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Objective:To investigate and evaluate if pulse oxygen saturation/fraction of inhaled oxygen (SpO 2/FiO 2) can be used, as replacement of arterial partial pressure of oxygen/fraction of inhaled oxygen (PaO 2/FiO 2), to assess oxygenation in acute respiratory distress syndrome (ARDS) patients at different high altitudes in Yunnan Province, and to find a rapid and non-invasive method for the diagnosis of ARDS at different altitudes. Methods:Patients with ARDS at different high altitudes in Yunnan Province from January 2019 to December 2020 were enrolled. The patients were divided into three groups according to different altitudes, and received different oxygen therapies according to their respective medical conditions. Group 1 consisted of patients with moderate to severe ARDS from the department of critical care medicine of the First Affiliated Hospital of Kunming Medical University (average altitude approximately 1 800 m), and received mechanical ventilation to maintain SpO 2 of 0.90-0.96 with a low FiO 2 for more than 30 minutes, and SpO 2, FiO 2, PaO 2 were recorded. Group 2 consisted of patients with moderate to severe ARDS at the department of critical care medicine of People's Hospital of Diqing Tibetan Autonomous Prefecture (mean altitude about 3 200 m), and received oxygen with an attached reservoir mask to maintain SpO 2 of 0.90-0.96 for 10 minutes, and then SpO 2, FiO 2, and PaO 2 were recorded. Group 3 consisted of patients with mild to moderate-severe ARDS who admitted to the emergency department of the People's Hospital of Lijiang (average altitude approximately 2 200 m); when SpO 2 < 0.90, patients received oxygen with the oxygen storage mask, and the FiO 2 required to maintain SpO 2 ≥ 0.90 was recorded, and SpO 2, FiO 2, PaO 2 were recorded after oxygen inhalation for 10 minutes. Spearman coefficient was used to analyze the correlation between SpO 2/FiO 2 and PaO 2/FiO 2 in each group. Linear analysis was used to derive the linear equation between SpO 2/FiO 2 and PaO 2/FiO 2, and to evaluate arterial pH, arterial partial pressure of carbon dioxide (PaCO 2), FiO 2, tidal volume (VT), positive end-expiratory pressure (PEEP) and other related factors which would change the correlation between SpO 2/FiO 2 and PaO 2/FiO 2. The receiver operator characteristic curve (ROC curve) was plotted to calculate the sensitivity and specificity of using SpO 2/FiO 2 instead of PaO 2/FiO 2 to assess oxygenation of ARDS patients. Results:Group 1 consisted of 24 ARDS patients from whom 271 blood gas analysis results were collected; group 2 consisted of 14 ARDS patients from whom a total of 47 blood gas analysis results were collected; group 3 consisted of 76 ARDS patients, and a total of 76 blood gas analysis results were collected. The PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa) in groups 1, 2 and 3 were 103 (79, 130), 168 (98, 195) and 232 (146, 271) respectively, while SpO 2/FiO 2 were 157 (128, 190), 419 (190, 445) and 319 (228, 446) respectively. Among the three groups, patients in group 1 had the lowest PaO 2/FiO 2 and SpO 2/FiO 2, while patients in group 3 had the highest. Spearman correlation analysis showed that PaO 2/FiO 2 was highly correlated with SpO 2/FiO 2 in groups 1, 2 and 3 ( r values were 0.830, 0.951, 0.828, all P < 0.05). Regression equation was fitted according to linear analysis: in group 1 SpO 2/FiO 2 = 58+0.97×PaO 2/FiO 2 ( R2 = 0.548, P < 0.001) ; in group 2 SpO 2/FiO 2 = 6+2.13×PaO 2/FiO 2 ( R2 = 0.938, P < 0.001); in group 3 SpO 2/FiO 2 = 53+1.33×PaO 2/FiO 2 ( R2 = 0.828, P < 0.001). Further analysis revealed that PEEP, FiO 2, and arterial blood pH could affect the correlation between SpO 2/FiO 2 and PaO 2/FiO 2. ROC curve analysis showed that the area under ROC curve (AUC) was 0.848 and 0.916 in group 1 with moderate to severe ARDS; based on the regression equation, the corresponding SpO 2/FiO 2 cut-off values at a PaO 2/FiO 2 of 100 mmHg and 200 mmHg were 155, 252 with a sensitivity of 84.9% and 100%, specificity of 87.2% and 70.6%, respectively. Patients with moderate to severe ARDS in group 2 (AUC was 0.945 and 0.977), the corresponding SpO 2/FiO 2 cut-off values at PaO 2/FiO 2 of 100 mmHg and 200 mmHg were 219 and 432 with the sensitivity of 100% and 85.2%, specificity of 82.5% and 100%, respectively. Patients with mild to moderate-severe ARDS in group 3 (AUC was 0.903 and 0.936), the corresponding SpO 2/FiO 2 cut-off values at a PaO 2/FiO 2 of 200 mmHg and 300 mmHg were 319 and 452 with the sensitivity of 100% and 100%, specificity of 80.9% and 86.2%, respectively. Conclusion:SpO 2/FiO 2 and PaO 2/FiO 2 in ARDS patients at different high altitudes in Yunnan Province have a good correlation, and non-invasive SpO 2/FiO 2 can be used to replace PaO 2/FiO 2 to assess the oxygenation in ARDS patients.
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Objective:To explore the feasibility of using pulse oxygen saturation (SpO 2) to evaluate the condition of patients with acute respiratory distress syndrome (ARDS) in the Lijiang region. Methods:Patients with ARDS who visited the department of emergency of People's Hospital of Lijiang from August to December 2020 were selected as study subjects. Patients were divided by severity into mild ARDS group [200 mmHg (1mmHg = 0.133 kPa)≤oxygenation index (PaO 2/FiO 2, P/F)≤300 mmHg] and moderate to severe ARDS group (P/F≤200 mmHg). The general condition, clinical diagnosis, arterial blood gas analysis results of the patients were recorded, and the differences of the above indexes between the two groups of ARDS were compared. Spearman correlation analysis was used to analyze the correlation between SpO 2 and arterial oxygen saturation (SaO 2). SpO 2 was carried into the Ellis equation and the Rice equation to calculate the derived P/F and analyze the correlation between the derived P/F and the P/F measured in arterial blood gas analysis; receiver operator characteristic curve (ROC curves) were plotted, the sensitivity and specificity of SpO 2/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) instead of P/F to assess oxygenation in patients with ARDS was calculated. To evaluate the feasibility of SpO 2 for the condition evaluation of patients with ARDS in the Lijiang region. Results:Compared with the mild ARDS group, the arterial partial pressure of oxygen (PaO 2), SaO 2 and hemoglobin (Hb) were significantly decreased in the moderate to severe ARDS group [PaO 2 (mmHg): 50.5 (39.3, 56.5) vs. 60.0 (55.0, 67.5), SaO 2: 0.86 (0.73, 0.91) vs. 0. 93 (0.90, 0.96), Hb (g/L): 142±27 vs. 156±24, respectively, all P < 0.05]. Correlation analysis revealed a significant positive correlation between SpO 2 and SaO 2 in ARDS patients residing at high altitude ( R = 0.650, P = 0.000). The P/F derived by the Rice formula was significantly and positively correlated with the P/F derived from arterial blood gas analysis ( R = 0.802, P = 0.000). The deduced P/F in mild and moderate to severe ARDS groups were all significantly correlated with the measured P/F ( R values were 0.562, 0.647, both P = 0.000). The P/F derived using the Ellis formula showed a significant positive correlation with the P/F derived from arterial blood gas analysis ( R = 0.822, P = 0.000). The deduced P/F of mild ARDS group and moderate to severe ARDS group were all positively correlated with the measured P/F ( R values were 0.556, 0.589, P values were 0.000, 0.010). There was a significant positive correlation between S/F and P/F in ARDS patients ( R = 0.828, P = 0.000), and the regression equation was S/F = 1.33 P/F+52.41. ROC curve analysis showed that S/F had some predictive value for patients with mild and moderate to severe ARDS, and area under ROC curve (AUC) and 95% confidence interval (95% CI) were 0.903 (0.829-0.977), 0.936 (0.870-1.000), both P = 0.000. When the cut-off value was 452 mmHg, S/F had a sensitivity of 100% and a specificity of 80.9% for predicting mild ARDS. When the cut-off value was 319 mmHg, S/F predicted moderate to severe ARDS with 95.1% sensitivity and 86.2% specificity. Conclusions:At high altitude, SpO 2 and SaO 2 have been correlated in patients with ARDS, and P/F derived using SpO 2 and measured P/F were significantly correlated in patients with ARDS, especially in those with moderate to severe ARDS. SpO 2 may be useful in the assessment of severity of illness in patients with ARDS at high altitude.
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Objective@#To explore the risk stratification of pulse oxygen saturation (SpO2) in patients with emergency hypoxemia patients, and to provide evidence for the identification of critical illness.@*Methods@#Self-designed clinical data registration form for patients with emergency hypoxemia, and prospective collection of 344 hypoxemia patients in the emergency department of Peking Union Medical College Hospital from March to April in 2018, including baseline data (name, gender, age, ID number, date, registration time), hospitalization method, past history, patient complaint and diagnosis, triage level, SpO2, whether to enter the rescue room, etc.@*Results@#All of 344 emergency hypoxemia patients, there were 163 cases (21.2%) of ambulances, and 107 cases (31.1%) of patients requiring immediate rescue. There were 54 cases (25.7%) and 53 cases (39.6%) in need of immediate rescue in day shift (8:00-20:00) and night shift (20:00-8:00 next day), with 9:00-10:00, 14:00-15:00, 20:00-24:00 in the majority. There was a statistical difference in the way of hospitalization, triage, and SpO2 (χ2=29.537, 25.780, t=4.722, all P<0.05) . SpO2 risk stratification was 0.905 in patients without pulmonary disease, and SpO2 risk stratification in patients with lung disease was 0.765.@*Conclusions@#Patients with hypoxemia account for a certain proportion in the emergency department and are in critical condition. The degree of critical condition of patients can be evaluated based on whether they have lung diseases, and the risk stratification of patients can be accurately determined with the help of SpO2, so as to further guide the hierarchical treatment measures for patients with emergency hypoxemia and rationally optimize the allocation of emergency resources.
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Objective To explore the risk stratification of pulse oxygen saturation (SpO2) in patients with emergency hypoxemia patients, and to provide evidence for the identification of critical illness. Methods Self-designed clinical data registration form for patients with emergency hypoxemia , and prospective collection of 344 hypoxemia patients in the emergency department of Peking Union Medical College Hospital from March to April in 2018, including baseline data (name, gender, age, ID number, date, registration time), hospitalization method, past history, patient complaint and diagnosis, triage level, SpO2, whether to enter the rescue room, etc. Results All of 344 emergency hypoxemia patients, there were 163 cases (21.2% ) of ambulances, and 107 cases (31.1% ) of patients requiring immediate rescue. There were 54 cases (25.7%) and 53 cases (39.6%) in need of immediate rescue in day shift (8:00-20:00) and night shift (20:00-8:00 next day), with 9:00-10:00, 14:00-15:00, 20:00-24:00 in the majority. There was a statistical difference in the way of hospitalization, triage, and SpO(2 25.780, t=4.722, all P<0.05). SpO2 risk stratification was 0.905 in patients without pulmonary disease, and SpO2 risk stratification in patients with lung disease was 0.765. Conclusions Patients with hypoxemia account for a certain proportion in the emergency department and are in critical condition. The degree of critical condition of patients can be evaluated based on whether they have lung diseases, and the risk stratification of patients can be accurately determined with the help of SpO2, so as to further guide the hierarchical treatment measures for patients with emergency hypoxemia and rationally optimize the χ2=29.537, allocation of emergency resources.
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Objective To study the therapeutic effects of prostaglandin E1 on the neonates with transposition of the great vessels with intact ventricular septum (TGV/IVS) retrospectively. Method From January 2004 to June 2009, 34 neonates with TGV/IVS were enrolled in this study. The pulse rate and oxygen saturation (SpO2) of patients were measured percutaneouly at admission. Lipo-prostaglandin E1 (Lipo-PGE1) was administered via peripheral vein with pumping infusion continuously after diagnosis by echocardiography in order to keep the ductus arteriosus (DA) patent. The dose and the time required for the Lipo-PGEl to produce effect were recorded. The changes of SpO2 before and after administration of Lipo-PGE1 were observed. The changes of DA's diameter detected by using echocardiography before and during the operation. Results In all patients the initial dose of Lipo-PGEl was 5 ng/( kg·min) except 3 patients whom larger dosed were required to give guided by the change of SpO2 with 10 ng/(kg·min) in two patients and 15 ng/(kg·min) in one patient. The time required for Lipo-PGE to produce the effect was 5-15 minutes in most infants with mean of (12 ± 3) minutes. The mean SpO2 of the patients measured at admission was (80.05±7.64)%, and it was (86.41±4.83)% two hours before operation (P < 0.05). The average diameter of DA was (0.37±0.08) cm at the time diagnosis and it was (0.51 ±0.15) cm during the operation. The adverse effects occurred in two patients and one of them had apnea and was treated mechanical ventilation. Conclusions Lipo-PGE1 given by continuous pumping infusion via peripheral vein in dose of 5 ng per kilogram per minute can maintainthe DA patency and promote the systemic oxygenation and perfusion, improving the circulation and oxygenation and correcting the acidosis until the plastic surgery performed. Most of the adverse effects of PGE1 are dose related.
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Objective To monitor pulse oxygen saturation(SpO_2)continuously in patients with chronic obstructive pulmonary disease (COPD) so as to study its clinical implication.Methods SpO_2, thoracic and abdominal respiratory activity was continually recorded during meal time by PSG in 19 patients with COPD. Body mass index and lung function were measured respectively. Results SpO_2 was lower after meal(P
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Continuous and noninvasive measurement of oxyhemoglobin and blood oxygen saturation can be fulfilled by measuring pulse oxygen saturadon, and thus early discovery of hypoxemia can be available.