CONTINUOUS SPO2 MONITORING MATTERS

Postoperative patients receiving analgesia in lower acuity settings, such as the ward, suffer frequent and prolonged episodes of hypoxemia.([FOOTNOTE=Overdyk, F. J., Carter, R., Maddox, R. R., Callura, J., Herrin, A. E., & Henriquez, C. Continuous oximetry/capnometry monitoring reveals frequent desaturation and bradypnea during patient-controlled analgesia. Anesth Analg. 2007;105(2):412-418.],[ANCHOR=],[LINK=]) Without continuous monitoring of oxygen saturation, these episodes of hypoxia often go undetected, which may place patients at-risk for adverse events. ([FOOTNOTE=Lee, L. A., Caplan, R. A., Stephens, L. S., et al. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015;122(3):659-665.],[ANCHOR=],[LINK=])-([FOOTNOTE=Sun, Z., Sessler, D. I., Dalton, J. E., et al. Postoperative Hypoxemia Is Common and Persistent: A Prospective Blinded Observational Study. Anesth Analg. 2015;121(3):709-715.],[ANCHOR=],[LINK=])

Sun et al. performed a multicenter prospective analysis of 833 non-cardiac postoperative patients receiving continuous monitoring with pulse oximetry that was blinded to clinicians in order to determine the rate of undetected hypoxemia.3 The authors concluded that postoperative patients suffer frequent and prolonged hypoxia, which typically goes undetected by nurse-recorded intermittent SpO2.

Time and depth of hypoxemia among postoperative patients receiving continuous monitoring with pulse oximetry that was blinded to clinicians3
Percentage Of Analyzed Patients Averaging Specific Minutes Per Hour Below Various SpO2 Thresholds    
Averaging > 10 min/hr with SpO2 < 90% Averaging >20 min/hr with SpO2 < 90% Averaging >5 min/hr with SpO2< 85%
21% 8% 8%
Percentage Of Analyzed Patients With At Least On Episode Below SpO2 Thresholds For Specific Periods Of Time    
>1 hour with smoothed SpO2 <90% >6 hours with smoothed SpO2 <90% >30 minutes with smoothed SpO2 <80%
37% 11% 3%

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Details of nurse recorded SpO2 values and percentage of episodes of hypoxemia uncaptured nurse recorded SpO2 values among postoperative patients3
Details Of Nurse Recorded SpO2 Values Obtained During Study Period (N=594)      
Median number of nurse SpO2 values 9    
Median number of nurse recorded SpO2 values per 24 hours
5.6    
Number of patients with at least one nurse recorded SpO2 values < 90%
30 (5%)
   
Percentage of episodes missed by nurse recorded SpO2 values in 214 patients "at least 1 contiguous episode of smoothed SpO2 <90% lasting >1 hour" 90%    
Percentage Of Patients With At Least One Episode Below Various SpO2 Thresholds For Specific Periods Of Time Among 564 Patients Without Nurse Recorded SpO2 Values > 90%.
     
  Episod > 1 Hour Episode > 2 Hour Episode > 6 hours
SpO2 < 90% 38% 27% 12%
SpO2 < 85% 10% 6% 1%

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