Multicenter Study

. 2022 Apr:68:31-37.

doi: 10.1016/j.jcrc.2021.11.009. Epub 2021 Dec 3.

Prognostication using SpO₂/FiO₂ in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study

Jan-Paul Roozeman¹, Guido Mazzinari², Ary Serpa Neto³, Markus W Hollmann⁴, Frederique Paulus⁵, Marcus J Schultz⁶, Luigi Pisani⁷; PRoVENT-COVID Collaborative Group

Collaborators, Affiliations

Collaborators

PRoVENT-COVID Collaborative Group:
A G Algera⁸, L S Boers⁸, L D J Bos⁸, M Botta⁸, D A Dongelmans⁸, M W Hollmann⁹, J Horn⁸, F Paulus¹⁰, J Pillay¹¹, M J Schultz¹², A Serpa Neto¹³, A M Tsonas⁸, A P J Vlaar⁸, M Botta⁸, A M Tsonas⁸, S Ahuja¹⁴, J P van Akkeren¹⁵, A G Algera⁸, C K Algoe⁸, R B van Amstel⁸, A Artigas¹⁶, O L Baur⁸, P van de Berg¹⁷, A E van den Berg¹⁸, D C J J Bergmans¹⁹, D I van den Bersselaar⁸, F A Bertens⁸, A J G H Bindels¹⁷, M M de Boer⁸, S den Boer²⁰, L S Boers⁸, M Bogerd⁸, L D J Bos⁸, M Botta⁸, J S Breel⁹, H de Bruin⁸, S de Bruin⁸, C L Bruna⁸, L A Buiteman-Kruizinga²¹, O L Cremer²², R M Determann²³, W Dieperink²⁴, D A Dongelmans⁸, H S Franke²⁴, M S Galek-Aldridge⁸, M J de Graaff²⁵, L A Hagens⁸, J J Haringman²⁶, S T van der Heide⁸, P L J van der Heiden²¹, N F L Heijnen¹⁹, S J P Hiel¹⁵, L L Hoeijmakers⁸, L Hol²⁷, M W Hollmann⁹, M E Hoogendoorn²⁶, J Horn⁸, R van der Horst²⁸, E L K Ie⁸, D Ivanov⁸, N P Juffermans²³, E Kho⁸, E S de Klerk⁹, A W M M Koopman-van Gemert²⁹, M Koopmans²³, S Kucukcelebi⁸, M A Kuiper³⁰, D W de Lange²², N van Mourik⁸, S G Nijbroek²⁷, M Onrust²⁴, E A N Oostdijk³¹, F Paulus¹⁰, C J Pennartz⁸, J Pillay¹¹, L Pisani⁸, I M Purmer¹⁸, T C D Rettig³², J P Roozeman²⁷, M T U Schuijt⁸, M J Schultz¹², A Serpa Neto¹³, M E Sleeswijk³³, M R Smit⁸, P E Spronk³⁴, W Stilma⁸, A C Strang³⁵, A M Tsonas⁸, P R Tuinman³⁶, C M A Valk⁸, F L Veen-Schra²⁶, L I Veldhuis⁸, P van Velzen³⁷, W H van der Ven⁹, A P J Vlaar⁸, P van Vliet³⁸, P H J van der Voort²⁴, L van Welie³⁹, H J F T Wesselink²⁶, H H van der Wier-Lubbers²⁶, B van Wijk⁸, T Winters⁸, W Y Wong⁸, A R H van Zanten³⁹

Affiliations

¹ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands. Electronic address: j.p.roozeman@amsterdamumc.nl.
² Department of Anesthesiology, Hospital Universitario la Fe, Valencia, Spain; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria Valencia, Spain.
³ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁴ Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands.
⁵ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands.
⁶ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
⁷ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy; Department of Anesthesiology and Intensive Care Medicine, Miulli Regional Hospital, Acquaviva delle Fonti, Italy.
⁸ Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands.
⁹ Department of Anaesthesiology, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands.
¹⁰ Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands; ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands.
¹¹ Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands; Department of Intensive Care, University Medical Center Groningen, Groningen, The Netherlands.
¹² Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
¹³ Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Center (ANZIC-RC), Monash University, Melbourne, Australia.
¹⁴ Department of Anaesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health System, Detroit, MI, United States of America.
¹⁵ Department of Intensive Care, Maxima Medical Center, Eindhoven, The Netherlands.
¹⁶ Critical Care Center, Sabadell Hospital, Sabadell, Spain.
¹⁷ Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands.
¹⁸ Department of Intensive Care, Haga Hospital, the Hague, The Netherlands.
¹⁹ Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands.
²⁰ Department of Intensive Care, Spaarne Hospital, Haarlem, The Netherlands.
²¹ Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands.
²² Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.
²³ Department of Intensive Care, OLVG Hospital, location East, Amsterdam, The Netherlands.
²⁴ Department of Intensive Care, University Medical Center Groningen, Groningen, The Netherlands.
²⁵ Department of Intensive Care, Sint Antonius Hospital, Nieuwegein, The Netherlands.
²⁶ Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands.
²⁷ Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands.
²⁸ Department of Intensive Care, Zuyderland Hospital, Heerlen and Sittard, The Netherlands.
²⁹ Department of Intensive Care, ZGT Hospital, Almelo, The Netherlands.
³⁰ Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
³¹ Department of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands.
³² Department of Intensive Care, Amphia Hospital, Breda, The Netherlands.
³³ Department of Intensive Care, FlevoHospital, Almere, The Netherlands.
³⁴ Department of Intensive Care, Gelre Hospital, Apeldoorn and Zutphen, The Netherlands.
³⁵ Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands.
³⁶ Department of Intensive Care, Amsterdam University Medical Centers, location 'VU Medical Center', Amsterdam, The Netherlands.
³⁷ Department of Intensive Care, Dijklander Hospital, location Hoorn, Hoorn, The Netherlands.
³⁸ Department of Intensive Care, Haaglanden Medical Center, location Westeinde, the Hague, The Netherlands.
³⁹ Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands.

PMID: 34872014
PMCID: PMC8641962
DOI: 10.1016/j.jcrc.2021.11.009

Multicenter Study

Prognostication using SpO₂/FiO₂ in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study

Jan-Paul Roozeman et al. J Crit Care. 2022 Apr.

. 2022 Apr:68:31-37.

doi: 10.1016/j.jcrc.2021.11.009. Epub 2021 Dec 3.

Authors

Jan-Paul Roozeman¹, Guido Mazzinari², Ary Serpa Neto³, Markus W Hollmann⁴, Frederique Paulus⁵, Marcus J Schultz⁶, Luigi Pisani⁷; PRoVENT-COVID Collaborative Group

Collaborators

PRoVENT-COVID Collaborative Group:
A G Algera⁸, L S Boers⁸, L D J Bos⁸, M Botta⁸, D A Dongelmans⁸, M W Hollmann⁹, J Horn⁸, F Paulus¹⁰, J Pillay¹¹, M J Schultz¹², A Serpa Neto¹³, A M Tsonas⁸, A P J Vlaar⁸, M Botta⁸, A M Tsonas⁸, S Ahuja¹⁴, J P van Akkeren¹⁵, A G Algera⁸, C K Algoe⁸, R B van Amstel⁸, A Artigas¹⁶, O L Baur⁸, P van de Berg¹⁷, A E van den Berg¹⁸, D C J J Bergmans¹⁹, D I van den Bersselaar⁸, F A Bertens⁸, A J G H Bindels¹⁷, M M de Boer⁸, S den Boer²⁰, L S Boers⁸, M Bogerd⁸, L D J Bos⁸, M Botta⁸, J S Breel⁹, H de Bruin⁸, S de Bruin⁸, C L Bruna⁸, L A Buiteman-Kruizinga²¹, O L Cremer²², R M Determann²³, W Dieperink²⁴, D A Dongelmans⁸, H S Franke²⁴, M S Galek-Aldridge⁸, M J de Graaff²⁵, L A Hagens⁸, J J Haringman²⁶, S T van der Heide⁸, P L J van der Heiden²¹, N F L Heijnen¹⁹, S J P Hiel¹⁵, L L Hoeijmakers⁸, L Hol²⁷, M W Hollmann⁹, M E Hoogendoorn²⁶, J Horn⁸, R van der Horst²⁸, E L K Ie⁸, D Ivanov⁸, N P Juffermans²³, E Kho⁸, E S de Klerk⁹, A W M M Koopman-van Gemert²⁹, M Koopmans²³, S Kucukcelebi⁸, M A Kuiper³⁰, D W de Lange²², N van Mourik⁸, S G Nijbroek²⁷, M Onrust²⁴, E A N Oostdijk³¹, F Paulus¹⁰, C J Pennartz⁸, J Pillay¹¹, L Pisani⁸, I M Purmer¹⁸, T C D Rettig³², J P Roozeman²⁷, M T U Schuijt⁸, M J Schultz¹², A Serpa Neto¹³, M E Sleeswijk³³, M R Smit⁸, P E Spronk³⁴, W Stilma⁸, A C Strang³⁵, A M Tsonas⁸, P R Tuinman³⁶, C M A Valk⁸, F L Veen-Schra²⁶, L I Veldhuis⁸, P van Velzen³⁷, W H van der Ven⁹, A P J Vlaar⁸, P van Vliet³⁸, P H J van der Voort²⁴, L van Welie³⁹, H J F T Wesselink²⁶, H H van der Wier-Lubbers²⁶, B van Wijk⁸, T Winters⁸, W Y Wong⁸, A R H van Zanten³⁹

Affiliations

¹ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands. Electronic address: j.p.roozeman@amsterdamumc.nl.
² Department of Anesthesiology, Hospital Universitario la Fe, Valencia, Spain; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria Valencia, Spain.
³ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁴ Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands.
⁵ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands.
⁶ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
⁷ Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy; Department of Anesthesiology and Intensive Care Medicine, Miulli Regional Hospital, Acquaviva delle Fonti, Italy.
⁸ Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands.
⁹ Department of Anaesthesiology, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands.
¹⁰ Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands; ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands.
¹¹ Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands; Department of Intensive Care, University Medical Center Groningen, Groningen, The Netherlands.
¹² Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
¹³ Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Center (ANZIC-RC), Monash University, Melbourne, Australia.
¹⁴ Department of Anaesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health System, Detroit, MI, United States of America.
¹⁵ Department of Intensive Care, Maxima Medical Center, Eindhoven, The Netherlands.
¹⁶ Critical Care Center, Sabadell Hospital, Sabadell, Spain.
¹⁷ Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands.
¹⁸ Department of Intensive Care, Haga Hospital, the Hague, The Netherlands.
¹⁹ Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands.
²⁰ Department of Intensive Care, Spaarne Hospital, Haarlem, The Netherlands.
²¹ Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands.
²² Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.
²³ Department of Intensive Care, OLVG Hospital, location East, Amsterdam, The Netherlands.
²⁴ Department of Intensive Care, University Medical Center Groningen, Groningen, The Netherlands.
²⁵ Department of Intensive Care, Sint Antonius Hospital, Nieuwegein, The Netherlands.
²⁶ Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands.
²⁷ Department of Intensive Care, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centers, location 'Academic Medical Center', Amsterdam, The Netherlands.
²⁸ Department of Intensive Care, Zuyderland Hospital, Heerlen and Sittard, The Netherlands.
²⁹ Department of Intensive Care, ZGT Hospital, Almelo, The Netherlands.
³⁰ Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
³¹ Department of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands.
³² Department of Intensive Care, Amphia Hospital, Breda, The Netherlands.
³³ Department of Intensive Care, FlevoHospital, Almere, The Netherlands.
³⁴ Department of Intensive Care, Gelre Hospital, Apeldoorn and Zutphen, The Netherlands.
³⁵ Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands.
³⁶ Department of Intensive Care, Amsterdam University Medical Centers, location 'VU Medical Center', Amsterdam, The Netherlands.
³⁷ Department of Intensive Care, Dijklander Hospital, location Hoorn, Hoorn, The Netherlands.
³⁸ Department of Intensive Care, Haaglanden Medical Center, location Westeinde, the Hague, The Netherlands.
³⁹ Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands.

PMID: 34872014
PMCID: PMC8641962
DOI: 10.1016/j.jcrc.2021.11.009

Abstract

Background: The SpO₂/FiO₂ is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO₂/FiO₂ for mortality in patients with ARDS due to COVID-19.

Methods: This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality.

Results: In 869 invasively ventilated patients, 28-day mortality was 30.1%. The SpO₂/FiO₂ on day 1 had no prognostic value. The SpO₂/FiO₂ on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO₂/FiO₂ on day 2 (OR, 0.66 [95%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO₂/FiO₂ and the PaO₂/FiO₂ calculated from SpO₂/FiO₂ were strongly correlated (Spearman's r = 0.79).

Conclusions: In this cohort of patients with ARDS due to COVID-19, the SpO₂/FiO₂ on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO₂/FiO₂ is a useful metric for risk stratification in invasively ventilated COVID-19 patients.

Keywords: Acute respiratory distress syndrome; COVID-19; Mechanical ventilation; Pulse oximetry; Resource limited settings; SpO(2)/FiO(2).

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest None.

Figures

**Fig. 1**
Predictive capacity of SpO₂/FiO₂ during the first three days of invasive ventilation. Panel A: SpO₂/FiO₂ on day 1, Panel B: SpO₂/FiO₂ on day 2, Panel C: SpO₂/FiO₂ on day 3. Legend: AUC, area under the curve.

**Fig. 2**
The relationship between observed and calculated PaO₂/FiO₂ values using a Deming regression. Legend: The dashed line depicts the ideal accuracy line; the solid line shows the Deming regression estimation.

See this image and copyright information in PMC

References

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Prognostication using SpO₂/FiO₂ in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study

Collaborators

Affiliations

Prognostication using SpO₂/FiO₂ in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical