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\title{Comparison of the Spo 2 /Fio 2 Ratio and the Pao 2 /Fio 2 Ratio in Patients with Acute Lung Injury or Acute Respiratory Distress Syndrome}
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             \author[1]{Nemat Bilan  MD}

             \affil[1]{  Tabriz University}

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\date{\small \em Received: 14 December 2013 Accepted: 2 January 2014 Published: 15 January 2014}

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\begin{abstract}
        


Background: Diagnostic criteria for acute lung injury(ALI) and ARDS requiring acute onset of disease, chest radiograph demonstrating bilateral pulmonary infiltrates, lack of significant left ventricular dysfunction and 2 2 Fio Pao (PF) ratio ? 300 for ALI or ? 200 for ARDS. recent criteria is requiring invasive arterial sampling.The pulse oximetric saturation Spo 2 /Fio 2 (SF) ratio may be a reliable non invasive alternative to the PF ratio. Methods: In this cross sectional study, Enrolled 70 patient ALI or ARDS that Admitted in Tabriz children's hospital PICU. Included in the analysis were corresponding measurement of Spo 2 , Fio 2 , Pao 2 , charted within 5 min of each other And computed SF and PF to determine the relationship between SF and PF ratio.

\end{abstract}


\keywords{ARDS, A ALI, , pulse oximetry.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
cute lung injury and ARDS are terrible syndromes with high mortality and morbidity \hyperref[b0]{[1]} {\ref [2]} . It is estimated that 30 to 60\% of all PICU admitted patient require mechanical ventilation and of these patient up to 25\% may have ALI and 5 to10\% may have ARDS. With the implementation of lung-protective ventilation strategies overall morbidity and mortality have improved signifycantly for both adult and children with ALI and ARDS \hyperref[b1]{[3]}\hyperref[b2]{[4]} . Based on American European consensus conference (AECC) in 1994: Diagnostic criteria for acute lung injury(ALI) and ARDS requiring acute onset of disease, chest radiograph demonstrating bilateral pulmonary infiltrates, lack of significant left ventricular dysfunction and 2 2 Fio Pao (PF) ratio ? 300 for ALI or ? 200 for ARDS \hyperref[b3]{5} .\par
The first three components can be established with clinical history or noninvasively tools such as chest radiograph or echocardiography. However PF criteria require arterial blood sampling \hyperref[b4]{[6]}\hyperref[b5]{[7]} . Concerns about anemia following blood sampling and a movement to minimally invasive approaches have led to reduction blood gas measurements in critically ill patient \hyperref[b6]{[8]}\hyperref[b7]{[9]} . however studies in ARDS and ALI patient are lacking .Furthermore SF threshold values could be used for diagnosing ARDS and ALI \hyperref[b4]{[6]}\hyperref[b5]{[7]}\hyperref[b6]{[8]}\hyperref[b7]{[9]}\hyperref[b8]{[10]} .\par
Pulse oximetry is the most commonly utilized technique to monitor Oxygenation.Noninvasive and safe. It indirectly measures arterial hemoglobin O 2 Saturation by differentiating oxy hemoglobin form deoxygenated hemoglobin using their respective light absorption at wave lengths of 660 nm (red) and 940 nm (infra red) \hyperref[b9]{[11]}\hyperref[b10]{[12]} . Pulse oximetry is used:1-detection of hypoxia.2-preven tion of hyperoxia. 3-for weaning from mechanical ventilation 4-titration of Fio 2 9-13 . In most PICU daily arterial blood sampling to calculate the PF ratio often impossible,then calculate the SF ratio and replacement by PF ratio for diagnose ARDS or ALI is non invasive and affordable \hyperref[b12]{14} . Using SF ratio determine the degree of hypoxemianon invasively without the need for arterial blood sampling \hyperref[b5]{7} .\par
In this study we computed the relationship between SF and PF ratio in critically ill patient with ALI and ARDS. We hypothesize that the continuously available and noninvasively SF ratio can be used instead the PF ratio in diagnosis of ALI and ARDS. 
\section[{II.}]{II.} 
\section[{Methods}]{Methods}\par
In this cross sectional study 70 children with ARDS or ALI that admitted in Tabriz children's hospital PICU, Iran between 2012 and 2013 were studied. In Patient with ARDS or ALI under Mechanical ventilation with same Fio 2 , Pao 2 measared with Arterial blood sampling and Spo 2 measured with pulse oximetry and charted with in 5 min of each other.Computed SF and PF ratio.\par
Inclusion criteria were children with ARDS or ALI and acute onset of disease and chest radiograph demonstrating bilateral pulmonary infiltrates, consistent with pulmonary edema.\par
Exclusion criteria were children with pulmonary edema due to heart failure and congenital heart disease and Anatomic anomalies of lung or air ways. 
\section[{III.}]{III.} 
\section[{Statistical Analysis}]{Statistical Analysis}\par
Statistical analyses were performed using the Statistical Package for Social Sciences, version 17.0 (SPSS,Chicago,Illinois). Quantitative data were pre sented as mean ± standard deviation (SD), while qualitative data were demonstrated as frequency and percent (\%). The categorical parameters were compared by (? 2 ) tests, and the continuous variables were compared by independent t test. A p value of <0.05 was considered statistically significant. Relationship between SF and PF, described by linear regression equation. ROC curves were plotted to determine the sensitivity and Specificity of the SF threshold values correlating with PF of 200 (ARDS) and 300 (ALI).\par
IV. 
\section[{Results}]{Results}\par
Of 70 children enrolled in this study, included 38 patient female (54.3\%) and 32 patient male (45.7\%) with a mean age of 32+ 5 months (mini mum 2 and maximum 144 months).\par
A total of 70 data pairs 56 (80\%) met the PF ratio criteria for RADS and 14(20\%) met the PF criteria for ALI. The median time difference between charted values of Spo 2 and Pao 2 pairs was 5 min . Table (1) demonstrates baseline findings of the patients enrolled in the study.\par
Age was no significantly relationship with SF ratio. Pvalue = 0.81 and was no significantly relationship with PF ratio Pvalue=0.99.\par
Sex was no significantly relationship with SF ratio Pvalue = 0.77 and was no significantly relationship with PF ratio Pvalue =0.06.\par
In general , SF ratio could be predicted well from PF ratio, described by the linear regression equation SF =57+0.61 PF. Based on this equation a PF ratio of 300 corresponds to an SF ratio of 235 and PF ratio of 200 to an SF ratio of 181. Pvalue <0.001[Fig1] The ALI SF cut off of 235 had 57\% sensitivity and 100\% specificity and ARDS cut off of 181 had 71\% sensitivity and 82\% specificity.\par
In general, the SF ratio had excellent discrimination ability for ARDS( AUC=0.86) [Fig2] and good discrimination ability for ALI and ARDS (AUC=0.89) [Fig3].   
\section[{Discussion}]{Discussion}\par
Acute lung injury (ALI) and ARDS significant causes of morbidity and mortality for patients admitted to PICU \hyperref[b13]{15} . The routine use of pulse oximetry and capnography has led to reduce ABG measurements. In most PICU \hyperref[b15]{16} , Pulse oximetry a is now available in most children's hospital and used routinely and shows oxygenation status, easier and continuously than Arterial blood sampling \hyperref[b16]{[17]}\hyperref[b17]{[18]} . Pulse oximetry prevents Arterial blood sampling and cost for ABG analysis \hyperref[b18]{19} . Using SF ratio for diagnose of ALI and ARDS lead to identification of undiagnosed cases of these syndromes \hyperref[b19]{20} . SF ratio may be useful in many organ failure scores, such as lung injury scores \hyperref[b20]{21} , multi organ dysfunction score \hyperref[b21]{22} ,sequential organ failure assessment 23 ,instead PF ratio to estimate the degree of hypoxemia.\par
In this study Included 70 patient with ALI or ARDS Pao 2 and Spo 2 measured with the same Fio 2 computed SF and PF ratio. We seen the relationship between SF and PF ratio was described following equation SF=57+0.61 PF and SF ratio threshold value for ALI was 235 and for ARDS was 181 corresponded of PF ratio 300 and 200.\par
In the similar study khemani et al who used pediatric data. They found than an SF cutoff of 201 could predict PF criteria for ARDS with 84\% sensitivity and 78\% specificity and an SF of 263 could predict ALI with 93\% sensitivity and 43\% specificity \hyperref[b23]{24} .\par
In adult patients, the one study by Rice et al They found than an SF cut off of 235 could predict for ARDS with 85\% sensitivity and 85\% specificity and SF cut off of 315 could predict for ALI with91\% sensitivity and 56 \% specificity \hyperref[b24]{25} . In this study, we assessed relationship between age and sex with PF and SF ratio. we measured Pao 2 and Spo 2 in maximum 5 min. The SF ratio thresholds determined in this study were based on PF ratio proposed by the AECC.\par
There are certainly limitation to the this study: First, ABG and pulse oximetry measurements were close in time to each other (median 5min). Given that changes in Spo 2 and Pao 2 may happen quickly. Second, we did not control for PH, Hemoglobin, Paco 2 , temperature,that maybe influenced by the relationship between Spo 2 and Pao 2 .\par
However non invasively SF ratio can be used for Diagnosis of ALI or ARDS. 
\section[{VI.}]{VI.} 
\section[{Conclusion}]{Conclusion}\par
According to this study SF ratio is a reliable non invasive and continuously available marker for PF ratio for diagnose children with ALI or ARDS. Then can be replaced pulse oximetry by Arterial blood sampling. According to complication of Arterial blood sampling such as Anemia, Bleeding, in critical illness, Pulse oximetry can be used instead Arterial blood sampling.\begin{figure}[htbp]
\noindent\textbf{12}\includegraphics[]{image-2.png}
\caption{\label{fig_0}Figure 1 :Figure 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-3.png}
\caption{\label{figure3}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.7423044217687075\textwidth}P{0.007950680272108844\textwidth}P{0.005059523809523809\textwidth}P{0.026743197278911564\textwidth}P{0.01445578231292517\textwidth}P{0.012287414965986395\textwidth}P{0.007227891156462585\textwidth}P{0.029634353741496595\textwidth}P{0.0036139455782312926\textwidth}P{0.0007227891156462585\textwidth}}
\multicolumn{7}{l}{Abstract-Background: Diagnostic criteria for acute lung}\\
\multicolumn{7}{l}{injury(ALI) and ARDS requiring acute onset of disease, chest}\\
\multicolumn{7}{l}{radiograph demonstrating bilateral pulmonary infiltrates, lack}\\
\multicolumn{7}{l}{of significant left ventricular dysfunction and}\tabcellsep 2 2 Pao (PF) ratio Fio\\
\multicolumn{7}{l}{Results: The relationship between SF and PF ratio was}\\
\multicolumn{2}{l}{described}\tabcellsep by\tabcellsep the\tabcellsep \multicolumn{2}{l}{following}\tabcellsep regression\tabcellsep equation\\
\multicolumn{7}{l}{SF=57+0/61PF (P<0/001). SF ratios of 181 and 235}\\
\multicolumn{7}{l}{corresponded of PF ratio 300 and 200. The ALI SF cutoff of}\\
\multicolumn{7}{l}{235 had 57\% sensitivity and 100\% specificity, and ARDS, SF}\\
\multicolumn{7}{l}{cutoff of 181 had 71\% sensitivity and 82\% specificity.}\\
\multicolumn{7}{l}{Conclusion: SF ratio is a reliable noninvasive marker for PF}\\
\multicolumn{7}{l}{ratio to identify children with ALI or ARDS and can be replaced}\\
\multicolumn{7}{l}{pulse oximetry by arterial blood sampling.}\\
\multicolumn{4}{l}{Keywords: ARDS, ALI,}\tabcellsep 2 2 pao Fio\tabcellsep \multicolumn{2}{l}{, pulse oximetry.}\\
\multicolumn{7}{l}{Abbreviations: Pao 2 : Arterial partial pressure of oxygen ,}\\
\multicolumn{7}{l}{Spo 2 : pulse Oximetric oxygen saturation, ARDS: Acute}\\
\multicolumn{7}{l}{Respiratory Distress syndrome, ALI: Acute lung injury,}\\
\multicolumn{7}{l}{Fio 2 : Fraction of inspiratory oxygen, SF=}\tabcellsep 2 Fio spo 2\tabcellsep ratio\tabcellsep ,\\
PF=\tabcellsep 2 Fio Pao 2\tabcellsep ratio\tabcellsep \multicolumn{4}{l}{,ABG= Arterial blood gas analysis,}\\
\multicolumn{7}{l}{PICU=Pediatric Intensive Care unit, Paco 2: Arterial}\\
\multicolumn{7}{l}{partial pressure of carbon dioxid, Sao 2= Arterial oxygen}\\
\multicolumn{2}{l}{saturation.}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
  {\small\itshape [Note: ?]} 
\caption{\label{tab_0}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.3004310344827586\textwidth}P{0.3004310344827586\textwidth}P{0.24913793103448273\textwidth}}
\tabcellsep MAX-MIN\tabcellsep MNAE\\
Pao 2 / Fio 2\tabcellsep 298-46\tabcellsep 155±61\\
Spo2/Fio 2\tabcellsep 248-77\tabcellsep 152±47\\
Spo 2\tabcellsep 99-71\tabcellsep 94±4\\
Fio 2\tabcellsep 100-40\tabcellsep 67±18\\
Pao 2\tabcellsep 176-41\tabcellsep 96±25\\
age\tabcellsep 144-2\tabcellsep 32±5\end{longtable} \par
 
\caption{\label{tab_1}Table 1 :}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[ Pediatr Crit Care Med ()]{b14}\label{b14} 	 		\textit{},  	 	 		\textit{Pediatr Crit Care Med}  		2007. 8 p. A39.  	 	 (suppl) 
\bibitem[Bernard et al.]{b3}\label{b3} 	 		‘?Thoracic SoG-The American European Consensus Confe rence on ARDS Definitions, mechanisms’.  		 			G R Bernard 		,  		 			Artigas 		,  		 			Brigham 		.  	 	 		\textit{American Journal}  		p. 1994.  	 
\bibitem[Gall et al. ()]{b22}\label{b22} 	 		‘A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study’.  		 			Le Gall 		,  		 			J R Lemeshow 		,  		 			S Saulnier 		,  		 			F 		.  	 	 		\textit{JAMA}  		1993. 270 p. .  	 
\bibitem[Ferguson and Frutos-Vivar ()]{b6}\label{b6} 	 		‘Acute respiratory distress syndrome: under recognition by clinicians and diagnostic accuracy of three clinical definitions’.  		 			N D Ferguson 		,  		 			F Frutos-Vivar 		,  		 			EstebanA 		.  	 	 		\textit{Crit Care Med}  		2005. 33 p. .  	 
\bibitem[Murray et al. ()]{b20}\label{b20} 	 		‘An expanded definition of the adult respiratory distress syndrome’.  		 			J F Murray 		,  		 			M A Matthay 		,  		 			J M Luce 		.  	 	 		\textit{Am Rev Respir Dis}  		1988. 138 p. .  	 
\bibitem[Numa and Newth ()]{b15}\label{b15} 	 		‘Assessment of lung function in the intensive care unit’.  		 			A H Numa 		,  		 			C J Newth 		.  	 	 		\textit{Pediatr Pulmonol}  		1995. 19 p. .  	 
\bibitem[Montgomery et al. ()]{b16}\label{b16} 	 		‘Causes of mortality in patients with the adult respiratory distress syndrome’.  		 			A B Montgomery 		,  		 			M A Stager 		,  		 			C J Carrico 		.  	 	 		\textit{Am Rev Respir Dis}  		1985. 132 p. .  	 
\bibitem[Khemani et al. ()]{b23}\label{b23} 	 		‘Comparison of the pulse oximetric saturation/ fraction of inspired oxygen ratio and the PaO2/ fraction of inspired oxygen ratio in children’.  		 			R G Khemani 		,  		 			N R Patel 		,  		 			Bart Rd 3rd 		,  		 			C J Newth 		.  	 	 		\textit{Chest}  		2008. 135  (3)  p. .  	 
\bibitem[Rice et al. ()]{b24}\label{b24} 	 		‘Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS’.  		 			T W Rice 		,  		 			A P Wheeler 		,  		 			G R Bernard 		,  		 			D L Hayden 		,  		 			D A Schoenfeld 		,  		 			L B Ware 		.  	 	 		\textit{Chest}  		2007. 132  (2)  p. .  	 
\bibitem[As ()]{b11}\label{b11} 	 		\textit{Consensus Conrerence on mechanical ventilation:Jonuary 28-30, 1993 at Northbrook, USA Intensive care Med},  		 			Slutsky As 		.  		1994. 20 p. .  	 
\bibitem[Roberts et al. ()]{b7}\label{b7} 	 		‘Control of blood gas measurements in intensive-care units’.  		 			D Roberts 		,  		 			P Ostryzniuk 		,  		 			E Loewen 		.  	 	 		\textit{Lancet}  		1991. 337 p. .  	 
\bibitem[Derivation and validation of spo2/Fio2 ratio toimpute for pao2/Fio2 ratio in the respiratory component of sequential organ failure assessment]{b12}\label{b12} 	 		\textit{Derivation and validation of spo2/Fio2 ratio toimpute for pao2/Fio2 ratio in the respiratory component of sequential organ failure assessment},  		 \url{2009-ncbi.nim,nih.gov}  		 	 	 (Ak shintani) 
\bibitem[Perkins et al. ()]{b8}\label{b8} 	 		‘Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation?’.  		 			G D Perkins 		,  		 			D F Mcauley 		,  		 			S Giles 		.  	 	 		\textit{Crit Care}  		2003. 7 p. R67.  	 
\bibitem[Khemani et al.]{b13}\label{b13} 	 		\textit{Epidemiologic factors of mechanically ventilated PICU patients in the United States},  		 			R G Khemani 		,  		 			B P Markovitz 		,  		 			Maq Curley 		.  		 	 
\bibitem[Kliegman ()]{b10}\label{b10} 	 		 			Robert M Kliegman 		.  		\textit{Nelson Text book of pediatric -19 th},  				2011. p. 318.  	 
\bibitem[Jensen et al. ()]{b5}\label{b5} 	 		‘Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry in adults’.  		 			L A Jensen 		,  		 			J E Onyskiw 		,  		 			N G Prasad 		.  	 	 		\textit{Heart Lung}  		1998. 27 p. .  	 
\bibitem[Ms Mortz,us patent 714,803,2004 pulse oximeter probe off detection system]{b9}\label{b9} 	 		\textit{Ms Mortz,us patent 714,803,2004 pulse oximeter probe off detection system},  		 	 
\bibitem[Marshall et al. ()]{b21}\label{b21} 	 		‘Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome’.  		 			J C Marshall 		,  		 			D J Cook 		,  		 			N V Christou 		.  	 	 		\textit{Crit Care Med}  		1995. 23 p. .  	 
\bibitem[Pilon et al. ()]{b4}\label{b4} 	 		‘Practice guideline for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness tests’.  		 			C S Pilon 		,  		 			M Leathley 		,  		 			R London 		.  	 	 		\textit{Crit Care Med}  		1997. 25 p. .  	 
\bibitem[Jubran ()]{b17}\label{b17} 	 		‘Pulse oximetry’.  		 			A Jubran 		.  	 	 		\textit{Intensive Care Med}  		2004. 30 p. .  	 
\bibitem[Merlani et al. ()]{b2}\label{b2} 	 		‘Quality improvement report: linking guideline to regular feedback to increase appropriate requests for clinical test; blood gas analysis in intensive care’.  		 			P Merlani 		,  		 			P Garnerin 		,  		 			M Diby 		.  	 	 		\textit{BMJ}  		2001. 323 p. .  	 
\bibitem[Jubran and Tobin ()]{b18}\label{b18} 	 		‘Reliability of pulse oximetry in titrating supplemental oxygen therapy in ventilatordependent patients’.  		 			A Jubran 		,  		 			M J Tobin 		.  	 	 		\textit{Chest}  		1990. 97 p. .  	 
\bibitem[Ware and Matthay ()]{b0}\label{b0} 	 		‘The acute respiratory distress syndrome’.  		 			L B Ware 		,  		 			M A Matthay 		.  	 	 		\textit{N Engl J Med}  		2000. 342 p. .  	 
\bibitem[Bernard et al. ()]{b1}\label{b1} 	 		‘The American-European Consensus Conference on ARDS: definitions,mechanisms, relevant outcomes, and clinical trial coordination’.  		 			G R Bernard 		,  		 			A Artigas 		,  		 			K L Brigham 		.  	 	 		\textit{Am J Respir Crit Care Med}  		1994. 149 p. .  	 
\bibitem[Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome: the Acute Respiratory Distress Syndrome Network N Engl J Med ()]{b19}\label{b19} 	 		‘Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome: the Acute Respiratory Distress Syndrome Network’.  	 	 		\textit{N Engl J Med}  		2000. 342 p. .  	 
\end{bibitemlist}
 			 		 	 
\end{document}
