Usually talking, we think about an SpO2 of 90% as acceptable. It is because an SpO2 of 90% usually correlates with a PaO2 of round 60 mmHg, and something beneath a PaO2 of 60 mmHg is taken into account hypoxia that requires remedy with supplemental oxygen.
Medicare, in setting tips for oxygen qualification, goals to make sure that folks actually want oxygen. So, they set the qualification threshold at 88%. In case your oxygen saturation is 88% or much less whereas resting or with exertion, you qualify for house oxygen remedy.
On this case, I’ve no situation with the rule of thumb—it is smart. Nevertheless, qualifying for nighttime or sleep oxygen is a unique story. Through the day, a saturation of 88% means you qualify for oxygen. However at night time, you not solely must drop beneath 88%, it additionally has to stay that low for no less than 5 minutes.
For instance, in a research we did final night time, a affected person’s SpO2 dipped to 83%, which is taken into account low. However due to Medicare’s nighttime oxygen necessities, this particular person doesn’t qualify for oxygen. Even when their SpO2 dropped to 70%, they wouldn’t qualify until it stayed beneath 88% for at the least 5 minutes.
I imagine it is a flaw within the system. Granted, decrease oxygen ranges throughout sleep are sometimes thought-about regular, however setting a time-based threshold appears unnecessarily inflexible. Maybe Medicare may as an alternative undertake a threshold like 85%—and if anybody’s SpO2 falls beneath that, even briefly, they need to qualify for nighttime oxygen remedy. This is able to account for these whose saturation dips considerably, even when the drop doesn’t final the complete 5 minutes.
Really, Medicare doesn’t all the time have the affected person’s greatest pursuits in thoughts when setting qualification insurance policies. What appears to information their decision-making extra is how they’ll get monetary savings. Whereas the rules be certain that solely those that actually want oxygen get it, the inflexible thresholds—particularly for nighttime oxygen—can go away some sufferers with out mandatory help. It appears much less about affected person care and extra about slicing prices.