Determination of oxygen saturation compared to a prescribed target range using continuous pulse oximetry in acutely unwell medical patients

Abstract

Background Both inadequate and excessive administration of oxygen to acutely unwell patients results in risk of harm. Guidelines recommend titration of oxygen to achieve a target oxygen saturation (SpO2) range. Information regarding whether this is being achieved is limited. Methods In this two-centre non-interventional study we used continuous pulse oximetry in acutely unwell medical patients over a 24-h period to determine the proportion of time spent with SpO2 within the prescribed target range and whether this is influenced by the target range, age, care in a high-dependency area and the number of oxygen adjustments. Results Eighty participants were included in the analysis. The mean (SD) proportion of time spent in target range was 55.6% (23.6), this was lower in those with a reduced hypercapnic target range (88–92% or below) compared to those with a range of 92–96%; difference − 13.1% (95% CI − 3.0 to − 23.2), P = 0.012. The proportion of time spent above range was 16.2% (22.9); this was higher in those with a reduced hypercapnic range; difference 21.6% (31.4 to 12), P < 0.001. The proportion of time below range was 28.4% (25.2); there was no difference between target ranges. The proportion of time spent in range was higher for those in a high dependency area in the multivariate model; difference 15.5% (95% CI 2.3 to 28.7), P = 0.02. Conclusions Medical patients receiving oxygen in a ward setting spend significant periods of time with SpO2 both above and below the prescribed target range while receiving oxygen therapy.

Automated oxygen titration with non-invasive ventilation in hypoxaemic adults with cardiorespiratory disease: a randomised cross-over trial

“…While this trial captures favourable performance characteristics of the automated oxygen control system, the static nature of the testing and short 10 min testing period of the automated oxygen control function limits the applicability of the findings, as real-life situations where the Airvo-3 NIV device with OptiO 2 might best be used may pose more pronounced and enduring periods of hypoxaemia or hyperoxaemia. 6 While participants received automated oxygen control, a single SpO 2 range of 92%–96% was targeted so our findings may not be generalisable to other target ranges. Additionally, when participants received manual oxygen control, stepwise changes in FiO 2 were made at 6 min intervals, which does not reflect real-world clinician-initiated oxygen adjustment.…”

“…In a standard medical ward, adjusting oxygen manually appears suboptimal, with SpO 2 target range maintained only around half the time. 6 This compares to intensive care units (ICUs), where manually adjusted oxygen under clinical trial conditions has been reported to maintain SpO 2 within target range approximately 90% of the time, 7 while in a cohort study, adherence to the target SpO 2 range was achieved only 43% of the time. 8 Novel automated oxygen control systems have been developed, operating an algorithm-based closed-loop controller that automatically titrates the delivered fractional concentration of inspired oxygen (FiO 2 ) to maintain SpO 2 within a prespecified target range.…”

“…In a standard medical ward, adjusting oxygen manually appears suboptimal, with SpO 2 target range maintained only around half the time. 6 This compares to intensive care units (ICUs), where manually adjusted oxygen under clinical trial conditions has been reported to maintain SpO 2 within target range approximately 90% of the time, 7 while in a cohort study, adherence to the target SpO 2 range was achieved only 43% of the time. 8 …”

Avaliação da oxigenoterapia em pacientes adultos em um hospital de ensino de Sergipe

“…In a complementary way, definition of the saturation target in the prescription is also important to assess the need to use oxygen therapy, or the possibility for suspension or weaning. When a patient does not have a SatO 2 target defined, they may receive excessive oxygen therapy, which is associated with a higher risk of mortality, mainly in patients at risk of hypercapnic respiratory failure, or insufficient oxygen therapy 17 . Such being the case, it is imperative that all patients in use of supplemental oxygen are monitored and that oximetry is performed on a regular basis, which should be considered as the "fifth vital sign", so that oxygen is titrated to the target saturation defined 2,6 .…”

Effect of automated titration of oxygen on time spent in a prescribed oxygen saturation range in adults in the ICU after cardiac surgery

“… 7 In contrast, SpO 2 was maintained within the target range for only 56 % of time in medical in-patients receiving HFNOT. 8 …”