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SpO2/FiO2 and PaO2/FiO2 for Predicting Intensive Care Admission in Wheezy Children: An Observational Study
Rakhi Beniwal1, Prerna Batra2, Vikram Bhaskar1
1Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
Insights
A low SpO2/FiO2 (SF) ratio < 300 at admission effectively predicts pediatric intensive care unit (PICU) admission in wheezy children. While SF ratio shows moderate correlation with PF ratio, it is a valuable tool for assessing critical care needs.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Physiology
- Critical Care
Background:
- Wheezing illnesses in children can lead to respiratory distress.
- Accurate prediction of pediatric intensive care unit (PICU) admission is crucial for timely intervention.
- The SpO2/FiO2 (SF) ratio is a non-invasive measure of oxygenation, while the PaO2/FiO2 (PF) ratio requires arterial blood gas analysis.
Purpose of the Study:
- To evaluate the sensitivity of an SF ratio cut-off < 300 for predicting PICU admission in wheezy children.
- To assess the SF ratio's and PF ratio's sensitivity for predicting in-hospital mortality.
- To determine the correlation between SF ratio and PF ratio in this pediatric population.
Main Methods:
- Prospective observational study involving 315 wheezy children (6 months to 12 years) admitted to the pediatric emergency department.
- Recorded SpO2 and FiO2 at admission; PaO2 measured via arterial blood gas analysis within 30 minutes.
- Outcomes included PICU admission and in-hospital mortality.
Main Results:
- An SF ratio < 300 demonstrated 97.30% sensitivity for predicting PICU admission.
- Both SF ratio < 300 and PF ratio < 200 showed 100% sensitivity for predicting in-hospital mortality, though with low specificity.
- A moderate correlation (r=0.44, P<0.001) was observed between SF ratio and PF ratio.
Conclusions:
- The SpO2/FiO2 ratio cut-off of < 300 is a sensitive predictor of PICU admission in wheezy children.
- SF ratio offers a valuable, non-invasive method for assessing the need for intensive care in pediatric respiratory distress.
- SF ratio has a moderate correlation with the PF ratio, indicating distinct but related physiological information.
Objective:
To determine the sensitivity of cut-off of SpO2/FiO2 (SF ratio) < 300 at hospital admission for predicting the need for admission in the pediatric intensive care unit (PICU) in wheezy children. Secondary objectives were to determine the sensitivity of cut-off of SF ratio < 300 for predicting in-hospital mortality and that of PaO2/FiO2 (PF ratio) < 200 for predicting intensive care admission and in-hospital mortality. We also ascertained the correlation between SF ratio and PF ratio in the above population.
Methods:
This prospective observational study was conducted on 315 wheezy children aged 6 months to 12 years requiring admission in the pediatric emergency department. Oxygen saturation (SpO2) and fraction of oxygen in inspired air (FiO2) were recorded at admission while the partial pressure of oxygen (PaO2) was measured using arterial blood gas analysis performed within half an hour of admission. All children were managed as per protocol and followed up during hospital stay. Outcome was defined as the need for admission in the pediatric intensive care unit (PICU) or in-hospital mortality.
Results:
Cut -offs of SF ratio < 300 and PF ratio < 200 were able to determine the need PICU admission with a sensitivity of 97.30% and 62.16% respectively. The best cut-off of SF ratio for predicting PICU admission was < 178.79 [AUC (95% CI) 0.841 (0.767, 0.914)], while that for PF ratio was < 201.81 [AUC (95% CI) of 0.849 (0.775, 0.924)]. Cut-offs of < 300 for SF ratio and < 200 of PF ratio, were able to predict in-hospital mortality with sensitivity of 100%, but specificity of only 3.33% and 46.67%, respectively. There was only a moderate correlation between SF ratio and PF ratio (r = 0.44, P < 0.001).
Conclusion:
SpO2/FiO2 cut-off of < 300 had a good sensitivity in determining need for PICU admission. SF ratio has only a moderate correlation with PF ratio.
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