Frontiers in Medicine (Apr 2023)
Oxygen saturation targets for adults with acute hypoxemia in low and lower-middle income countries: a scoping review with analysis of contextual factors
- Austin Herbst,
- Swati Goel,
- Abi Beane,
- Abi Beane,
- Abi Beane,
- B. Jason Brotherton,
- B. Jason Brotherton,
- Dingase Dula,
- E. Wesley Ely,
- E. Wesley Ely,
- E. Wesley Ely,
- Stephen B. Gordon,
- Stephen B. Gordon,
- Rashan Haniffa,
- Rashan Haniffa,
- Rashan Haniffa,
- Rashan Haniffa,
- Bethany Hedt-Gauthier,
- Felix Limbani,
- Michael S. Lipnick,
- Michael S. Lipnick,
- Michael S. Lipnick,
- Samuel Lyon,
- Carolyne Njoki,
- Peter Oduor,
- George Otieno,
- Luigi Pisani,
- Jamie Rylance,
- Mark G. Shrime,
- Mark G. Shrime,
- Doris Lorette Uwamahoro,
- Doris Lorette Uwamahoro,
- Sky Vanderburg,
- Wangari Waweru-Siika,
- Theogene Twagirumugabe,
- Theogene Twagirumugabe,
- Elisabeth Riviello
Affiliations
- Austin Herbst
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Swati Goel
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- Abi Beane
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Abi Beane
- Nat Intensive Care Surveillance-MORU, Colombo, Sri Lanka
- B. Jason Brotherton
- Kijabe Hospital, Kijabe, Kenya
- B. Jason Brotherton
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, PA, United States
- Dingase Dula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- E. Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- E. Wesley Ely
- 0Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, United States
- E. Wesley Ely
- 1Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, United States
- Stephen B. Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Stephen B. Gordon
- 2Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- Rashan Haniffa
- Nat Intensive Care Surveillance-MORU, Colombo, Sri Lanka
- Rashan Haniffa
- 3University College London Hospitals, London, United Kingdom
- Rashan Haniffa
- 4University Hospital-Kotelawala Defence University, Boralesgamuwa, Sri Lanka
- Bethany Hedt-Gauthier
- 5Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Felix Limbani
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Michael S. Lipnick
- 6Hypoxia Research Laboratory, University of California, San Francisco, San Francisco, CA, United States
- Michael S. Lipnick
- 7Center for Health Equity in Surgery and Anesthesia, University of California, San Francisco, San Francisco, CA, United States
- Michael S. Lipnick
- 8Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States
- Samuel Lyon
- 9Harvard Medical School, Boston, MA, United States
- Carolyne Njoki
- 0Department of Surgery, Faculty of Health Sciences, Egerton University, Nakuru, Kenya
- Peter Oduor
- 0Department of Surgery, Faculty of Health Sciences, Egerton University, Nakuru, Kenya
- George Otieno
- Kijabe Hospital, Kijabe, Kenya
- Luigi Pisani
- 1Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Jamie Rylance
- 2Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Mark G. Shrime
- 9Harvard Medical School, Boston, MA, United States
- Mark G. Shrime
- 2Mercy Ships, Lindale, TX, United States
- Doris Lorette Uwamahoro
- 3College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Doris Lorette Uwamahoro
- 4University Teaching Hospital of Kigali, Kigali, Rwanda
- Sky Vanderburg
- 5Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Wangari Waweru-Siika
- 6Department of Anaesthesia, Aga Khan University, Nairobi, Kenya
- Theogene Twagirumugabe
- 3College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Theogene Twagirumugabe
- 7University Teaching Hospital of Butare, Butare, Rwanda
- Elisabeth Riviello
- 8Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- DOI
- https://doi.org/10.3389/fmed.2023.1148334
- Journal volume & issue
-
Vol. 10
Abstract
Knowing the target oxygen saturation (SpO2) range that results in the best outcomes for acutely hypoxemic adults is important for clinical care, training, and research in low-income and lower-middle income countries (collectively LMICs). The evidence we have for SpO2 targets emanates from high-income countries (HICs), and therefore may miss important contextual factors for LMIC settings. Furthermore, the evidence from HICs is mixed, amplifying the importance of specific circumstances. For this literature review and analysis, we considered SpO2 targets used in previous trials, international and national society guidelines, and direct trial evidence comparing outcomes using different SpO2 ranges (all from HICs). We also considered contextual factors, including emerging data on pulse oximetry performance in different skin pigmentation ranges, the risk of depleting oxygen resources in LMIC settings, the lack of access to arterial blood gases that necessitates consideration of the subpopulation of hypoxemic patients who are also hypercapnic, and the impact of altitude on median SpO2 values. This process of integrating prior study protocols, society guidelines, available evidence, and contextual factors is potentially useful for the development of other clinical guidelines for LMIC settings. We suggest that a goal SpO2 range of 90-94% is reasonable, using high-performing pulse oximeters. Answering context-specific research questions, such as an optimal SpO2 target range in LMIC contexts, is critical for advancing equity in clinical outcomes globally.
Keywords
