Abstract
BackgroundBoth 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.MethodsIn 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.ResultsEighty 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.ConclusionsMedical 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.
Highlights
Both inadequate and excessive administration of oxygen to acutely unwell patients results in risk of harm
The 2015 British Thoracic Society (BTS) national emergency oxygen audit demonstrated only 69% of patients receiving oxygen had Peripheral oxygen saturation (SpO2) within a prescribed range when evaluated at a single timepoint [12] and a 2017 Australian audit demonstrated S pO2 matched a prescribed range in 61% of patients admitted to an Acute Medical Unit [13]
Adults admitted to Wellington Regional Hospital (WRH) and Hutt Valley Hospital (HVH) with an acute illness who were under the care of a medical team in a general ward or high dependency setting and were receiving oxygen with a clinician prescribed target SpO2 range were eligible for inclusion
Summary
Both inadequate and excessive administration of oxygen to acutely unwell patients results in risk of harm. There are no studies using continuous S pO2 monitoring, investigating the proportion of time patients spend with SpO2 within a prescribed target range and the time-exposure to oxygen saturation above and below range. This is important in order to understand the risk associated with oxygen therapy in current clinical practice and how this risk can be reduced
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