DOES IMPLEMENTING PULSE OXIMETRY IN A CRITICAL CARE UNIT RESULT IN SUBSTANTIAL ARTERIAL BLOOD-GAS SAVINGS

Objectives: To examine the impact of pulse oximetry on the use of arterial blood gas and other laboratory determinations and to examine predictors of the use of arterial blood gas measurements. Design: Before (preoximetry)/after (postoximetry) study. Setting: Thirty-bed multidisciplinary critical care unit. Patients: Consecutive admissions of 300 patients (150 before and 150 after oximetry). Measurements: For each patient examined, the number of arterial blood gas determinations, serum electrolyte levels, complete blood chemistries, arterial lactate levels, and creatinine samples were recorded for the initial 9 days of the stay in the critical care unit. These data were stratified by nursing shift (day vs night) and by the source of the admission (medical vs surgical). Other information collected included demographic variables, the severity of illness, the length of stay in the critical care unit, and various ventilatory parameters. Results: Introducing pulse oximetry was associated with a marginal (10.3 percent; p<0.025) reduction in the use of arterial blood gas determinations. This decrease was accounted for by changes occurring on the night shift and in the surgical patient. These findings were also observed for serum electrolyte determinations. No significant differences in the use of arterial blood gas measurements were found for medical patients. No significant differences were found in the use of arterial lactate levels, complete blood chemistries, or creatinine determinations. Significant predictors of arterial blood gas determinations included the number of days intubated, the number of ventilator orders, the number of days on an inspired oxygen content (FIo2) greater than 50 percent, and the acute physiology and chronic health evaluation II (APACHE II) score. Conclusions: The implementation of pulse oximetry in this manner gives an idea how effective the technology will be in reducing the use of arterial blood gas determinations without guidelines for the use of pulse oximetry. As only a marginal decrease was observed in the total population of medical and surgical patients, and only on the night shift, formal and standardized guidelines for the most efficient use of pulse oximetry should be considered. If these were considered, pulse oximetry may indeed make a significant contribution to improving the efficiency of care services.