Objective：To analyze the value of continuous finger pulse oxygen saturation（SpO₂）monitoring in guiding oxygen therapy in pneumonia patients with hypoxemia. Methods：A total of 101 viral pneumonia patients with hypoxemia were enrolled，56 with continuous finger pulse oximetry monitoring and 45 with routine monitoring. Two groups were compared about hospital days， arterial blood gas（ABG）counts，course of oxygen therapy，as well as the differences in blood oxygenation and inflammatory factors [interleukin-6（IL-6）and C-reactive protein（CRP）]on day（7±1）. The continuous finger pulse oximetry monitoring group was divided into an escalation group and a no-escalation group according to whether or not an oxygen therapy escalation event occurred within 48 h of admission and the monitoring data of the two groups were analyzed. Correlations of finger pulse oximetry and pulse rate - related parameters with inflammatory and immune factors were analyzed. Finger pulse oximetry monitoring data were also analyzed in the case of a further oxygen therapy escalation event within 48 h after escalation to bilevel positive airway pressure（BiPAP）oxygen therapy. The value of finger pulse oximetry in diagnosing early oxygen escalation events was explored using receiver operating characteristic （ROC）curve. Results：①The ABG counts，the day of oxygen therapy initiation escalation and reaching the maximum parameters in the continuous finger pulse oximetry monitoring group were less than those in the routine finger pulse oximetry monitoring group（P ＜ 0.05）. Compared with the routine finger pulse oximetry monitoring group, the continuous finger pulse oximetry monitoring group had higher PaO₂/FiO₂ and lower levels of IL-6 and CRP on day（7±1）of admission（P ＜ 0.05）. ②The differences in monitoring parameters in the continuous finger pulse oximetry monitoring group in terms of lowest SpO₂（ SpO_2L），mean SpO₂（ mSpO₂），the percentage of time with daily SpO₂ below 86%，88%，90%，92% and 94%（T₈₆，T₈₈，T₉₀，T₉₂，and T₉₄），and standard deviation of SpO₂ in 24 h between the escalation group and no - escalation group were statistically significant（all P ＜ 0.05）. IL - 6，CRP and immunoglobulin G were significantly correlated with SpO₂ parameters. ③ Continuous monitoring parameters on BiPAP days in the continuous finger pulse oximetry monitoring group showed events of sudden oxygen desaturation accompanied by increasing pulse rate. Such hypoxic events were found to be associated with BiPAP offline. The difference in descending area（DA）of SpO₂ desaturation was statistically significant between the escalation and no-escalation groups. The ROC for DA diagnosis of escalation events of early oxygen therapy on BiPAP respiratory support was 0.852（P ＜ 0.05），suggesting that DA can be used as a predictor of oxygen therapy escalation events. Conclusion：Continuous finger pulse oximetry monitoring parameter T₉₂ can identify the risk of progressive exacerbation of hypoxic events at an early stage，which assist in the timely adjustment of oxygen therapy regimen. The DA of SpO₂ desaturation under BiPAP daily offline can be used as a predictor of escalation events of oxygen therapy. Continuous finger pulse oximetry monitoring help guide decisions about oxygen therapy regimens in pneumonia patients with hypoxemia.