The lowest O2 saturation I've ever seen

Specialties Critical

Published

I recently cared for a patient with severe ARDS. She was deteriorating rapidly and was placed on a rotoprone bed (prone rotation therapy). High PEEP and/ or APRV were not suitable for her as she already had a large amount of subcutaneous emphysema and was at extremely high risk for a tension pneumothorax. The patient had to be frequently bagged and once proned we could not flip her back supine or she would code.

Over the course of about 36 hours the patients O2 sats dropped steadily even with the prone therapy. She favored laying on her right side (good lung down) for her best sat in the 60s. She quickly desatted to the 20s when flat prone and came up to the 40s when laying on her left side.

Now slowly her levels dropped lower and although proning was futile the family was not ready to let go, she was young and it was very sad. Ultimately I ended up seeing her O2 sat drop as low as 3% while rotating prone. There were 3 stars of accuracy the whole time, a great waveform, pulse correlated exactly with the HR and her extremities were warm and pink. The MD told me an O2 sat is not linear at this low of a level but I'm not sure what he meant. Yes, the oxyhemoglobin dissociation curve is not linear but does that mean her sat was not accurate? It would happen time and time again to the single digits, teens and 20s for lengthy periods of time until she ultimately went into the inevitable PEA. (She was a DNR at that point.)

I've never seen anything like it and would love some insight! Thanks.

Was there ever an ABG done when they were saturating that low? I'd be curious to know their PaO2. It's pretty crazy what young hearts can take despite the lack of O2 and other vital nutrients.

I took care of a 50-something hypoplastic right heart pt once. When born her parents told her to take her home to die because the surgeries (which still don't have optimal outcomes) weren't yet available. Well her body developed collaterals and kept her alive. She satted in the 60's her entire life, married twice, adopted three children and worked full time. She's still out there somewhere, blue as blue can be.

But like a previous poster said, working with congenital heart patients I don't get worried until my sats hit 30 or so in any of my single ventricle (and sometimes not single ventricle) patients. As our doctors sometimes say "just lower your standards". Maybe not the best way to look at things but sometimes there's nothing else you can do, and yes, they do survive.

I recently cared for a patient with severe ARDS. She was deteriorating rapidly and was placed on a rotoprone bed (prone rotation therapy). High PEEP and/ or APRV were not suitable for her as she already had a large amount of subcutaneous emphysema and was at extremely high risk for a tension pneumothorax. The patient had to be frequently bagged and once proned we could not flip her back supine or she would code.

Over the course of about 36 hours the patients O2 sats dropped steadily even with the prone therapy. She favored laying on her right side (good lung down) for her best sat in the 60s. She quickly desatted to the 20s when flat prone and came up to the 40s when laying on her left side.

Now slowly her levels dropped lower and although proning was futile the family was not ready to let go, she was young and it was very sad. Ultimately I ended up seeing her O2 sat drop as low as 3% while rotating prone. There were 3 stars of accuracy the whole time, a great waveform, pulse correlated exactly with the HR and her extremities were warm and pink. The MD told me an O2 sat is not linear at this low of a level but I'm not sure what he meant. Yes, the oxyhemoglobin dissociation curve is not linear but does that mean her sat was not accurate? It would happen time and time again to the single digits, teens and 20s for lengthy periods of time until she ultimately went into the inevitable PEA. (She was a DNR at that point.)

I've never seen anything like it and would love some insight! Thanks.

How were her extremities warm and pink with such a low oxygenation?

How were her extremities warm and pink with such a low oxygenation?

Yeah I was wondering that...my kids might tolerate a sat of 50 fine but they sure are blue...I actually had a "little boy blue" today as I called him. Comfortably satting low to mid 50's on 8L of high flow but there was no way he was going to tolerate a non-rebreather or bipap and since he was in no resp distress why bother? Kiddo looked like he'd eaten a blue popsicle and hands feet and body were blue blue blue.

Sometimes when we can't get sats on the extremities we'll wrap the probe on an earlobe...or member if one is available! If you can't get a sat in the diaper though you're not likely to get one anywhere else... :unsure:

Specializes in Medsurg/ICU, Mental Health, Home Health.
Sometimes when we can't get sats on the extremities we'll wrap the probe on an earlobe...or member if one is available! If you can't get a sat in the diaper though you're not likely to get one anywhere else... :unsure:

In adults, I'll use the ear lobe as well. (Not one of the wrap probes, though). For reasons I don't think I need to explain, we don't use our patients' memberes. :) But I have used a nose!

And I must say I imagined you asking around, "does anyone have a member available?"

In adults, I'll use the ear lobe as well. (Not one of the wrap probes, though). For reasons I don't think I need to explain, we don't use our patients' memberes. :) But I have used a nose!

And I must say I imagined you asking around, "does anyone have a member available?"

Haha yes probably not as acceptable in the adult world! Our babes don't notice and if they're that sick they're probably pretty sedated (we don't do that to the walkie-talkie satting 50 two year olds!)

I work with babies, so it's different, but there's one in my unit now who occasionally still has a 'Mac attack' and sats single digits. She's always been really sensitive and would go from 99% to 9% in a heartbeat. I'm hoping she doesn't have residual damage from all these spells, she always recovers beautifully, but you never know.

I work with babies, so it's different, but there's one in my unit now who occasionally still has a 'Mac attack' and sats single digits. She's always been really sensitive and would go from 99% to 9% in a heartbeat. I'm hoping she doesn't have residual damage from all these spells, she always recovers beautifully, but you never know.

haha I haven't heard of a "mac attack" we call them "death spells". Took care of a baby years ago who literally needed chest compressions every time she pooped...but that's another problem, but she would wake up from it and look at us like to say "what are you all staring at and yelling about? can's a baby poop in peace?" haha. She's still kickin too, and far more appropriate than anyone ever imagined she would be

Specializes in ER, progressive care.

wow, and I thought 50-60% was bad...that was the lowest I have ever seen on a patient.

Specializes in ICU.

I had a patient who had contracted pneumonia, gone septic, and presented initially with confusion. They checked his sats in the ED and got numbers in the 20s. They didn't believe the reading, did an ABG, and got a PaO2 of 29. They had him on the vent in five seconds flat after that, so by the time he got to me his sats were 100%. It is really something that he was talking to them with a PaO2 of 29, though. He was just getting the day of the week wrong. :eek:

Specializes in NICU.

I just started in a NICU a couple of months ago. I think the lowest I've seen so far was 38%. Scared the crap out of me. On an adult on medical, I think I saw 52%.

Yes, I took care of a patient like this as a tech. All the nurses were so worried and amazed the doctor was sending her home with a sat. of 60%!

Specializes in Intensive Care Unit.

Lowest Pao2 I ever saw was high 20's....ECMO, CCRT, you name it he had it....but he lived :)

+ Add a Comment