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Correlation Between PaO2/FIO2 and Peripheral Capillary Oxygenation/FIO2 in Burned Children With Smoke Inhalation
Janos Cambiaso-Daniel1, Charles D Voigt, Eric Rivas
11Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX. 2Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria. 3Department of Kinesiology and Sport Management, Texas Tech University, Lubbock TX 4Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany. 5Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX.
Insights
Peripheral capillary oxygenation/FIO2 ratio strongly correlates with PaO2/FIO2 in burned children with smoke inhalation injury. This finding suggests peripheral capillary oxygenation/FIO2 can serve as a reliable surrogate for diagnosing acute respiratory distress syndrome.
Area of Science:
- Pediatric critical care medicine
- Burn injury management
- Respiratory distress syndrome diagnosis
Background:
- Smoke inhalation injury in burned children can lead to acute respiratory distress syndrome (ARDS).
- Accurate diagnosis of ARDS is crucial for timely and effective treatment.
- The PaO2/FIO2 ratio is a standard measure for ARDS diagnosis, but requires arterial blood gas analysis.
Purpose of the Study:
- To evaluate the correlation between peripheral capillary oxygenation/FIO2 (SpO2/FIO2) and PaO2/FIO2 ratios in pediatric burn patients with smoke inhalation injury.
- To determine if the SpO2/FIO2 ratio can be a reliable surrogate for the PaO2/FIO2 ratio in diagnosing ARDS.
- To identify optimal SpO2 thresholds for this surrogate use.
Main Methods:
- Retrospective chart review of burned children with smoke inhalation injury admitted between 1996 and 2014.
- Analysis of simultaneously obtained peripheral capillary oxygenation, FIO2, and arterial blood gas measurements (PaO2).
- Calculation and comparison of SpO2/FIO2 and PaO2/FIO2 ratios, including subgroup analysis for ARDS patients.
Main Results:
- A strong correlation (r > 0.81) was observed between SpO2/FIO2 and PaO2/FIO2 ratios, particularly when SpO2 was ≤98%.
- The strongest correlation (r=0.93) was found at SpO2 ≤92%.
- In patients who developed ARDS, the correlation remained strong (r=0.89) at SpO2 ≤98% and (r=0.91) at SpO2 ≤92%.
Conclusions:
- The SpO2/FIO2 ratio demonstrates a strong correlation with the PaO2/FIO2 ratio in burned children with smoke inhalation injury.
- The SpO2/FIO2 ratio, especially with SpO2 thresholds of ≤98% or ≤92%, can potentially serve as a non-invasive surrogate for PaO2/FIO2.
- This surrogate measure may aid in the diagnosis and management of ARDS in this vulnerable pediatric population, particularly when aiming for SpO2 levels of 90-95%.
Objectives:
Determine whether the peripheral capillary oxygenation/FIO2 ratio correlates with the PaO2/FIO2 ratio in burned children with smoke inhalation injury, with the goal of understanding if the peripheral capillary oxygenation/FIO2 ratio can serve as a surrogate for the PaO2/FIO2 ratio for the diagnosis of acute respiratory distress syndrome.
Design:
Retrospective chart review.
Setting:
Shriners Hospitals for Children-Galveston.
Patients:
All burned children with smoke inhalation injury who were admitted from 1996 to 2014 and had simultaneously obtained peripheral capillary oxygenation, FIO2 and PaO2 measurements.
Interventions:
None.
Measurements And Main Results:
Two hundred seventy-three patients (63% male, 8 ± 5 yr, 53% ± 24% total body surface area burns) were analyzed. Peripheral capillary oxygenation/FIO2 ratios were divided into four subgroups based on peripheral capillary oxygenation values (≤ 100%, ≤ 98%, ≤ 95%, and ≤ 92%). Significance was accepted at r greater than 0.81. The r (number of matches) was 0.66 (23,072) for less than or equal to 100%, 0.87 (18,932) for less than or equal to 98%, 0.89 (7,056) for less than or equal to 95%, and 0.93 (4,229) for less than or equal to 92%. In the subgroup of patients who developed acute respiratory distress syndrome, r was 0.65 (8,357) for less than or equal to 100%, 0.89 (7,578) for less than or equal to 98%, 0.89 (4,115) for less than or equal to 95%, and 0.91 (2,288) less than or equal to 92%.
Conclusions:
PaO2/FIO2 and peripheral capillary oxygenation/FIO2 strongly correlate in burned children with smoke inhalation injury, with a peripheral capillary oxygenation of less than 92% providing the strongest correlation. Thus, peripheral capillary oxygenation/FIO2 ratio may be able to serve as surrogate for PaO2/FIO2, especially when titrating FIO2 to achieve a peripheral capillary oxygenation of 90-95% (i.e., in the acute respiratory distress syndrome range).
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