Room-air Pulse Oximetry Research Articles

Prone Positioning of Patients With Coronavirus Disease 2019 Who Are Nonintubated in Hypoxic Respiratory Distress: Single-Site Retrospective Health Records Review

IntroductionIn March and April 2020 of the coronavirus disease 2019 pandemic, site clinical practice guidelines were implemented for prone positioning of patients with suspected coronavirus disease 2019 in hypoxic respiratory distress who are awake, alert, and spontaneously breathing. The purpose of this pandemic disaster practice improvement project was to measure changes in pulse oximetry associated with prone positioning of patients with coronavirus disease 2019 infection in adult acute respiratory distress or adult respiratory distress syndrome, who are awake, alert, spontaneously breathing, and nonintubated. MethodsA retrospective chart review of patients who were coronavirus disease 2019 positive in the emergency department from March 30, 2020 to April 30, 2020 was conducted for patients with a room air pulse oximetry <90% and a preprone position pulse oximetry ≤94% who tolerated prone positioning for at least 30 minutes. The primary outcome was the change in pulse oximetry associated with prone positioning, measured on room air, with supplemental oxygen, and approximately 30 minutes after initiating prone positioning. Median and mean differences were compared with the Wilcoxon signed-rank test and paired t-test. ResultsOf the 440 patients with coronavirus disease 2019, 31 met inclusion criteria. Median pulse oximetry increased as 83% (interquartile range, 75%-86%) on room air, 90% (interquartile range, 89%-93%) with supplemental oxygen, and 96% (interquartile range, 94%-98%) with prone positioning (z = -4.48, P < .001). A total of 45% (n = 14) were intubated during their hospital stay, and 26% (n = 8) of the included patients died. DiscussionIn patients with coronavirus disease 2019 who are awake, alert, and spontaneously breathing, an initially low pulse oximetry reading improved with prone positioning. Future studies are needed to determine the association of prone positioning with subsequent endotracheal intubation and mortality.

SULFHEMOGLOBINEMIA: SULFURING FROM A RARE CONDITION

SESSION TITLE: Fellows Pulmonary Physiology Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Sulfhemoglobin is a rare dyshemoglobin resulting from incorporation of sulfur into the oxidized form of iron in the hemoglobin moiety. Sulfhemoglobin is unable to bind oxygen for the life of the erythrocyte, leading to discrepant pulse oximetry and arterial oxygen tension (PaO2). Oxygenation of the tissues is only mildly affected due to the right shift of the oxy-hemoglobin dissociation curve for the remaining oxyhemoglobin molecules. Occupational exposures, medications, and sulfide-producing intestinal flora have been implicated in its development. Sulfhemoglobin and methemoglobin share similar presentations of cyanosis, hypoxia without hypoxemia, and absorptive peak wavelengths on co-oximetry, and thus distinguishing the difference can be a diagnostic challenge. CASE PRESENTATION: A 64-year-old female with recent initiation of ferrous sulfate for anemia, Lynch syndrome s/p hysterectomy, abdominal peritoneal resection and pelvic radiation, multiple bowel obstructions s/p end colostomy, and newly diagnosed colonic adenocarcinoma with colovesicular fistula, presented with concern for bowel obstruction. Room air pulse oximetry was around 80% and unresponsive to oxygen. CT PE study demonstrated segmental and subsegmental pulmonary emboli. Anticoagulation was started and she was admitted for exploratory laparotomy. Arterial blood gases on nasal cannula, high flow nasal cannula and CPAP, all demonstrated preserved arterial oxygenation discordant with low observed pulse oximetry. Further workup with TTE, methemoglobin levels, and hemoglobin electrophoresis were normal and a pulmonary consult was requested for preoperative evaluation. Specialized testing sent to Mayo revealed elevated sulfhemoglobin at 3.5%. Ferrous sulfate was discontinued and the patient underwent surgery. Unfortunately, due to inability to fully resect the colonic mass, the patient pursued comfort measures. DISCUSSION: Sulfhemoglobinemia is a rare dyshemoglobinemia reported in conjunction with medications, bowel pathology and occupational exposures. In our patient, ferrous sulfate was the most likely precipitant, but multiple predisposing conditions including colonic malignancy, fistula and previous intra-abdominal surgeries may have contributed. Therapeutic management presents a unique challenge due to the irreversible binding of sulfur to the hemoglobin moiety and lack of response to methylene blue or other antidotes. Treatment focuses on removing the offending agent with repeat evaluation after roughly 120 days. Exchange transfusions can be considered for severe cases. CONCLUSIONS: Sulfhemoglobinemia is a rare but likely under-recognized clinical entity. Given the ubiquitous nature of sulfur-containing medications, the diagnosis should be considered in patients with discordant pulse oximetry and arterial oxygen saturations. Reference #1: Derbas L, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220521 Reference #2: Askew, Stephen et al. On the dysfunctional hemoglobins and cyanosis connection: practical implications for the clinical detection and differentiation of methemoglobinemia and sulfhemoglobinemia. Journal of Biomedical Optics Express. 2018 July, Vol. 9, No. 7 Reference #3: Noor M, Beutler E. Acquired sulfhemoglobinemia. an underreported diagnosis? West J Med 1998;169:386–9 DISCLOSURES: No relevant relationships by Kaitlin Bradley, source=Web Response No relevant relationships by Richard Cornwell, source=Web Response No relevant relationships by Hilary Faust, source=Web Response

Room-air Pulse Oximetry: effects of Smoking, Age, Gender, Blood pressure, Respiratory rate and Body mass index

Room-air Pulse Oximetry: effects of Smoking, Age, Gender, Blood pressure, Respiratory rate and Body mass index

Initial ED oxygen saturation ≤90% increases the risk of a complicated hospital course in pediatric asthmatics requiring admission

Emergency physicians are responsible for admitting children with asthma who do not respond to initial therapy. We examined the hypothesis that an initial room air pulse oximetry ≤90% elevates the risk of a complicated hospital course in children who require admission with acute asthma. MethodsCharts of all patients ages 2 years–17 years admitted for asthma from January 2017 to December 2017 were reviewed. An explicit chart review was performed by trained data extractors using a standardized form. Results: A total of 244 children meeting inclusion criteria were admitted for asthma from the ED during the study period. All patients had an initial room air pulse oximetry documented. Sixty-five were admitted to PICU status (27%), and 179 (73%) were admitted to floor status. The relative risk of a complicated course in those patients presenting with a saturation of ≤90% was 11.3 (95% CI 3.9–32.6). The mean initial pulse oximetry on patients with a complicated course was 85% versus 93% for those without a complicated course (p < 0.005). ConclusionOur data suggest that in pediatric asthmatics that require admission from the ED, those with pulse oximetry readings less than or equal to 90% on presentation are at higher risk of a complicated hospital course.

P068: Significance of asymptomatic oxygen desaturation in elderly ED patients: A pilot study

Introduction: Pulse oximetry is a standard component of Emergency Department (ED) patient monitoring. Pulse oximetry measures peripheral capillary oxygen saturation (SpO2) levels and can be used to monitor cardiorespiratory conditions. The normal SpO2 level for adults is approximately 96%. Oxygen saturations of &amp;lt;92% are considered problematic and levels &amp;lt;90% may indicate cardiorespiratory disease. However, low oxygen saturations are often seen in elderly patients with comorbidities. This research investigated the significance of hypoxia in asymptomatic older ED patients with no apparent acute illness. Methods: ED patients &amp;gt;75 years with a documented room air pulse oximetry reading &amp;lt;92% were eligible. Exclusion criteria included dyspnea, chest pain, SBP &amp;lt;100mmHg, HR &amp;gt;120 or &amp;lt;50; sustained tachypnea (RR &amp;gt; 20); acute cardiopulmonary conditions, delirium or acutely altered mentation. Eligible patients were separated into two groups: 1) Sustained hypoxia: two or more SpO2 readings &amp;lt;92% 2) Unsustained hypoxia: one SpO2 reading &amp;lt;92%. 30-day adverse events were tracked using a Sunrise Emergency Care record review. Adverse outcomes investigated included death, MI, CHF, PE, cardioversion, ICU admission, intubation, ED revisit or re-hospitalization. Patient characteristics studied were age, sex, arrival mode, triage complaint, CTAS level, pulse, BP, RR, weight, residence (independent, assisted living, facility), comorbidities, PHN, referral, disposition, and test results (CXR, troponin, ECG, CT). Follow-up phone calls were completed after 30 days to assess patient status and confirm ED revisit. Results: A total of 876 ED patients &amp;gt;75 years were screened and 30-day follow-up data was analyzed for 34 enrolled patients. The sustained hypoxia group (n = 23) showed higher rates of 30-day adverse outcomes of death, ED re-visitation, MI, CHF, a severe episode of COPD, PE and ICU stays compared to the unsustained hypoxia group (n = 11). Administrative data of 31,095 patients &amp;gt;75 years from four Calgary EDs in 2017 was also analyzed and 7,771 (20%) were hypoxic at triage (SpO2 &amp;lt;92%). Adverse outcomes and mortality were significant in discharged hypoxic patients (especially if SpO2 &amp;lt;90%). Conclusion: ED re-visits, cardiorespiratory complications, and mortality were significant in discharged sustained hypoxic patients, especially if O2 sat &amp;lt;90%. Pulse oximetry assessment of oxygen saturation in seniors’ care facilities and physicians’ offices may be important in screening for future adverse health outcomes in elderly patients.

Diagnostic room-air pulse oximetry: Effects of age, smoking, sex, respiratory rate, blood pressure and body mass index

Diagnostic room-air pulse oximetry: Effects of age, smoking, sex, respiratory rate, blood pressure and body mass index

Characteristics of Alpha-1 Antitrypsin-Deficient Individuals in the Long-term Oxygen Treatment Trial and Comparison with Other Subjects with Chronic Obstructive Pulmonary Disease.

Alpha-1 antitrypsin deficiency (AATD) predisposes to chronic obstructive pulmonary disease, but is underrecognized. Oxygenation and exercise desaturation in individuals with AATD-associated chronic obstructive pulmonary disease has been sparsely studied. The Long-term Oxygen Treatment Trial (LOTT) permits comparing these features of individuals with AATD with alpha-1 antitrypsin-replete (called "usual chronic obstructive pulmonary disease") LOTT participants. Compare demographic, clinical, baseline oxygenation, and exercise desaturation features in participating AATD subjects with those of other LOTT subjects. LOTT is a multicenter randomized controlled trial comparing use of supplemental oxygen versus not in subjects with chronic obstructive pulmonary disease and moderate hypoxemia (resting oxygen saturation as measured by pulse oximetry, 89-93%) or normal oxygen saturation at rest and significant exercise desaturation. Among the 597 LOTT participants with nonmissing alpha-1 antitrypsin levels, 11 (1.8%) had severe AATD and 44 (7.4%) had mild/moderate AATD. Comparison of the 11 severely AAT-deficient individuals with the 542 LOTT participants with usual chronic obstructive pulmonary disease showed that the AATD subjects were younger and despite less smoking, had lower FEV1/FVC (mean post-bronchodilator FEV1/FVC, 0.38 ± 0.06 vs. 0.46 ± 0.13; P = 0.002). Comparison with 27 age-, sex-, and FEV1-matched alpha-1 antitrypsin-normal LOTT participants showed no baseline difference in resting room air pulse oximetry saturation (AATD, 93.6% ± 2.3% vs. 92.7% ± 2.2%; P = 0.64). Exercise-related desaturation was more severe in the individuals with AATD based on desaturation to 88% or less sooner during a 6-minute-walk test, having a higher percentage of desaturation points (e.g., <90%) during exercise, and having a higher distance-saturation product (defined as the distance walked in 6 min multiplied by the nadir saturation achieved during the 6-minute-walk test). These data suggest that individuals with AATD experience more profound desaturation with exercise than age-, sex-, race-, and FEV1-matched control subjects with usual chronic obstructive pulmonary disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00692198).

Diagnostic evaluation of hepatopulmonary syndrome in Egyptian children with chronic liver disease.

There are few data on prevalence of hepatopulmonary syndrome (HPS) in children with chronic liver disease (CLD). This prospective study evaluated the prevalence and diagnostic procedures of HPS in Egyptian children with CLD. One hundred twenty (120) children with CLD were subjected to room-air pulse oximetry in supine and upright position, contrast enhanced echocardiography (CEE) and technetium-99m-labeled macroaggregated albumin (99mTc-MAA) perfusion lung scan. Arterial blood gas (ABG) analysis in upright position was performed for all children with identified intrapulmonary vascular dilatation (IPVD). Clinical, laboratory, imaging and endoscopic data were recorded and analyzed. Hypoxemia was found in 14 cases (11.7%) of the total cohort all of them had IPVD, whereas 6 cases (5%) of the patients had IPVD without hypoxemia. Therefore, HPS and subclinical HPS were diagnosed in 11.7% and 5% of CLD patients, respectively. Only 10 HPS patients had a pathological arterial oxygen saturation (SaO2) in the supine position (< or = 97%) but all showed a pathological SaO2 decrease (> or = 4%) after changing from supine to upright position. 99mTc-MAA perfusion lung scan revealed IPVD in 16.7% whereas CEE detected IPVD in 10% only of enrolled patients. There were strong correlations between shunt index estimated by lung scintiscan and oxygenation parameters in HPS patients. The characteristics of HPS patients were similar to that of non-HPS patients except for clubbing, dyspnea, cyanosis, orthodoexia and bleeding varices that were more associated with HPS patients as well as well as the Child-Pugh grades, which tended toward higher scores in HPS patients.

Mediastinal Thoracic Duct Cyst

Thoracic duct cysts of the mediastinum are rare. This case report describes a 68-year-old woman who was successfully treated with surgical resection. The clinical and radiographic presentation and pathology are discussed, and the pertinent literature is reviewed.

Pulmonary Embolism Risk Stratification: Pulse Oximetry and Pulmonary Embolism Severity Index

Risk stratification of pulmonary embolism (PE) patients is important to determine appropriate management. We evaluated two published risk-stratification tools in emergency department (ED) PE patients: a pulse oximetry cutoff below 92.5% oxygen (at 5280 feet elevation) and the Pulmonary Embolism Severity Index (PESI). Electronic medical records of all patients diagnosed with PE were abstracted to identify their triage vital signs, co-morbidities, and adverse short-term outcomes (AO) either requiring interventions (defined as respiratory failure, hypotension requiring pressors, and hemodynamic impairment requiring thrombolytics) or resulting in death. We applied these models to our ED PE patients and assessed their performance. There were 168 PE patients identified, with an overall AO rate of 7.1% (12/168), including a 3.0% mortality rate. A room-air pulse oximetry cutoff of 92.5%, for values measured at 5280 feet, classified 89/136 patients as low risk, 1.1% of which had an AO, and 47/136 patients as high risk, of which 10.6% had AO. This pulse oximetry cutoff had a sensitivity of 83% (95% confidence interval [CI] 36-99%), specificity of 68% (95% CI 58-76%), and a negative predictive value (NPV) of 99% (95% CI 93-100%). PESI classified 91/168 patients as low risk (class I or II): 2.2% had AO but none died, and 77/168 were classified as high risk (class III, IV, or V), with an AO rate of 13.0%. A PESI cutoff score of II had a sensitivity of 83% (95% CI 52-98%), specificity of 57% (95% CI 49-65%), and NPV of 98% (95% CI 92-100%). Both PESI and pulse oximetry measurements are moderately accurate identifiers of low-risk patients with PE.

Diagnostic room-air pulse oximetry: effects of smoking, race, and sex

Objective We sought to determine the distribution of oximetry (Sp o 2) values in awake, asymptomatic adults and the effect of personal characteristics on these values. Methods Using a cross-sectional design, we sampled oximetry readings in awake, asymptomatic adults in an emergency department setting. Personal characteristics were analyzed using logistic regression, with lower oximetry readings, defined by the 20th percentile, as the dependent variable. Results Of 871 eligible subjects, 50 (5.7%) had an Sp o 2 value less than 97%, and 13 (1.5%) had an Sp o 2 value less than 96%. Lower readings were associated with the following characteristics (odds ratio with 95% confidence interval): male sex, 3.8 (2.5-5.6); age ≥60 years, 2.4 (1.3-4.5); white race, 5.3 (3.6-7.8); obesity, 3.2 (2.1-4.8); history of asthma, 3.2 (1.6-6.2). Smoking was not associated with lower Sp o 2 values. Conclusion Room-air Sp o 2 values less than 97% are rare in asymptomatic, awake adults. White race and male sex are associated with lower Sp o 2 readings.

Derivation of a Triage Algorithm for Chest Radiography of Community‐acquired Pneumonia Patients in the Emergency Department

Community-acquired pneumonia (CAP) accounts for 1.5 million emergency department (ED) patient visits in the United States each year. To derive an algorithm for the ED triage setting that facilitates rapid and accurate ordering of chest radiography (CXR) for CAP. The authors conducted an ED-based retrospective matched case-control study using 100 radiographic confirmed CAP cases and 100 radiographic confirmed influenzalike illness (ILI) controls. Sensitivities and specificities of characteristics assessed in the triage setting were measured to discriminate CAP from ILI. The authors then used classification tree analysis to derive an algorithm that maximizes sensitivity and specificity for detecting patients with CAP in the ED triage setting. Temperature greater than 100.4 degrees F (likelihood ratio = 4.39, 95% confidence interval [CI] = 2.04 to 9.45), heart rate greater than 110 beats/minute (likelihood ratio = 3.59, 95% CI = 1.82 to 7.10), and pulse oximetry less than 96% (likelihood ratio = 2.36, 95% CI = 1.32 to 4.20) were the strongest predictors of CAP. However, no single characteristic was adequately sensitive and specific to accurately discriminate CAP from ILI. A three-step algorithm (using optimum cut points for elevated temperature, tachycardia, and hypoxemia on room air pulse oximetry) was derived that is 70.8% sensitive (95% CI = 60.7% to 79.7%) and 79.1% specific (95% CI = 69.3% to 86.9%). No single characteristic adequately discriminates CAP from ILI, but a derived clinical algorithm may detect most radiographic confirmed CAP patients in the triage setting. Prospective assessment of this algorithm will be needed to determine its effects on the care of ED patients with suspected pneumonia.

Diagnosis of Pulmonary Embolism

Case 1: A 77-year-old Caucasian woman with a probable diagnosis of ovarian cancer developed an acute onset of shortness of breath two days after being discharged for a workup of symptomatic ascites. Her medical history was signifi cant for hypertension and atrial fi brillation, and she was taking therapeutic doses of coumadin. She presented to the emergency department; was found to have a large, left pleural effusion; and was admitted to the hospital. A thoracentesis removed 2.1 L of fl uid. The patient’s respiratory distress improved; however, she experienced a second episode of sudden onset shortness of breath prior to her anticipated discharge. She was afebrile, with a room air pulse oximetry of 80%, pulse of 121 beats per minute, and respiratory rate of 28. A chest x-ray (CXR) showed only a small pleural effusion remaining on the left. An electrocardiogram (EKG) showed atrial fi brillation. A chest computed tomography (CT) was performed and showed bilateral pulmonary emboli.

Presentation of Congenital Heart Disease in the Neonate and Young Infant

Presentation of Congenital Heart Disease in the Neonate and Young Infant

The sensitivity of room-air pulse oximetry in the detection of hypercapnia

Objective To estimate the sensitivity of room-air pulse oximetry in the detection of moderate hypercapnia. Methods In this retrospective case-control study, charts were reviewed from patients with and without moderate hypercapnia (Pa co 2 >50 mm Hg), as determined by analysis of arterial blood gas samples obtained in the ED. Test characteristics (sensitivity, specificity, and likelihood ratios [LR) for room-air pulse oximetry ≤96% to detect hypercapnia were calculated, as were confidence intervals. Results A total of 349 charts were eligible for abstraction—92 cases and 257 controls. A room-air pulse oximetry reading ≤96% detected 88 of 92 cases of hypercapnia. Test characteristics were as follows (with 95% confidence interval): sensitivity, 0.96 (0.89-0.99); specificity, 0.39 (0.33-0.45), LR of a room-air pulse oximetry value >96%, 0.1 (0.04-0.3); and LR of a room-air pulse oximetry value ≤96%, 1.6 (1.4-1.7). Conclusion Room-air pulse oximetry detects moderate hypercapnia with high sensitivity.

Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism

Abstract Purpose A simple method is needed to risk stratify normotensive patients with pulmonary embolism. We studied whether bedside clinical data can predict in-hospital complications from pulmonary embolism. Methods We performed a multicenter derivation phase, followed by validation in a single center. All patients were normotensive; the diagnosis of pulmonary embolism was established by objective imaging. Classification and regression analysis was performed to derive a decision tree from 27 parameters recorded from 207 patients. The validation study was conducted on a separate group of 96 patients to determine the derived criterion's diagnostic accuracy for in-hospital complications (cardiogenic shock, respiratory failure, or death). Results Mortality in the derivation phase was 4% (n = 8) at 24 hours and 10% (n = 21) at 30 days. A room-air pulse oximetry reading Conclusion Mortality from pulmonary embolism in normotensive patients is high. A room-air pulse oximetry reading ≥95% at diagnosis is associated with a significantly lower probability of in-hospital complications from pulmonary embolism.

Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism

Purpose A simple method is needed to risk stratify normotensive patients with pulmonary embolism. We studied whether bedside clinical data can predict in-hospital complications from pulmonary embolism. Methods We performed a multicenter derivation phase, followed by validation in a single center. All patients were normotensive; the diagnosis of pulmonary embolism was established by objective imaging. Classification and regression analysis was performed to derive a decision tree from 27 parameters recorded from 207 patients. The validation study was conducted on a separate group of 96 patients to determine the derived criterion's diagnostic accuracy for in-hospital complications (cardiogenic shock, respiratory failure, or death). Results Mortality in the derivation phase was 4% (n = 8) at 24 hours and 10% (n = 21) at 30 days. A room-air pulse oximetry reading <95% was the most important predictor of death; mortality was 2% (95% confidence interval [CI]: 0% to 6%) in patients with pulse oximetry ≥95% versus 20% (95% CI: 12% to 29%) with pulse oximetry <95%. In the validation phase, the room-air pulse oximetry was <95% at the time of diagnosis in 9 of 10 patients who developed an in-hospital complication (sensitivity, 90%) and ≥95% in 55 of 86 patients without complications (specificity, 64%). Conclusion Mortality from pulmonary embolism in normotensive patients is high. A room-air pulse oximetry reading ≥95% at diagnosis is associated with a significantly lower probability of in-hospital complications from pulmonary embolism.

The ability of pulse oximetry to screen for hypoxemia and hypercapnia in patients breathing room air

This study was designed to determine whether high room-air pulse oximetry can rule out hypoxemia or moderate hypercapnia. Based on retrospective analysis of 513 arterial blood gas results, oxygen saturation cutpoints were derived. Coincidentally, a room-air oxygen saturation (RAO 2 sat) value of 96% was selected as a cutpoint to screen for both hypoxemia (PaO 2 < 70 mm Hg) and moderate hypercapnia (PaCO 2 > 50 mm Hg). These tests were validated prospectively by using a convenience sample of 213 Emergency Department patients in whom room-air arterial blood gas sampling was ordered. To detect hypoxemia, the sensitivity of RAO 2 sat ≤ 96% was 1.0 [0.95–1.0, 95% confidence interval (CI)] and specificity was 0.54 (0.45–0.64, 95% CI). To detect hypercapnia, the sensitivity of RAO 2 sat ≤ 96% was 1.0 (0.7–1.0) and specificity was 0.31 (0.25–0.38, 95% CI). We concluded that RAO 2 sat ≥ 97% rules out hypoxemia and may also rule out moderate hypercapnia.

Can room air pulse oximetry be used to screen for clinically significant hypercapnia?

Can room air pulse oximetry be used to screen for clinically significant hypercapnia?

Contribution of Routine Pulse Oximetry to Evaluation and Management of Patients With Respiratory Illness in a Pediatric Emergency Department

Study objective: To determine whether routine pulse oximetry in a pediatric emergency department can be used to identify patients with a low oxygen saturation (SaO 2) that is unexpected on the basis of clinical evaluation. Design: Prospective comparison of blinded, clinical evaluation by physicians with subsequent pulse oximetry readings. Setting:Pediatric ED in an urban,university medical center. Participants: A convenience sample of 368 patients presenting to the pediatric ED with respiratory illnesses. Methods: The history, physical examination, pediatric ED management, and therapy were recorded. Based on clinical assessment, the physician was asked whether the patient had a low SaO 2(≤92%). Room-air pulse oximetry was then obtained, with subsequent treatment and management plans recorded. Results: Clinical assessment had a sensitivity of 33%, specificity of 86%, negative predictive value of 85%, and positive predictive value of 35% for detecting children with low SaO 2. Unexpected low SaO 2 usually led to a change in patient management or disposition. Conclusion: Clinical evaluation in a pediatric ED does not screen adequately for the detection of hypoxemia and should be supplemented by routine pulse oximetry in all patients with respiratory findings. [Maneker AJ, Petrack EM, Krug SE: Contribution of routine pulse oximetry to evaluation and management of patients with respiratory illness in a pediatric emergency department. Ann Emerg Med January 1995;25:36-40.]