PULSE OXIMETRY MONITORING CAN CHANGE ROUTINE OXYGEN SUPPLEMENTATION PRACTICES IN THE POSTANESTHESIA CARE UNIT

Routine use of supplemental oxygen (O-2) in the postanesthesia care unit (PACU) traditionally has been used to minimize the incidence of hypoxemia. However, with the advent of continuous noninvasive monitoring by pulse oximetry, is routine administration of O-2 necessary? We hypothesized that administering O-2 as needed, based on pulse oximetry data, would effect considerable cost savings without compromising patient care. Five hundred adult (greater than or equal to 18 yr) patients breathing 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) that 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 unnecessary in 63% of patients for the duration of their PACU stay. Cost savings 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 annualized figure for patients in our hospital (approximately 10,000 cases) would be an additional $623,272. Inasmuch as pulse oximetry monitoring is now standard in the PACU, perhaps it is time to apply the objective data it supplies, thereby creating cost savings while maintaining patient care standards.