Accuracy of Pulse Oximetry for Long-Term Oxygen Therapy Assessment in Chronic Obstructive Pulmonary Disease.

IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM
Brian Garnet, Rodrigo Diaz-Lankenau, Elie Jean, Michael Campos
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引用次数: 1

Abstract

Rationale: Landmark studies of long-term oxygen therapy (LTOT) in patients with chronic obstructive pulmonary disease (COPD) used arterial oxygen pressure (PaO2) to define severe hypoxemia; however, oxygen saturation as measured by pulse oximetry (SpO2) is commonly used instead. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend evaluation with arterial blood gas (ABG) analysis if SpO2 is ⩽92%. This recommendation has not been evaluated in stable outpatients with COPD undergoing testing for LTOT. Objectives: To evaluate the performance of SpO2 compared with ABG analysis of PaO2 and arterial oxygen saturation (SaO2) to detect severe resting hypoxemia in patients with COPD. Methods: Retrospective analysis of paired SpO2 and ABG values from stable outpatients with COPD who underwent LTOT assessment in a single center. We calculated false negatives (FNs) as an SpO2 >88% or >89% in the presence of pulmonary hypertension with a PaO2 ⩽55 mm Hg or ⩽59 mm Hg in the presence of pulmonary hypertension. Test performance was assessed using receiver operating characteristic (ROC) analysis, intraclass correlation coefficient (ICC), test bias, precision, and accuracy root-mean-square (Arms). An adjusted multivariate analysis was used to evaluate factors affecting SpO2 bias. Results: Of 518 patients, the prevalence of severe resting hypoxemia was 74 (14.3%), with 52 missed by SpO2 (FN, 10%), including 13 (2.5%) with an SpO2 > 92% (occult hypoxemia). FNs and occult hypoxemia in Black patients were 9% and 1.5%, respectively, and were 13% and 5%, respectively, among active smokers. The correlation between SpO2 and SaO2 was acceptable (ICC = 0.78; 95% confidence interval, 0.74-0.81); and the bias of SpO2 was 0.45%, with a precision of 2.6 (-4.65 to +5.55%) and Arms of 2.59. These measurements were similar in Black patients, but in active smokers, correlation was lower and bias showed greater overestimation of SpO2. ROC analysis suggests that the optimal SpO2 cutoff to warrant LTOT evaluation by ABG analysis is ⩽94%. Conclusions: SpO2 as the only measure of oxygenation carries a high FN rate in detecting severe resting hypoxemia in patients with COPD undergoing evaluation for LTOT. Reflex measurement of PaO2 by ABG analysis should be used as recommended by GOLD, ideally at a cutoff higher than an SpO2 ⩽92%, especially in active smokers.

脉搏血氧计在慢性阻塞性肺病长期氧疗评估中的准确性。
理由:慢性阻塞性肺病(COPD)患者长期氧疗(LTOT)的标志性研究使用动脉氧压(PaO2)来定义严重低氧血症;但是通常使用通过脉搏血氧计(SpO2)测量的氧饱和度来代替。全球慢性阻塞性肺病倡议(GOLD)指南建议,如果SpO2为92%,则使用动脉血气分析进行评估。该建议尚未在接受LTOT测试的稳定的COPD门诊患者中进行评估。目的:评价SpO2与ABG分析的PaO2和动脉血氧饱和度(SaO2)在检测COPD患者严重静息低氧血症中的性能。方法:回顾性分析在一个中心接受LTOT评估的COPD稳定门诊患者的SpO2和ABG配对值。我们计算了假阴性(FNs),即在存在肺动脉高压且PaO2⩽55的情况下,SpO2>88%或>89% 毫米 Hg或⩽59 毫米 汞在肺动脉高压中的存在。使用受试者工作特性(ROC)分析、组内相关系数(ICC)、测试偏差、精度和准确度均方根(Arms)评估测试性能。使用调整后的多变量分析来评估影响SpO2偏倚的因素。结果:518例患者中,严重静息低氧血症的发生率为74例(14.3%),其中52例SpO2漏诊(FN,10%),其中13例(2.5%)SpO2> 92%(隐匿性低氧血症)。黑人患者的FNs和隐匿性低氧血症分别为9%和1.5%,活跃吸烟者分别为13%和5%。SpO2和SaO2之间的相关性是可接受的(ICC = 0.78;95%置信区间,0.74-0.81);SpO2的偏差为0.45%,精度为2.6(-4.65至+5.55%),Arms为2.59。黑人患者的这些测量结果相似,但在活跃吸烟者中,相关性较低,偏差显示SpO2过高。ROC分析表明,通过ABG分析进行LTOT评估的最佳SpO2截止值为94%。结论:SpO2作为唯一的氧合指标,在接受LTOT评估的COPD患者中检测严重静息低氧血症具有高FN率。根据GOLD的建议,应使用ABG分析的PaO2反射测量,最好是在高于SpO2的截止点 ⩽92%,尤其是活跃吸烟者。
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来源期刊
Annals of the American Thoracic Society
Annals of the American Thoracic Society Medicine-Pulmonary and Respiratory Medicine
CiteScore
9.30
自引率
3.60%
发文量
0
期刊介绍: The Annals of the American Thoracic Society (AnnalsATS) is the official international online journal of the American Thoracic Society. Formerly known as PATS, it provides comprehensive and authoritative coverage of a wide range of topics in adult and pediatric pulmonary medicine, respiratory sleep medicine, and adult medical critical care. As a leading journal in its field, AnnalsATS offers up-to-date and reliable information that is directly applicable to clinical practice. It serves as a valuable resource for clinical specialists, supporting their formative and continuing education. Additionally, the journal is committed to promoting public health by publishing research and articles that contribute to the advancement of knowledge in these fields.
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