Respiratory failure & ventilation
Limitations of SpO2 / FiO2-ratio for classification and monitoring of acute respiratory distress syndrome—an observational cohort study
Authors' conclusion
The use of SpO2/FiO2 interchangeably with PaO2/FiO2 for severity classification and monitoring of ARDS is limited by its inadequate trending ability and high dependence on FiO2 settings, which may influence treatment decisions and patient selection in clinical trials.
Study context
- Population
- Acute respiratory distress syndrome (ARDS) patients (Berlin criteria or ICD 9/10-codes) from three high-resolution ICU databases
- Participants
- 708 patients · 3 ICU databases
- Exposure
- SpO2/FiO2 vs PaO2/FiO2 for ARDS severity classification and monitoring
- Outcome
- ARDS severity classification by SpO2/FiO2 vs PaO2/FiO2 and tracking of disease progression
Methodological detailsmulticentre databases (ICU Cockpit, MIMIC-IV, SICdb), time-matched datapoints
- Multicentre databases (ICU Cockpit, MIMIC-IV, SICdb)
- Time-matched datapoints
Main finding
As reported in the abstract
ARDS severity misclassification by SpO2/FiO2
Datapoints misclassified by SpO2/FiO2
33%
Misclassified datapoints classified as more severe
84%
Observational data: associations, not effects.
Further findings
Tracking change in ARDS severity
- High dependence of SpO2/FiO2 on FiO2 settings; change in severity tracked in less than 20% of events
Original publication
Limitations of SpO2 / FiO2-ratio for classification and monitoring of acute respiratory distress syndrome—an observational cohort study. Crit Care. Published 19 February 2025. doi:10.
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