Hypoxaemia Is Reduced by Pulse Oximetry Monitoring in the Operating Theatre and in the Recovery Room

Møller, Jakob Møllenbach; Jensen, Per; Johannessen, N. W.; Espersen, Kurt

doi:10.1093/bja/68.2.146

Cited by 70 publications

(21 citation statements)

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“…For example, respiratory compromise is a more common cause of postoperative admission and read-mission to critical care units than cardiac dysrhythmias. 25,26 Saturation monitoring clearly facilitates diagnosis of hypoxemia, 27 and treatment enhances saturation. 28 …”

Section: Discussionmentioning

confidence: 99%

Postoperative Hypoxemia Is Common and Persistent

Sun

Sessler²,

Dalton

et al. 2015

Anesthesia &Amp; Analgesia

250

114

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BACKGROUND The incidence, severity, and duration of postoperative oxygen desaturation in the general surgical population are poorly characterized. We therefore used continuous pulse oximetry to quantify arterial oxygen saturation (SpO2) in a cross-section of patients having noncardiac surgery. METHODS Oxygen saturation, blinded to clinicians, was recorded at 1-minute intervals in patients >45 years old for up to 48 hours after noncardiac surgery in 1250 patients from Cleveland Clinic Main Campus and 250 patients from the Juravinski Hospital. We determined (1) the cumulative minutes of raw minute-by-minute values below various hypoxemic thresholds; and (2) the contiguous duration of kernel-smoothed (sliding window) values below various hypoxemic thresholds. Finally, we compared our blinded continuous values with saturations recorded during routine nursing care. RESULTS Eight hundred thirty-three patients had sufficient data for analyses. Twenty-one percent had ≥10 min/h with raw SpO2 values <90% averaged over the entire recording duration; 8% averaged ≥20 min/h <90%; and 8% averaged ≥5 min/h <85%. Prolonged hypoxemic episodes were common, with 37% of patients having at least 1 (smoothed) SpO2 <90% for an hour or more; 11% experienced at least 1 episode lasting ≥6 hours; and 3% had saturations <80% for at least 30 minutes. Clinical hypoxemia, according to nursing records, measured only in Cleveland Clinic patients (n = 594), occurred in 5% of the monitored patients. The nurses missed 90% of smoothed hypoxemic episodes in which saturation was <90% for at least one hour. CONCLUSIONS Hypoxemia was common and prolonged in hospitalized patients recovering from noncardiac surgery. The SpO2 values recorded in medical records seriously underestimated the severity of postoperative hypoxemia.

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Section: Discussionmentioning

confidence: 99%

Postoperative Hypoxemia Is Common and Persistent

Sun

Sessler²,

Dalton

et al. 2015

Anesthesia &Amp; Analgesia

250

114

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“…[1] Postoperative hypoxaemia occurs commonly and has been documented even after minor procedure under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Hypoxaemia is one of the most feared critical events during anesthesia and the recovery period. [1] Arterial hypoxaemia can occur anytime during anesthesia with astonishing suddenness. Severe hypoxaemia can kill a patient or leave the victim with devastating neurological handicaps.…”

Section: Introductionmentioning

confidence: 99%

Detection of hypoxia in the early postoperative period

et al. 2012

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The aim of this study was to determine the incidence of early postoperative hypoxia after general anesthesia and to evaluate the need of oxygen supplementation. A total of 150 patients aged between 18–60 years belonging to ASA I or II were studied. Patients were alternately allocated to two groups of 75 each. Group-I (n=75) patients received 2 L of oxygen via nasopharyngeal catheter during transfer from operation theatre to recovery room and in the recovery room for a period of 4 h. Group–II (n=75) patients did not receive oxygen either during transfer or in the recovery room. Twenty percent in Group–II developed hypoxaemia during transfer from operation theatre to recovery room out of which 24% developed mild (SaO2 86–90%), 2.66% moderate (SaO2 85–81%), and 1.33% extreme (SaO2 <76%) hypoxaemia. None of the patients in Group – I, who received oxygen supplementation, developed hypoxaemia in the early postoperative period.

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“…Since then, anesthesia-related mortality has dropped nearly 20-fold in developed settings 8-10. Much of this decline is attributable to improvements in the safety of anesthesia administration and monitoring, including the nearly universal use of pulse oximetry that has been associated with the earlier diagnosis and correction of hypoxemia 7,11-14…”

mentioning

confidence: 99%

The incidence of hypoxemia during surgery: evidence from two institutions

Ehrenfeld

Funk

Schalkwyk

et al. 2010

Can J Anesth/J Can Anesth

102

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Purpose The incidence of hypoxemia in patients undergoing surgery is largely unknown and may have a clinical impact. The objective of this study was to determine the incidence of intraoperative hypoxemia in a large surgical population. Methods We performed a retrospective study of electronically recorded pulse oximetry data obtained from two large academic medical centres. All adults (age C 16 yr) undergoing non-cardiac surgery during a three-year period at the two hospitals were included in the analysis. Our main outcome measure was the percentage of patients with episodes of hypoxemia (SpO 2 \ 90) or severe hypoxemia (SpO 2 B 85) for two minutes or longer during the intraoperative period (induction of anesthesia, surgery, and emergence). Results We evaluated 95,407 electronic anesthesia records at the two hospitals. During the intraoperative period, 6.8% of patients had a hypoxemic event, and 3.5% of patients had a severely hypoxemic event of two consecutive minutes or longer. Seventy percent of the hypoxemic episodes occurred during either induction or emergence-time periods that represent 21% of the total intraoperative time. From induction to emergence, one episode of hypoxemia occurred every 28.9 hr, and one episode of severe hypoxemia occurred every 55.7 hr of intraoperative time. Conclusion Despite advances in monitoring technology, hypoxemia continues to occur commonly in the operating room and may be a serious safety concern because of its potential impact on end organ function and long-term outcomes. Further studies are needed to improve our understanding of the clinical impact of intraoperative hypoxemia and the strategies that will be most useful in minimizing its occurrence. RésuméObjectif L'incidence de l'hypoxe´mie chez les patients subissant une chirurgie est tre`s mal connue et pourrait avoir des re´percussions cliniques. L'objectif de cette e´tude e´tait de de´terminer l'incidence de l'hypoxe´mie perope´ratoire chez une vaste population chirurgicale. Méthode Nous avons re´alise´une e´tude re´trospective des donne´es d'oxyme´trie du pouls sauvegarde´es e´lectroniquement dans deux centres me´dicaux universitaires importants. Dans notre analyse, nous avons inclus tous les adultes (aˆge C 16 ans) subissant une chirurgie non cardiaque au cours d'une

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Hypoxaemia Is Reduced by Pulse Oximetry Monitoring in the Operating Theatre and in the Recovery Room

Cited by 70 publications

References 0 publications

Postoperative Hypoxemia Is Common and Persistent

Postoperative Hypoxemia Is Common and Persistent

Detection of hypoxia in the early postoperative period

The incidence of hypoxemia during surgery: evidence from two institutions

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