Chest
Reliability of Pulse Oximetry in Titrating Supplemental Oxygen Therapy in Ventilator-Dependent Patients
Section snippets
Hospital Survey
A telephone survey was conducted to determine if pulse oximetry is being used to evaluate the response to titrations in FIo2. The medical directors of 25 hospitals (both university affiliated and private community hospitals) from various geographic locations throughout the United States were contacted. The medical director was asked whether he/she used pulse oximetry to titrate FIo2 in ventilator-dependent patients, and, if so, what target SpO2 he/she employed.
Patient Study
Patients: Fifty-four patients
Hospital Survey
The target SpO2 values employed by the directors of ICUs at the various institutions that we surveyed are displayed in Figure 1. A wide scatter of target SpO2 values is apparent (85 percent to 95 percent). In addition, one physician decreased FIo2 until a SpO2 of 90 percent was reached, at which time, FIo2 was increased by 0.10. Of note was the fact that 64 percent of the physicians employed a SpO2 target of 90 percent or less. Although 22 (88 percent) of the ICU directors stated that they used
DISCUSSION
This study indicates that physicians employ a wide variety of target SpO2 values when using pulse oximetry to assess the response to titrations of FIo2 in ventilator-dependent patients (Fig 1). Although we found that pulse oximetry was reliable when assessing the response to adjustments of FIo2, the optimal SpO2 target value depended on the patient’s skin color. In white patients, a SpO2 target of 92 percent was reliable in predicting a satisfactory level of oxygenation. In black patients,
ACKNOWLEDGMENT
The authors gratefully thank Drs. Robert F. Lodato and Gilbert D’Alonzo for their helpful comments, and the medical residents and nursing staff for their assistance with this project. In addition, we are indebted to the young woman whose medical problem stimulated this study.
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Manuscript received September 21; revision accepted December 18.
Reprint requests: Dr. Jubran, University of Texas at Houston, 6431 Fannin, Houston 77030