Correlation of Oxygen Index, Oxygen Saturation Index, and PaO 2 /FiO 2  Ratio in Invasive Mechanically Ventilated Adults

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A bstract

Background

With the oxygen saturation index (OSI) being a noninvasive surrogate for oxygen index (OI) and P/F ratio, examining the correlation between PaO ₂/FiO ₂ (P/F ratio), OI, and OSI in mechanically ventilated adults will benefit in those settings where arterial blood gas monitoring is not readily accessible.

Materials and methods

Data were collected for patients ≥18 years who were under invasive (endotracheal intubation) mechanical ventilation at medical or surgical wards in a tertiary care hospital.

Results

After natural log transformation, the correlations between P/F ratio and OI ( r = −0.94) and OI and OSI ( r = 0.82) were strong, but weaker between P/F ratio and OSI ( r = −0.69).

Conclusion

Future bigger studies are needed to evaluate whether monitoring OSI and/or OI over P/F ratio will impact treatment outcomes.

How to cite this article

Vadi S. Correlation of Oxygen Index, Oxygen Saturation Index, and PaO ₂/FiO ₂ Ratio in Invasive Mechanically Ventilated Adults. Indian J Crit Care Med 2021;25(1):54–55.

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Most cited references 5

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Oxygenation Saturation Index Predicts Clinical Outcomes in ARDS

Katherine DesPrez, J McNeil, Chunxue Wang … (2017)

Background Traditional measures of ARDS severity such as Pa o 2 /F io 2 may not reliably predict clinical outcomes. The oxygenation index (OI [F io 2 × mean airway pressure × 100)/Pa o 2 ]) may more accurately reflect ARDS severity but requires arterial blood gas measurement. We hypothesized that the oxygenation saturation index (OSI [F io 2 × mean airway pressure × 100)/oxygen saturation by pulse oximetry (Sp o 2 )]) is a reliable noninvasive surrogate for the OI that is associated with hospital mortality and ventilator-free days (VFDs) in patients with ARDS. Methods Critically ill patients enrolled in a prospective cohort study were eligible if they developed ARDS (Berlin criteria) during the first 4 ICU days and had mean airway pressure, Sp o 2 /F io 2 , and Pa o 2 /F io 2 values recorded on the first day of ARDS (N = 329). The highest mean airway pressure and lowest Sp o 2 /F io 2 and Pa o 2 /F io 2 values were used to calculate OI and OSI. The association between OI or OSI and hospital mortality or VFD was analyzed by using logistic regression and linear regression, respectively. The area under the receiver-operating characteristic curve (AUC) for mortality was compared among OI, OSI, Sp o 2 /F io 2 , Pa o 2 /F io 2 , and Acute Physiology and Chronic Health Evaluation II scores. Results OI and OSI were strongly correlated (rho = 0.862; P < .001). OSI was independently associated with hospital mortality (OR per 5-point increase in OSI, 1.228 [95% CI, 1.056-1.429]; P = .008). OI and OSI were each associated with a reduction in VFD (OI, P = .023; OSI, P = .005). The AUC for mortality prediction was greatest for Acute Physiology and Chronic Health Evaluation II scores (AUC, 0.695; P < .005) and OSI (AUC, 0.602; P = .007). The AUC for OSI was substantially better in patients aged < 40 years (AUC, 0.779; P < .001). Conclusions In patients with ARDS, the OSI was correlated with the OI. The OSI on the day of ARDS diagnosis was significantly associated with increased mortality and fewer VFDs. The findings suggest that OSI is a reliable surrogate for OI that can noninvasively provide prognostic information and assessment of ARDS severity.

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Defining acute lung disease in children with the oxygenation saturation index.

Stefani Thomas, Teresa Shaffer, Douglas Willson … (2009)

To evaluate whether a formula could be derived using oxygen saturation (Spo2) to replace Pao2 that would allow identification of children with acute lung injury and acute respiratory distress syndrome. Definitions of acute lung injury and acute respiratory distress syndrome require arterial blood gases to determine the Pao2/Fio2 ratio of 300 (acute lung injury) and 200 (acute respiratory distress syndrome). Post hoc data analysis of measurements abstracted from two prospective databases of randomized controlled trials. Academic pediatric intensive care units. A total of 255 children enrolled in two large prospective trials of therapeutic intervention for acute lung disease: calfactant and prone positioning. Data were abstracted including Pao2, Paco2, pH, Fio2, and mean airway pressure. Repeated-measures analyses, using linear mixed-effects models, were used to build separate prediction equations for the Spo2/Fio2 ratio, oxygenation index [(Fio2 x Mean Airway Pressure)/Pao2], and oxygen saturation index [(Fio2 x Mean Airway Pressure)/Spo2 ]. A generalization of R was used to measure goodness-of-fit. Generalized estimating equations with a logit link were used to calculate the sensitivity and specificity for the cutoffs of Pao2/Fio2 ratio of 200 and 300 and equivalent values of Spo2/Fio2 ratio, oxygenation index, and oxygen saturation index. An Spo2/Fio2 ratio of 253 and 212 would equal criteria for acute lung injury and acute respiratory distress syndrome, respectively. An oxygenation index of 5.3 would equal acute lung injury criteria, and an oxygenation index of 8.1 would qualify for acute respiratory distress syndrome. An oxygen saturation index, which includes the mean airway pressure and the noninvasive measure of oxygenation, of 6.5 would be equivalent to the acute lung injury criteria, and an oxygen saturation index of 7.8 would equal acute respiratory distress syndrome criteria. Noninvasive methods of assessing oxygenation may be utilized with reasonable sensitivity and specificity to define acute lung injury and acute respiratory distress syndrome, and, with prospective validation, have the potential to increase the number of children enrolled into clinical trials.

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Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk.

Sarah Rubin, Robinder G. Khemani, Christopher Newth … (2015)

Requiring PaO2/FiO2 ratio (PF) to define ARDS may bias towards children with cardiovascular dysfunction and hypoxemia. We sought to evaluate (1) the Berlin definition of ARDS in children using PF; (2) the effect of substituting SpO2/FiO2(SF) ratio; (3) differences between patients with and without arterial blood gases; and (4) the ability of SpO2 and PaO2 indices to discriminate ICU mortality.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Crit Care Med

Journal ID (iso-abbrev): Indian J Crit Care Med

Journal ID (publisher-id): IJCCM

Title: Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine

Publisher: Jaypee Brothers Medical Publishers

ISSN (Print): 0972-5229

ISSN (Electronic): 1998-359X

Publication date (Print): January 2021

Volume: 25

Issue: 1

Pages: 54-55

Affiliations

[1]Department of Critical Care Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Center, Mumbai, Maharashtra, India

Author notes

Sonali Vadi, Department of Critical Care Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Center, Mumbai, Maharashtra, India, Phone: +91 22-3066 6666, e-mail: sonalivadi@ 123456hotmail.com

Article

DOI: 10.5005/jp-journals-10071-23506

PMC ID: 7874290

PubMed ID: 33603302

SO-VID: 89cf12f3-e6c1-46c8-bb5c-4e25a69b3d72

License:

© Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.