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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1756716
Original Article

Evaluation of Correlation and Agreement between SpO2/FiO2 ratio and PaO2/FiO2 ratio in Neonates

Hemananda K. Muniraman 
1   Division of Neonatology, Department of Child Health, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona, United States
2   Department of Pediatrics, Creighton University School of Medicine, Phoenix, Arizona, United States
,
Rutuja Kibe
3   Division of Neonatology, Department of Pediatrics, LAC+ USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Abhijeet Namjoshi
1   Division of Neonatology, Department of Child Health, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona, United States
,
Ashley Y. Song
4   Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
,
Ashwini Lakshmanan
5   Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
6   Fetal and Neonatal Institute, Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Rangasamy Ramanathan
3   Division of Neonatology, Department of Pediatrics, LAC+ USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Manoj Biniwale 
3   Division of Neonatology, Department of Pediatrics, LAC+ USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Abstract

Objectives This article evaluates correlation and agreement between oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF) ratio and partial pressure of oxygen (PaO2)/FiO2 (PF) ratio. It also derives and validates predictive PF ratio from noninvasive SF ratio measurements for clinically relevant PF ratios and derives SF ratio equivalent of PF ratio cutoffs used to define acute lung injury (ALI, PF < 300) and acute respiratory distress syndrome (ARDS, PF < 200).

Methods Retrospective cohort study including neonates with respiratory failure over a 6-year study period. Correlation and agreement between PF ratio with SF ratio was analyzed by Pearson's correlation coefficient and Bland–Altman analysis. Generalized estimating equation was used to derive PF ratio from measured PF ratio and derive corresponding SF ratio for PF ratio cutoffs for ALI and ARDS.

Results A total of 1,019 paired measurements from 196 neonates with mean 28 (± 4.7) weeks' gestational age and 925 (± 1111) g birth weight were analyzed. Strong correlation was noted between SF ratio and PF ratio (r = 0.90). Derived PF ratios from regression (1/PF = –0.0004304 + 2.0897987/SF) showed strong accuracy measures for PF ratio cutoffs < 200 (area under the curve [AUC]: 0.85) and < 100 (AUC: 0.92) with good agreement. Equivalent SF ratio to define ALI was < 450, moderate ARDS was < 355, and severe ARDS was < 220 with strong accuracy measures (AUC > 0.81, 0.84, and 0.93, respectively).

Conclusion SF ratio correlated strongly with PF ratio with good agreement between derived PF ratio from noninvasive SpO2 source and measure PF ratio. Derived PF ratio may be useful to reliably assess severity of respiratory failure in neonates. Further studies are needed to validate SF ratio with clinical illness severity and outcomes.

Keywords

PaO2/FiO2 ratio - SpO2/FiO2 ratio - respiratory distress syndrome - neonates - hypoxemic respiratory failure

Competing Interests

There are no competing interests and no conflict of interests to declare in relation to this work. No honorarium, sponsorship, or grants were used in the production of this manuscript.




Publication History

Received: 16 July 2022

Accepted: 10 August 2022

Article published online:
29 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ranieri VM, Rubenfeld GD, Thompson BT. et al; ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307 (23) 2526-2533
    PubMedGoogle Scholar
  • 2 Ray S, Rogers L, Pagel C, Raman S, Peters MJ, Ramnarayan P. PaO2/FIO2 ratio derived from the SpO2/FIO2 ratio to improve mortality prediction using the Pediatric Index of Mortality-3 score in transported intensive care admissions. Pediatr Crit Care Med 2017; 18 (03) e131-e136
    CrossrefPubMedGoogle Scholar
  • 3 Khemani RG, Rubin S, Belani S. et al. Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk. Intensive Care Med 2015; 41 (01) 94-102
    CrossrefPubMedGoogle Scholar
  • 4 Shann F, Pearson G, Slater A, Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med 1997; 23 (02) 201-207
    CrossrefPubMedGoogle Scholar
  • 5 Szymonowicz W, Yu VY, Wilson FE. Antecedents of periventricular haemorrhage in infants weighing 1250 g or less at birth. Arch Dis Child 1984; 59 (01) 13-17
    CrossrefPubMedGoogle Scholar
  • 6 Gentili A, Pasini L, Iannella E. et al. Predictive outcome indexes in neonatal congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 2015; 28 (13) 1602-1607
    CrossrefPubMedGoogle Scholar
  • 7 Narayanan A, Batra P, Faridi MMA, Harit D. PaO2/FiO2 ratio as predictor of mortality in neonates with meconium aspiration syndrome. Am J Perinatol 2019; 36 (06) 609-614
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Khemani RG, Thomas NJ, Venkatachalam V. et al; Pediatric Acute Lung Injury and Sepsis Network Investigators (PALISI). Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. Crit Care Med 2012; 40 (04) 1309-1316
    CrossrefPubMedGoogle Scholar
  • 9 Chen W, Janz DR, Shaver CM, Bernard GR, Bastarache JA, Ware LB. Clinical characteristics and outcomes are similar in ARDS diagnosed by oxygen saturation/Fio2 ratio compared with Pao2/Fio2 ratio. Chest 2015; 148 (06) 1477-1483
    CrossrefPubMedGoogle Scholar
  • 10 Khemani RG, Patel NR, Bart III RD, Newth CJL. Comparison of the pulse oximetric saturation/fraction of inspired oxygen ratio and the PaO2/fraction of inspired oxygen ratio in children. Chest 2009; 135 (03) 662-668
    CrossrefPubMedGoogle Scholar
  • 11 Brown SM, Grissom CK, Moss M. et al; NIH/NHLBI PETAL Network Collaborators. Nonlinear imputation of Pao2/Fio2 from Spo2/Fio2 among patients with acute respiratory distress syndrome. Chest 2016; 150 (02) 307-313
    CrossrefPubMedGoogle Scholar
  • 12 van der Burg PS, de Jongh FH, Miedema M, Frerichs I, van Kaam AH. Effect of minimally invasive surfactant therapy on lung volume and ventilation in preterm infants. J Pediatr 2016; 170: 67-72
    CrossrefPubMedGoogle Scholar
  • 13 Muniraman HK, Song AY, Ramanathan R. et al. Evaluation of oxygen saturation index compared with oxygenation index in neonates with hypoxemic respiratory failure. JAMA Netw Open 2019; 2 (03) e191179
    CrossrefPubMedGoogle Scholar
  • 14 Rawat M, Chandrasekharan PK, Williams A. et al. Oxygen saturation index and severity of hypoxic respiratory failure. Neonatology 2015; 107 (03) 161-166
    CrossrefPubMedGoogle Scholar