Saidy Saikou, Iqbal Ali, Baig Saqib H
Division of Pulmonary, Allergy and Critical Care, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
J Intensive Care Med. 2025 Jul 16:8850666251351594. doi: 10.1177/08850666251351594.
BackgroundPulse oximeters sometimes fail to accurately reflect arterial oxygen saturation (SaO), particularly in darker-skinned patients resulting in undiagnosed hypoxemia, potentially delaying recognition and appropriate interventions.Research QuestionWe aimed to evaluate the prevalence and predictors of SpO-SaO discrepancies, particularly occult hypoxemia, and to assess their association with clinical outcomes in ICU patients.Study Design and MethodsWe conducted a retrospective cohort analysis using the Blood-gas and Oximetry Linked Dataset (BOLD), analyzing critically ill patients from the eICU-CRD database (2014-2015). Patients with paired SpO-SaO measurements within five minutes were included. We identified SpO-SaO discrepancies as a difference of >2.99% and defined occult hypoxemia as an arterial partial pressure of oxygen (PaO) < 60 mm Hg or SaO < 89% with an SpO > 88%. The primary outcomes included ICU length of stay (LOS), Sequential Organ Failure Assessment (SOFA) score, and in-hospital mortality.ResultsAmong 36,280 ICU patients, 23.6% had SpO-SaO discrepancies, and 4.7% had occult hypoxemia. Black patients were overrepresented in both groups, with an adjusted odds ratio (aOR) of 1.35 (95% CI: 1.25-1.47) for discrepancy and 1.22 (95% CI: 1.04-1.47) for occult hypoxemia. Higher BMI, lower pH, elevated creatinine, and higher Charlson Comorbidity Index scores were also significant predictors. Patients with discrepancies had worse clinical outcomes, including increased SOFA scores in the following 24 h (β = 0.31; < .0001) and higher in-hospital mortality (aOR 1.15; < .0001). Occult hypoxemia was associated with even worse outcomes, including a longer ICU LOS (IRR 1.12; < .0001) and significantly increased mortality (aOR 1.73; < .0001).InterpretationOne in four critically ill patient in our cohort experienced SpO-SaO discrepancy which is associated with adverse clinical outcomes. Black race, obesity, and higher comorbidity burden were significant predictors of these discrepancies. Our findings emphasize the need for more rigorous clinician oversight in the use of this technology.
背景
脉搏血氧仪有时无法准确反映动脉血氧饱和度（SaO），尤其是在肤色较深的患者中，这会导致低氧血症未被诊断出来，可能会延误识别和适当的干预措施。
研究问题
我们旨在评估SpO - SaO差异（尤其是隐匿性低氧血症）的发生率和预测因素，并评估它们与ICU患者临床结局的关联。
研究设计与方法
我们使用血气与血氧测定关联数据集（BOLD）进行了一项回顾性队列分析，分析了eICU - CRD数据库（2014 - 2015年）中的重症患者。纳入在五分钟内有配对SpO - SaO测量值的患者。我们将SpO - SaO差异定义为差值>2.99%，并将隐匿性低氧血症定义为动脉血氧分压（PaO）<60 mmHg或SaO<89%且SpO>88%。主要结局包括ICU住院时间（LOS）、序贯器官衰竭评估（SOFA）评分和院内死亡率。
结果
在36280例ICU患者中，23.6%存在SpO - SaO差异，4.7%存在隐匿性低氧血症。两组中黑人患者的比例都过高，差异的调整优势比（aOR）为1.35（95%CI：1.25 - 1.47），隐匿性低氧血症的aOR为1.22（95%CI：1.04 - 1.47）。较高的体重指数、较低的pH值、升高的肌酐水平和较高的Charlson合并症指数评分也是显著的预测因素。有差异的患者临床结局更差，包括接下来24小时内SOFA评分增加（β = 0.31；P <.0001）和较高的院内死亡率（aOR 1.15；P <.0001）。隐匿性低氧血症与更差的结局相关，包括更长的ICU住院时间（IRR 1.12；P <.0001）和显著增加的死亡率（aOR 1.73；P <.0001）。
解读
我们队列中的四分之一重症患者经历了SpO - SaO差异，这与不良临床结局相关。黑人种族、肥胖和更高的合并症负担是这些差异的显著预测因素。我们的研究结果强调在使用这项技术时需要更严格的临床医生监督。
