The significance of hypoxemia with low inspired O2 fraction before extubation

Arterial and transcutaneous O2 (PtcO2) and CO2 (PtcCO2) tensions, arterial O2 saturations (SaO2) and P50 values were measured in 47 patients before extubation. In order to unmask ventilation to perfusion (VA/Q) inequality, all variables were obtained without CPAP and with FIO2 of 0.40 as well as with CPAP of 5 cm H2O and FIO2 of 0.40, 0.35, 0.30, 0.25, and 0.21. Eighty to 90% of the patients had PaO2/FIO2 lower than 300 torr and no significant difference in PaO2 or SaO2 was found between those who were successfully extubated (group S, n = 38) and those who required reintubation (group R, n = 9). On the other hand, the patients in group R had significantly lower P50 values, and their PtcO2 values decreased at a greater incline with the lowering of FIO2 than those in group S. Pulmonary dysfunction does not solely explain the need for reintubation in group R. It is obvious that arterial hypoxemia may become more dangerous when the patient has a low P50, anemia, or hypermetabolism. Because PtcO2 seems to uncover these factors, it is a valuable method for predicting the patient's condition before extubation.