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Occurrence of hypoxia in the wards of a rural hospital.

INTRODUCTION: Hypoxia usually indicates the presence of a critical condition in a patient and usually oxygen therapy is required. Oxygen therapy in given in conditions of respiratory failure. These conditions are pneumonia, acute severe asthma, chronic bronchitis, myocardial infarction. Hypoxia which may be unnoticed in admitted patient has been reported in various studies (1-3). A study done in Jaipur showed hypoxia was present in a significant member of patients. In Papua New Guinea, 10-40% children were shown to have [O.sub.2] saturation < 90% (4). Following intravenous sedation given for maxillofacial surgery, 20% of patient in post anesthetic recovery had hypoxia.

Oximetry remains underutilized modality to diagnose hypoxia. This study was planned to assess the magnitude of hypoxia which is unnoticed in patients admitted in the wards of our tertiary care hospital by using pulse oximeter.

MATERIALS AND METHODS: Patients admitted in the hospital in Medical wards and ICU of SGT Medical college and hospital, a tertiary care rural hospital, were studied. Informed consent was obtained and details of the patients including name, age, sex and smoking history were noted from the case files. Oxygen saturation and pulse rate were recorded.

Oxygen situation (Sp[O.sub.2]) of the patients was measured for 1 minute. The pulse oximeters are pre- calibrated against direct measurements of arterial blood oxygen saturation (Sp[O.sub.2]) in volunteers. The calibration algorithm is stored in a digital microprocessor within the pulse oximeter. The calibration curve is used to generate the oximeter estimate of Sp[O.sub.2] during subsequent use.

A cut off level of 90% was taken as a warning sign of impending hypoxia and respiratory failure. The hypoxia, if detected was reported to the doctor on duty so that oxygen could be started to such patients.

III. RESULTS:--A total of 800 patients were studied. Out of them 550 were males and 250 were females. Of all these patients, 88(11%) were found to be having Sp[O.sub.2] <90%. Among these 88 patients, 50 (57.0%) were males and 38(43%) were females.

Among the patients found to have normal saturation (712 pts), 412 (57.87%) were males and 300 (42.13%) were females. Smoking history was positive in 62(70.46%) patients and 26(29.54%) were non--smokers.

Hypoxia was noted in 20 patients who already had diagnosis of respiratory failure and were in the ICU. Out of these, 12(60%) were diagnosed to have respiratory failure but were still not oxygen therapy and 8(40%) were found to be hypoxic despite being on oxygen therapy . Therefore, in 68 (8.50%) patients previously unnoticed hypoxia was seen.

Also tachycardia was found more consistently in patients of hypoxia (45%) as compared to patients with normal oxygen saturation (28%).

Patients with hypoxia were maximum in the wards of General Medicine. Patients with hypoxia were also found in the ICU. The most common diagnosis among the patients with hypoxia was COAD. Other causes were stroke, end stage renal disease.

IV. DISCUSSION: Early recognition of hypoxia leads to the successful treatment and can prevent unwanted mortality. The clinical feature of hypoxia are non-specific and lead to a delay in diagnosis. Symptoms of hypoxia are usually--altered mental state, cyanosis, dyspnoea, tachypnoea, hypoventilation, arrhythmias, peripheral vasodilatation , systemic hypertension, nausea , vomiting, GI disturbances and coma--all of which are not confirmatory (7).

Pulse oximeter does not show correct reading in conditions like--low cardiac output, anemia, C[O.sub.2] retention (7). Nevertheless, pulse oximeter should be used in the wards to unmask the patients of unnoticed respiratory failure. In our study, 11 % of the total patients admitted in the hospital had hypoxia. In the previous studies (4,5,8) done in various other hospitals, 7.8% to 40% of patients had hypoxia. In our study the most common diagnosis was COPD in patients in the medical wards. In another study (9), nocturnal hypoxia was found to be common in patients admitted in the medical wards and nocturnal oxygen therapy was needed for them.

In the Indian scenario, continuous motoring of the patients in not possible as the doctor-patient ratio in very low. Pulse oximeter proves to be an ideal device for an early recognition of hypoxia. In our study, 77.27% of the patients out of the total hypoxemic patients were diagnosed for the first time. In an earlier study (10), only 1.55% of patients were found to have unnoticed hypoxia. This may have been due to better motoring of the patients due to a better staff to patient ratio.

Thus, by timely recognition of hypoxia, a major group of patients can be prevented from the dire consequences of hypoxia like cardiac and respiratory arrest, hypotension and metabolic acidosis (6).

V. CONCLUSION: Pulse oximeter can be used to detect the hypoxia in the admitted patients at an early stage. It can also be used to monitor oxygen therapy after diagnosis of hypoxia. Hence, it has the potential of being included in the daily motoring charts of the patients admitted in the hospital.

REFERENCES:

(1-) Anthonisen N.R. Hypoxemia and [O.sub.2] therapy. Am Rev Respir Dis 1982; 126: 729-33.

(2-) Fairley B.H. Oxygen therapy for surgical patients. Am Rev Respir Dis 1980; 122(pt.2):37-40.

(3-) Hedley W.J., Winter P.M. Oxygen therapy. Clin pharmacol ther 1967; 8:696-737.

(4-) Wandi F., Peel D., Duke T. Hypoxemia among children in rural hospitals in Papua New Guinea. Ann Trop Pediatric. 2006;26:277-84.

(5-) Hardeman J.H., Sabol S.R., Goldwasser M.S. Incidence of hypoxemia in the post anesthetic recovery room in patients having undergone i.v. sedation for outpatient oral surgery. J Oral Maxillofacial Surgery 1990; 48:942-44.

(6-) Leach R.M., Treacher D.F. ABC of oxygen: Oxygen transport--2.Tissue hypoxia. BMJ 1998; 312:1370-3.

(7-) Saunders N.A., Powles A.C., Rebuck A.S. Ear oximetry : Accuracy and practicability in the assessment of arterial oxygenation. Am Rev Respir Dis 1976;113:745-9.

(8-) Foran M., Ahn R., Novik J., Tyer--Viola L., Chilufya K., Katamba K., et al. Prevalence of undiagnosed hypoxemia in adults and children in an underresourced district hospital in Zambia. Int J Emerg Med.2010;3:351-6.

(9-) Roffe C., Sills S., Pountain S.J., Allen M.: A randomized controlled trial of the effect of fixed-dose routine nocturnal oxygen supplementation on oxygen saturation in patients with acute stroke. J Stroke Cerebsrovasc Dis. 2010;19:29-35.

(10-) Al-Mobeireek A.F., Abba A.A., Kumo A.M. Should oxygen saturation be included in the vital signs in sheet of all medical admissions? Int J Clin Pract 2002;56:167-8.

(11-) Singh, et al : Hypoxia in the wards. Lung India. Vol 29. Issue 4. Oct.--Dec. 2012;page 32931.

Amandeep Singh Kaloti, Charanjeet Kaur, R. K. Goel, Anoop Chhabra

[1.] Assistant Professor. Department of Medicine, S. G. T. Medical College & Research Institute. Budhera, Gurgaon.

[2.] Senior Resident, Department of Obstetrics & Gynecology, S. G. T. Medical College & Research Institute. Budhera, Gurgaon.

[3.] Professor. Department of Medicine, S. G. T. Medical College & Research Institute. Budhera, Gurgaon.

[4.] Assistant Professor. Department of Medicine, S. G. T. Medical College & Research Institute. Budhera, Gurgaon.

CORRESPONDING AUTHOR:

Dr. Amandeep Singh Kaloti, H.no.B-103, staff quarters, S.G.T Medical College, Budhera, Gurgaon.--122505.

E-mail: amansaini1231@rediffmail.com
Table--1 Distribution of hypoxia in patients

Ward/ICU           Total       Patients      Diagnosed
                   number of   with          respiratory
                   patients    Sp[O.sub.2]   failure
                               > 90%

General Medicine   800         712           20
ward & ICU

Ward/ICU           Undiagnosed   Percentage of
                   respiratory   patients with
                   failure       Sp[O.sub.2] < 90%

General Medicine   68            11%
ward & ICU
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Article Details
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Title Annotation:ORIGINAL ARTICLE
Author:Kaloti, Amandeep Singh; Kaur, Charanjeet; Goel, R.K.; Chhabra, Anoop
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Clinical report
Geographic Code:9INDI
Date:Apr 8, 2013
Words:1261
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