症监护病房中亚洲患者的Spo和Sao之间的分离较小；然而，高估和低估均与死亡风险增加相关，尤其是在慢性血液透析或外周灌注受损的患者中。
