Arterial Oxygen Saturation: A Vital Sign?

Abstract

The physical examination is a key part of a continuum that extends from the history of the present illness to the therapeutic outcome. An  understanding of the pathophysiological mechanism behind a physical sign is essential for arriving at the correct diagnosis. Early  detection of deteriorating physical/vital signs and their appropriate interpretation is thus the key to achieve correct and timely  management. By definition, vital signs are “the signs of life that may be monitored or measured, namely pulse rate, respiratory rate,  body temperature, and blood pressure.” Vital signs are the simplest, cheapest and probably the most inexpensive information gathered  bedside in outpatient or hospitalized patients. The pulse oximeter was introduced in the 1980s. It is an accurate and non-invasive method  for the measurement of arterial hemoglobin oxygen saturation (SaO2). Pulse oximetry‑based arterial oxygen saturation can be  effectively used bedside in in-hospital and ambulatory patients with diagnosed or suspected lung disease. The present pandemic of  COVID-19 should be considered as a wake-up call. Articles related to arterial oxygen saturation and its importance as a vital sign in  patient care were searched online especially in PubMed. Available studies were studied in full length and data was extracted. Discussion:  A. Clinical Utility of Oxygen Saturation Monitoring: There are many studies reporting the clinical applicability and usefulness of pulse  oximetry in the early detection of hypoxemic events during intraoperative and postoperative periods. B. Role of clinical expertise accompanied by knowledge of physiology: A diagnostic sign is useful only if it is interpreted accurately and applied appropriately while  evaluating a patient. The World Health Organisation also appreciates these facts and published “The WHO Pulse Oximetry Training  Manual.” Understanding the physiology behind and overcoming limitations of the diagnostic sign by clinical expertise is important. While  using pulse oximetry, a clinician needs to keep in mind the sigmoidal nature of the oxygen‑Hb dissociation curve. Considering these  benefits of SaO2 measurement, there have been several references in the past to consider oxygen saturation as the fifth vital sign. In the  present pandemic oxygen saturation i.e., SpO2 (arterial oxygen saturation) measured by pulse oxymeter, has been the single most  important warning and prognostic sign be it for households, offices, street vendors, hospitals or governments. Measurement of trends of  SaO2 added with respiratory rate will provide clinicians with a holistic overview of respiratory functions and multidimensional  conditions associated with hypoxemia.