Rj. Dibenedetto et al., PULSE OXIMETRY MONITORING CAN CHANGE ROUTINE OXYGEN SUPPLEMENTATION PRACTICES IN THE POSTANESTHESIA CARE UNIT, Anesthesia and analgesia, 78(2), 1994, pp. 365-368
Routine use of supplemental oxygen (O-2) in the postanesthesia care un
it (PACU) traditionally has been used to minimize the incidence of hyp
oxemia. However, with the advent of continuous noninvasive monitoring
by pulse oximetry, is routine administration of O-2 necessary? We hypo
thesized that administering O-2 as needed, based on pulse oximetry dat
a, would effect considerable cost savings without compromising patient
care. Five hundred adult (greater than or equal to 18 yr) patients br
eathing room air when arriving in the PACU were enrolled in the study.
During PACU care, when O-2 saturation (Spo(2)) was continuously more
than 94%, no supplemental O-2 was given. When Spo(2) was less than 94%
, supplemental O-2 was given at an inspired O-2 concentration (FIO2) t
hat would increase it to above 94%. Also, when preoperative Spo(2) was
less than 94% and postoperative Spo(2) was more than the preoperative
Spo(2), no supplemental O-2 was given. Supplemental O-2 was unnecessa
ry in 63% of patients for the duration of their PACU stay. Cost saving
s to the 307 patients in one study not receiving O-2 was $31,928 if it
had been billed separately from the PACU global charge. The annualize
d figure for patients in our hospital (approximately 10,000 cases) wou
ld be an additional $623,272. Inasmuch as pulse oximetry monitoring is
now standard in the PACU, perhaps it is time to apply the objective d
ata it supplies, thereby creating cost savings while maintaining patie
nt care standards.