Original Investigation Pediatrics

Evaluation of Oxygen Saturation Index Compared With Oxygenation Index in Neonates With Hypoxemic Respiratory Failure

Hemananda K. Muniraman,  Ashley Y. Song, Rangasamy Ramanathan, et al

JAMA Netw Open. 2019;2(3):e191179. doi:10.1001/jamanetworkopen.2019.1179

Abstract

Importance 背景

Oxygenation index (OI), an invasive measurement, is routinely used as a marker of severity of hypoxemic respiratory failure in neonates. Oxygen saturation index (OSI) is a noninvasive measurement and has been shown to be a reliable surrogate marker of OI in children and adults with respiratory failure.

氧合指数(OI)是一种有创检查，常规用于评价新生儿低氧性呼吸功能衰竭的严重程度。氧饱和度指数(OSI)是一种无创测定方法，在合并呼吸功能衰竭的儿童及成人能够可靠地反映OI。

Objectives 目的

To evaluate the correlation of OI with OSI and to derive and validate predictive OI from noninvasive OSI measurements for clinically relevant OI values.

评价OI与OSI的相关性，建立并验证从无创OSI测定结果预测有临床意义的OI的准确性。

Design, Setting, and Participants  试验设计，场景及研究人群

For this retrospective cohort study, 220 neonates requiring invasive mechanical ventilation for hypoxic respiratory failure during the first 3 days of admission were recruited from a level III neonatal intensive care unit during a 6-year period, from January 1, 2012, to December 31, 2017. Data were analyzed from January 2017 to December 2017.

这是一项回顾性队列研究，入选了2012年1月1日至2017年12月31日期间一个三级新生儿ICU收治的因缺氧性呼吸功能衰竭需要有创机械通气治疗的220名新生儿。收集患儿入院后最初3天的数据。

Main Outcomes and Measures  主要预后指标

The primary outcome was correlation of OI with OSI, analyzed using Pearson correlation coefficient. The secondary outcome was derivation and validation of OI from OSI. The data were split into derivative samples, from which a predictive equation for OI was derived using generalized linear model, and a validation sample was used to assess the predictive ability of the derived OI. Bland-Altman plot was used to assess agreement between derived OI and measured OI.

主要预后指标为OI与OSI的相关性，采用Pearson相关系数进行分析。次要预后指标为建立并验证从OSI预测OI。将数据分为推导样本（采用广义线性模型建立OI预测方程）及验证样本（用于评价预测OI的准确性）。采用Bland-Altman图评价预测OI与测定OI的一致性。

Results  结果

A total of 1442 paired OI and OSI measurements from 220 infants (190 preterm and 30 term; median [interquartile range] gestational age, 29 [26-33] weeks; mean [SD] birth weight, 1602 [1092] g) were recorded during the study. The median (interquartile range) number of samples was 5 (3-9) per patient. Overall, OI and OSI showed strong correlation (r = 0.89). The correlation was stronger in preterm infants (<28 weeks, r = 0.93; 28-33 weeks, r = 0.93) and within an oxygen saturation range of 85% to 95% (r = 0.94). The predictive derivative equation showed a strong linear association and good agreement in both derivation and validation data sets, with strong accuracy measures of derived OI for OI cutoffs of 5, 10, 15, 20, and 25.

220名婴儿（190名早产，30名足月；中位[四分位区间]孕周，29 [26-33]周；平均[SD]出生体重，1602 [1092] g）共有1442对OI及OSI测定结果纳入研究。每名患儿的样本中位数（四分位区间）为5 (3-9)。总体而言，OI与OSI具有很强的相关性(r = 0.89)。早产儿的相关性更强（<28周，r = 0.93；28-33周，r = 0.93），且氧饱和度在85% - 95%范围内相关性更强 (r = 0.94)。推导数据集和验证数据集结果显示，预测方程具有很好的线性相关及一致性，且OI临界值为5，10，15，20和25时，预测OI的准确性很高。

Conclusions and Relevance 结论与意义

A strong correlation of OI with OSI was found. Derived OI from OSI was in good agreement and strongly predictive of clinically relevant OI cutoffs from 5 to 25. Oxygenation index derived from noninvasive sources may be useful to reliably assess severity of respiratory failure and response to therapy on a continuous basis.

我们发现OI与OSI具有很强的相关性。根据OSI推测OI具有很好的一致性，且能够准确预测有临床意义的OI临界值（从5至25）。根据无创方法推测的氧合指数能够可靠地持续评价呼吸功能衰竭的严重程度，以及对治疗的反应。