(1177) Continuous Pulse Oximetry and Capnography for Postoperative Respiratory Failure and Adverse Outcomes

Introduction: The current practice of periodic spot-pulse oximetry checks every 4-8 hours may fail to identify prolonged hypoxia and acute respiratory depression in a timely manner in medical-surgical settings. This systematic review aimed to investigate the efficacy of continuous pulse oximetry (CPOX), with and without capnography, in terms of their ability to identify postoperative respiratory failure, opioid-induced respiratory depression, and the prevention of downstream adverse events when compared to routine monitoring.

Methods: A systematic literature search was conducted for articles published from 1946 to April 2023 across Ovid Medline, Embase, and Cochrane Library databases, focusing on observational studies or clinical trials. The protocol of the study was registered in Prospero, and Prisma guidelines were followed. Pooled analysis was performed utilizing R version 4.1.1 software and the meta package, with sensitivity analysis applied to ascertain result stability.

Results: In total, 23 studies were included in this systematic review, of which 17 investigated CPOX with capnography, and 6 examined CPOX alone. Notably, CPOX exhibited superior performance in recognizing desaturation (SpO2 < 90%), with an odds ratio of 11.94 (95% CI: 6.85, 20.82; p< 0.001) when compared to standard monitoring. However, no significant differences were observed between the two groups concerning outcomes such as intensive care unit (ICU) transfer, reintubation, and non-invasive ventilation.

Conclusions: Based on the evidence gathered, CPOX demonstrated efficacy in detecting oxygen desaturation in postoperative patients within hospital wards but not for ICU transfer, reintubation, and non-invasive ventilation.