DOI: 10.1097/CCM.0b013e3181710b07

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Issn Print: 0090-3493

Publication Date: 2008/05/01


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Delayed oxygenation assessment in patients with severe community-acquired pneumonia

Stijn I. Blot; Alejandro Rodriguez; Jordi Rello

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We appreciate the interest of Souza and Zavaski on our article (1). This study was a secondary analysis from a cohort reported elsewhere (2). As clearly indicated in the primary manuscript (2), data collection was prospectively organized and processes of care were documented at the emergency department. Inotropic use (shock) or mechanical ventilation requirements were assessed at intensive care unit admission. Outcomes and basic characteristics of patients excluded were not different from those included in the final analysis. Many evidences confirm that substantial delay in recognition of sepsis and adequate management adversely affect patient outcomes (3–6), and therefore we conclude that early oxygenation assessment favorably affects the course of the critically ill patient.
Time to pulse oximetry and arterial blood gas sampling were merged as one variable to limit the burden of missing values. Yet, no differences were noted when either pulse oximetry monitoring or arterial blood gas sampling was considered separately. Both procedures are first steps in the diagnostic algorithm for patients with respiratory failure. Whatever the result of the oxygenation assessment was, the time to carry out the procedure indicates how fast the patients were taken care of in the emergency room.
Beyond of epidemiologic considerations, clinical implications are stronger. We believe that severity of community-acquired pneumonia should be assessed at the bedside by simple physiologic variables. As indicated in a recent editorial comment (7), our findings suggest that pulse oximetry should be performed in the triage at the emergency department, being a simple, cheap and largely available method to identify poor perfusion or hypoxemia.
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