The ability of Oxygen Reserve Index® to detect hyperoxia in critically ill patients

Abstract

Background Hyperoxia is associated with increased morbidity and mortality in the intensive care unit. Classical noninvasive measurements of oxygen saturation with pulse oximeters are unable to detect hyperoxia. The Oxygen Reserve Index (ORI) is a continuous noninvasive parameter provided by a multi-wave pulse oximeter that can detect hyperoxia. Primary objective was to evaluate the diagnostic accuracy of the ORI for detecting arterial oxygen tension (PaO2) > 100 mmHg in neurocritical care patients. Secondary objectives were to test the ability of ORI to detect PaO2 > 120 mmHg and the ability of pulse oximetry (SpO2) to detect PaO2 > 100 mmHg and PaO2 > 120 mmHg. Methods In this single-center study, we collected ORI and arterial blood samples every 6 h for 3 consecutive days. Diagnostic performance was estimated using the area under the receiver operating characteristic curve (AUROC). Results There were 696 simultaneous measurements of ORI and PaO2 in 62 patients. Considering the repeated measurements, the correlation between ORI and PaO2 was r = 0.13. The area under the receiver operating characteristic curve (AUROC), obtained to test the ability of ORI to detect PaO2 > 100 mmHg, was 0.567 (95% confidence interval = 0.566–0.569) with a sensitivity of 0.233 (95%CI = 0.230–0.235) and a specificity of 0.909 (95%CI = 0.907–0.910). The AUROC value obtained to test the ability of SpO2 to detect a PaO2 > 100 mmHg was 0.771 (95%CI = 0.770–0.773) with a sensitivity of 0.715 (95%CI = 0.712–0.718) and a specificity of 0.700 (95%CI = 0.697–0.703). The diagnostic performance of ORI and SpO2 for detecting PaO2 > 120 mmHg was AUROC = 0.584 (95%CI = 0.582–0.586) and 0.764 (95%CI = 0.762–0.766), respectively. The AUROC obtained for SpO2 was significantly higher than that for ORI (p < 0.01). Diagnostic performance was not affected by sedation, norepinephrine infusion, arterial partial pressure of carbon dioxide, hemoglobin level and perfusion index. Conclusion In a specific population of brain-injured patients hospitalized in a neurointensive care unit, our results suggest that the ability of ORI to diagnose hyperoxia is relatively low and that SpO2 provides better detection.

Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-End Anastomosis for a Malignant Thyroid Tumor With Tracheal Invasion

“…The ORI also dropped to 0 on an occasion during a difficult tube change, but an immediate switch to ventilation from the side of the operative field prevented a significant drop in SpO 2 . After ORI decreases and reaches 0, SpO 2 begins to decrease; the speed to anticipate the desaturation by the ORI is much faster than SpO 2 [ 7 - 9 ]. Therefore, we can plan how to handle the critical situation to prevent hypoxia.…”

Determination of the incidence of hyperoxia and the effectiveness of oxygen reserve index guided FiO2 titration in preventing hyperoxia.

“…3). When SpO 2 , which is indisputable in the detection of hypoxemia, is 100% and reaches its maximum value, PaO 2 may be at high values and its level is unpredictable (4,11). The disadvantages of arterial blood gas analysis, which is the gold standard in hyperoxia detection and oxygen monitoring, such as being invasive, incurring extra cost, time delay, blood loss when repeated, having complications related to puncture, and inability to provide continuous data, lead to the limited use of this method and cause hyperoxia to be overlooked (3,12).…”

“…and ORi together to prevent complications and mortality. (3.17 Although the European Society of Intensive Care Medicine consensus speci ed that there is enough data to recommend that both hypoxemia and hyperoxia should be avoided in TBI patients and agreed on a general normoxia recommendation with optimal PaO2 of 80-120 mmHg (10-16 kPa) in TBI patients with or without increased intracranial pressure, although speci c PaO2 targets need to be individualized (11,21).…”

“…Oxygen is a double-edged sword, and although it was proven that its hyperoxia end has many pulmonary, cardiac, metabolic, vascular, and cerebral harmful effects and increases morbidity and mortality, studies reported that the average PaO 2 during general anesthesia is 206 mmHg (22) and even more than 500 mmHg in some case groups (4,16). Therefore, it is important to apply optimum oxygenation in a narrow therapeutic range (11).…”

Effectiveness of the oxygen reserve index in detecting and preventing hyperoxia in critically ill patients on mechanical ventilation: a randomized controlled trial

“…In critically ill patients, hyperoxia can lead to lung injury in addition to barotrauma caused by mechanical ventilation support (2). High arterial oxygen tension has potential risks, including hypercapnia, atelectasis, acute tracheobronchitis, pneumonia, acute hyperoxic acute lung injury, acute respiratory distress syndrome (ARDS), systemic vasoconstriction, and cardiac output depression (1, 5,8,9). Therefore, avoiding hyperoxia is essential for preventing ventilator-induced lung injury, and it should be considered as part of lung-protective ventilation strategies.…”