Pediatric anesthesia & critical care
Luck, an Inquisitive Mind, and Opportunities: Lessons Learned: A Blinded Study of Pulse Oximetry before It Became a Standard of Care
Authors' conclusion
The authors conclude that pulse oximetry, in contrast to changes in vital signs, does provide an early warning of developing hypoxemia in anesthetized children.
Study context
- Population
- Pediatric surgical patients under anaesthesia
- Participants
- 152 participants
- Comparison
- Available vs Unavailable
- Availablen = 76
- Unavailablen = 76reference
- Primary endpoint
- Major hypoxic events (SpO2 85% or less for 30 s or more)
Methodological detailssingle-blind, A trained observer recorded all intraoperative hypoxic episodes and informed the team of all major events
- Single-blind
- A trained observer recorded all intraoperative hypoxic episodes and informed the team of all major events
Primary result
As reported in the abstract
Major hypoxic events
Unavailable
24
events
Available
11
events
P = 0.021
Further findings
| Outcome | Available | Unavailable | P value |
|---|---|---|---|
| Hypoxic events diagnosed by oximeter but not by anaesthesiologist | 5 events | 13 events | P = 0.0495 |
| Borderline oxygenation in room air (90% saturation or less) · end of anaesthesia | 3 of 57 | 12 of 60 | P = 0.009 |
Major events by age
- More major events in children 2 yr or younger
- P = 0.013
Major events in ASA III and IV patients (subgroup)
- ASA III and IV more likely to suffer a major event, Available
- P = 0.009
- ASA III and IV more likely to suffer a major event, Unavailable
- 0.006
Timing of hypoxaemia detection
- Pulse oximeter diagnosed hypoxemia before observed cyanosis or bradycardia
- Major hypoxic events unrelated to duration of anaesthesia
Hypoxic events during induction
- Major events evenly distributed among induction, maintenance and awakening; more hypoxic events during induction in the Unavailable group
- P = 0.031
Safety
Morbidity after a hypoxic event
- No morbidity documented in any patient who suffered a hypoxic event
Original publication
Luck, an Inquisitive Mind, and Opportunities: Lessons Learned: A Blinded Study of Pulse Oximetry before It Became a Standard of Care. Anesthesiology. Published 7 March 2023. doi:10.
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