Study of early warning for desaturation provided by Oxygen Reserve Index in obese patients

Ekaterina Tsymbal, Sebastian Ayala, Amrik Singh, Richard L Applegate 2nd, Neal W Fleming, Ekaterina Tsymbal, Sebastian Ayala, Amrik Singh, Richard L Applegate 2nd, Neal W Fleming

Abstract

Acute hemoglobin desaturation can reflect rapidly decreasing PaO2. Pulse oximetry saturation (SpO2) facilitates hypoxia detection but may not significantly decrease until PaO2 < 80 mmHg. The Oxygen Reserve Index (ORI) is a unitless index that correlates with moderately hyperoxic PaO2. This study evaluated whether ORI provides added arterial desaturation warning in obese patients. This IRB approved, prospective, observational study obtained written informed consent from Obese (body mass index (BMI) kg m-2; 30 < BMI < 40) and Normal BMI (19 < BMI < 25) adult patients scheduled for elective surgery requiring general endotracheal anesthesia. Standard monitors and an ORI sensor were placed. Patient's lungs were pre-oxygenated with 100% FiO2. After ORI plateaued, general anesthesia was induced, and endotracheal intubation accomplished using a videolaryngoscope. Patients remained apneic until SpO2reached 94%. ORI and SpO2 were recorded continuously. Added warning time was defined as the difference between the time to SpO2 94% from ORI alarm start or from SpO2 97%. Data are reported as median; 95% confidence interval. Complete data were collected in 36 Obese and 36 Normal BMI patients. ORI warning time was always longer than SpO2 warning time. Added warning time provided by ORI was 46.5 (36.0-59.0) seconds in Obese and 87.0 (77.0-109.0) seconds in Normal BMI patients, and was shorter in Obese than Normal BMI patients difference 54.0 (38.0-74.0) seconds (p < 0.0001). ORI provided what was felt to be clinically significant added warning time of arterial desaturation compared to SpO2. This added time might allow earlier calls for help, assistance from other providers, or modifications of airway management.Trial registration ClinicalTrials.gov NCT03021551.

Keywords: Arterial desaturation; Endotracheal intubation; Oxygen reserve index; Preoxygenation; Pulse oximetry.

Conflict of interest statement

NWF declares he has received research support from Masimo. RLA declares he has received research support from Masimo, has served as a consultant to Masimo and has received honoraria from Masimo for lectures. ET, SA and AS declare they have no conflicts of interest.

© 2020. The Author(s).

Figures

Fig. 1
Fig. 1
Oxygen Reserve Index (ORI) and pulse oximetry oxygen saturation (SpO2) data were compared at 5 timepoints: (1) baseline; (2) end of pre-oxygenation (ORI plateau); (3) start of intubation; (4) SpO2 = 94%; and (5) during ventilation with 100% FiO2 when ORI again reached a plateau
Fig. 2
Fig. 2
Comparison of Oxygen Reserve Index (ORI) values in Obese (30 −2) and Normal BMI (19 < BMI < 25 kg m−2) patients at three measurement points: end of pre-oxygenation, start of intubation and plateau value following resumption of mechanical ventilation
Fig. 3
Fig. 3
Comparison of defined study times. a Comparison of tolerable apnea to warning times provided by Oxygen Reserve Index (ORI) and pulse oximetry oxygen saturation (SpO2) in Obese patients (body mass index (BMI); 30 < BMI < 40 kg m−2); b Comparison of tolerable apnea to warning times provided by ORI and SpO2 in Normal BMI patients (19 < BMI < 25 kg m−2). ORI warning time was longer than SpO2 warning time in all patients; c Comparison of warning times in Obese patients to those in Normal BMI patients provided by ORI; and d comparison of warning times in Obese patients to those in Normal BMI patients provided by SpO2

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