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Risks Posed by Inaccurate Sensors

Inaccurate sensors pose a risk of inappropriate management of a patient. High reading sensors can lead to delayed interventions and insufficient oxygen therapy. Low reading sensors can lead to unnecessary interventions and lead to excessive oxygen therapy. Clinical trials have confirmed that inaccurate sensors can be identified and also concluded that if clinical decisions are based on data from inaccurate sensors patients can get the wrong management.

Many published clinical guidelines and protocols recommend that decisions are based on very specific oxygen saturation value cutoffs without the need for confirmation by blood gas (e.g. BTS guidelines, National Institute for Health and Clinical Excellence http://www.nice.org.uk/guidance/CG/Published , Scottish Intercollegiate Guidelines Network. Bronchiolitis in Children, NHS Quality Improvement Scotland, The American Academy of Paediatrics - Diagnosis and management of Bronchiolitis).

Low reading sensors can lead to
  1. a falsely low estimation of the oxygen resulting in a decision to carry out urgent immediate intubation with the related risks. This decision is only shown to have been hasty retrospectively once there has been time to take arterial blood and send it for detailed gas analysis.
  2. excess oxygen leading to Retinopathy of Prematurity (ROP) and blindness, and chronic lung disease. The need for ‘low’ normal levels is recognised and the exact limits of this are currently under investigation with the multinational BOOST trials (Benefits Of Oxygen Saturation Targeting). (http://www.ctc.usyd.edu.au/BoostII/main_body/Home.htm). In the UK alone some 2,500 premature babies have some scarring associated with ROP and approximately 600 are blinded every year (based on National Statistics Office and RNIB data).
  3. excess oxygen and metabolic disturbance in patients such as those with reduced respiratory drive and/or at risk of hypercapnia (http://www.brit-thoracic.org.uk/LibraryGuidelines/tabid/69/Default.aspx British Thoracic Society (BTS) Guidelines). This could be a patient with chronic chest problems who usually runs with a relatively low normal oxygen saturation where increasing their oxygen above the individuals norm leads to carbon dioxide retention, metabolic acidosis and admission to Intensive Care.
  4. increased risk of carbon dioxide retention and hypercapnia in situations such as overdose and poisoning.
  5. risks of increasing morbidity due to excess oxygen following hypoxic insult, such as myocardial infarct or stroke. Recommendations are changing from freely administering oxygen to titrating and prescribing the flow and concentration of oxygen to achieve an appropriate accurately maintained oxygen saturation to achieve correct tissue oxygenation. (BTS Guidelines).

High reading sensors can lead to
  1. A falsely high estimation of oxygen saturation which can lead to a delay in more active management. The decision to intubate an injured patient often needs to be taken speedily and correctly whilst awaiting blood taking and blood gas analysis.
  2. Hypoxic damage, including brain damage (cerebral palsy, strokes), organ failure, etc due to poor tissue oxygenation.