估算 Pao2/Fio2 比率的连续无创方法

Q4 Medicine Critical care explorations Pub Date : 2024-10-25 eCollection Date: 2024-11-01 DOI:10.1097/CCE.0000000000001174

Francis-Olivier Beauchamp, Michaël Sauthier

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引用次数: 0

摘要

目的验证一种仅使用标准连续数据监测对所有重症儿科患者的 Pao2/Fio2 (PF) 比率进行连续估算的方法：设计：对高时间分辨率数据库进行回顾性研究：患者/受试者：我们纳入了从 2015 年 5 月至 2023 年 5 月期间入院的所有患者，这些患者均有动脉血气 (ABG) 和同期连续脉冲血氧饱和度 (Spo2) 值。我们使用之前验证过的数学模型，通过计算估计的 ePao2/Fio2 (ePF) 比值来确定低氧血症的程度，并将其与 Spo2/Fio2 (SF) 进行比较，以 PF 比值作为参考标准：干预措施：无：我们共分析了 20,828 份 ABG。当 Spo2 低于或等于 97% 时，ePF 比值显示的低氧血症分类（无、轻度/中度或重度）明显优于 SF 比值（0.80 vs. 0.72；p <0.001），固定偏差更低（16.26 vs. -35.24；p <0.001），平均绝对误差更低（37.从布兰德-阿尔特曼图（248.10 vs. 292.45; p < 0.001）和决定系数（0.68 vs. 0.59; p < 0.001）来看，ePF 比值也具有更好的一致性差异（248.10 vs. 292.45; p < 0.001）和决定系数（0.68 vs. 0.59; p < 0.001）。当 Spo2 超过 97% 时，ePF 比率的分类效果更好，Kappa 值（0.53 vs. 0.43；p < 0.001）和固定偏差（-0.63 vs. 65.68；p < 0.001）更低：结论：基于 ePF 的 PF 比值可连续估计低氧血症的严重程度，其性能优于 SF 比值。

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A Continuous and Noninvasive Method to Estimate Pao₂/Fio₂ Ratio.

Objectives: To validate a method for continuously estimating the Pao₂/Fio₂ (PF) ratio in all critically ill pediatric patients using only standard continuous data monitoring.

Design: Retrospective study on a high temporal resolution database.

Setting: PICU in Montreal, QC, Canada.

Patients/subjects: We included any patients admitted from May 2015 to May 2023 who had an arterial blood gas (ABG) with concurrent continuous pulsed oximetry saturation (Spo₂) values. We used our previously validated mathematical model to determine the magnitude of hypoxemia by computing the estimated ePao₂/Fio₂ (ePF) ratio and comparing it to the Spo₂/Fio₂ (SF), using PF ratio as the reference standard.

Interventions: None.

Measurements and main results: We analyzed a total of 20,828 ABGs. When Spo₂ was below or equal to 97%, the ePF ratio showed a significantly better hypoxemia classification (none, light/moderate, or severe) than the SF ratio (0.80 vs. 0.72; p < 0.001), a lower fixed bias (16.26 vs. -35.24; p < 0.001), a lower mean absolute error (37.92 vs. 63.93; p < 0.001) and a lower proportional bias (slope of 1.01 vs. 0.81; p < 0.001). ePF ratio has also a better limits of agreement difference from Bland-Altman plot (248.10 vs. 292.45; p < 0.001) and coefficient of determination (0.68 vs. 0.59; p < 0.001). When Spo₂ was above 97%, the ePF ratio had better classification with Kappa (0.53 vs. 0.43; p < 0.001) and lower fixed bias (-0.63 vs. 65.68; p < 0.001).

Conclusions: The PF ratio based on ePF allows for a continuous estimation of hypoxemia severity with a better performance than the SF ratio.

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