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Open Medicine

formerly Central European Journal of Medicine

Editor-in-Chief: Darzynkiewicz, Zbigniew

IMPACT FACTOR 2018: 1.221

CiteScore 2018: 1.01

SCImago Journal Rank (SJR) 2018: 0.329
Source Normalized Impact per Paper (SNIP) 2018: 0.479

ICV 2017: 152.94

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Volume 11, Issue 1


Volume 10 (2015)

ARDS diagnosed by SpO2/FiO2 ratio compared with PaO2/FiO2 ratio: the role as a diagnostic tool for early enrolment into clinical trials

Franz J. Wiedermann
  • Corresponding author
  • Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Martina Stichlberger
  • Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Bernhard Glodny
Published Online: 2016-08-02 | DOI: https://doi.org/10.1515/med-2016-0056

Dear Sir,

Chen W and co-authors report on the diagnostic tool for early enrolment of patients with ARDS into clinical trials by using SpO2/FiO2 ratio compared with PaO2/FiO2 ratio. The authors concluded that ARDS patients diagnosed by SpO2/FiO2 ratio have similar clinical characteristics and outcomes compared with patients diagnosed by PaO2/FiO2 ratio [1].

The work is satisfactory, however, the physiological relationship between measurement of oxygenation either by pulsoxymetry or blood gas analysis is in our opinion clear [2].

One point should be addressed that in a case of carboxyhemoglobinemia the measurement of oxygenation by pulsoxymetry could fail, and blood gas analyses by CO-oxymetry is the only way to exclude this disease. Recent studies revealed that cigarette smoking measured both by history and biomarker is associated with an increased risk of ARDS in patients with nonpulmo-nary sepsis [3, 4]. Smokers can have an increased level of carboxyhemoglobin up to 15% [5], therefore early use of blood gas analysis is crucial.

The early diagnosis of ARDS is made on a broad spectrum of evidence on clinical, radiological, and oxygenation criteria. Early use of blood gas analyses should not be replaced by pulsoxymetry, at least one arterial blood gas should be obtained at patient’s admission. For avoiding arterial puncture capillary blood gas analysis can be used.

Author contribution

All authors discussed the topic and helped to draft the manuscript together.

Competing interests

The authors declare that they have no competing interests.


  • [1]

    Chen W, Janz DR, Shaver CM, Bernard GR, Bastarache JA, Ware LB. Clinical characteristics and outcomes are similar in ARDS diagnosed by SpO2/FiO2 Ratio compared with PaO2/FiO2 Ratio. Chest 2015; (online first) CrossrefGoogle Scholar

  • [2]

    Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB. Comparison of the SpO2/FiO2 ratio and the PaO2/FiO2 ratio in patients with acute lung injury or ARDS. Chest 2007; 132:410-417 Google Scholar

  • [3]

    ReillyJP, Christie JD. Primed for injury: cigarette smokers and acute respiratory distress syndrome. Crit Care Med 2015; 43:2015-2016 Google Scholar

  • [4]

    Calfee, CS, Matthay MA, Ksangelaris KN, Siew ED, Janz DR, Bernard GR, et al. Cigarette smoke exposure and the acute respiratory distress syndrome. Crit Care Med 2015; 43:1790-1797 Google Scholar

  • [5]

    Castleden CM, Cole PV. Variations in carboxyheamoglobin levels in smokers. Br Med J1974; 4:736-738 CrossrefGoogle Scholar

About the article

Received: 2015-10-23

Accepted: 2016-03-07

Published Online: 2016-08-02

Published in Print: 2016-01-01

Citation Information: Open Medicine, Volume 11, Issue 1, Pages 297–297, ISSN (Online) 2391-5463, DOI: https://doi.org/10.1515/med-2016-0056.

Export Citation

© 2016 Franz J. Wiedermann et al.. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

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