Managing patients with acute respiratory distress syndrome (ARDS) requires frequent changes in mechanical ventilator respiratory settings to optimize arterial oxygenation assessed by arterial oxygen partial pressure (PaO 2 ) and saturation (SaO 2 ). Pulse oxymetry (SpO 2 ) has been suggested as a non-invasive surrogate for arterial oxygenation however its accuracy in COVID-19 patients is unknown. In this study, we aimed to investigate the influence of COVID-19 status on the association between SpO 2 and arterial oxygenation. We prospectively included patients with ARDS and compared COVID-19 to non-COVID-19 patients, regarding SpO 2 and concomitant arterial oxygenation (SaO 2 and PaO 2 ) measurements, and their association. Bias was defined as mean difference between SpO 2 and SaO 2 measurements. Occult hypoxemia was defined as a SpO 2 ≥ 92% while concomitant SaO 2 < 88%. Multiple linear regression models were built to account for confounders. We also assessed concordance between positive end-expiratory pressure (PEEP) trial-induced changes in SpO 2 and in arterial oxygenation. We included 55 patients, among them 26 (47%) with COVID-19. Overall, SpO 2 and SaO 2 measurements were correlated (r = 0.70; p < 0.0001), however less so in COVID-19 than in non-COVID-19 patients (r = 0.55, p < 0.0001 vs. r = 0.84, p < 0.0001, p = 0.002 for intergroup comparison). Bias was + 1.1%, greater in COVID-19 than in non-COVID-19 patients (2.0 vs. 0.3%; p = 0.02). In multivariate analysis, bias was associated with COVID-19 status (unstandardized β = 1.77, 95%CI = 0.38–3.15, p = 0.01), ethnic group and ARDS severity. Occult hypoxemia occurred in 5.5% of measurements (7.7% in COVID-19 patients vs. 3.4% in non-COVID-19 patients, p = 0.42). Concordance rate between PEEP trial-induced changes in SpO 2 and SaO 2 was 84%, however less so in COVID-19 than in non-COVID-19 patients (69% vs. 97%, respectively). Similar results were observed for PaO 2 regarding correlations, bias, and concordance with SpO 2 changes. In patients with ARDS, SpO 2 was associated with arterial oxygenation, but COVID-19 status significantly altered this association.
【저자키워드】 Therapeutics, Diagnosis, 【초록키워드】 COVID-19, ARDS, severity, oxygen, Concordance, Accuracy, Hypoxemia, Patient, mechanical ventilator, patients, association, acute respiratory distress, Analysis, COVID-19 patient, Oxygenation, PEEP, Positive end-expiratory pressure, changes, Non-invasive, Non-COVID-19 patients, syndrome, confounders, occult, mean difference, correlations, Multiple, Linear regression model, managing, greater, defined, occurred, significantly, less, changes in, suggested, correlated, Bia, non-COVID-19 patient, PaO, patients with ARDS, with COVID-19, 【제목키워드】 COVID-19, pulse oximetry, Impact, Patient, association, acute respiratory distress, Oxygenation, syndrome,