Management of Post-Operative Desaturation

Immediate Technical Verification

The American Society of Anesthesiologists recommends verifying pulse oximeter accuracy and oxygen delivery system function immediately after surgery to ensure accurate oxygen saturation readings 1
The American College of Surgeons suggests checking the oxygen delivery device and flow rate to match prescribed therapy 1
The American Thoracic Society recommends confirming that the oxygen cylinder contains oxygen and is not empty 1
The Society of Critical Care Medicine advises checking that the tubing is connected to the oxygen wall outlet, not compressed air 1

The American College of Physicians recommends targeting an SpO2 of 94-98% for patients without risk of hypercapnic respiratory failure 1, 2
The American Thoracic Society suggests using a nasal cannula at 2-6 L/min or simple face mask at 5-10 L/min for patients with SpO2 85-93% 1
The European Respiratory Society recommends targeting an SpO2 of 88-92% for patients with risk of hypercapnic respiratory failure (COPD, obesity hypoventilation) 1, 2
The American College of Chest Physicians suggests starting with a 24% Venturi mask at 2-3 L/min or 28% Venturi mask at 4 L/min for patients with COPD or obesity hypoventilation 1

The Society of Critical Care Medicine recommends performing an urgent evaluation of respiratory rate, heart rate, blood pressure, and mental status to identify potential life-threatening causes of desaturation 1
The American Heart Association suggests calculating the NEWS or equivalent physiological track-and-trigger score to assess the severity of illness 1

The American Thoracic Society recommends obtaining an arterial blood gas (ABG) within 60 minutes if the patient is critically ill, has an unexpected or inappropriate fall in SpO2, or has risk factors for hypercapnia 1, 3
The European Respiratory Society suggests using an arterial sample (not capillary) for critically ill patients or those with shock/hypotension 1

The American College of Emergency Physicians recommends systematically assessing for disconnection or malfunction of the oxygen delivery system, pulmonary edema, pneumonia or aspiration, pulmonary embolism, bronchospasm, and upper airway obstruction 1
The American Society of Anesthesiologists suggests evaluating for residual anesthetic effects or opioid-induced respiratory depression 2

The American Society of Anesthesiologists recommends reinstituting home CPAP immediately on return to the ward if oxygen saturation cannot be maintained with supplemental oxygen alone for obese patients with OSA 4
The European Society of Anaesthesiology suggests supplementing oxygen via CPAP machine or nasal specula under CPAP mask for obese patients with OSA 4

The American Thoracic Society recommends observing oxygen saturation for at least 5 minutes after starting or increasing oxygen therapy 1
The Society of Critical Care Medicine suggests using continuous pulse oximetry for critically ill patients 1

The American College of Physicians recommends urgent clinical review if the patient requires oxygen restarted at a higher concentration than before to maintain the same target saturation, has persistent hypoxemia despite appropriate oxygen therapy, or has signs of respiratory fatigue or increased work of breathing 1, 2

The American Thoracic Society recommends initiating CPAP or non-invasive positive pressure ventilation for SpO2 <90% despite supplemental oxygen 2
The European Respiratory Society suggests continuing preoperative CPAP/BiPAP for patients who were using these modalities before surgery 2

The American College of Physicians recommends avoiding high-flow oxygen empirically without targeted saturation goals 3
The American Thoracic Society suggests avoiding oxygen therapy alone without checking for hypercapnia in patients with underlying respiratory disease 3

The American Society of Anesthesiologists recommends discharging patients to the ward only when routine discharge criteria are met, respiratory rate is normal, and arterial oxygen saturation returns to pre-operative values with or without oxygen supplementation 4, 2