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Usefulness of non-invasive methods for the monitoring of oxygenation parameters in patients with COVID-19 associated acute respiratory distress syndrome (ARDS)

Published:January 30, 2022DOI:https://doi.org/10.1016/j.ejim.2022.01.033
      Dear Editor,
      We have read with great interest the article recently published by Zaccagnini et al. [
      • Zaccagnini G.
      • Berni A.
      • Pieralli F.
      Correlation of non-invasive oxygenation parameters with PaO2/FiO2 ratio in patients with COVID-19 associated ARDS.
      ], entitled "Correlation of non-invasive oxygenation parameters with PaO2/FiO2 ratio in patients with COVID-19 associated ARDS", where they conclude that the SpO2/FiO2 (S/F) ratio is a reliable, non-invasive and easy to track parameter, to monitor patients with coronavirus disease 2019 (COVID-19) with moderate and severe acute respiratory distress syndrome (ARDS), potentially useful to reduce the need to place arterial catheters and the possible consequent thrombotic complications related to COVID–19, so we consider it important to add some comments on this topic.
      In Colombia as of January 12, 2022, there were a total of 5380,841 confirmed cases of COVID-19 with 153,622 active cases.1.18% of these cases were hospitalized and 0.29% in Intensive Care Unit (ICU) [

      El Coronavirus en Colombia [Internet]. [cited 2022 Jan 12]. Available from: https://coronaviruscolombia.gov.co/Covid19/index.html.

      ]. While there has been a large decrease in the requirement for hospitalization and ICU, it is still an alarming figure.
      As in other parts of the world, in Colombia the most frequent cause of hospitalization in patients with COVID-19 is given by ARDS. This is why in order to optimize the true requirement of in-hospital management, the Ministry of Health established major and minor criteria, with special importance given to the requirement of invasive mechanical ventilation (IMV) and PaO2/FiO2 parameters <250 mmHg and respiratory rate [

      Ministerio de Salud y Protección Social. Lineamientos Para El Manejo Clínico De Pacientes Con Infección Por Nuevo Coronavirus Covid-19 Julio 2020. 2020;1–32. Available from: https://www.minsalud.gov.co/Ministerio/Institucional/Procesosyprocedimientos/PSSS03.pdf.

      ].
      Therefore, and taking into account our experience in the critical care of patients with COVID-19, we consider of utmost importance the evaluation and values of both PaO2/FiO2, SpO2/FiO2 (S/F) and the ROX index, since they are an important guide when defining the requirement of invasive mechanical ventilation and in this way allow us to act in the most agile and effective way to reduce the prolonged time of hypoxia caused by ARDS.
      However, for the hospitalized patient, on multiple occasions, the intake of arterial gasses for the follow-up of PaO2/FiO2 becomes wasteful. For this reason in many cases it is necessary to resort to an arterial catheter (in addition to allowing the intensivist the hemodynamic monitoring in a more reliable way), a situation that can have negative outcomes, from the infection of the puncture site to thrombotic complications. Therefore, we consider important the clinical evidence reported by the authors, since we can have peace of mind and security when it comes to being guided by the S/F relationship for the classification of hypoxemia.
      At the national level, there are no relevant data on what the most important parameter for the classification of hypoxemia should be. For this reason we motivate the authors to carry out multicenter studies where we can replicate their experience and report our own data which would allow us to make better decisions with a decrease in comorbidities.

      References

        • Zaccagnini G.
        • Berni A.
        • Pieralli F.
        Correlation of non-invasive oxygenation parameters with PaO2/FiO2 ratio in patients with COVID-19 associated ARDS.
        Eur J Intern Med. 2021; (Available from:): 21-23https://doi.org/10.1016/j.ejim.2021.12.015
      1. El Coronavirus en Colombia [Internet]. [cited 2022 Jan 12]. Available from: https://coronaviruscolombia.gov.co/Covid19/index.html.

      2. Ministerio de Salud y Protección Social. Lineamientos Para El Manejo Clínico De Pacientes Con Infección Por Nuevo Coronavirus Covid-19 Julio 2020. 2020;1–32. Available from: https://www.minsalud.gov.co/Ministerio/Institucional/Procesosyprocedimientos/PSSS03.pdf.