Comparison of non-invasive to invasive oxygenation ratios for diagnosing acute respiratory distress syndrome following coronary artery bypass graft surgery: a prospective derivation-validation cohort study

• DOI: 10.1186/s13019-018-0804-8
• Publication Date: 2018-11-27T07:21:35Z
• Authors: Farshid R. Bashar; Amir Vahedian-Azimi; Behrooz Farzanegan; Reza Goharani; Seyedpouzhia Shojaei; Sevak Hatamian; Seyed M. M. Mosav...; Masoum Khoshfetrat; Mohammad A. K. Kh...; Anna Tomdio; Andrew C. Miller
• Keywords: Male; RD1-811; 610; Oxygenation indices; Coronary artery bypass graft surgery; Severity of Illness Index; 03 medical and health sciences; 0302 clinical medicine; Anesthesiology; Humans; RD78.3-87.3; Oximetry; Prospective Studies; Coronary Artery Bypass; Aged; Ratio of peripheral capillary oxygen saturation to fractional inspired oxygen; Aged, 80 and over; Respiratory Distress Syndrome; Acute respiratory distress syndrome; Ratio of arterial oxygen partial pressure to fractional inspired oxygen; Middle Aged; 3. Good health; Oxygen; Ratio of partial pressure of alveolar oxygen to fractional inspired oxygen; Surgery; Female; Research Article

To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (SpO2)/fraction of inspired (FiO2) and partial pressure alveolar (PAO2)/FiO2 may be used as effective surrogates for the arterial (PaO2)/FiO2. Also, to SpO2/FiO2 PAO2/FiO2 values that correspond PaO2/FiO2 thresholds identifying acute respiratory distress syndrome (ARDS) in patients following coronary artery bypass graft (CABG) surgery. A prospective derivation-validation cohort study Open-Heart ICU an academic teaching hospital. Recorded variables included patient demographics, ventilator settings, chest radiograph results, SPO2, PaO2, PAO2, SaO2, FiO2. Linear regression modeling was quantify relationship between indices. Receiver operating characteristic (ROC) curves were sensitivity specificity threshold values. One-hundred seventy-five enrolled derivation cohort, 358 validation cohort. The SPO2/FiO2 ratios could predicted well from PaO2/FiO2, described by linear models = 71.149 + 0.8PF 38.098 2.312PF, respectively. According equation, a ratio 300 equaled 311 (R2 0.857, F 1035.742, < 0.0001) 732 0.576, 234.887, 0.0001). had 90% sensitivity, 80% specificity, LR+ 4.50, LR- 0.13, PPV 98, NPV 42.1 diagnosis mild ARDS. 86% 8.45, 0.16, 98.9, 36 excellent discrimination ability ARDS (AUC ± SE 0.92 0.017; 95% CI 0.889 0.947) did 0.915 0.018; 0.881 to0.942). PaO2 SaO2 correlated ARDS, with correlating SPO2/ FiO2 (Sensitivity 90%, Specificity 80%). allow early real-time rapid identification while decreasing cost, phlebotomy, blood loss, pain, skin breaks, vascular punctures associated serial gas measurements.