Evaluation of Non-Invasive Oxygen Saturation Index Compared With Oxygenation Index in Pulmonary and Non-Pulmonary Patients Admitted in PICU


The Oxygenation Index (OI= [MAP×FiO2]/PaO2×100), an invasive diagnostic criterion, is routinely used as a marker of severity of acute respiratory distress syndrome (ARDS). In order to determine of OI, arterial blood gas (ABG) through an invasive procedure is indispensably used to obtain PaO2. The Oxygenation saturation Index (OSI= [MAP×FiO2]/ SPO2 ×100), as an alternative method, can be implemented using pulse oximetry to assess SpO2. For this epidemiologic-analytic study, 74 intubated patients admitted in a pediatric intensive care unit of Abouzar hospital of Ahvaz during the first 3-day admission were selected equally in pulmonary and non-pulmonary groups within a six months period, from January 1, 2019, to May 31, 2019. Two indexes of OI and OSI in both patients were evaluated, and eventually, the results were analyzed by linear regression using Spss. A comparison of the two OI and OSI indexes showed a meaningful relationship was found (P<0.001), which has a higher correlation coefficient of 0.726 in patients with the pulmonary disease than non-pulmonary patients with 0.394. The present study demonstrates that the index of oxygen saturation (OSI) with a sensitivity of 78% and specificity of 83% in the patients without acute pulmonary distress syndrome is a suitable indicator instead of the invasive index of OI. Also, in patients with pulmonary disease that meet the medium range of Berlin criteria, with a sensitivity of 100% and specificity of 76%, the OSI index can be used to predict the status of patients.

[1] Bindl L, Dresbach K, Lentze MJ. Incidence of acute respiratory distress syndrome in German children and adolescents: a population-based study, Crit Care Med. 2005 Jan 33(1): 209-312, DOI: 10.1097/01.ccm.0000151137.76768.08
[2] Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, et al. Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study. Pediatr Crit Care Med. 2007 Jul 8(4):317-23, DOI:10.1097/01.PCC.0000269408.64179.FF
[3] Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. : Incidence and outcomes of acute lung injury on ARDS. N Engl J Med. 2005 Oct 20; 353(16):1685-93. DOI: 10.1056/NEJMoa050333
[4] Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A.: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome, N Engl J Med;342:1301-8, 2000. DOI: 10.1056/NEJM200005043421801
[5] Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protectiveventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med; 338:347-54, 1998. DOI: 10.1056/NEJM199802053380602
[6] Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L , et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24, DOI:10.1164/ajrccm.149.3.7509706
[7] Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-33. DOI: 10.1001/jama.2012.5669
[8] Ferguson ND, Frutos-Vivar F, Esteban A, Fernández-Segoviano P, Aramburu JA, Nájera L. et al. Acute respiratory distress syndrome: underrecognition by clinicians and diagnostic accuracy of three clinical definitions.Crit Care Med. 2005;33:2228–223. doi: 10.1007/978-3-319-03746-2.
[9] Roberts D, Ostryzniuk P, Loewen E, Shanks A, Wasyluk T, Pronger L. et al. Control of blood gas measurements in intensive-care units. Lancet. 1991;337:1580–1582. doi: 10.1016/0140-6736(91)93271-A.
[10] Khemani RG, Patel NR, Bart RD, Newth CJL, Comparison of the pulse oximetry saturation/ fraction of inspired oxygen ratio and the PaO2/fraction of inspired oxygen ratio in children. Chest 2009;135: 662-8. DOI:10.1378/chest.08-2239.
[11] Thomas NJ, Shaffer ML, Willson DF, Shih MC, Curley MA. Defining acute lung disease in children with the oxygenation saturation index. Pediatr Crit Care Med 2010;11:12-7, DOI: 10.1097/PCC.0b013e3181b0653d
[12] Khemani RG1, Thomas NJ, Venkatachalam V, Scimeme JP, Berutti T, Schneider JB, et al. Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. Crit Care Med 2012;40:1309-16. DOI: 10.1097/CCM.0b013e31823bc61b
[13] Wilmott R., Bush A., Deterding R., Ratjen F, Heather P.S, Li Z, Kendig's Disorders of the Respiratory Tract in Children, Elsevier, 9th Edition, 2019.
[14] Lobete C, Medina A, Rey C, Mayordomo-Colunga J, Concha A, Menéndez S., Correlation of oxygen saturation as measured by pulse oximetry/fraction of inspired oxygen ratio with PaO2/fraction of inspired oxygen ratio in a heterogeneous sample of critically ill children. Journal of Critical Care 28, 538.e1–538.e7, 2013. DOI:10.1016/j.jcrc.2012.12.006
[15] Khemani RG, Rubin S, Belani S, Leung D, Erickson S, Smith LS, et al., Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk, Intensive Care Med, Intensive Care Med. 2015 Jan;41(1):94-102. DOI:10.1007/s00134-014-3486-2
[16] Rawat M, Chandrasekharan PK, Williams A, Gugino S, Koenigsknecht C, Swartz D, Munmun Rawat, et al., Oxygen Saturation Index and Severity of Hypoxic Respiratory Failure, Neonatology;107:161–166, 2015. DOI:10.1159/000369774
[17] Murthy Doreswaamy S, Anbu Chakkarapani A, Murthy P, Oxygen Saturation Index – A Noninvasive Tool for Monitoring Hypoxemic Respiratory Failure in Newborns, Indian Pediatrics, Vol 53, 2016.
IssueVol 58, No 2 (2020) QRcode
Oxygen saturation index (OSI) Oxygenation index (OI) Intubated patients Acute respiratory distress syndrome

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Alisamir M, Mirkarimi M, Hajatnia S, Zadkarami M. Evaluation of Non-Invasive Oxygen Saturation Index Compared With Oxygenation Index in Pulmonary and Non-Pulmonary Patients Admitted in PICU. Acta Med Iran. 2020;58(2):78-82.