Routine Oximetry: A Fifth Vital Sign?

doi:10.1378/chest.94.2.227a

Chest

Volume 94, Issue 2, August 1988, Page 227

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Basic Medical Economics and Systems Efficiency

Today, most pulmonary specialists, whether in private practice, large clinics or hospital-based medical centers, have ready access to accurate pulse oximeters. These oximeters are usually available on a “continuous standby basis” for selected patients. In such settings they are essentially as available as an ophthalmoscope, automated blood pressure cuff, etc. Most often, nurses, technicians, physicians' assistants, etc are the personnel measuring the patients' saturation with this equipment. I

Why Have the Data?

In the hospital-based pulmonary clinic which I attend, the availability and simplicity of routine oximetry is much greater than the spirometry (see Loggan's protocol) and I certainly would recommend employment of routine oximetry before routine spirometry In my experience, routine oximetry is helpful for carefully monitoring all patients who are receiving continuous supplemental oxygen therapy and also in those patients with moderate to severe pulmonary disease who have “borderline” hypoxemia

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Citation Excerpt :
The British Thoracic Society (BTS) has issued guidelines for the provision of oxygen to give recommendations for target arterial oxygen saturation (SpO2) in acutely unwell patients.1 Pulse oximetry is so universally used in the critical care setting that it is often regarded as a fifth vital sign.2 Nevertheless, pulse oximetry has its limitations, because during normoxia and hyperoxia, the arterial blood is nearly fully saturated (SpO2 ≥ 97%) in the typical patients, especially those receiving supplemental oxygen.3
Providing supplemental oxygen is common in the management of critically ill patients, yet the optimal oxygen regimen remains unclear.
To explore the optimal range of PaO₂ in critically ill patients.
This is a retrospective study conducted in the Medical Information Mart for Intensive Care III (MIMIC-III) database. The patients with a least 48 h of oxygen therapy were included. Nonlinear regression was used to analyze the association between PaO₂ and mortality. We derived an optimal range of PaO₂ and evaluated the association between the proportion of PaO₂ measurements within this range and mortality.
In total, 8401 patients were included in the study. A J-shaped relationship was observed between median PaO₂ and hospital mortality. Compared with the reference group of 100–120 mmHg, patients with values of 80–100 mmHg and 120–140 mmHg had higher hospital mortality (adjusted odds ratio [aOR], 1.23; 95% CI, 1.05–1.43 and 1.29; 95%CI, 1.08–1.54, respectively). Similarly, mortality rates were significantly higher for PaO₂ <80 mmHg and ≥140 mmHg (aOR, 1.97; 95%CI, 1.58–2.45 and 1.42; 95%CI, 1.19–1.69, respectively). Patients spent a greater proportion of time within 100–120 mmHg tended to have a lower mortality rate.
Among critically ill patients, the relationship between median PaO₂ and hospital mortality was J-shaped. The lowest rates of mortality was observed in those with PaO₂ levels within 100 to 120 mmHg.
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