• Respiratory care · Oct 2019

    SpO2/FIO2 on Presentation as a Predictor for Early Hemodynamic Deterioration in Intermediate Risk Acute Pulmonary Embolism.

    • Lisa Domaradzki, Mehrdad Ghahramani, Ryan Rogers, Mohammed Ruzieh, Ryan Wilson, and Andry Van de Louw.
    • Division of Pulmonary and Critical Care Medicine, Pennsylvania State University College of Medicine and Milton S Hershey Medical Center, Hershey, Pennsylvania.
    • Respir Care. 2019 Oct 1; 64 (10): 1279-1285.

    BackgroundPatients with intermediate-risk acute pulmonary embolism are at risk of hemodynamic deterioration, and identification of risk factors for decompensation could guide the administration of thrombolytics. We aimed to assess whether SpO2 /FIO2 on presentation is associated with early hemodynamic deterioration in this population.MethodsA retrospective chart review of subjects admitted between 2006 and 2018 with intermediate-risk pulmonary embolism (hemodynamically stable with right ventricle to left ventricle ratio > 0.9 or tricuspid annular plane systolic excursion < 18 mm). Early hemodynamic deterioration was defined as requirements for vasopressors or rescue thrombolytics within 48 h. Results are presented as median (interquartile range).ResultsA total of 178 subjects were included. Early hemodynamic deterioration occurred in 13% of the subjects and was associated with a median (interquartile range) lower SpO2 /FIO2 on presentation in univariate analysis (243 [123-275] versus 438 [335-457], P < .001) and in a multivariate analysis, including heart rate and right ventricle to left ventricle ratio as covariates (odds ratio 0.992, 95% CI 0.987-0.996; P < .001). The initial SpO2 /FIO2 predicted hemodynamic deterioration with an area under the receiver operating characteristic curve of 0.81 and a threshold of 260 was associated with a sensitivity of 74% and specificity of 88%. Sensitivity analyses restricted to subjects with hypoxemia on presentation and subjects with an elevated troponin level led to similar results.ConclusionsIn intermediate-risk pulmonary embolism, SpO2 /FIO2 on presentation can help predict the risk of early hemodynamic deterioration.Copyright © 2019 by Daedalus Enterprises.

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