Study of early warning for desaturation provided by Oxygen Reserve Index in obese patients

Ekaterina Tsymbal,Richard L Applegate,Amrik Singh,Neal W Fleming,Sebastian Ayala

doi:10.1007/s10877-020-00531-w

Ekaterina Tsymbal, Richard L Applegate + Show 3 more

Open Access

https://doi.org/10.1007/s10877-020-00531-w

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Abstract

Acute hemoglobin desaturation can reflect rapidly decreasing PaO2. Pulse oximetry saturation (SpO2) facilitates hypoxia detection but may not significantly decrease until PaO2 < 80 mmHg. The Oxygen Reserve Index (ORI) is a unitless index that correlates with moderately hyperoxic PaO2. This study evaluated whether ORI provides added arterial desaturation warning in obese patients. This IRB approved, prospective, observational study obtained written informed consent from Obese (body mass index (BMI) kg m−2; 30 < BMI < 40) and Normal BMI (19 < BMI < 25) adult patients scheduled for elective surgery requiring general endotracheal anesthesia. Standard monitors and an ORI sensor were placed. Patient’s lungs were pre-oxygenated with 100% FiO2. After ORI plateaued, general anesthesia was induced, and endotracheal intubation accomplished using a videolaryngoscope. Patients remained apneic until SpO2reached 94%. ORI and SpO2 were recorded continuously. Added warning time was defined as the difference between the time to SpO2 94% from ORI alarm start or from SpO2 97%. Data are reported as median; 95% confidence interval. Complete data were collected in 36 Obese and 36 Normal BMI patients. ORI warning time was always longer than SpO2 warning time. Added warning time provided by ORI was 46.5 (36.0–59.0) seconds in Obese and 87.0 (77.0–109.0) seconds in Normal BMI patients, and was shorter in Obese than Normal BMI patients difference 54.0 (38.0–74.0) seconds (p < 0.0001). ORI provided what was felt to be clinically significant added warning time of arterial desaturation compared to SpO2. This added time might allow earlier calls for help, assistance from other providers, or modifications of airway management.Trial registration ClinicalTrials.gov NCT03021551.

Highlights

Prolonged hypoxemia can produce tissue injury and serious perioperative complications including dysrhythmias, brain injury or death [1]
The incidence of co-existing diseases was greater in Obese patients, but the distribution of American Society of Anesthesiologists Patient Status classifications was comparable between the two study groups (Chi-square p = 0.337)
We found Oxygen Reserve Index (ORI) provides a clinically significant added warning time for impending desaturation in both Obese and Normal BMI patients

Summary

Introduction

Prolonged hypoxemia can produce tissue injury and serious perioperative complications including dysrhythmias, brain injury or death [1]. Prior to widespread utilization of pulse oximetry, hypoxemia was the leading cause of anesthesiaassociated perioperative mortality worldwide [2]. Arterial blood gas (ABG) analysis provides a definitive measurement of oxygenation status [4], but is limited by its intermittent and invasive nature. Provides efficient cost-effective monitoring, so it is often used in lieu of ABG analysis [4]. Pulse oximetry oxygen saturation (SpO2) is determined by measuring the absorption of two emitted light wavelengths (660 nm and 940 nm) and calculating the proportion of oxyhemoglobin to deoxyhemoglobin [5]. S pO2 decreases rapidly as P aO2 falls below 80 mmHg and can fail to provide early detection of impending critical hypoxemia [4, 6, 7]. There are many clinical scenarios and patient factors that increase the risk

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