Preventing Oxygen Desaturation- Clinical Features and Treatments

Introduction

Monitoring of oxygen saturation is crucial for keeping the patient healthy. Desaturation is defined as a drop from a baseline oxygen saturation of less than 90% to an oxygen saturation below 90%. Hemoglobin concentration and oxygen intake have an impact on the degradation of oxygen during apnea. Desaturation of less than 70 % increases the patient's risk for dysrhythmias (altered heart rate), hypoxic brain injury, and death. In hospitalized patients, causes of oxygen desaturation are dependent on disorders of ventilation and disorder of oxygenation. In patients reporting oxygen desaturation, airway patency and adequacy of respiration should be assessed immediately. In patients who are under mechanical ventilator support, it should be noted that the endotracheal tube is not obstructed. Pulse oximeters can be used to determine the oxygen saturation rates at home. In a hospital setup, additional parameters like chest X-ray, ECG (electrocardiogram), and arterial blood gas assessment help evaluate patients' oxygen saturation levels. Oxygen is the most important medicine in treating a patient admitted to an emergency department, and oxygen, when given judiciously to hypoxic patients, turns out to be life-saving.

What Is Pulse Oximetry?

The fifth vital sign in humans is oxygen saturation. Oxygen saturation determination is vital in examining acutely ill and breathless patients. Along with oxygen saturation, vital signs like pulse rate, blood pressure, respiratory rate, and temperature are also recorded in cases where supplemental oxygen has to be administered. Pulse oximetry is a non-invasive and painless technique used to monitor oxygen saturation. In patients with unstable oxygen saturation, pulse oximeters are used. Along with oxygen saturation, pulse oximeters also determine pulse rate. Prolonged application of an oximeter probe may lead to pressure sores at the sight of probe application.

What Are the Clinical Features of Oxygen Desaturation?

The following features are noted in patients suffering from oxygen desaturation:

• The skin color of the patient may change into gray or blue. A change in skin color is considered a late sign of oxygen desaturation.

• Patients suffering from lowered oxygen levels have difficulty sleeping flat on the bed.

• Patients with decreased oxygen saturation levels face difficulty speaking as they must catch their breath between sentences they try to talk.

• Restlessness and anxiety are the early signs of hypoxia.

• Changes in mental status, disorientation, and loss of consciousness are worsening signs of oxygen desaturation.

How Is Oxygen Saturation Treated?

Oxygen therapy is prescribed for controlling and preventing oxygen desaturation. Levels of arterial blood gases and oxygen saturation levels help determine the requirement for oxygen saturation. High-flow nasal cannula oxygen therapy techniques help provide oxygen at 20 to 40 L/min (liters per minute), and the oxygen given is humidified. Humidification of oxygen prevents airway inflammation and maintains mucociliary functions.

What Interventions Can Be Done to Prevent Oxygen Desaturation?

The following interventions can be done to prevent oxygen desaturation:

• Raising the head of the bed on which the patient is lying helps in descending the diaphragm, maximizes the inhalation, and reduces the pressure on the lungs.

• Deep breathing, as well as coughing, helps the patient in effectively clearing the airways and maintaining oxygen levels.

• Bronchodilators relax the smooth muscles and improve inhalation in patients suffering from respiratory disorders.

• Oral suctioning is prescribed for individuals who have weakened cough reflexes. Oral suctioning clears the mucous from the airways enhancing oxygen saturation levels.

• Wheat and barley contain the protein known as gluten. In those with celiac disease, this protein reduces the absorption of iron. Keeping iron levels stable helps to raise oxygen saturation levels.

• The clinicians advise increasing the intake of iron-rich food items like spinach, meat, chicken, and liver. Apart from this, iron supplements can also be prescribed to compensate for deficient iron levels.

• Antioxidants also play an essential role in maintaining the oxygen saturation levels.

What Are the Oxygen Safety Guidelines for At-Home and Hospital Setups?

Following safety guidelines should be followed in hospitals and home setups while providing oxygen therapy:

• Respiration is a medication and should be prescribed and adjusted only under a physician’s supervision.

• Oxygen cylinders should always be kept upright, and chained and appropriate holders should be used.

• Smoking should be strictly prohibited near oxygen delivery devices as it may lead to oxygen combustion.

• Oxygen cylinders should be kept at least 1.5 meters from the heat source.

What Things to Inform the Doctor Before Starting Oxygen Therapy?

The following information should always be provided to a clinician whenever someone seeks treatment for oxygen desaturation:

• Family History: If any members of the patient's family, such as their parents, have diabetes mellitus (raised blood glucose levels), hypertension (increased blood pressure), hypotension, or a renal or hepatic problem, the patient should let the doctor know. Additionally, they must declare whether any of their siblings or other family members have a history of serious illnesses. The common signs and symptoms in the patient's family as well as the genetic pattern of the condition are known to the doctors thanks to this information. The doctor uses family history of the condition to better manage and treat patients.

• Personal History: Changed symptoms that a person experiences, such as excessive weight gain or loss, drowsiness, lethargy, swollen legs, increased heart rate, increased thirst, increased want to eat, and increased or decreased urination, are included in their personal history.

• Other Systemic Disorders: If a patient has additional underlying illnesses like liver malfunction or kidney disease, they should always let their doctor know. The various underlying systemic disorders are taken into account when doctors prescribe drugs.

What Is the Impact of Smoking on Oxygen Saturation Levels?

Following are a few impacts of smoking on oxygen saturation levels:

• For iron absorption, vitamin C is an important factor. Smoking reduces vitamin C affinity in the body. As a result, heme in hemoglobin which is made up of iron and carries oxygen, gets reduced. Reduction in heme levels leads to decreased oxygen-carrying capacity, and hence, desaturation occurs.

• Various studies also state that in chronic smokers, the oxygen levels in bone marrow also get altered. This results in decreased oxygen saturation.

Conclusion:

Oxygen saturation monitoring is of utmost importance for maintaining the patient's health. Oxygen destruction during apnea is affected by hemoglobin concentration and oxygen consumption. Desaturation of less than 70 % increases the patient's risk for dysrhythmias (altered heart rate), hypoxic brain injury, and death. In hospitalized patients, causes of oxygen desaturation are dependent on disorders of ventilation and disorder of oxygenation. Oxygen therapy is prescribed for controlling and preventing oxygen desaturation. Levels of arterial blood gases and oxygen saturation levels help determine the requirement for oxygen saturation.