P014: PREVENTING POST OPERATIVE ARTERIAL OXYGEN DESATURATIONS USING PULSE OXIMETRY WITH AUTOMATED VERBAL PROMPTS
Joseph LaGrew, MD, Anthony Destephens, BS, Andrew Gifford, BS, Judith Wishin, RN, Nik Gravenstein, MD, Sampson Lampotang, PhD; UF Department of Anesthesia
Introduction: Arterial Oxygen desaturation may occur after many anesthetics and analgesics. Continuous pulse oximetry monitoring can guide provider intervention in the post anesthesia care unit (PACU) and improve care of post operative arterial oxygen desaturation. Although pulse oximetry-generated alarms have benefited PACU patients significantly, they have negative effects as well. Some studies have suggested the presence of alarms may affect patient recovery from surgery. Pulse oximeter alarms can contribute to alarm overload/ fatigue and may present occupational hazards to health care workers or distract from other patients’ care. Finally, frequent alarms and provider interventions may impact the patient’s perceived quality of recovery.
Verbal automated pulse oximetry utilizes oxygen saturation (SpO2) thresholds to verbally prompt patient breathing when SpO2 values dip below a specified preset value. Prompts mimic the initial provider intervention to patients who desaturate but do so before provider intervention is required, preventing an audible alarm in those patients who comply with verbal instructions. This prospective, randomized study evaluated the effects of verbal automated pulse oximetry on the number hypoxic events, oxygen usage, treatment time, and quality of PACU experience for nurses and patients.
Materials/Methods: One hundred fifty (150) consenting patients will be recruited and randomized to treatment with standard care or standard care plus prophylactic verbal automated pulse oximetry associated with pulse oximetry saturation values less than or equal to 93%. This automated pulse oximetry utilizes DDS middleware (Harvard MD PnP group) to access real time physiologic data from a monitor (IntelliVue MP50, Philips) through a serial RS232 connection to an embedded Linux system (Beaglebone Black). Patients and providers are observed during the immediate post operative course for desaturation events, alarms and any interventions required. Bedside providers and patients are given a follow up survey of their immediate post operative experience.
Demographics are analyzed using Student’s t-test for continuous variables and Fisher’s exact test for categorical variables. Desaturation episodes, supplemental oxygen utilizations, provider intervention data, and patient and provider satisfaction survey information are analyzed using 2-way repeated measures analysis of variance (ANOVA) with multiple comparisons.
Preliminary Results: In the studied cohort (n= 20), there is a trend toward decreased alarms in the intervention group (1.73 per patient) as compared to the control group (4.77 per patient). Additionally, there are trends toward more provider interventions (2 interventions per patient in the control group v 1.11 in the study group) and more time spent on care of the patient (1.5 min per patient in the control group versus 0.124 min in the study group). There was also a trend towards perceived decreased in alarms, overall noise and time addressing desaturations from nurses treating patients in the study group as compared to the control group. There were no trends toward decreased supplemental oxygen usage or increased patient satisfaction in the study group as compared to the control group.
Conclusion: Preliminary results indicate that verbal automated pulse oximetry use in the PACU decreased the number of audible SpO2 alarms per patient and decreased time required to treat Oxygen desaturation.