Comparison of SpO2/FiO2 and PaO2/FiO2 ratios as markers of acute lung injury

  • Dewi Shandi Laila Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik General Hospital, Medan, North Sumatera
  • Chairul Yoel Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik General Hospital, Medan, North Sumatera
  • Hakimi Hakimi Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik General Hospital, Medan, North Sumatera
  • Munar Lubis Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik General Hospital, Medan, North Sumatera
Keywords: acute lung injury, children, S/F ratio, P/F ratio

Abstract

Background One of the diagnostic criteria for acute lung injury (ALI) is the PaO2/FiO2 (P/F) ratio. This measurement is obtained by blood gas analysis, which involves an invasive procedure (arterial blood draw). In order to reduce invasive procedures on critically ill patients, an alternative non-invasive marker for ALI is needed. The SpO2/FiO2 (S/F) ratio attained by pulse oximetry may be a suitable alternative.

Objective To investigate for a correlation between S/F ratio and P/F ratio, in order to find an alternative non-invasive marker of ALI.

Methods A cross-sectional study was conducted in the pediatric intensive care unit (PICU) at Haji Adam Malik Hospital, Medan from August 2012 to June 2013. Subjects (children aged 1 month – 18 years) underwent blood gas analysis when their pulse oximetry showed saturation of 80-97% within 24 hours of ventilator use. We measured PaO2, SpO2, and FiO2 and calculated S/F and P/F ratios. Data were analyzed by Spearman’s correlation and linear regression tests.

Results Of 69 PICU patients, 39 children fulfilled the criteria for ALI. The S/F ratio and P/F ratio had a weak correlation (r=0.2; P=0.18). The linear regression equation was S/F ratio = 129.67 + 0.11 (P/F), with S/F ratio values of 162.67 and 151.67 correlating to P/F ratio values of 300 and 200, respectively.

Conclusion  The S/F ratio has a weak correlation with P/F ratio for ALI in children.  

References

Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe G, et al. Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study. Pediatr Crit Care Med. 2007;8:317-23.

Zimmerman JJ, Akhtar SR, Caldwell E, Rubenfeld GD. Incidence and outcomes of pediatric acute lung injury. Pediatrics. 2009;124:87-95.

Saharan S, Lodha R, Kabra SK. Management of acute lung injury/ARDS. Indian J Pediatr. 2010;77:1296-302.

Li Y, Wang Q, Chen H, Gao HM, Zhou T, Qian SY. Epidemiological features and risk factor analysis of children with acute lung injury. World J Pediatr. 2012;8:43-6.

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818-24.

Khemani RG, Patel NR, Bart RD, Newth CJ. Comparison of the pulse oximetric saturation/fraction of inspired oxygen ratio and the PaO2/fraction of inspired oxygen ratio in children. Chest. 2009;135:662-8.

Malley WJ, editor. Oxygen transport and internal respiration. In: Clinical blood gases assessment and intervention. Philadelphia: Elsevier (USA); 2005. p. 170-3.

Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB, et al. Comparison of the SpO2/FiO2 ratio and the PaO2/FiO2 ratio in patients with acute lung injury or ARDS. Chest. 2007;132:410-7.

Khemani RG, Thomas N, Venkatachalam V, Scimeme JP, Berutti T, Schneider JB, et al. Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. Crit Care Med. 2012;40:1309-16.

ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526-33.

De Luca D, Piastra M, Chidini G, Tissieres P, Calderini E, Essouri S, et al. The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus. Intensive Care Med. 2013;39:2083-91.

Khemani GR, Rubin S, Belani S, Leung D, Erickson S, Smith LS, et al. Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk. Intensive Care Med. 2015;41:94. doi:10.1007/s00134-014-3486-2.

Published
2017-02-28
How to Cite
1.
Laila D, Yoel C, Hakimi H, Lubis M. Comparison of SpO2/FiO2 and PaO2/FiO2 ratios as markers of acute lung injury. PI [Internet]. 28Feb.2017 [cited 28Mar.2024];57(1):30-. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/194
Section
Articles
Received 2016-11-24
Accepted 2017-02-06
Published 2017-02-28