Moore F A, Haenel J B, Moore E E, Abernathy C M
Department of Surgery, Denver General Hospital, CO 80204-4507.
Am J Surg. 1990 Dec;160(6):647-51. doi: 10.1016/s0002-9610(05)80766-4.
An oxygen-monitoring protocol was established in the surgical intensive care unit (SICU) at the Denver General Hospital in July 1988. A 3-month surveillance audit ending March 1989 prospectively documented 100 consecutive hypoxic events in 51 of 241 (21%) SICU patients. These episodes occurred during mechanical ventilation in 46 patients, during spontaneous ventilation in 15 patients with artificial airways, and the remaining 39 occurred in nonintubated patients. Hypoxemia was recognized by pulse oximetry in 59, arterial blood gas analysis in 24, mixed venous oximetry in 15, and transcutaneous oxygen monitoring in 2. These events were due to problems with the ventilator or airway in 42, recent interventions in 21, new pulmonary process in 19, progression of underlying disease in 11, and unknown causes in 7. Two thirds resulted from mechanical problems amenable to simple intervention; there were two adverse outcomes. In conclusion, acute hypoxia is a frequent potentially morbid SICU event. Advances in continuous oxygen monitoring permit early identification and thereby may limit adverse outcomes, but should not prompt an expensive diagnostic work-up.
1988年7月，丹佛总医院外科重症监护病房（SICU）制定了一项氧监测方案。截至1989年3月的为期3个月的监测审计前瞻性地记录了241名SICU患者中51名（21%）连续发生的100次低氧事件。这些事件发生在46例机械通气患者、15例有人工气道的自主通气患者中，其余39例发生在未插管患者中。59例通过脉搏血氧饱和度测定法、24例通过动脉血气分析、15例通过混合静脉血氧饱和度测定法、2例通过经皮氧监测识别出低氧血症。这些事件中，42例是由于呼吸机或气道问题，21例是由于近期干预措施，19例是由于新的肺部病变，11例是由于基础疾病进展，7例原因不明。三分之二是由可通过简单干预解决的机械问题导致的；有两例不良后果。总之，急性低氧是SICU常见的潜在致病事件。连续氧监测的进展有助于早期识别，从而可能限制不良后果，但不应引发昂贵的诊断检查。
