Utilization of Corrected SpO 2 or Corrected SpO 2 Target to Homogenize the Practices Regarding Management of Oxygen Therapy

Abstract

Background:

SpO₂ target influences oxygen utilization with increased by 3-fold the oxygen flow with 4% difference in SpO₂ target. It was recently showed that oximeter brand influenced the SpO₂ measurements. Combination of the errors on the SpO₂ measurement related to the oximeter brand and choice of different target may have major impact on the clinical management of patients in the clinical practice and during research. One solution may be to use a corrected SpO₂ target rather than a universal SpO₂ target to homogenize the practices. The other solution is to correct the SpO₂ values based on the known SpO₂-SaO₂ biases. The objective of the study was to evaluate if the utilization of a corrected SpO₂ target or of corrected SpO₂ values could homogenize the O₂ management.

Methods:

We performed a secondary analysis of the Oxygap study to evaluate the oxygen utilization (increase, decrease, or no change of O₂ support) in the 211 included patients. The oxygen flow was modified based on individual SpO₂ values to maintain (i) a non-corrected SpO₂ target of 92-96%, using the Nonin, Nellcor, Masimo, Philips and (ii) a corrected SpO₂ target with same pulse oximeters. The correcting factors were based on the SpO₂-SaO₂ bias for each oximeters found in the Oxygap study, respectively -3.1, -0.3, -0.2 and +0.9%. We also evaluated the impact of the utilization of corrected SpO₂ values, based on the known SpO₂-SaO₂ bias.

Results:

Based on the values obtained in the Oxygap study with 211 patients, the oxygen management showed significant discrepancies when SpO₂ were not corrected or when SpO₂ target was not corrected (Figure, panel A). When SpO₂ values were corrected (Figure, panel B) or when SpO₂ target were corrected (Figure, panel C), the management of oxygen support was homogenized with reduction of discrepancies.

Conclusions:

The utilization of corrected SpO₂ values or corrected SpO₂ target may allow to reduce the large discrepancies in O₂ utilization based on confounding factors related to pulse oximetry measurements. Additional corrections based on skin pigmentation will be required when bias will be adequately evaluated.

Management of oxygen support in the cohort of 211 patients of the OXYGAP study to maintain SpO2 within 92-96% with uncorrected SpO2 (Panel A), with corrected SpO2 (Panel B) or with corrected SpO2 target (Panel C)