• Nicola Malagutti, Andrea Di Laora, Carlo Barbetta, Elisabetta Groppo, Valeria Tugnoli, Elisabetta Sette, Luigi Astolfi, William Beswick, Michela Borin, Andrea Ciorba, Stefano Pelucchi, Francesco Stomeo, and Marco Contoli.
• ENT & Audiology Department, University Hospital of Ferrara, Ferrara, Italy.
• J Emerg Med. 2018 Nov 1; 55 (5): 627-634.

BackgroundDyspnea secondary to acute upper airways airflow limitation (UAAFL) represents a clinical emergency that can be difficult to recognize without a suitable history; even when etiology is known, parameters to assess the severity are unclear and often improperly used.ObjectivesThe aim of this study was to assess the role of peripheral oxygen saturation (SpO2) as a predictor of severity of upper airway obstruction.MethodsThe authors propose an experimental model of upper airway obstruction by a progressive increase of UAAFL. Ten healthy volunteers randomly underwent ventilation for 6 min with different degrees of UAAFL. SpO2, heart rate, respiratory rate (RR), tidal volume, accessory respiratory muscle activation, and subjective dyspnea indexes were measured.ResultsIn this model, SpO2 was not reliable as the untimely gravity index of UAAFL. Respiratory rate, visual analogue scale (VAS), and Borg dyspnea scale were statistically correlated with UAAFL (p < 0.0001 for RR and p < 0.05 for VAS and Borg scale). No significant changes were observed on heart rate (p > 0.05) and tidal volume (p > 0.05); a RR ≤ 7 breaths/min; VAS and Borg scale showed statistically significant parameters changes (p < 0.05).ConclusionsRR, VAS, and Borg dyspnea scales are sensitive parameters to detect and stage, easily and quickly, the gravity of an upper airways impairment, and should be used in emergency settings for an early diagnosis of a UAAFL. SpO2 is a poorer predictor of the degree of upper airways flow limitation.Copyright © 2018 Elsevier Inc. All rights reserved.

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