Oxygen saturation targets for adults with acute hypoxemia in low and lower-middle income countries: a scoping review with analysis of contextual factors

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Herbst, Austin, Goel, Swati, Beane, Abi, Brotherton, B Jason, Dula, Dingase, Ely, E Wesley, Gordon, Stephen B ORCID: 0000-0001-6576-1116, Haniffa, Rashan, Hedt-Gauthier, Bethany, Limbani, Felix et al (show 13 more authors) , Lipnick, Michael S, Lyon, Samuel, Njoki, Carolyne, Oduor, Peter, Otieno, George, Pisani, Luigi, Rylance, Jamie, Shrime, Mark G, Uwamahoro, Doris Lorette, Vanderburg, Sky, Waweru-Siika, Wangari, Twagirumugabe, Theogene and Riviello, Elisabeth (2023) Oxygen saturation targets for adults with acute hypoxemia in low and lower-middle income countries: a scoping review with analysis of contextual factors. FRONTIERS IN MEDICINE, 10. 1148334-.

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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.

Item Type:	Article
Uncontrolled Keywords:	Africa, context, LMICs, oxygen saturation targets, SpO(2)
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	01 Feb 2024 09:36
Last Modified:	01 Feb 2024 09:36
DOI:	10.3389/fmed.2023.1148334
Open Access URL:	https://doi.org/10.3389/fmed.2023.1148334
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3178262