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Pulse oximetry ...the cochrane analysis....does it really help?

The proliferation of monitors in anaesthesia is obvious. The goal of monitoring as an adjunct to clinical decision making is to directly reduce the incidence of complications. This is based on the premise that unambiguous and accurate information, which is readily interpretable and available, will help the anaesthesiologist in choosing and initiating correct therapeutic interventions. The unanswered question is whether the individual anaesthesiologist's performance—the human factor—is perhaps far more important than implementing new monitoring equipment or other new safety initiatives in a situation in which we wish to reduce the rate of postoperative complications. However, we do not know whether pulse oximetry might protect against the human factor when that factor is negligent.

Pulse oximetry monitoring substantially reduced the extent of perioperative hypoxaemia, enabled the detection and treatment of hypoxaemia and related respiratory events and promoted several changes in patient care. The implementation of perioperative pulse oximetry monitoring was not, however, the breakthrough that could reduce the number of postoperative complications. The question remains whether pulse oximetry improves outcomes in other situations. Pulse oximetry has already been adopted into clinical practice all over the world. It may be a tool that guides anaesthesiologists in the daily management of patients, in teaching situations, in emergencies and especially in caring for children. Although results of studies are not conclusive, the data suggest that there may be a benefit for a population at high risk of postoperative pulmonary complications. Results of the studies of general surgery indicate that perioperative monitoring with pulse oximetry does not improve clinically relevant outcomes, effectiveness or efficiency of care despite an intense, methodical collection of data from a large population.

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