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Hypoxemic and hyperoxemic likelihood in pulse oximetry ranges: NICU observational study
  1. Thomas E Bachman1,
  2. Christopher J L Newth2,
  3. Narayan P Iyer3,
  4. Patrick A Ross2,
  5. Robinder G Khemani2
  1. 1 Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
  2. 2 Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
  3. 3 Neonatology, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
  1. Correspondence to Thomas E Bachman, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic; Tbachman{at}me.com

Abstract

Objective Describe the likelihood of hypoxemia and hyperoxemia across ranges of oxygen saturation (SpO2), during mechanical ventilation with supplemental oxygenation.

Design Retrospective observational study.

Setting University affiliated tertiary care neonatal intensive care unit.

Patients Two groups of neonates based on postmenstrual age (PMA): <32 weeks (n=104) and >36 weeks (n=709).

Main measures Hypoxemia was defined as a PaO2 <40 mm Hg, hyperoxemia as a PaO2 of >99 mm Hg and normoxemia as a PaO2 of 50–80 mm Hg. Twenty-five per cent was defined as marked likelihood of hypoxemia or hyperoxemia.

Results From these infants, 18 034 SpO2–PaO2 pairs were evaluated of which 10% were preterm. The PMA (median and IQR) of the two groups were: 28 weeks (27–30) and 40 weeks (38–41). With SpO2 levels between 90% and 95%, the likelihoods of hypoxemia and hyperoxemia were low and balanced. With increasing levels of SpO2, the likelihood of hyperoxemia increased. It became marked in the preterm group when SpO2 was 99%–100% (95% CI 29% to 41%) and in the term group with SpO2 levels of 96%–98% (95% CI 29% to 32%). The likelihood of hypoxemia increased as SpO2 decreased. It became marked in both with SpO2 levels of 80%–85% (95% CI 20% to 31%, 24% to 28%, respectively).

Conclusions The likelihood of a PaO2 <40 mm Hg is marked with SpO2 below 86%. The likelihood of a PaO2 >99 mm Hg is marked in term infants with SpO2 above 95% and above 98% in preterm infants. SpO2 levels between 90% and 95% are appropriate targets for term and preterm infants.

  • neonatology
  • intensive care
  • monitoring
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Footnotes

  • Contributors TEB and CJLN conceptualised the study. TEB, CJLN and NPI compiled the database. TEB carried out the initial analyses and drafted the initial manuscript. CJLN, NPI, PAR and RGK interpreted the data including editing the manuscripts for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval IRB Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Sharing of data will be considered for specific research projects. Requests should be sent to the corresponding author.

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