Correlation and Prediction of Oxygen Index from Oxygen Saturation Index in Neonates with Acute Respiratory Failure

Abstract

Objective The aim of this article was to evaluate the correlation between the oxygen index (OI) and the oxygen saturation index (OSI, measured by pulse oximetry and noninvasively) in neonates with acute respiratory failure and to predict the OI from the OSI.

Study Design A retrospective cohort study was conducted in neonates requiring invasive mechanical ventilation who had arterial blood gas between 2018 and 2019 at a neonatal intensive care unit. The correlation between OI and OSI was analyzed by using the Pearson correlation coefficient.

Results A total of 636 measurements from 68 neonates (35 preterm and 33 terms) were recruited into the study. There was a strong correlation between the OI and the OSI (r = 0.90) in all neonates. The correlation between the OI and the OSI in persistent pulmonary hypertension of the newborn, congenital cyanotic heart disease, and other causes of respiratory failure also showed a strong correlation (r = 0.88, 0.93, and 0.88, respectively). The correlation was strong in neonates with an oxygen saturation less than 85% (r = 0.88), those with oxygen saturation ranging from 85 to 95% (r = 0.87), and also in preterm and term infants (gestational age < 28, 28 − 34, 34 − 36, and ≥37 weeks, r = 0.87, 0.92, 0.89, and 0.90, respectively). There were strong accuracy measures of the OI for OI cutoffs of 5, 10, 15, and 20 (area under the curve > 0.85). The equation relating the OI and OSI was represented by: OI = (2.3 × OSI) – 4.

Conclusion The OSI has a strong correlation with the OI, is a reliable assessor of the severity of respiratory failure in neonates without arterial sampling, and has high accuracy when the OI is less than 40.

Key Points

1. OSI is calculated as (FiO₂ × mean airway pressure × 100)/SpO₂.

2. OSI is as effective tool as OI for assessing the severity of pediatric acute respiratory distress syndrome.

3. OSI has a strong correlation with OI in neonatal respiratory failure.

Keywords

neonates - respiratory failure - oxygenation index - oxygen saturation index

Publication History

Received: 15 June 2021

Accepted: 08 October 2021

Accepted Manuscript online:
19 October 2021

Article published online:
28 November 2021

• References

• 1 Pramanik AK, Rangaswamy N, Gates T. Neonatal respiratory distress: a practical approach to its diagnosis and management. Pediatr Clin North Am 2015; 62 (02) 453-469
• 2 Thatrimontrichai A. Evidence-based neonatal care. J Health Sci Med Res 2019; 37 (03) 163-169
• 3 Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev 2013; 14 (01) 29-36 , quiz 36–37
• 4 Khemani RG, Smith LS, Zimmerman JJ, Erickson S. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05, suppl 1): S23-S40
• 5 Khemani RG, Thomas NJ, Venkatachalam V. et al; Pediatric Acute Lung Injury and Sepsis Network Investigators (PALISI). Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. Crit Care Med 2012; 40 (04) 1309-1316
• 6 Lakshminrusimha S, Konduri GG, Steinhorn RH. Considerations in the management of hypoxemic respiratory failure and persistent pulmonary hypertension in term and late preterm neonates. J Perinatol 2016; 36 (Suppl. 02) S12-S19
• 7 Kumar D, Super DM, Fajardo RA, Stork EE, Moore JJ, Saker FA. Predicting outcome in neonatal hypoxic respiratory failure with the score for neonatal acute physiology (SNAP) and highest oxygen index (OI) in the first 24 hours of admission. J Perinatol 2004; 24 (06) 376-381
• 8 Wu H, Hong X, Qu Y. et al. The value of oxygen index and base excess in predicting the outcome of neonatal acute respiratory distress syndrome. J Pediatr (Rio J) 2021; 97 (04) 409-413
• 9 Thomas NJ, Shaffer ML, Willson DF, Shih MC, Curley MA. Defining acute lung disease in children with the oxygenation saturation index. Pediatr Crit Care Med 2010; 11 (01) 12-17
• 10 Khemani RG, Rubin S, Belani S. et al. Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk. Intensive Care Med 2015; 41 (01) 94-102
• 11 DesPrez K, McNeil JB, Wang C, Bastarache JA, Shaver CM, Ware LB. Oxygenation saturation index predicts clinical outcomes in ARDS. Chest 2017; 152 (06) 1151-1158
• 12 Muniraman HK, Song AY, Ramanathan R. et al. Evaluation of oxygen saturation index compared with oxygenation index in neonates with hypoxemic respiratory failure. JAMA Netw Open 2019; 2 (03) e191179
• 13 Rawat M, Chandrasekharan PK, Williams A. et al. Oxygen saturation index and severity of hypoxic respiratory failure. Neonatology 2015; 107 (03) 161-166
• 14 Hadzic D, Zulic E, Alihodzic H, Softic D, Kovacevic D. Oxygen saturation index for assessment of respiratory failure in neonates. Sanamed 2018; 13 (02) 123-129
• 15 Doreswamy SM, Chakkarapani AA, Murthy P. Oxygen saturation index, a noninvasive tool for monitoring hypoxemic respiratory failure in newborns. Indian Pediatr 2016; 53 (05) 432-433
• 16 Vali P, Underwood M, Lakshminrusimha S. Hemoglobin oxygen saturation targets in the neonatal intensive care unit: is there a light at the end of the tunnel?. Can J Physiol Pharmacol 2019; 97 (03) 174-182
• 17 Ghuman AK, Newth CJ, Khemani RG. The association between the end tidal alveolar dead space fraction and mortality in pediatric acute hypoxemic respiratory failure. Pediatr Crit Care Med 2012; 13 (01) 11-15
• 18 Khalesi N, Choobdar FA, Khorasani M, Sarvi F, Haghighi Aski B, Khodadost M. Accuracy of oxygen saturation index in determining the severity of respiratory failure among preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med 2021; 34 (14) 2334-2339