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New Study Investigates the Impact of ORi™-Guided Oxygen Titration on Hyperoxemia-Mediated Morbidity

Researchers Found That ORi-Guided Thoracic Anesthesia May Reduce Hospital Length of Stay and Increase Patient Safety


Norso Medical partner, Masimo, announced today the findings of a study published in the Journal of PeriAnesthesia Nursing in which Drs. Mashasi Ishikawa and Atsuhiro Sakamoto at Nippon Medical School in Tokyo evaluated the utility and impact of Masimo Patient SafetyNet™ by surveying nurses before and after implementation.1 The researchers found that use of the remote monitoring and clinical notification system decreased the number of physical assessments needed, resulting in a reduction in the nursing workload and also recommended the use of continuous respiratory rate and oxygen saturation monitoring (which was implemented as part of the system) after general anesthesia for patients' safety.



ORi, available outside the U.S. since 2014, is a noninvasive and continuous parameter intended to provide additional insight into a patient's oxygen status under supplemental oxygen. Enabled by the multi-wavelength rainbow® Pulse CO-Oximetry platform, ORi is provided alongside oxygen saturation (SpO2) measured by clinically proven Masimo SET® pulse oximetry.


Noting that during OLV, a common technique for facilitating a wide variety of pulmonary procedures, 100% fraction of inspired oxygen (FiO2) supplem


ental oxygen administration is commonly used, which exposes patients to the possibility of hyperoxia-induced lung injury, the researchers sought to determine whether ORi could "protect patient from the harmful effects of hyperoxemia with a noninvasive probe during OLV." They divided 103 patients with lung tumors (18-70 years of age, ASA I-III), enrolled between September 2018 and September 2019 and requiring OLV as part of elective thoracic surgery, into four groups as noted below:




During OLV, oxygen titration was performed without ORi for patients in groups 1 and 2, while groups 3 and 4 used ORi from Masimo Radical-7® Pulse CO-Oximeters® and rainbow® sensors. For all 4 groups, SpO2 and partial pressure of arterial oxygen (PaO2) were routinely measured while FiO2 was routinely administered at 50% after induction, rising to 60% when the OLV was applied, and increasing to 70%-100% as necessary.

The researchers found that ORi monitoring was associated with significantly shorter duration of OLV with FiO2 > 60%, with significantly lower mean FiO2 values during OLV (as shown in the table above), and with lower recorded PaO2 values. They also found that the duration of FiO2 > 80% during OLV was strongly correlated with longer hospital stays (p < 0.001).


The observation that mean FiO2 values were found to be significantly lower in the ORi groups (3 and 4), compared to the groups without ORi (1 and 2), led the researchers to hypothesize that "the risk of hyperoxia will be lower in patients undergoing ORi monitor[ing]." The researchers noted, "ORi cannot replace arterial blood gas analysis; however, it is useful to assess oxygenation. In groups without ORi monitors, the FiO2 was significantly higher than 80%. Moreover, in our study, it was revealed that these patients had a longer hospital stay."


There was no significant difference in ORi values between the low-flow (group 3) and high-flow (group 4) cohorts.


The researchers concluded, "The adjustment of ORi with peripheral oxygen saturation and blood gas analysis demonstrated that hyperoxemia could be prevented during OLV in patients under low flow or high flow anesthesia. We concluded that ORi-guided thoracic anesthesia may reduce hospital stay and increase patient safety."


Norso Medical is official Irish Distributor for all Masimo Products. Norso Medical Limited, is a local supplier of medical equipment ranging from Patient Monitors, Ultrasound and Pre-Hospital Monitoring strive to bring state of the art products to areas such as Anesthetics, ICU, General Wards, Pre-Hospital Transport and Primary care. Norso Medical are the sole exclusive sales/service agent for:

  • Mindray Patient Monitors, Ultrasound

  • Masimo Co Oximetry including SpHb, Sedline 4Ch EEG and other connected monitoring devices.

  • Clear Diamond Screen protection

  • ADC Range of Primary care devices


References

  1. Saracoglu A, Yamansavci Şirzai E, Yildizeli B, Yüksel M, Aykaç ZZ. Oxygen Reserve Index Guided Oxygen Titration in One Lung Ventilation with Low Fresh Gas Glow. Turkish Journal of Medical Sciences. 2021 May. DOI: 10.3906/sag-2009-149.

  2. Published clinical studies on pulse oximetry and the benefits of Masimo SET® can be found on our website at https://www.masimo.com. Comparative studies include independent and objective studies which are comprised of abstracts presented at scientific meetings and peer-reviewed journal articles.

  3. Castillo A et al. Prevention of Retinopathy of Prematurity in Preterm Infants through Changes in Clinical Practice and SpO2 Technology. Acta Paediatr. 2011 Feb;100(2):188-92.

  4. de-Wahl Granelli A et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns. BMJ. 2009;Jan 8;338.

  5. Taenzer A et al. Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: a before-and-after concurrence study. Anesthesiology. 2010:112(2):282-287.

  6. Taenzer A et al. Postoperative Monitoring – The Dartmouth Experience. Anesthesia Patient Safety Foundation Newsletter. Spring-Summer 2012.

  7. McGrath S et al. Surveillance Monitoring Management for General Care Units: Strategy, Design, and Implementation. The Joint Commission Journal on Quality and Patient Safety. 2016 Jul;42(7):293-302.

  8. McGrath S et al. Inpatient Respiratory Arrest Associated With Sedative and Analgesic Medications: Impact of Continuous Monitoring on Patient Mortality and Severe Morbidity. J Patient Saf. 2020 14 Mar. DOI: 10.1097/PTS.0000000000000696.

  9. Estimate: Masimo data on file.

  10. http://health.usnews.com/health-care/best-hospitals/articles/best-hospitals-honor-roll-and-overview