Skip to main content
Top
Published in: BMC Pulmonary Medicine 1/2021

Open Access 01-12-2021 | Obstructive Sleep Apnea Syndrome | Research

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

Authors: James C. P. Harper, Ruth Semprini, Nethmi A. Kearns, Lee Hatter, Grace E. Bird, Irene Braithwaite, Allie Eathorne, Mark Weatherall, Richard Beasley

Published in: BMC Pulmonary Medicine | Issue 1/2021

Login to get access

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.
Literature
1.
go back to reference O’Driscoll BR, Howard LS, Bucknall C, et al. British Thoracic Society emergency oxygen audits. Thorax. 2011;66:734–5.CrossRef O’Driscoll BR, Howard LS, Bucknall C, et al. British Thoracic Society emergency oxygen audits. Thorax. 2011;66:734–5.CrossRef
2.
go back to reference Haldane JS. A Lecture on the Symptoms, Causes, and Prevention of Anoxaemia (Insufficient Supply of Oxygen to the Tissues), and the Value of Oxygen in its Treatment. BMJ. 1919;2:65–71.CrossRef Haldane JS. A Lecture on the Symptoms, Causes, and Prevention of Anoxaemia (Insufficient Supply of Oxygen to the Tissues), and the Value of Oxygen in its Treatment. BMJ. 1919;2:65–71.CrossRef
3.
go back to reference O’Driscoll BR, Howard LS, Davison AG. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008;63(Suppl 6):vi1-68.PubMed O’Driscoll BR, Howard LS, Davison AG. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008;63(Suppl 6):vi1-68.PubMed
4.
go back to reference British Thoracic Society Emergency Oxygen Guideline Group. BTS Guidelines for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72(Suppl 1):ii1-ii90.. British Thoracic Society Emergency Oxygen Guideline Group. BTS Guidelines for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72(Suppl 1):ii1-ii90..
5.
go back to reference Beasley R, Chien J, Douglas J, et al. Target oxygen saturation range: 92–96% Versus 94–98%. Respirology. 2017;22:200–2.CrossRef Beasley R, Chien J, Douglas J, et al. Target oxygen saturation range: 92–96% Versus 94–98%. Respirology. 2017;22:200–2.CrossRef
6.
go back to reference Beasley R, Chien J, Douglas J, et al. Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: Swimming between the flags. Respirology. 2015;20:1182–91.CrossRef Beasley R, Chien J, Douglas J, et al. Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: Swimming between the flags. Respirology. 2015;20:1182–91.CrossRef
7.
go back to reference Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 2018;391:1693–705.CrossRef Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 2018;391:1693–705.CrossRef
8.
go back to reference Siemieniuk RAC, Chu DK, Kim LHY, et al. Oxygen therapy for acutely ill medical patients: A clinical practice guideline. BMJ. 2018;363:1–10. Siemieniuk RAC, Chu DK, Kim LHY, et al. Oxygen therapy for acutely ill medical patients: A clinical practice guideline. BMJ. 2018;363:1–10.
9.
go back to reference Austin MA, Wills KE, Blizzard L, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010;341:c5462–c5462.CrossRef Austin MA, Wills KE, Blizzard L, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010;341:c5462–c5462.CrossRef
10.
go back to reference Buist M, Bernard S, Nguyen TV, et al. Association between clinically abnormal observations and subsequent in-hospital mortality: A prospective study. Resuscitation. 2004;62:137–41.CrossRef Buist M, Bernard S, Nguyen TV, et al. Association between clinically abnormal observations and subsequent in-hospital mortality: A prospective study. Resuscitation. 2004;62:137–41.CrossRef
11.
go back to reference Bowton DL, Scuderi PE, Haponik EF. The incidence and effect on outcome of hypoxemia in hospitalized medical patients. Am J Med. 1994;97:38–46.CrossRef Bowton DL, Scuderi PE, Haponik EF. The incidence and effect on outcome of hypoxemia in hospitalized medical patients. Am J Med. 1994;97:38–46.CrossRef
13.
go back to reference Kamran A, Chia E, Tobin C. Acute oxygen therapy: an audit of prescribing and delivery practices in a tertiary hospital in Perth. Western Australia Intern Med J. 2018;48:151–7.PubMed Kamran A, Chia E, Tobin C. Acute oxygen therapy: an audit of prescribing and delivery practices in a tertiary hospital in Perth. Western Australia Intern Med J. 2018;48:151–7.PubMed
15.
go back to reference Cameron L, Pilcher J, Weatherall M, et al. The risk of serious adverse outcomes associated with hypoxaemia and hyperoxaemia in acute exacerbations of COPD. Postgrad Med J. 2012;88:684–9.CrossRef Cameron L, Pilcher J, Weatherall M, et al. The risk of serious adverse outcomes associated with hypoxaemia and hyperoxaemia in acute exacerbations of COPD. Postgrad Med J. 2012;88:684–9.CrossRef
18.
go back to reference Claure N, Bancalari E. Automated closed loop control of inspired oxygen concentration. Respir Care. 2013;58:151–61.CrossRef Claure N, Bancalari E. Automated closed loop control of inspired oxygen concentration. Respir Care. 2013;58:151–61.CrossRef
19.
go back to reference Lellouche F, Bouchard PA, Roberge M, et al. Automated oxygen titration and weaning with FreeO2 in patients with acute exacerbation of COPD: a pilot randomized trial. Int J COPD. 2016;11:1983–90.CrossRef Lellouche F, Bouchard PA, Roberge M, et al. Automated oxygen titration and weaning with FreeO2 in patients with acute exacerbation of COPD: a pilot randomized trial. Int J COPD. 2016;11:1983–90.CrossRef
22.
go back to reference Albin RJ, Criner GJ, Thomas S, et al. Pattern of non-ICU inpatient supplemental oxygen utilization in a university hospital. Chest. 1992;102:1672–5.CrossRef Albin RJ, Criner GJ, Thomas S, et al. Pattern of non-ICU inpatient supplemental oxygen utilization in a university hospital. Chest. 1992;102:1672–5.CrossRef
23.
go back to reference Hansen EF, Hove JD, Bech CS, et al. Automated oxygen control with O2matic® during admission with exacerbation of COPD. Int J COPD. 2018;13:3997–4003.CrossRef Hansen EF, Hove JD, Bech CS, et al. Automated oxygen control with O2matic® during admission with exacerbation of COPD. Int J COPD. 2018;13:3997–4003.CrossRef
Metadata
Title
Determination of oxygen saturation compared to a prescribed target range using continuous pulse oximetry in acutely unwell medical patients
Authors
James C. P. Harper
Ruth Semprini
Nethmi A. Kearns
Lee Hatter
Grace E. Bird
Irene Braithwaite
Allie Eathorne
Mark Weatherall
Richard Beasley
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2021
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-021-01700-6

Other articles of this Issue 1/2021

BMC Pulmonary Medicine 1/2021 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.