The paramount parameter: arterial oxygen tension versus arterial oxygen saturation as target in trials on oxygenation in intensive care

AbstractPulse oximetry for detecting critical CHD produces more false positive tests at high altitudes than at sea level, because at altitude the average resting saturation is lower and the variability is higher. This increases diagnostic difficulties, especially in small isolated communities without paediatric echocardio-graphy, and requires expensive transport to a regional medical centre. One way of reducing diagnostic errors is to measure arterial oxygen saturation while the infant is breathing 100% oxygen. In the absence of right-to-left shunting through the heart, the ductus, or the lungs, arterial oxygen tension will exceed 150 mmHg and arterial oxygen saturation will be 100%. With right-to-left shunting, arterial oxygen tension will be <100 mmHg, and thus <96% (usually much lower).

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Evaluation of Bronchial Hyperresponsiveness by Monitoring of Transcutaneous Oxygen Tension and Arterial Oxygen Saturation during Methacholine Challenge in Asthmatic Children

Journal of Asthma ◽

10.1080/02770900500498972 ◽

2006 ◽

Vol 43 (2) ◽

pp. 145-149 ◽

Cited By ~ 3

Author(s):

Junying Wang ◽

Hiroyuki Mochizuki ◽

Reiko Muramatsu ◽

Hirokazu Arakawa ◽

Kenichi Tokuyama ◽

...

Keyword(s):

Oxygen Saturation ◽

Oxygen Tension ◽

Arterial Oxygen Saturation ◽

Bronchial Hyperresponsiveness ◽

Arterial Oxygen ◽

Methacholine Challenge ◽

Transcutaneous Oxygen Tension ◽

Transcutaneous Oxygen ◽

Asthmatic Children

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Use of transcutaneous oxygen tension, arterial oxygen saturation, and respiratory resistance to assess the response to inhaled methacholine in asthmatic children and normal adults.

Thorax ◽

10.1136/thx.46.6.433 ◽

1991 ◽

Vol 46 (6) ◽

pp. 433-437 ◽

Cited By ~ 34

Author(s):

N M Wilson ◽

S B Phagoo ◽

M Silverman

Keyword(s):

Oxygen Saturation ◽

Oxygen Tension ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Respiratory Resistance ◽

Transcutaneous Oxygen Tension ◽

Transcutaneous Oxygen ◽

Asthmatic Children ◽

Normal Adults

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Relationship between arterial oxygen tension and mortality of patients in intensive care unit on mechanical ventilation support

Turkish Journal of Trauma and Emergency Surgery ◽

10.5505/tjtes.2018.51430 ◽

2018 ◽

Author(s):

Ayhan Kaydu

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Oxygen Tension ◽

Arterial Oxygen Tension ◽

Arterial Oxygen ◽

Ventilation Support ◽

Mechanical Ventilation Support

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Peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome in COVID-19 patients admitted to intermediate respiratory and intensive care units

Critical Care ◽

10.1186/s13054-021-03803-2 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Jaume Mesquida ◽

A. Caballer ◽

L. Cortese ◽

C. Vila ◽

U. Karadeniz ◽

...

Keyword(s):

Intensive Care ◽

Oxygen Saturation ◽

Intensive Care Units ◽

Near Infrared ◽

Arterial Oxygen Saturation ◽

Invasive Mechanical Ventilation ◽

Endothelial Damage ◽

Arterial Oxygen ◽

Blood Oxygen Saturation

Abstract Background COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. Methods This is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). Results Healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. Conclusion Patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477. Retrospectively registered 30 December 2020.

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Effects of lung hyperinflation and presence of positive end-expiratory pressure on arterial and tissue oxygenation during endotracheal suctioning

American Journal of Critical Care ◽

10.4037/ajcc1993.2.4.317 ◽

1993 ◽

Vol 2 (4) ◽

pp. 317-325 ◽

Cited By ~ 2

Author(s):

D McIntosh ◽

MM Baun ◽

J Rogge

Keyword(s):

Oxygen Tension ◽

Oxygen Delivery ◽

Tissue Oxygenation ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen Tension ◽

Arterial Oxygen ◽

Positive End Expiratory Pressure ◽

Oxygen Extraction Ratio ◽

Endotracheal Suctioning ◽

Mixed Venous

PURPOSE: To explore the effects of endotracheal suctioning on mixed venous oxygen tension and other measures of arterial and tissue oxygenation, to determine if these would be clinically useful outcome measures of endotracheal suctioning. BACKGROUND: Measuring arterial oxygenation only as an outcome of endotracheal suctioning can be misleading in that it may appear adequate in the presence of marked decreases in mixed venous oxygen tension, a good indicator of the adequacy of tissue oxygenation. METHODS: Eighteen instrumented and oleic acid-injured animal models of acute respiratory failure undergoing closed-system endotracheal suctioning were studied according to a 2 x 2 factorial design to measure the effects of oxygen inflations at tidal volume or 135% of tidal volume either in the presence or absence of positive end-expiratory pressure. RESULTS: Using multivariate analysis of variance for repeated measures, protocol by time effects for mixed venous oxygen tension, arterial oxygen saturation, arterial oxygen tension, oxygen delivery and oxygen extraction ratio were statistically significant. Changes in mixed venous oxygen tension and arterial oxygen saturation were parallel. CONCLUSIONS: Continuous measurement of mixed venous oxygen tension allows the calculation of oxygen delivery and oxygen extraction ratio, which provide a better estimation of the effects of endotracheal suctioning on tissue oxygenation than arterial oxygen tension alone.

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Comparing the effect of endotracheal tube suction using open method with two different size catheters 12 and 14 on discharge secretion, pain, heart rate, blood pressure, and arterial oxygen saturation of patients in the intensive care unit: A randomized clinical trial

Annals of Tropical Medicine and Public Health ◽

10.4103/atmph.atmph_181_17 ◽

2017 ◽

Vol 10 (5) ◽

pp. 1312

Author(s):

Akvan Paymard ◽

Mostafa Javadi ◽

Hossein Hejr ◽

Mohammad Zolad ◽

Arash Khalili

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Intensive Care Unit ◽

Heart Rate ◽

Intensive Care ◽

Oxygen Saturation ◽

Endotracheal Tube ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Tube Suction

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Effect of Supine and Prone Positions on Arterial Oxygen Tension in the Preterm Infant

PEDIATRICS ◽

10.1542/peds.63.4.528 ◽

1979 ◽

Vol 63 (4) ◽

pp. 528-531 ◽

Cited By ~ 1

Author(s):

Richard J. Martin ◽

Nancy Herrell ◽

Dov Rubin ◽

Avroy Fanaroff

Keyword(s):

Intensive Care ◽

Preterm Infant ◽

Preterm Infants ◽

Prone Position ◽

Oxygen Tension ◽

Neonatal Intensive Care ◽

Arterial Oxygen Tension ◽

Arterial Oxygen ◽

Sleep State ◽

Optimal Position

To determine the optimal position for the preterm infant, arterial oxygen tension (Pao2) was monitored in 16 preterm infants by the transcutaneous method with the infants in both supine and prone positions. When the infants were prone, Pao2 rose by a mean of 7.4 mm Hg (P < .001), an increase of 15%. In those infants with residual cardiopulmonary disease, a 25% increase was noted. The higher Pao2 in the prone position was accompanied by a significant decrease in the amount of time the chest wall moved asynchronously. This improved oxygenation in the prone position appears to be the result of enhanced ventilation/ perfusion ratios and not merely secondary to an alteration in sleep state with positioning of the infant. These findings may have important implications in the management of preterm infants requiring neonatal intensive care.

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