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Using The Pocket Oximeter: Does A Higher SpO2 Lull You Into False Safety?

Discussion in 'Monitoring Vitals' started by yerrag, Jun 6, 2017.

  1. yerrag

    yerrag Member

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    I'm using an oximeter and I think I'm learning better to use it.

    Mr rat is in the vet hospital as I recounted in another thread: Not Quite Ready For Progesterone

    I had to use to oximeter, which gives me readings of blood oxygenation saturation levels (SpO2) and heart rate.

    Because the rat was having high heart rate readings, and arrhythmic, I had to use bag breathing for an hour or longer in attempting to lower the heart rate and to correct the irregular heartbeat. The oximeter was very useful as it gave me a real-time update on the effect of bag breathing. Especially since bag breathing is not usually done for a long time, I wanted to be able to stop its use when the oximeter indicates something amiss - like say, oxygen saturation going down, or the heart rate getting faster. Of course, I was only observing the reaction of the rat during the bag breathing period, like the breathing rate.

    The rat was on vet hospital oxygen, and it was used to ensure high oxygenation (or so it seemed). The SpO2 reading was always high, at 98 or 99. This was like an assurance that the rat was getting enough oxygen.

    I could either supplement the bag breathing with hospital oxygen or without. When I supplemented with hospital oxygen, I saw no improvement in the rat's heart rate, although the SpO2 reading was consistently high. When I removed the hospital oxygen, I observed an improvement in the heart rate, although SpO2 readings were lower.

    This made me decide to do bag breathing without the hospital oxygen for the hour-long bag breathing. This really is an experiment, as I don't know if I'll be overdoing the bag breathing and will be creating a crisis condition. I decided that if the SpO2 would go below 90, I would stop bag breathing.

    I was able to finish the hour-long bag breathing. It was successful in lowering the rat's heart rate to half. The rat's breathing rate went down a relaxed comfortable 24 breaths/minute. But what I learned from this was to treat the SpO2 reading as not something that is static, and not as something where a higher value is always better. I had to see the fluctuation of SpO2 reading from 90 to 97 in the course of the hour-long bag breathing as I would a bus with passengers.

    If say 100 is the maximum number of passengers that can board a bus, the bus would be considered full at 100 passengers. If no passenger can deboard the bus at all, the bus would always be full. A bus that is always full looks good, but if no passenger is able to deboard at the destination though, is the bus really doing its job?

    If the bus is your blood vessels, and the passengers are oxygen, an SpO2 reading that is always near saturation could mean that no (or not much) oxygen is being delivered to your cells.

    I think this is what's happening when we are given oxygen from hospital tanks. The oximeter would make us think we are getting the full benefit of oxygenation, because it tells us that our blood is saturated with oxygen. It does not tell us whether the oxygen is really being delivered to the cells. In a situation where blood CO2 is low, and oxygen is not being fully distributed to cells, the SpO2 reading could be high, and we could be easily lulled into the safety of thinking we are getting enough oxygenation to our cells. Yet we struggle with our breathing, our heart rate is fast, and our breath rate is fast. And certainly, our hospital doctors just go through the motions.

    The oximeter is a nice tool, but we need to be aware of putting the readings into the proper context. During the hour-long baf breathing, the SpO2 and heart rate showed fluctuations, with the SpO2 going from 90 to 97 and back, and the heart rate would slowly go down but not in a straight line but fluctuating where each succeeding high is a lower high and where each succeeding low is a lower low.

    I would never have known how to use an oximeter in this way, but I thought of sharing this. Of course, I could be wrong in thinking this way, so I welcome your comments on this.
     
  2. Dante

    Dante Member

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    My experiences have led me to reach more or less a same conclusion. From what i understand, pulse oximeter measures oxy-haemoglobin or the oxygen bound to haemoglobin , so it doesn't tell whether sufficient oxygen is offloaded to cells which you explained via the bus analogy. So, while low oximeter reading is bad high reading doesn't always mean enough oxygen to the cells ( which require cellular CO2 for oxygen to be loaded to the cells via bohr effect ). The only time i got low oximeter reading 91-92 % was when i was very sick with a flu. Generally it hovers around 98% but even during my days of hyperventilation and other signs of tissue hypoxia (like pale nails) oximeter was still showing a reading of 98%.
     
  3. OP
    yerrag

    yerrag Member

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    Thanks Dante. I'm glad to get confirmation from your experience with the use of an oximeter.

    I'll probably play around some more with the oximeter. One thing I can try is to observe the fluctuation in the readings of an oximeter over a period of one hour, when I'm at rest, over 3 sets of conditions: 1) with me breathing hospital oxygen thru a tube that feeds oxygen to the nostrils (not plugging up the nostrils so that I still get air); 2) with bag breathing without hospital oxygen; and 3) with normal breathing (no hospital oxygen and no bag breathing).

    It would be interesting to compare the oxygen saturation heart rate, breath rate, and temperature under these conditions. Probably take a reading every 10 minutes and compare.

    p.s. Just thought about option 2. 1 hour may be too long. I may get into respiratory acidosis.
     
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