Does perioperative pulse oximetry improve outcome? Seeking the best available evidence to answer the clinical question

Abstract

The aim of this chapter is to clarify the effect of perioperative monitoring with pulse oximetry and to identify the adverse outcomes that might be prevented or improved by its use. Trials were identified by computerized searches of The Cochrane Library, MEDLINE and EMBASE, and by checking the reference lists of trials and review articles. All controlled trials that randomized patients to either pulse oximetry or no pulse oximetry during the perioperative period, including the operating and recovery room, were included in the search. Pulse oximetry monitoring was shown to substantially reduce the extent of perioperative hypoxaemia, enabling the detection and treatment of hypoxaemia and related respiratory events, and promoting several changes in patient care. The implementation of perioperative pulse oximetry monitoring does not significantly reduce the number of postoperative complications, but the question remains whether pulse oximetry can improve outcomes in other situations. Pulse oximetry has been adopted all over the world in clinical practice as a tool that guides anaesthesiologists in the daily management of patients: in teaching situations, in emergencies, and especially in the care of children. Given the relatively small number of patients studied in these trials and the rare events being sought, the studies of perioperative monitoring with pulse oximetry were not able to show an improvement in the outcomes studied.