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CRITICAL CARE AND TRAUMA

The Impact of Continuous Pulse Oximetry Monitoring on Intensive Care Unit Admissions from a Postsurgical Care Floor

Anesthesia and Cardiopulmonary Services, University Health Systems East; Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania

Address correspondence to E. Andrew Ochroch, MD, Assistant Professor, Department of Anesthesiology, University of Pennsylvania Health System, 680 Dulles Building, 3400 Spruce Street, Philadelphia, PA 19104. Address e-mail to ochrocha{at}uphs.upenn.edu.

Continuous pulse oximetry (CPOX) has the potential to increase vigilance and decrease pulmonary complications and thus decrease intensive care unit (ICU) admissions. In a randomized nonblinded study of 1219 subjects we compared the effects of CPOX and standard monitoring on the rate of transfer to an ICU from a 33-bed postcardiothoracic surgery care floor. There was no difference in the rate of ICU readmission between the CPOX and standard monitor groups. Despite older age and comorbidity, estimated cost to time of censoring (enrollment to completion of the study) was less in the monitored patients who required ICU transfer than in the unmonitored patients who required ICU transfer (mean estimated cost difference of $28,195; P = 0.04). Use of CPOX altered the reasons that patients were transferred to an ICU but did not affect the rate of transfer. The duration, and thus estimated cost, of ICU stay was significantly less in the CPOX-monitored group. The potential for CPOX to allow for early intervention, or perhaps prevention of pulmonary complications, needs to be explored. Routine CPOX monitoring did not reduce transfer to ICU, mortality, or overall estimated cost of hospitalization, and it is unclear if there is any real benefit from the application of this technology in patients on a general care floor who are recovering from cardiothoracic surgery.