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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Correlation between oxygenation indexes&#46; SpO<span class="elsevierStyleInf">2</span>&#58; oxygen saturation with pulse oximeter&#59; PaO<span class="elsevierStyleInf">2</span>&#58; oxygen pressure in arterial blood&#59; SatO<span class="elsevierStyleInf">2</span>&#58; oxygen saturation in arterial blood&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fraction of inspired oxygen&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pneumonia is the hallmark of severe COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Strain in healthcare systems across the world has forced countless hospitals to conduct grueling triages to decide who gets to be admitted when healthcare saturation was rampant&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> As these decisions are inherently complex&#44; numerous risk scores and predictor factors have been described to aid the attending medical team&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#8211;5</span></a> These often include clinical and laboratory values&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">One commonly utilized criteria to determine patient severity is the severity of hypoxemia&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> This can be assessed with arterial oxygen pressure &#40;PaO<span class="elsevierStyleInf">2</span>&#41;&#44; PaO<span class="elsevierStyleInf">2</span> to inspired fraction of oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41; ratio&#44; arterial oxygen saturation &#40;SatO<span class="elsevierStyleInf">2</span>&#41;&#44; pulse oximeter oxygen saturation &#40;SpO<span class="elsevierStyleInf">2</span>&#41;&#44; SatO<span class="elsevierStyleInf">2</span> to FiO<span class="elsevierStyleInf">2</span> ratio&#44; SpO<span class="elsevierStyleInf">2</span> to FiO<span class="elsevierStyleInf">2</span> ratio&#44; and the prescribed oxygen device&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of these criteria for hypoxemia severity in non-intubated patients has been criticized given the expected high inter-patient variability in FiO<span class="elsevierStyleInf">2</span>&#44; shunt fraction&#44; and physician&#39;s choice of oxygenation device and oxygen flow&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Therefore&#44; relying on these criteria is suboptimal given the low comparability between different patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this study&#44; we aimed to compare the severity of hypoxemia in patients with severe COVID-19 according to oxygenation index arriving at an emergency department&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a retrospective cohort study collecting information on every patient who arrived at the emergency department &#40;ED&#41; of a reference COVID-19 tertiary center between April 1st&#44; 2020&#44; and April 30th&#44; 2021&#46; At arrival&#44; every patient had to go through a triage station where vital signs &#40;including SpO<span class="elsevierStyleInf">2</span>&#41; were documented before entering the emergency department&#46; Once in the emergency department&#44; all patients who had low SpO<span class="elsevierStyleInf">2</span> &#40;usually<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92&#37;&#41; received supplemental oxygen&#46; Only nasal cannula and non-rebreathing masks were available at our center&#46; Arterial blood gas analysis was performed in all patients with suspected COVID-19&#46; Generally&#44; FiO<span class="elsevierStyleInf">2</span> was estimated heuristically by the treating physician by adding to the baseline FiO<span class="elsevierStyleInf">2</span> &#40;21&#37;&#41; 3&#37; for every extra liter of oxygen per minute&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> For example&#44; a patient receiving 2<span class="elsevierStyleHsp" style=""></span>l of minute of supplemental oxygen would have a calculated FiO<span class="elsevierStyleInf">2</span> of 27&#37; &#40;21<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3&#42;2&#41;&#46; SpO<span class="elsevierStyleInf">2</span> was obtained at ambient air&#44; while arterial blood gas was obtained almost universally when patients received supplemental oxygen&#46; Given the closeness between SpO<span class="elsevierStyleInf">2</span> and blood gas analysis&#44; we believe it is reasonable to assume that the clinical status of the patient is comparable between these two circumstances&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We obtained data about PaO<span class="elsevierStyleInf">2</span>&#44; SatO<span class="elsevierStyleInf">2</span>&#44; SpO<span class="elsevierStyleInf">2</span>&#44; and FiO<span class="elsevierStyleInf">2</span>&#44; with which we calculated PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; and SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#46; All SpO<span class="elsevierStyleInf">2</span> were taken at triage with a Nihon MU-631RK portable monitor&#44; and as such&#44; were ambient-air &#40;FiO<span class="elsevierStyleInf">2</span> 21&#37;&#41;&#46; SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> was included to better compare oxygenation indexes&#46; Blood gas analysis was performed in the emergency department with the RADIOMETER ABL90 flex analyzer&#44; which directly measured SatO<span class="elsevierStyleInf">2</span> and PaO<span class="elsevierStyleInf">2</span>&#46; Oxygen device used at the time of the arterial blood gas analysis could not be confidently determined&#44; so it was not included&#46; Since the low reliability of FiO<span class="elsevierStyleInf">2</span> is the most criticized aspect of using the oxygenation device as a marker of hypoxia severity&#44; it does not affect our analysis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We categorized a patient&#39;s hypoxemia severity by quintiles of SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; and SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#40;from now on referred to as &#8220;oxygenation indexes&#8221;&#41;&#46; Lower values indicate a higher hypoxemia severity&#46; We determined strength of concordance between oxygenation index quintiles with chord diagrams across all three oxygenation index pairs&#46; We calculated Spearman correlation coefficients for the three possible pairs of oxygenation indexes&#46; We built scatterplots and used locally weighted scatterplot smoothing regression to graphically represent the data&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All analyses were conducted with R software version 4&#46;0&#46;0&#46; The study was approved by the Research in Humans ethics committee of the authors&#8217; institution&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 23&#44;049 triage visits occurred during the study period&#44; corresponding to 19&#44;644 individual patients&#46; Of these&#44; 8123 were due to suspected COVID-19&#46; Among 4663 patients that were finally admitted to the ED&#44; arterial blood gas analysis was obtained for 2960 patients&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Median FiO<span class="elsevierStyleInf">2</span> was 0&#46;34 &#40;inter-quartile range &#91;IQR&#93; 0&#46;25&#8211;0&#46;60&#41;&#44; PaO<span class="elsevierStyleInf">2</span> 68<span class="elsevierStyleHsp" style=""></span>mmHg &#40;57&#8211;84&#41;&#44; SatO<span class="elsevierStyleInf">2</span> 94&#37; &#40;91&#8211;97&#41;&#44; SpO<span class="elsevierStyleInf">2</span> 83&#37; &#40;73&#8211;88&#41;&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 211 &#40;124&#8211;281&#41;&#44; SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 274 &#40;160&#8211;364&#41;&#44; and SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 395 &#40;348&#8211;419&#41;&#46; Correlation among oxygenation indexes is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; A strong correlation was seen between PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#38; SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#38; SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; while a very strong correlation was seen between PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#38; SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;88&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; None of the variable pairs showed a linear relationship&#46; All oxygenation indexes showed a considerable cross-over among quintiles &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; with only 785 &#40;26&#46;5&#37;&#41; patients being in the same severity quintile across all indexes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Our study shows there is considerable heterogeneity when classifying hypoxemia severity with different oxygenation indexes&#46; While good correlation was observed among the three evaluated pairs&#44; the lower correlation between SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> and the others could be due to inaccuracy of pulse oximeters when used in patients with low oxygen saturation&#44; physician imprecision when estimating FiO<span class="elsevierStyleInf">2</span>&#44; and&#47;or mixed blood in the gas analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> It is likely multiple factors are involved in most cases&#44; which is consistent with the previously mentioned concerns&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> For example&#44; if solely based on SpO<span class="elsevierStyleInf">2</span> at triage&#44; a patient could be wrongly classified as having a more severe disease&#44; giving preference to a patient in better condition&#46; Also&#44; follow up could be hard if it is done only with oxygenation parameters&#46; The morning medical team could classify the patient with a given severity with blood gas analysis&#44; while the evening group could use a pulse oximeter and determine intubation is indicated&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Degree of hypoxemia is not a good measure when considered by itself in non-intubated patients with COVID-19 pneumonia&#44; as considerable variation occurs depending on whether pulse oximetry or blood gas analysis is utilized&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Data availability</span><p id="par0065" class="elsevierStylePara elsevierViewall">Code used for the analysis is freely available at <a href="https://github.com/isaac-nunez/Oxygenation_indexes">https&#58;&#47;&#47;github&#46;com&#47;isaac-nunez&#47;Oxygenation&#95;indexes</a>&#46; Data will be made available upon reasonable request to the corresponding author&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Sources of funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest&#46;</p></span></span>"
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              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe Covid-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;A&#46; Berlin"
                            1 => "R&#46;M&#46; Gulick"
                            2 => "F&#46;J&#46; Martinez"
                          ]
                        ]
                      ]
                    ]
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2020"
                        "volumen" => "383"
                        "paginaInicial" => "2451"
                        "paginaFinal" => "2460"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32412710"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0055"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "The Lancet&#46; Humanitarian crises in a global pandemic&#46; Lancet 2020&#59;396&#58;447&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The low-harm score for predicting mortality in patients diagnosed with COVID-19&#58; a multicentric validation study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Soto-Mota"
                            1 => "B&#46;A&#46; Marfil-Garza"
                            2 => "E&#46; Mart&#237;nez Rodr&#237;guez"
                            3 => "J&#46;O&#46; Barreto Rodr&#237;guez"
                            4 => "A&#46;E&#46; L&#243;pez Romo"
                            5 => "P&#46; Alberti Minutti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/emp2.12259"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Emerg Physicians Open"
                        "fecha" => "2020"
                        "volumen" => "1"
                        "paginaInicial" => "1436"
                        "paginaFinal" => "1443"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33230506"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Common hematological values predict unfavorable outcomes in hospitalized COVID-19 patients"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; N&#250;&#241;ez"
                            1 => "&#193;&#46;A&#46; Priego-Ranero"
                            2 => "H&#46;B&#46; Garc&#237;a-Gonz&#225;lez"
                            3 => "B&#46; Jim&#233;nez-Franco"
                            4 => "R&#46; Bonilla-Hern&#225;ndez"
                            5 => "G&#46; Dom&#237;nguez-Cherit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clim.2021.108682"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Immunol"
                        "fecha" => "2021"
                        "volumen" => "225"
                        "paginaInicial" => "108682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33549831"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction models for diagnosis and prognosis of covid-19&#58; systematic review and critical appraisal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Wynants"
                            1 => "B&#46; Van Calster"
                            2 => "G&#46;S&#46; Collins"
                            3 => "R&#46;D&#46; Riley"
                            4 => "G&#46; Heinze"
                            5 => "E&#46; Schuit"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2020"
                        "paginaInicial" => "m1328"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Why COVID-19 silent hypoxemia is baffling to physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Tobin"
                            1 => "F&#46; Laghi"
                            2 => "A&#46; Jubran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.202006-2157CP"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2020"
                        "volumen" => "202"
                        "paginaInicial" => "356"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32539537"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio&#58; the mismeasure of oxygenation in COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
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                            2 => "F&#46; Laghi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/13993003.00274-2021"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2021"
                        "volumen" => "57"
                        "paginaInicial" => "2100274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33767005"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Volume-targeted versus pressure-limited noninvasive ventilation in subjects with acute hypercapnic respiratory failure&#58; a multicenter randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            3 => "Q&#46; Nie"
                            4 => "B&#46; Xie"
                            5 => "X&#46; An"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Respir Care"
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                        "volumen" => "61"
                        "paginaInicial" => "1440"
                        "paginaFinal" => "1450"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0090"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulse oximetry&#58; understanding its basic principles facilitates appreciation of its limitations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;D&#46; Chan"
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                            2 => "M&#46;M&#46; Chan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2013.02.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2013"
                        "volumen" => "107"
                        "paginaInicial" => "789"
                        "paginaFinal" => "799"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23490227"
                            "web" => "Medline"
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Scientific letter
Heterogeneity of hypoxemia severity according to pulse oximetry and blood gas analysis in COVID-19 pneumonia
Heterogeneidad de la severidad de hipoxemia de acuerdo a oximetría de pulso y gases arteriales en neumonía COVID-19
I. Núñeza,
Corresponding author
isaac.nunezs@incmnsz.mx

Corresponding author.
, A. Soto-Motab
a Departamento de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
b Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Correlation between oxygenation indexes&#46; SpO<span class="elsevierStyleInf">2</span>&#58; oxygen saturation with pulse oximeter&#59; PaO<span class="elsevierStyleInf">2</span>&#58; oxygen pressure in arterial blood&#59; SatO<span class="elsevierStyleInf">2</span>&#58; oxygen saturation in arterial blood&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fraction of inspired oxygen&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pneumonia is the hallmark of severe COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Strain in healthcare systems across the world has forced countless hospitals to conduct grueling triages to decide who gets to be admitted when healthcare saturation was rampant&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> As these decisions are inherently complex&#44; numerous risk scores and predictor factors have been described to aid the attending medical team&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#8211;5</span></a> These often include clinical and laboratory values&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">One commonly utilized criteria to determine patient severity is the severity of hypoxemia&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> This can be assessed with arterial oxygen pressure &#40;PaO<span class="elsevierStyleInf">2</span>&#41;&#44; PaO<span class="elsevierStyleInf">2</span> to inspired fraction of oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41; ratio&#44; arterial oxygen saturation &#40;SatO<span class="elsevierStyleInf">2</span>&#41;&#44; pulse oximeter oxygen saturation &#40;SpO<span class="elsevierStyleInf">2</span>&#41;&#44; SatO<span class="elsevierStyleInf">2</span> to FiO<span class="elsevierStyleInf">2</span> ratio&#44; SpO<span class="elsevierStyleInf">2</span> to FiO<span class="elsevierStyleInf">2</span> ratio&#44; and the prescribed oxygen device&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of these criteria for hypoxemia severity in non-intubated patients has been criticized given the expected high inter-patient variability in FiO<span class="elsevierStyleInf">2</span>&#44; shunt fraction&#44; and physician&#39;s choice of oxygenation device and oxygen flow&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Therefore&#44; relying on these criteria is suboptimal given the low comparability between different patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this study&#44; we aimed to compare the severity of hypoxemia in patients with severe COVID-19 according to oxygenation index arriving at an emergency department&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a retrospective cohort study collecting information on every patient who arrived at the emergency department &#40;ED&#41; of a reference COVID-19 tertiary center between April 1st&#44; 2020&#44; and April 30th&#44; 2021&#46; At arrival&#44; every patient had to go through a triage station where vital signs &#40;including SpO<span class="elsevierStyleInf">2</span>&#41; were documented before entering the emergency department&#46; Once in the emergency department&#44; all patients who had low SpO<span class="elsevierStyleInf">2</span> &#40;usually<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>92&#37;&#41; received supplemental oxygen&#46; Only nasal cannula and non-rebreathing masks were available at our center&#46; Arterial blood gas analysis was performed in all patients with suspected COVID-19&#46; Generally&#44; FiO<span class="elsevierStyleInf">2</span> was estimated heuristically by the treating physician by adding to the baseline FiO<span class="elsevierStyleInf">2</span> &#40;21&#37;&#41; 3&#37; for every extra liter of oxygen per minute&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> For example&#44; a patient receiving 2<span class="elsevierStyleHsp" style=""></span>l of minute of supplemental oxygen would have a calculated FiO<span class="elsevierStyleInf">2</span> of 27&#37; &#40;21<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3&#42;2&#41;&#46; SpO<span class="elsevierStyleInf">2</span> was obtained at ambient air&#44; while arterial blood gas was obtained almost universally when patients received supplemental oxygen&#46; Given the closeness between SpO<span class="elsevierStyleInf">2</span> and blood gas analysis&#44; we believe it is reasonable to assume that the clinical status of the patient is comparable between these two circumstances&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We obtained data about PaO<span class="elsevierStyleInf">2</span>&#44; SatO<span class="elsevierStyleInf">2</span>&#44; SpO<span class="elsevierStyleInf">2</span>&#44; and FiO<span class="elsevierStyleInf">2</span>&#44; with which we calculated PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; and SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#46; All SpO<span class="elsevierStyleInf">2</span> were taken at triage with a Nihon MU-631RK portable monitor&#44; and as such&#44; were ambient-air &#40;FiO<span class="elsevierStyleInf">2</span> 21&#37;&#41;&#46; SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> was included to better compare oxygenation indexes&#46; Blood gas analysis was performed in the emergency department with the RADIOMETER ABL90 flex analyzer&#44; which directly measured SatO<span class="elsevierStyleInf">2</span> and PaO<span class="elsevierStyleInf">2</span>&#46; Oxygen device used at the time of the arterial blood gas analysis could not be confidently determined&#44; so it was not included&#46; Since the low reliability of FiO<span class="elsevierStyleInf">2</span> is the most criticized aspect of using the oxygenation device as a marker of hypoxia severity&#44; it does not affect our analysis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We categorized a patient&#39;s hypoxemia severity by quintiles of SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; and SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#40;from now on referred to as &#8220;oxygenation indexes&#8221;&#41;&#46; Lower values indicate a higher hypoxemia severity&#46; We determined strength of concordance between oxygenation index quintiles with chord diagrams across all three oxygenation index pairs&#46; We calculated Spearman correlation coefficients for the three possible pairs of oxygenation indexes&#46; We built scatterplots and used locally weighted scatterplot smoothing regression to graphically represent the data&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All analyses were conducted with R software version 4&#46;0&#46;0&#46; The study was approved by the Research in Humans ethics committee of the authors&#8217; institution&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 23&#44;049 triage visits occurred during the study period&#44; corresponding to 19&#44;644 individual patients&#46; Of these&#44; 8123 were due to suspected COVID-19&#46; Among 4663 patients that were finally admitted to the ED&#44; arterial blood gas analysis was obtained for 2960 patients&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Median FiO<span class="elsevierStyleInf">2</span> was 0&#46;34 &#40;inter-quartile range &#91;IQR&#93; 0&#46;25&#8211;0&#46;60&#41;&#44; PaO<span class="elsevierStyleInf">2</span> 68<span class="elsevierStyleHsp" style=""></span>mmHg &#40;57&#8211;84&#41;&#44; SatO<span class="elsevierStyleInf">2</span> 94&#37; &#40;91&#8211;97&#41;&#44; SpO<span class="elsevierStyleInf">2</span> 83&#37; &#40;73&#8211;88&#41;&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 211 &#40;124&#8211;281&#41;&#44; SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 274 &#40;160&#8211;364&#41;&#44; and SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 395 &#40;348&#8211;419&#41;&#46; Correlation among oxygenation indexes is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; A strong correlation was seen between PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#38; SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#38; SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; while a very strong correlation was seen between PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#38; SatO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;88&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; None of the variable pairs showed a linear relationship&#46; All oxygenation indexes showed a considerable cross-over among quintiles &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; with only 785 &#40;26&#46;5&#37;&#41; patients being in the same severity quintile across all indexes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Our study shows there is considerable heterogeneity when classifying hypoxemia severity with different oxygenation indexes&#46; While good correlation was observed among the three evaluated pairs&#44; the lower correlation between SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> and the others could be due to inaccuracy of pulse oximeters when used in patients with low oxygen saturation&#44; physician imprecision when estimating FiO<span class="elsevierStyleInf">2</span>&#44; and&#47;or mixed blood in the gas analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> It is likely multiple factors are involved in most cases&#44; which is consistent with the previously mentioned concerns&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> For example&#44; if solely based on SpO<span class="elsevierStyleInf">2</span> at triage&#44; a patient could be wrongly classified as having a more severe disease&#44; giving preference to a patient in better condition&#46; Also&#44; follow up could be hard if it is done only with oxygenation parameters&#46; The morning medical team could classify the patient with a given severity with blood gas analysis&#44; while the evening group could use a pulse oximeter and determine intubation is indicated&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Degree of hypoxemia is not a good measure when considered by itself in non-intubated patients with COVID-19 pneumonia&#44; as considerable variation occurs depending on whether pulse oximetry or blood gas analysis is utilized&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Data availability</span><p id="par0065" class="elsevierStylePara elsevierViewall">Code used for the analysis is freely available at <a href="https://github.com/isaac-nunez/Oxygenation_indexes">https&#58;&#47;&#47;github&#46;com&#47;isaac-nunez&#47;Oxygenation&#95;indexes</a>&#46; Data will be made available upon reasonable request to the corresponding author&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Sources of funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest&#46;</p></span></span>"
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                          0 => array:2 [
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                            3 => "J&#46;O&#46; Barreto Rodr&#237;guez"
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                        "paginaFinal" => "1443"
                        "link" => array:1 [
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                          0 => array:2 [
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                      "titulo" => "Why COVID-19 silent hypoxemia is baffling to physicians"
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                            0 => "M&#46;J&#46; Tobin"
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                    0 => array:2 [
                      "doi" => "10.1164/rccm.202006-2157CP"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
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                        "paginaInicial" => "356"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32539537"
                            "web" => "Medline"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33767005"
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                      "titulo" => "Volume-targeted versus pressure-limited noninvasive ventilation in subjects with acute hypercapnic respiratory failure&#58; a multicenter randomized controlled trial"
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Article information
ISSN: 21735727
Original language: English
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