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A simplified method for deriving shunt and reduced VA/Q in infants
  1. L Rowe1,
  2. J G Jones2,
  3. D Quine3,
  4. S S Bhushan3,
  5. B J Stenson3
  1. 1
    Department of Anaesthetics, Norfolk and Norwich University Hospital, Norwich, UK
  2. 2
    Department of Medicine, Addenbrooke’s Hospital, Cambridge, UK
  3. 3
    Neonatal Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to J Gareth Jones, Woodlands, Rufforth, York YO23 3QF, UK; johngareth423{at}btinternet.com

Abstract

Background: Right to left shunt and regional hypoventilation (reduced ventilation/perfusion ratio (VA/Q)) have different effects on the curve relating inspired oxygen (PIO2) to oxygen saturation measured by pulse oximetry (SpO2) and can be derived non-invasively from measurements of SpO2 and inspired oxygen pressure (PIO2) using complex models of gas exchange. We developed a simpler computerised “slide-rule” method of making these derivations.

Aims: To describe the slide-rule method and determine agreement between measurements derived with this and a more complex algorithm.

Methods: Series of PIO2 versus SpO2 data points obtained during 43 studies in 16 preterm infants with bronchopulmonary dysplasia were analysed. Percentage shunt and the degree of right shift (kPa) of the PIO2 versus SpO2 curve compared with the oxyhaemoglobin dissociation curve (a measure of VA/Q) were determined for each dataset with both methods, and the results were compared using the method of Bland and Altman.

Results: The computer slide-rule method produced results for all 43 datasets. The more complex model could derive results for 40/43 datasets. The mean differences (95% limits of agreement) between the two methods for measurements of shunt were −1.7% (−6.5 to +3.5%) and for measurements of right shift were 0.3 kPa (−2.9 to +3.6 kPa).

Conclusion: The slide-rule method was reliable for deriving shunt and right shift (reduced VA/Q) of the PIO2 versus SpO2 curve when compared with the more complex algorithm. The new method should enable wider clinical application of these measurements of oxygen exchange.

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Footnotes

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • Ethics approval Ethics committee approval was obtained from the Lothian Local Research Ethics Committee, Royal Infirmary of Edinburgh NHS Trust.

  • Patient consent Parental consent obtained.

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