sats/oxygen guidelines/situation

[philnonymous]

Hi folks,

Let me ask you about this, because people I've talked to disagree.

There was a patient admitted with a problem, probably related to IBD, with severe diarrhea, fever, vomiting. Everything but the diarrhea was brought under control, but the doctors were kind of baffled as to what was causing all the problems. Prednisone and IV antibiotics were prescribed. After a day or two the patient developed intermittent chest congestion with severe coughing. The doctors didn't know what it was -- chest X-ray showed nothing.

While sleeping, sats at one point dropped to about 85 or 86. The patient wasn't in any particular distress, and sats started rising slowly now that the patient was awake, getting up around 90. Still, there was a lot of chest congestion. I don't know if the patient showed any cyanosis, but I doubt it. Blood pressure was unremarkable, pulse was a little high, maybe 100.

Should oxygen be given? What are your thoughts? The congestion would come and go. All things equal, I would prefer to give oxygen, but am I missing something?

[RN1980]

obstructive sleep apnea? may need sleep study after d/c. if dropping of sats was just transient without any effect of hr by lowering or raising it prolly not a big deal. if it worries you ask the doc for a sat titration order.

[lifetimern]

I am curious what this patients baseline oxygen saturation is. Unless the patient has some underlying respiratory disease or is a heavy smoker, it is unusual for a wakeful person to have sats in the low 90s. If the patient is a non-smoker with no history of lung disease, I would be wary of a Sat. in the low 90s while he is awake. If his baseline O2 sat. is, as one would suspect, in the high 90s, I would be downright concerned. Remember, the oxyhemoglobin dissociation curve illustrates that a sat of 88-90% may represent significant hypoxemia.

In my opinion this person needs oxygen and a full work-up to determine what is causing his desaturation.

[philnonymous]

Well, when the patient wasn't have the congestion, his o2 was normal, above 95. I think the decrease had a lot to do with having the congestion while sleeping. He was eventually given breathing treatments. (Turns out the congestion was probably a result of allergy to mesalamine).

His baseline HR was always kind of high, perhaps due to the prednisone, so it didn't change much during the low o2 time. I just wonder to what extent having transient o2 lower than 90 is bad for the brain... hope it's nothing.

[nursenow]

Mid/high 80s when an older person is sleeping is not unusual but the 90 after being awake for awhile is low.