Oxygen Desaturation Patterns in Emphysema Patients: A Retrospective Analysis of Pulse Oximetry Titration During Nebuliser Therapy at King Hussein Medical Center

Objective: To evaluate pulse oximetry patterns and oxygen titration practices during nebuliser therapy in emphysema patients admitted to the pulmonology department.
Methods: Retrospective chart review of 320 adult emphysema patients hospitalized at King Hussein Medical Center (January 2022–December 2025). Data extracted included demographics, smoking history, home oxygen requirements, admission SpO₂, oxygen flow rates during nebulisation, pre- and post-nebulisation SpO₂, desaturation incidence (SpO₂ <88% or drop >4% from baseline), and need for non-invasive ventilation (NIV).
Results: Mean age 68.4±9.6 years, 72.5% male, mean FEV₁ 42.6±14.8% predicted. Desaturation occurred in 118 patients (36.9%, 95% CI: 31.6–42.2%). Independent predictors: baseline SpO₂ <92% (OR=3.42, 95% CI: 2.08–5.62, p<0.001), home oxygen requirement (OR=2.85, 95% CI: 1.72–4.72, p<0.001), FEV₁ <30% predicted (OR=2.54, 95% CI: 1.48–4.36, p=0.001), and oxygen flow rate ≤2 L/min (OR=2.18, 95% CI: 1.32–3.60, p=0.002). Desaturators had longer hospital stays (median 9 vs. 6 days, p<0.001) and higher NIV requirement (22.0% vs. 6.9%, p<0.001). Increasing flow rate to 5–6 L/min reduced desaturation incidence from 52.3% to 8.4% (p<0.001) without observed adverse events.
Conclusion: Desaturation during nebuliser therapy is common in hospitalized emphysema patients. Baseline hypoxemia, severe airflow obstruction, and low oxygen flow rates are independent predictors. Higher flow rates (5–6 L/min) appear safe and effective in preventing desaturation. Protocolized oxygen titration is recommended.