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{ "pk": 17975, "title": "Emergency Department SpO2/FiO2 Ratios Correlate with Mechanical Ventilation and Intensive Care Unit Requirements in COVID-19 Patients", "subtitle": null, "abstract": "<p><strong>Background:</strong> Patients with coronavirus 2019 (COVID-19) are at high risk for respiratory dysfunction. The pulse oximetry/fraction of inspired oxygen (SpO2/FiO2) ratio is a non-invasive assessment of respiratory dysfunction substituted for the PaO2:FiO2 ratio in Sequential Organ Failure Assessment scoring. We hypothesized that emergency department (ED) SpO2/FiO2 ratios correlate with requirement for mechanical ventilation in COVID-19 patients. Our objective was to identify COVID-19 patients at greatest risk of requiring mechanical ventilation, using SpO2/FiO2 ratios.</p>\n<p><strong>Methods:</strong> We performed a retrospective review of patients admitted with COVID-19 at two hospitals. Highest and lowest SpO2/FiO2 ratios (percent saturation/fraction of inspired O2) were calculated on admission. We performed chi-square, univariate, and multiple regression analysis to evaluate the relationship of admission SpO2/FiO2 ratios with requirement for mechanical ventilation and intensive care unit (ICU) care.</p>\n<p><strong>Results:</strong> A total of 539 patients (46% female; 84% White), with a mean age 67.6 ± 18.6 years, met inclusion criteria. Patients who required mechanical ventilation during their hospital stay were statistically younger in age (P = 0.001), had a higher body mass index (P < .001), and there was a higher percentage of patients who were obese (P = 0.03) and morbidly obese (P < .001). Shortness of breath, cough, and fever were the most common presenting symptoms with a median temperature of 99°F. Average white blood count was higher in patients who required ventilation (P =<0.001). A highest obtained ED SpO2/FiO2 ratio of ≤300 was associated with a requirement for mechanical ventilation. A lowest obtained ED SpO2/FiO2 ratio of ≤300 was associated with a requirement for intensive care unit care. There was no statistically significant correlation between ED SpO2/FiO2 ratios >300 and mechanical ventilation or intensive care unit (ICU) requirement.</p>\n<p><strong>Conclusion: </strong>The ED SpO2/FiO2 ratios correlated with mechanical ventilation and ICU requirements during hospitalization for COVID-19. These results support ED SpO2/FiO2 as a possible triage tool and predictor of hospital resource requirements for patients admitted with COVID-19. Further investigation is warranted.</p>", "language": null, "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "COVID-19" }, { "word": "SpO2/FiO2 ratio" }, { "word": "Emergency Medicine" }, { "word": "intensive care unit" }, { "word": "mechincal ventilation" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2qj4h8s4", "frozenauthors": [ { "first_name": "Gary", "middle_name": "", "last_name": "Zhang", "name_suffix": "", "institution": "Maine Medical Center, Department of Surgery, Portland, Maine", "department": "None" }, { "first_name": "Michael", "middle_name": "J.", "last_name": "Burla", "name_suffix": "", "institution": "Maine Medical Center, Department of Surgery, Portland, Maine; Southern Maine Healthcare, Department of Emergency Medicine, Biddeford, Maine; Tufts School of Medicine, Boston, Massachusetts", "department": "" }, { "first_name": "Benjamin", "middle_name": "B.", "last_name": "Caesar", "name_suffix": "", "institution": "Maine Medical Center, Department of Surgery, Portland, Maine", "department": "" }, { "first_name": "Carolyne", "middle_name": "R.", "last_name": "Falank", "name_suffix": "", "institution": "Maine Medical Center, Department of Surgery, Portland, Maine", "department": "None" }, { "first_name": "Peter", "middle_name": "", "last_name": "Kyros", "name_suffix": "", "institution": "Maine Medical Center, Department of Surgery, Portland, Maine", "department": "" }, { "first_name": "Victoria", "middle_name": "C.", "last_name": "Zucco", "name_suffix": "", "institution": "Maine Medical Center, Department of Surgery, Portland, Maine", "department": "None" }, { "first_name": "Aneta", "middle_name": "", "last_name": "Strumilowska", "name_suffix": "", "institution": "University of New England College of Osteopathic Medicine, Biddeford, Maine", "department": "" }, { "first_name": "Daniel", "middle_name": "C.", "last_name": "Cullinane", "name_suffix": "", "institution": "Maine Medical Center, Department of Surgery, Portland, Maine", "department": "" }, { "first_name": "Forest", "middle_name": "", "last_name": "Sheppard", "name_suffix": "", "institution": "Maine Medical Center, Department of Surgery, Portland, Maine", "department": "" } ], "date_submitted": "2023-03-31T15:34:40Z", "date_accepted": "2023-03-31T15:34:40Z", "date_published": "2024-04-18T13:00:00Z", "render_galley": { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/17975/galley/10644/download/" }, "galleys": [ { "label": "Layout", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/17975/galley/9620/download/" }, { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/17975/galley/10644/download/" } ] }