RELIABILITY OF PULSE OXIMETRY IN TITRATING SUPPLEMENTAL OXYGEN-THERAPY IN VENTILATOR-DEPENDENT PATIENTS
RELIABILITY OF PULSE OXIMETRY IN TITRATING SUPPLEMENTAL OXYGEN-THERAPY IN VENTILATOR-DEPENDENT PATIENTS
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DOI：
10.1378/chest.97.6.1420
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发表时间：
1990-06-01
期刊：
影响因子：
9.6
通讯作者：
TOBIN, MJ
中科院分区：
文献类型：
--
作者：
JUBRAN, A;TOBIN, MJ
脉搏血氧饱和度被广泛应用于重症监护环境，但很少有研究探讨其在临床决策中的作用。脉搏血氧仪可能有用的一个领域是呼吸机依赖患者的吸入氧浓度分数（FIO 2）的滴定。不幸的是，这种用途的书面指南并不存在，在对重症监护室主任的调查中，我们发现他们采用了广泛的目标血氧饱和度（SpO 2）值。因此，我们进行了一项研究，以确定在调整呼吸机依赖患者的FIO 2时，SpO 2是否可以可靠地替代动脉血氧分压（PaO 2）的测量。我们检查了54例危重患者的多个SpO 2目标值，目标是PaO 2 ≥。60 mm Hg，同时最大限度地降低O2中毒的风险。在白色患者中，我们发现92%的SpO 2目标值在预测满意的氧合水平方面是可靠的。然而，在黑人患者中，这样的SpO 2阅读通常与严重的低氧血症（PaO 2低至49 mm Hg）相关，并且需要更高的SpO 2目标，95%。此外，血氧饱和度读数不准确（即SpO 2和直接SaO 2测量值之间的差异> 4%）在黑人患者中（27%）比白色患者（11%，p < 0.05）更常见。总之，在接受机械通气的白色患者中，当滴定补充O2时，SpO 2目标值为92%是可靠的;然而，在黑人患者中，这样的SpO 2阅读通常与严重低氧血症相关，需要更高的SpO 2目标值95%，以确保满意的氧合水平。
Pulse oximetry is widely used in the critical care setting, but few studies have examined its usefulness in clinical decision making. One area where pulse oximetry might be useful is in the titration of fractional inspired O2 concentration (FIO2) in ventilator-dependent patients. Unfortunately, documented guidelines for this use do not exit, and in a survey of directors of intensive care units, we found that they employed a wide range of target O2 saturation (SpO2) values. Consequently, we undertook a study to determine if SpO2 could be reliably substituted for measurements of arterial O2 tension (PaO2) when adjusting FIO2 in ventilator-dependent patients. We examined a number of SpO2 target values in 54 critically ill patients aiming for a PaO2 of .gtoreq. 60 mm Hg, while minimizing the risk of O2 toxicity. In white patients, we found that a SpO2 target of 92 percent was reliable in predicting a satisfactory level of oxygenation. However, in black patients, such a SpO2 reading was commonly associated with significant hypoxemia (PaO2 as low as 49 mm Hg), and a higher SpO2 target, 95 percent was required. In addition, inaccurate oximetry readings (ie, > 4 percent difference between SpO2 and direct SaO2 measurements) were more common in black (27 percent) than in white patients (11 percent, p < 0.05). In conclusion, a SpO2 target of 92 percent was reliable when titrating supplemental O2 in white patients receiving mechanical ventilation; however, in black patients, such a SpO2 reading was commonly associated with significant hypoxemia, and a higher SpO2 target, 95 percent, was required to ensure a satisfactory level of oxygenation.