ARDS diagnosed by SpO2/FiO2 ratio compared with PaO2/FiO2 ratio: the role as a diagnostic tool for early enrolment into clinical trials

Franz J. Wiedermann; Martina Stichlberger; Bernhard Glodny

doi:10.1515/med-2016-0056

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ARDS diagnosed by SpO₂/FiO₂ ratio compared with PaO₂/FiO₂ ratio: the role as a diagnostic tool for early enrolment into clinical trials

Franz J. Wiedermann , Martina Stichlberger and Bernhard Glodny

Published/Copyright: August 2, 2016

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From the journal Open Medicine Volume 11 Issue 1

Key words: acute respiratory distress syndrome; diagnosis; pulsoxymetry; carboxyhemoglobinemia

Dear Sir,

Chen W and co-authors report on the diagnostic tool for early enrolment of patients with ARDS into clinical trials by using SpO₂/FiO₂ ratio compared with PaO₂/FiO₂ ratio. The authors concluded that ARDS patients diagnosed by SpO₂/FiO₂ ratio have similar clinical characteristics and outcomes compared with patients diagnosed by PaO₂/FiO₂ ratio [1].

The work is satisfactory, however, the physiological relationship between measurement of oxygenation either by pulsoxymetry or blood gas analysis is in our opinion clear [2].

One point should be addressed that in a case of carboxyhemoglobinemia the measurement of oxygenation by pulsoxymetry could fail, and blood gas analyses by CO-oxymetry is the only way to exclude this disease. Recent studies revealed that cigarette smoking measured both by history and biomarker is associated with an increased risk of ARDS in patients with nonpulmo-nary sepsis [3, 4]. Smokers can have an increased level of carboxyhemoglobin up to 15% [5], therefore early use of blood gas analysis is crucial.

The early diagnosis of ARDS is made on a broad spectrum of evidence on clinical, radiological, and oxygenation criteria. Early use of blood gas analyses should not be replaced by pulsoxymetry, at least one arterial blood gas should be obtained at patient’s admission. For avoiding arterial puncture capillary blood gas analysis can be used.

Author contribution

All authors discussed the topic and helped to draft the manuscript together.

Competing interests

The authors declare that they have no competing interests.

References

[1] Chen W, Janz DR, Shaver CM, Bernard GR, Bastarache JA, Ware LB. Clinical characteristics and outcomes are similar in ARDS diagnosed by SpO₂/FiO₂ Ratio compared with PaO₂/FiO₂ Ratio. Chest 2015; 10.1378/chest.15-0169 (online first)Search in Google Scholar PubMed PubMed Central

[2] Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB. Comparison of the SpO₂/FiO₂ ratio and the PaO₂/FiO₂ ratio in patients with acute lung injury or ARDS. Chest 2007; 132:410-41710.1378/chest.07-0617Search in Google Scholar PubMed

[3] ReillyJP, Christie JD. Primed for injury: cigarette smokers and acute respiratory distress syndrome. Crit Care Med 2015; 43:2015-201610.1097/CCM.0000000000001121Search in Google Scholar PubMed PubMed Central

[4] Calfee, CS, Matthay MA, Ksangelaris KN, Siew ED, Janz DR, Bernard GR, et al. Cigarette smoke exposure and the acute respiratory distress syndrome. Crit Care Med 2015; 43:1790-179710.1097/CCM.0000000000001089Search in Google Scholar PubMed PubMed Central

[5] Castleden CM, Cole PV. Variations in carboxyheamoglobin levels in smokers. Br Med J1974; 4:736-73810.1136/bmj.4.5947.736Search in Google Scholar PubMed PubMed Central

Received: 2015-10-23

Accepted: 2016-3-7

Published Online: 2016-8-2

Published in Print: 2016-1-1

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.