Chest
Volume 102, Issue 6, December 1992, Pages 1672-1675
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Clinical Investigations
Pattern of Non-ICU Inpatient Supplemental Oxygen Utilization in a University Hospital

https://doi.org/10.1378/chest.102.6.1672Get rights and content

Random assessments of SaO2 were performed via pulse oximetry in 274 hospitalized non-ICU patients prescribed supplemental O2 in a large tertiary care university hospital. In 507 assessments performed in patients inspiring the prescribed O2, 426 were receiving excessive amounts of O, to maintain a SaO2 ≥92 percent. In 233 of these assessments, SaO2 was ≥92 percent while breathing ambient air. In an additional 193 assessments, the concentration of inspired supplemental O2 was excessive to maintain a SaO2 ≥92 percent. However, in 81 assessments performed in patients inspiring O2, the prescribed amount was insufficient to maintain SaO2 ≥92 percent. These results indicate that O, prescription in hospitalized non-ICU patients is excessive or not required in the majority of cases. Furthermore, routine use of pulse oximetry in hospitalized patients prescribed O, may be useful in determining the continued need for supplemental O, and adjusting the proper concentration needed to avoid hypoxemia.

Section snippets

Materials And Methods

Study patients potentially included all hospitalized adult medical and surgical patients receiving supplemental O2 for greater than 24 h outside the ICU. Patients who were receiving O2 for a medical emergency (ie, myocardial infarction, anemia, carboxyhemoglobinemia) or those who had an unstable underlying medical condition were excluded. In addition, patients with inadequate digit perfusion, jaundice or highly pigmented skin in whom accurate oximetry could not be obtained were similarly

Population Studied

Of the 1,084 O2 assessments and titrations randomly performed, 614 were performed on 172 medical patients and 470 on 102 surgical patients (Table 1). No attempt was made to categorize the admitting diagnoses. The decision to institute the use of supplemental O2 and the concentration of inspired O2 was made by the treating physicians. In all patients, the concentration of inspired O2 measured on the oxygen delivery device at the time of the O2 titration study corresponded to the amount ordered

Discussion

The results of this study demonstrate that the use of supplemental O2 in hospitalized patients outside the ICU is arbitrary, poorly monitored and does not uniformly comply with regulations regarding its prescription. One alarming finding in this study is that a significant number of patients prescribed O2 (20 percent) remain hypoxemic due to insufficiently prescribed concentrations of inspired O2 and follow-up monitoring. Although our study was not designed to evaluate nursing, respiratory

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Manuscript received March 3; revision accepted April 16.

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