Supplement oxygen impairs detection of hypoventilation by pulse oximetry

Eugene Fu, John B. Downs, John W. Schweiger, Rafael V. Miguel, Robert A. Smith

Research output: Contribution to journalArticle

220 Citations (Scopus)

Abstract

Study objective: This two-part study was designed to determine the effect of supplemental oxygen on the detection of hypoventilation, evidenced by a decline in oxygen saturation (SpO2) with pulse oximetry. Design: Phase 1 was a prospective, patient-controlled, clinical trial. Phase 2 was a prospective, randomized, clinical trial. Setting: Phase 1 took place in the operating room. Phase 2 took place in the postanesthesia care unit (PACU). Patients: In phase 1, 45 patients underwent abdominal, gynecologic, urologie, and lower-extremity vascular operations. In phase 2, 288 patients were recovering from anesthesia. Intervention: In phase 1, modeling of deliberate hypoventilation entailed decreasing by 50% the minute ventilation of patients receiving general anesthesia. Patients breathing a fraction of inspired oxygen (FIO2) of 0.21 (n = 25) underwent hypoventilation for up to 5 min. Patients with an FIO2 of 0.25 (n = 10) or 0.30 (n = 10) underwent hypoventilation for 10 min. In phase 2, spontaneously breathing patients were randomized to breathe room air (n = 155) or to receive supplemental oxygen (n = 133) on arrival in the PACU. Measurements and results: In phase 1, end-tidal carbon dioxide and SpO2 were measured during deliberate hypoventilation. A decrease in SpO2 occurred only in patients who breathed room air. No decline occurred in patients with FIO2 levels of 0.25 and 0.30. In phase 2, SpO2 was recorded every min for up to 40 min in the PACU. Arterial desataration (SpO2 < 90%) was fourfold higher in patients who breathed room air than in patients who breathed supplemental oxygen (9.0% vs 2.3%, p = 0.02). Conclusion: Hypoventilation can be detected reliably by pulse oximetry only when patients breathe room air. In patients with spontaneous ventilation, supplemental oxygen often masked the ability to detect abnormalities in respiratory function in the PACU. Without the need for capnograpliy and arterial blood gas analysis, pulse oximetry is a useful tool to assess ventilatory abnormalities, but only in the absence of supplemental inspired oxygen.

Original languageEnglish
Pages (from-to)1552-1558
Number of pages7
JournalChest
Volume126
Issue number5
DOIs
StatePublished - Nov 1 2004
Externally publishedYes

Fingerprint

Hypoventilation
Oximetry
Oxygen
Air
Ventilation
Respiration
Patients' Rooms
Blood Gas Analysis
Controlled Clinical Trials
Operating Rooms
Carbon Dioxide
General Anesthesia
Blood Vessels
Lower Extremity

Keywords

  • Hypoventilation
  • Pulse oximetry
  • Supplemental oxygen

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Fu, E., Downs, J. B., Schweiger, J. W., Miguel, R. V., & Smith, R. A. (2004). Supplement oxygen impairs detection of hypoventilation by pulse oximetry. Chest, 126(5), 1552-1558. https://doi.org/10.1378/chest.126.5.1552

Supplement oxygen impairs detection of hypoventilation by pulse oximetry. / Fu, Eugene; Downs, John B.; Schweiger, John W.; Miguel, Rafael V.; Smith, Robert A.

In: Chest, Vol. 126, No. 5, 01.11.2004, p. 1552-1558.

Research output: Contribution to journalArticle

Fu, E, Downs, JB, Schweiger, JW, Miguel, RV & Smith, RA 2004, 'Supplement oxygen impairs detection of hypoventilation by pulse oximetry', Chest, vol. 126, no. 5, pp. 1552-1558. https://doi.org/10.1378/chest.126.5.1552
Fu, Eugene ; Downs, John B. ; Schweiger, John W. ; Miguel, Rafael V. ; Smith, Robert A. / Supplement oxygen impairs detection of hypoventilation by pulse oximetry. In: Chest. 2004 ; Vol. 126, No. 5. pp. 1552-1558.
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abstract = "Study objective: This two-part study was designed to determine the effect of supplemental oxygen on the detection of hypoventilation, evidenced by a decline in oxygen saturation (SpO2) with pulse oximetry. Design: Phase 1 was a prospective, patient-controlled, clinical trial. Phase 2 was a prospective, randomized, clinical trial. Setting: Phase 1 took place in the operating room. Phase 2 took place in the postanesthesia care unit (PACU). Patients: In phase 1, 45 patients underwent abdominal, gynecologic, urologie, and lower-extremity vascular operations. In phase 2, 288 patients were recovering from anesthesia. Intervention: In phase 1, modeling of deliberate hypoventilation entailed decreasing by 50{\%} the minute ventilation of patients receiving general anesthesia. Patients breathing a fraction of inspired oxygen (FIO2) of 0.21 (n = 25) underwent hypoventilation for up to 5 min. Patients with an FIO2 of 0.25 (n = 10) or 0.30 (n = 10) underwent hypoventilation for 10 min. In phase 2, spontaneously breathing patients were randomized to breathe room air (n = 155) or to receive supplemental oxygen (n = 133) on arrival in the PACU. Measurements and results: In phase 1, end-tidal carbon dioxide and SpO2 were measured during deliberate hypoventilation. A decrease in SpO2 occurred only in patients who breathed room air. No decline occurred in patients with FIO2 levels of 0.25 and 0.30. In phase 2, SpO2 was recorded every min for up to 40 min in the PACU. Arterial desataration (SpO2 < 90{\%}) was fourfold higher in patients who breathed room air than in patients who breathed supplemental oxygen (9.0{\%} vs 2.3{\%}, p = 0.02). Conclusion: Hypoventilation can be detected reliably by pulse oximetry only when patients breathe room air. In patients with spontaneous ventilation, supplemental oxygen often masked the ability to detect abnormalities in respiratory function in the PACU. Without the need for capnograpliy and arterial blood gas analysis, pulse oximetry is a useful tool to assess ventilatory abnormalities, but only in the absence of supplemental inspired oxygen.",
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N2 - Study objective: This two-part study was designed to determine the effect of supplemental oxygen on the detection of hypoventilation, evidenced by a decline in oxygen saturation (SpO2) with pulse oximetry. Design: Phase 1 was a prospective, patient-controlled, clinical trial. Phase 2 was a prospective, randomized, clinical trial. Setting: Phase 1 took place in the operating room. Phase 2 took place in the postanesthesia care unit (PACU). Patients: In phase 1, 45 patients underwent abdominal, gynecologic, urologie, and lower-extremity vascular operations. In phase 2, 288 patients were recovering from anesthesia. Intervention: In phase 1, modeling of deliberate hypoventilation entailed decreasing by 50% the minute ventilation of patients receiving general anesthesia. Patients breathing a fraction of inspired oxygen (FIO2) of 0.21 (n = 25) underwent hypoventilation for up to 5 min. Patients with an FIO2 of 0.25 (n = 10) or 0.30 (n = 10) underwent hypoventilation for 10 min. In phase 2, spontaneously breathing patients were randomized to breathe room air (n = 155) or to receive supplemental oxygen (n = 133) on arrival in the PACU. Measurements and results: In phase 1, end-tidal carbon dioxide and SpO2 were measured during deliberate hypoventilation. A decrease in SpO2 occurred only in patients who breathed room air. No decline occurred in patients with FIO2 levels of 0.25 and 0.30. In phase 2, SpO2 was recorded every min for up to 40 min in the PACU. Arterial desataration (SpO2 < 90%) was fourfold higher in patients who breathed room air than in patients who breathed supplemental oxygen (9.0% vs 2.3%, p = 0.02). Conclusion: Hypoventilation can be detected reliably by pulse oximetry only when patients breathe room air. In patients with spontaneous ventilation, supplemental oxygen often masked the ability to detect abnormalities in respiratory function in the PACU. Without the need for capnograpliy and arterial blood gas analysis, pulse oximetry is a useful tool to assess ventilatory abnormalities, but only in the absence of supplemental inspired oxygen.

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KW - Pulse oximetry

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