RT Journal Article
SR Electronic
T1 S<sub>pO<sub>2</sub></sub>/F<sub>IO<sub>2</sub></sub> on Presentation as a Predictor for Early Hemodynamic Deterioration in Intermediate Risk Acute Pulmonary Embolism
JF Respiratory Care
FD American Association for Respiratory Care
SP 1279
OP 1285
DO 10.4187/respcare.06797
VO 64
IS 10
A1 Lisa Domaradzki
A1 Mehrdad Ghahramani
A1 Ryan Rogers
A1 Mohammed Ruzieh
A1 Ryan Wilson
A1 Andry Van de Louw
YR 2019
UL http://rc.rcjournal.com/content/64/10/1279.abstract
AB BACKGROUND: Patients 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.METHODS: A retrospective chart review of subjects admitted between 2006 and 2018 with intermediate-risk pulmonary embolism (hemodynamically stable with right ventricle to left ventricle ratio &gt; 0.9 or tricuspid annular plane systolic excursion &lt; 18 mm). Early hemodynamic deterioration was defined as requirements for vasopressors or rescue thrombolytics within 48 h. Results are presented as median (interquartile range).RESULTS: A 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 &lt; .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 &lt; .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.CONCLUSIONS: In intermediate-risk pulmonary embolism, SpO2/FIO2 on presentation can help predict the risk of early hemodynamic deterioration.