Oxygen levels falling below 90- any medics about

[Coffeeforus]

DS(7) was admitted to hospital earlier this year with a chest infection, shortness of breath and low oxygen levels (around 89-92) and kept in for two nights. His oxygen levels kept falling below 90 during the night and the machine alarm kept going off. The nurses mostly ignored it except when it persisted for a few minutes. I went to the nurses station three times to report it and they checked him, didn’t given him more oxygen but just left, and on the third time the nurse was quite grumpy about it. She turned the sound off on the machine, put my son’s hoodie over it so I couldn’t see the screen and snapped at me that it has to be below 90 for 10 minutes before it’s a concern. At shift change in the morning the new nurse did a double take at the hoodie and sound off and sharply said to me who did this. I replied a nurse did and she frowned and glared at me like I was lying.

Fast forward to 6 months later and DS was admitted to the High Dependency Unit in hospital this week for 3 days for breathing difficulties where he has now been diagnosed with probable asthma (tbc at consultants clinic in 2 weeks after medicine treatments at home and doing peak flow meter readings daily etc). His oxygen kept falling below 90 in the HDU and every single time this was addressed by giving him more oxygen, and combined with other treatments, he was slowly weaned off the oxygen as he improved.

He had another episode of wheezing a few months ago (given an inhaler) and all together with these three episodes of breathing issues the doctors conclude it is ‘emerging asthma.’

What I don’t understand is how he was treated the first time in hospital when his falling oxygen levels were pretty much ignored? Does anyone have experience of this? It just seems such a contrast between the two experiences of low oxygen levels and how they were approached.

I think one likely explanation from the nurse's perspective is that the finger things for those machines tend not to fit children and can give inaccurate readings. We had the same when dd was in hospital (with a broken arm, so no breathing issues) and the alarm kept going off all night. The nurses just ignored it until I came to ask and then they explained it to me that it wasn't correct and said they could just turn the alarm off if it was keeping us up (it was, so they did). Obviously, in your case, there are breathing issues and I would have expected it to be investigated a bit more given the symptoms he presented with.

@mindutopia yes those finger sensors aren’t the most accurate for children we were told on this visit, but as you say given that DS was admitted for breathing difficulties etc I was surprised and worried that they were so dismissive of the alarm going off repeatedly. On this latest visit it has taken three days to get him stable enough to go home and it was such a different approach/treatment for almost identical admitting reasons.

I'm
A paediatric nurse abs my first thought was this, or it wasn't a good trace. Those machines are incredibly sensitive to any little movement. However, if it was a good trace, and the probe was on properly. She should have given oxygen. We would probably give it a few minutes to see if it self resolved. But if it was happening multiple times, then give oxygen. Putting a hoodie over the monitor is not acceptable!

Clearly can’t comment on specifics, but it’s not unusual for sats to dip down transiently in sleep. So long as it comes back up quickly it’s not usually a problem. A lot of the management of low sats depends on context - someone sick enough to be on HDU and already on oxygen having their sats drop is much more worrying. Also, as per pp’s, sats probes are notoriously temperamental and are prone to interference from all sorts - it does take a bit of experience and understanding of the physics and physiology to know if the numbers are accurate/worrying.

Yes. Context is important for example We would allow a child with known severe sleep aponea, who'd just had their tonsils out. To go lower for longer as that is their normal. But a child with asthma etc would not be allowed to do that.