Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluation
Introduction UK guidelines suggest that pulse oximetry, rather than blood gas sampling, is adequate for monitoring of patients with COVID-19 if CO2 retention is not suspected. However, pulse oximetry has impaired accuracy in certain patient groups, and data are lacking on its accuracy in patients wi...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/7/1/e000778.full |
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| author | Bradley Lonergan Keir Elmslie James Philip Benjamin Bennett Silas Fuller Charles McFadyen Janis Burns Robert Tidswell Aikaterini Vlachou |
| author_facet | Bradley Lonergan Keir Elmslie James Philip Benjamin Bennett Silas Fuller Charles McFadyen Janis Burns Robert Tidswell Aikaterini Vlachou |
| author_sort | Bradley Lonergan |
| collection | DOAJ |
| description | Introduction UK guidelines suggest that pulse oximetry, rather than blood gas sampling, is adequate for monitoring of patients with COVID-19 if CO2 retention is not suspected. However, pulse oximetry has impaired accuracy in certain patient groups, and data are lacking on its accuracy in patients with COVID-19 stepping down from intensive care unit (ICU) to non-ICU settings or being transferred to another ICU.Methods We assessed the bias, precision and limits of agreement using 90 paired SpO2 and SaO2 from 30 patients (3 paired samples per patient). To assess the agreement between pulse oximetry (SpO2) and arterial blood gas analysis (SaO2) in patients with COVID-19, deemed clinically stable to step down from an ICU to a non-ICU ward, or be transferred to another ICU. This was done to evaluate whether the guidelines were appropriate for our setting.Results Mean difference between SaO2 and SpO2 (bias) was 0.4%, with an SD of 2.4 (precision). The limits of agreement between SpO2 and SaO2 were as follows: upper limit of 5.2% (95% CI 6.5% to 4.2%) and lower limit of −4.3% (95% CI −3.4% to −5.7%).Conclusions In our setting, pulse oximetry showed a level of agreement with SaO2 measurement that was slightly suboptimal, although within acceptable levels for Food and Drug Authority approval, in people with COVID-19 judged clinically ready to step down from ICU to a non-ICU ward, or who were being transferred to another hospital’s ICU. In such patients, SpO2 should be interpreted with caution. Arterial blood gas assessment of SaO2 may still be clinically indicated. |
| format | Article |
| id | doaj-art-909c3c7708454439992b23be5eb9964e |
| institution | Kabale University |
| issn | 2052-4439 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-909c3c7708454439992b23be5eb9964e2024-11-23T23:05:10ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392020-09-017110.1136/bmjresp-2020-000778Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluationBradley Lonergan0Keir Elmslie James Philip1Benjamin Bennett2Silas Fuller3Charles McFadyen4Janis Burns5Robert Tidswell6Aikaterini Vlachou7Critical Care, Royal Brompton and Harefield NHS Foundation Trust, London, UKNational Heart and Lung Institute, Imperial College London, London, UKCritical Care, Royal Brompton and Harefield NHS Foundation Trust, London, UKCritical Care, Royal Brompton and Harefield NHS Foundation Trust, London, UKCritical Care, Royal Brompton and Harefield NHS Foundation Trust, London, UKjunior clinical fellow, Department of Anaesthesia and Critical Care, Royal Brompton and Harefield NHS Foundation TrustCritical Care, Royal Brompton and Harefield NHS Foundation Trust, London, UKCritical Care, Royal Brompton and Harefield NHS Foundation Trust, London, UKIntroduction UK guidelines suggest that pulse oximetry, rather than blood gas sampling, is adequate for monitoring of patients with COVID-19 if CO2 retention is not suspected. However, pulse oximetry has impaired accuracy in certain patient groups, and data are lacking on its accuracy in patients with COVID-19 stepping down from intensive care unit (ICU) to non-ICU settings or being transferred to another ICU.Methods We assessed the bias, precision and limits of agreement using 90 paired SpO2 and SaO2 from 30 patients (3 paired samples per patient). To assess the agreement between pulse oximetry (SpO2) and arterial blood gas analysis (SaO2) in patients with COVID-19, deemed clinically stable to step down from an ICU to a non-ICU ward, or be transferred to another ICU. This was done to evaluate whether the guidelines were appropriate for our setting.Results Mean difference between SaO2 and SpO2 (bias) was 0.4%, with an SD of 2.4 (precision). The limits of agreement between SpO2 and SaO2 were as follows: upper limit of 5.2% (95% CI 6.5% to 4.2%) and lower limit of −4.3% (95% CI −3.4% to −5.7%).Conclusions In our setting, pulse oximetry showed a level of agreement with SaO2 measurement that was slightly suboptimal, although within acceptable levels for Food and Drug Authority approval, in people with COVID-19 judged clinically ready to step down from ICU to a non-ICU ward, or who were being transferred to another hospital’s ICU. In such patients, SpO2 should be interpreted with caution. Arterial blood gas assessment of SaO2 may still be clinically indicated.https://bmjopenrespres.bmj.com/content/7/1/e000778.full |
| spellingShingle | Bradley Lonergan Keir Elmslie James Philip Benjamin Bennett Silas Fuller Charles McFadyen Janis Burns Robert Tidswell Aikaterini Vlachou Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluation BMJ Open Respiratory Research |
| title | Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluation |
| title_full | Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluation |
| title_fullStr | Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluation |
| title_full_unstemmed | Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluation |
| title_short | Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluation |
| title_sort | working accuracy of pulse oximetry in covid 19 patients stepping down from intensive care a clinical evaluation |
| url | https://bmjopenrespres.bmj.com/content/7/1/e000778.full |
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