CHEST Guidelines-Low-Pulse-Oximetry-Reading

Low-Pulse-Oximetry-Reading_chest (1)

Pdf Summary

The article "Low Pulse Oximetry Reading: Time for Action or Reflection?" by Andrew R. Tomlinson, MD and colleagues, delves into the intricacies and potential inaccuracies associated with pulse oximetry, a noninvasive method used to estimate arterial oxygen saturation. Since its inception in the 1970s, pulse oximetry has become a vital tool in perioperative and intensive care settings due to its ability to estimate hemoglobin saturation via the absorption of red and infrared light by oxygenated and deoxygenated hemoglobin. <br /><br />However, the technique is not without its flaws, as erroneous readings can arise from various factors such as motion artifacts, darker skin pigmentation, and dyshemoglobins. This misinterpretation risk is especially pertinent when the oxygen saturation readings do not align with a patient's clinical data or medical history. It is noted that significant desaturation in ambulatory patients without severe pulmonary conditions or vascular disease is rare.<br /><br />The article emphasizes the potential inaccuracies during exercise, especially when used alongside the six-minute walk test (6MWT). Concerns are raised about erroneous readings due to motion artifact with continuous pulse oximetry, though recent guidelines have begun to support its use during field walking tests because of evidence suggesting desaturation may not always occur at the test's end.<br /><br />The authors recount their findings from reviewing 48 patient referrals for cardiopulmonary exercise testing, revealing that some patients underwent extensive evaluations merely based on potentially inaccurate 6MWT oximetry readings, leading to unnecessary healthcare expenditures and patient risks.<br /><br />The article advocates for the confirmation of suspected desaturations before further diagnostic procedures, stressing the need for assessing pulse oximetry readings' validity through waveform quality and concordance with heart rate. Unexpected results should warrant careful examination to prevent unnecessary investigations, thus reducing health-care costs and patient burden.

Keywords

pulse oximetry

oxygen saturation

noninvasive method

motion artifacts

dyshemoglobins

six-minute walk test

desaturation

healthcare costs

waveform quality

cardiopulmonary exercise testing