Postoperative Hypoxemia Is Common and Persistent

Abstract

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.

Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery

“…This has likely introduced heterogeneity with potential avoidable oxygen therapy but also untreated hypoxemia being present in our sample. Indeed, hypoxemia 32 has been found to be a common, persistent, and often underdiagnosed postoperative complication. The association of this variable with the reported outcomes, even in the presence of that heterogeneity, emphasizes its importance.…”

Wearable Cardiorespiratory Monitoring Employing a Multimodal Digital Patch Stethoscope: Estimation of ECG, PEP, LVET and Respiration Using a 55 mm Single-Lead ECG and Phonocardiogram

“…Respiratory parameters also play an important role in the clinical, postanesthetic routine. It has been shown that respiratory complications are major causes of prolonged hospital stay, poor overall outcomes, and increased mortality [5][6][7]. Outbreaks of respiratory syndromes such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and the currently ongoing COVID-19 pandemic [8] further emphasize the importance of tools for an early diagnosis [9].…”

A prospective study of post-cesarean delivery hypoxia after spinal anesthesia with intrathecal morphine 150 μg

“…These values were selected based on their use in prior studies. 9,10 If more than half of the oxygen saturation measurements were deemed by the machine to be artifact or of poor quality, then the window was excluded from the analysis. The definition and algorithm to determine whether a reading was artifactual is propriety company information, and not publically available.…”