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Russell MK, Horton JF, Clermont CA, Demarty JM, Transfiguracion LC, Worobets BR, Pineda ME, Santaniemi N, Stergiou P, Asmussen MJ, Day TA. Validation of Polar Elixir™ Pulse Oximeter against Arterial Blood Gases during Stepwise Steady-State Inspired Hypoxia. Med Sci Sports Exerc 2024; 56:1585-1594. [PMID: 38635406 DOI: 10.1249/mss.0000000000003460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of peripheral oxygen saturation (SpO 2 ) measurements from Polar Elixir™ pulse oximetry technology compared with arterial oxygen saturation (SaO 2 ) measurements during acute stepwise steady-state inspired hypoxia at rest. A post hoc objective was to determine if SpO 2 measurements could be improved by recalibrating the Polar Elixir™ algorithm with SaO 2 values from a random subset of participants. METHODS The International Organization for Standardization (ISO) protocol (ISO 80601-2-61:2017) for evaluating the SpO 2 accuracy of pulse oximeter equipment was followed whereby five plateaus of SaO 2 between 70% and 100% were achieved using stepwise reductions in inspired O 2 during supine rest. Blood samples drawn through a radial arterial catheter from 25 participants were first used to compare SaO 2 with SpO 2 measurements from Polar Elixir™. Then the Polar Elixir™ algorithm was recalibrated using SaO 2 data from 13 random participants, and SpO 2 estimates were recalculated for the other 12 participants. For SaO 2 values between 70% and 100%, root mean square error, intraclass correlation coefficients (ICC), Pearson correlations, and Bland-Altman plots were used to assess the accuracy, agreement, and strength of relationship between SaO 2 values and SpO 2 values from Polar Elixir™. RESULTS The initial root mean square error for Polar Elixir™ was 4.13%. After recalibrating the algorithm, the RMSE was improved to 2.67%. The ICC revealed excellent levels of agreement between SaO 2 and Polar Elixir™ SpO 2 values both before (ICC(1,3) = 0.837, df = 574, P < 0.001) and after (ICC(1,3) = 0.942, df = 287, P < 0.001) recalibration. CONCLUSIONS Relative to ISO standards, Polar Elixir™ yielded accurate SpO 2 measurements during stepwise inspired hypoxia at rest when compared with SaO 2 values, which were improved by recalibrating the algorithm using a subset of the SaO 2 data.
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Affiliation(s)
- Monica K Russell
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | - John F Horton
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | | | | | | | - Breann R Worobets
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | - Mark E Pineda
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | | | - Pro Stergiou
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
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Kalra A, Wilcox C, Holmes SD, Tonna JE, Jeong IS, Rycus P, Anders MM, Zaaqoq AM, Lorusso R, Brodie D, Keller SP, Kim BS, Whitman GJR, Cho SM. Characterizing the Racial Discrepancy in Hypoxemia Detection in Venovenous Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis. Lung 2024; 202:471-481. [PMID: 38856932 PMCID: PMC11456976 DOI: 10.1007/s00408-024-00711-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Skin pigmentation influences peripheral oxygen saturation (SpO2) compared to arterial saturation of oxygen (SaO2). Occult hypoxemia (SaO2 ≤ 88% with SpO2 ≥ 92%) is associated with increased in-hospital mortality in venovenous-extracorporeal membrane oxygenation (VV-ECMO) patients. We hypothesized VV-ECMO cannulation, in addition to race/ethnicity, accentuates the SpO2-SaO2 discrepancy due to significant hemolysis. METHODS Adults (≥ 18 years) supported with VV-ECMO with concurrently measured SpO2 and SaO2 measurements from over 500 centers in the Extracorporeal Life Support Organization Registry (1/2018-5/2023) were included. Multivariable logistic regressions were performed to examine whether race/ethnicity was associated with occult hypoxemia in pre-ECMO and on-ECMO SpO2-SaO2 calculations. RESULTS Of 13,171 VV-ECMO patients, there were 7772 (59%) White, 2114 (16%) Hispanic, 1777 (14%) Black, and 1508 (11%) Asian patients. The frequency of on-ECMO occult hypoxemia was 2.0% (N = 233). Occult hypoxemia was more common in Black and Hispanic patients versus White patients (3.1% versus 1.7%, P < 0.001 and 2.5% versus 1.7%, P = 0.025, respectively). In multivariable logistic regression, Black patients were at higher risk of pre-ECMO occult hypoxemia versus White patients (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.18-2.02, P = 0.001). For on-ECMO occult hypoxemia, Black patients (aOR = 1.79, 95% CI = 1.16-2.75, P = 0.008) and Hispanic patients (aOR = 1.71, 95% CI = 1.15-2.55, P = 0.008) had higher risk versus White patients. Higher pump flow rates (aOR = 1.29, 95% CI = 1.08-1.55, P = 0.005) and on-ECMO 24-h lactate (aOR = 1.06, 95% CI = 1.03-1.10, P < 0.001) significantly increased the risk of on-ECMO occult hypoxemia. CONCLUSION SaO2 should be carefully monitored if using SpO2 during ECMO support for Black and Hispanic patients especially for those with high pump flow and lactate values at risk for occult hypoxemia.
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Affiliation(s)
- Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Wilcox
- Department of Critical Care, Mercy Hospital of Buffalo, Buffalo, NY, USA
| | - Sari D Holmes
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery and Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT, 84132, USA
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Peter Rycus
- Extracorporeal Life Support Organization, Ann Arbor, MI, USA
| | - Marc M Anders
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Akram M Zaaqoq
- Department of Anesthesiology, Division of Critical Care, University of Virginia, Charlottesville, VA, USA
| | - Roberto Lorusso
- Cardiothoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven P Keller
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, 600 N. Wolfe Street, Phipps 455, Baltimore, MD, 21287, USA.
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Kalra A, Shou BL, Zhao D, Wilcox C, Keller SP, Kim BS, Whitman GJR, Cho SM. Extracorporeal Membrane Oxygenation Physiological Factors Influence Pulse Oximetry and Arterial Oxygen Saturation Discrepancies. Ann Thorac Surg 2024; 117:1221-1228. [PMID: 37748529 PMCID: PMC10959762 DOI: 10.1016/j.athoracsur.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Cannulation strategy, vasopressors, and hemolysis are important physiological factors that influence hemodynamics in extracorporeal membrane oxygenation (ECMO). We hypothesized these factors influence the discrepancy between oxygen saturation measured by pulse oximetry (Spo2) and arterial blood gas (Sao2) in patients on ECMO. METHODS We retrospectively analyzed adults (aged ≥18 years) on venoarterial or venovenous ECMO at a tertiary academic ECMO center. Spo2-Sao2 pairs with oxygen saturation ≥70% and measured within 10 minutes were included. Occult hypoxemia was defined as Sao2 ≤88% with a time-matched Spo2 ≥92%. Adjusted linear mixed-effects modeling was used to assess the Spo2-Sao2 discrepancy with preselected demographics and time-matched laboratory variables. Vasopressor use was quantified by vasopressor dose equivalences. RESULTS Of 139 venoarterial-ECMO and 88 venovenous-ECMO patients, we examined 20,053 Spo2-Sao2 pairs. The Spo2-Sao2 discrepancy was greater in venovenous-ECMO (1.15%) vs venoarterial-ECMO (-0.35%, P < .001). Overall, 81 patients (35%) experienced occult hypoxemia during ECMO. Occult hypoxemia was more common in venovenous-ECMO (65%) than in venoarterial-ECMO (17%, P < .001). In linear mixed-effects modeling, Spo2 underestimated Sao2 by 9.48% in central vs peripheral venoarterial-ECMO (95% CI, -17.1% to -1.79%; P = .02). Higher vasopressor dose equivalences significantly worsened the Spo2-Sao2 discrepancy (P < .001). In linear mixed-effects modeling, Spo2 overestimated Sao2 by 25.43% in single lumen-cannulated vs double lumen-cannulated venovenous-ECMO (95% CI, 5.27%-45.6%; P = .03). Higher vasopressor dose equivalences and lactate dehydrogenase levels significantly worsened the Spo2-Sao2 discrepancy (P < .001). CONCLUSIONS Venovenous-ECMO patients are at higher risk for occult hypoxemia compared with venoarterial-ECMO. A higher vasopressor requirement and different cannulation strategies (central venoarterial-ECMO; single-lumen venovenous-ECMO) were significant factors for clinically significant Spo2-Sao2 discrepancy in both ECMO modes.
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Affiliation(s)
- Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin L Shou
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - David Zhao
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christopher Wilcox
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven P Keller
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Bo Soo Kim
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
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Kalra A, Wilcox C, Holmes SD, Tonna JE, Jeong IS, Rycus P, Anders MM, Zaaqoq AM, Lorusso R, Brodie D, Keller SP, Kim BS, Whitman GJR, Cho SM. Characterizing the Racial Discrepancy in Hypoxemia Detection in VV-ECMO: An ELSO Registry Analysis. RESEARCH SQUARE 2023:rs.3.rs-3617237. [PMID: 38014220 PMCID: PMC10680917 DOI: 10.21203/rs.3.rs-3617237/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Importance Skin pigmentation influences peripheral oxygen saturation (SpO2) measured by pulse oximetry compared to the arterial saturation of oxygen (SaO2) measured via arterial blood gas analysis. However, data on SpO2-SaO2 discrepancy are limited in venovenous-extracorporeal membrane oxygenation (VV-ECMO) patients. Objective To determine whether there is racial/ethnical discrepancy between SpO2 and SaO2 in patients receiving VV-ECMO. We hypothesized VV-ECMO cannulation, in addition to race/ethnicity, accentuates the SpO2-SaO2 discrepancy due to significant hemolysis. Design Retrospective cohort study of the Extracorporeal Life Support Organization Registry from 1/2018-5/2023. Setting International, multicenter registry study including over 500 ECMO centers. Participants Adults (≥ 18 years) supported with VV-ECMO with concurrently measured SpO2 and SaO2 measurements. Exposure Race/ethnicity and ECMO cannulation. Main outcomes and measures Occult hypoxemia (SaO2 ≤ 88% with SpO2 ≥ 92%) was our primary outcome. Multivariable logistic regressions were performed to examine whether race/ethnicity was associated with occult hypoxemia in pre-ECMO and on-ECMO SpO2-SaO2 calculations. Covariates included age, sex, temporary mechanical circulatory support, pre-vasopressors, and pre-inotropes for pre-ECMO analysis, plus single-lumen versus double-lumen cannulation, hemolysis, hyperbilirubinemia, ECMO pump flow rate, and on-ECMO 24h lactate for on-ECMO analysis. Results Of 13,171 VV-ECMO patients (median age = 48.6 years, 66% male), there were 7,772 (59%) White, 2,114 (16%) Hispanic, 1,777 (14%) Black, and 1,508 (11%) Asian patients. The frequency of on-ECMO occult hypoxemia was 2.0% (N = 233). Occult hypoxemia was more common in Black and Hispanic versus White patients (3.1% versus 1.7%, P < 0.001 and 2.5% versus 1.7%, P = 0.025, respectively).In multivariable logistic regression, Black patients were at higher risk of pre-ECMO occult hypoxemia versus White patients (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.18-2.02, P = 0.001). For on-ECMO occult hypoxemia, Black patients (aOR = 1.79, 95%CI = 1.16-2.75, P = 0.008) and Hispanic patients (aOR = 1.71, 95%CI = 1.15-2.55, P = 0.008) had higher risk versus White patients. Furthermore, higher pump flow rate (aOR = 1.29, 95%CI = 1.08-1.55, P = 0.005) and higher on-ECMO 24h lactate (aOR = 1.06, 95%CI = 1.03-1.10, P < 0.001) significantly increased the risk of on-ECMO occult hypoxemia. Conclusions and Relevance Hispanic and Black VV-ECMO patients experienced occult hypoxemia more than White patients. SaO2 should be carefully monitored during ECMO support for Black and Hispanic patients especially for those with high pump flow and lactate values at risk for occult hypoxemia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Bo Soo Kim
- Johns Hopkins University School of Medicine
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Guluzade NA, Huggard JD, Duffin J, Keir DA. A test of the interaction between central and peripheral respiratory chemoreflexes in humans. J Physiol 2023; 601:4591-4609. [PMID: 37566804 DOI: 10.1113/jp284772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
How central and peripheral chemoreceptor drives to breathe interact in humans remains contentious. We measured the peripheral chemoreflex sensitivity to hypoxia (PChS) at various isocapnic CO2 tensions (P C O 2 ${P_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ) to determine the form of the relationship between PChS and centralP C O 2 ${P_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ . Twenty participants (10F) completed three repetitions of modified rebreathing tests with end-tidalP O 2 ${P_{{{\mathrm{O}}_{\mathrm{2}}}}}$ (P ET O 2 ${P_{{\mathrm{ET}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ) clamped at 150, 70, 60 and 45 mmHg. End-tidalP C O 2 ${P_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ (P ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ),P ET O 2 ${P_{{\mathrm{ET}}{{\mathrm{O}}_{\mathrm{2}}}}}$ , ventilation (V ̇ $\dot{V}$ E ) and calculated oxygen saturation (SC O2 ) were measured breath-by-breath by gas-analyser and pneumotach. TheV ̇ $\dot{V}$ E -P ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ relationship of repeat-trials were linear-interpolated, combined, averaged into 1 mmHg bins, and fitted with a double-linear function (V ̇ $\dot{V}$ E S, L min-1 mmHg-1 ). PChS was computed at intervals of 1 mmHg ofP ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ as follows: the difference inV ̇ $\dot{V}$ E between the three hypoxic profiles and the hyperoxic profile (∆V ̇ $\dot{V}$ E ) was calculated; three ∆V ̇ $\dot{V}$ E values were plotted against corresponding SC O2 ; and linear regression determined PChS (Lmin-1 mmHg-1 %SC O2 -1 ). These processing steps were repeated at eachP ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ to produce the PChS vs. isocapnicP C O 2 ${P_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ relationship. These were fitted with linear and polynomial functions, and Akaike information criterion identified the best-fit model. One-way repeated measures analysis of variance assessed between-condition differences.V ̇ $\dot{V}$ E S increased (P < 0.0001) with isoxicP ET O 2 ${P_{{\mathrm{ET}}{{\mathrm{O}}_{\mathrm{2}}}}}$ from 3.7 ± 1.5 L min-1 mmHg-1 at 150 mmHg to 4.4 ± 1.8, 5.0 ± 1.6 and 6.0 ± 2.2 Lmin-1 mmHg-1 at 70, 60 and 45 mmHg, respectively. Mean SC O2 fell progressively (99.3 ± 0%, 93.7 ± 0.1%, 90.4 ± 0.1% and 80.5 ± 0.1%; P < 0.0001). In all individuals, PChS increased withP ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ , and this relationship was best described by a linear model in 75%. Despite increasing central chemoreflex activation, PChS increased linearly withP ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ indicative of an additive central-peripheral chemoreflex response. KEY POINTS: How central and peripheral chemoreceptor drives to breathe interact in humans remains contentious. We measured peripheral chemoreflex sensitivity to hypoxia (PChS) at various isocapnic carbon dioxide tensions (P C O 2 ${P_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ) to determine the form of the relationship between PChS and centralP C O 2 ${P_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ . Participants performed three repetitions of modified rebreathing with end-tidalP O 2 ${P_{{{\mathrm{O}}_{\mathrm{2}}}}}$ fixed at 150, 70, 60 and 45 mmHg. PChS was computed at intervals of 1 mmHg of end-tidalP C O 2 ${P_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ (P ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ) as follows: the difference inV ̇ $\dot{V}$ E between the three hypoxic profiles and the hyperoxic profile (∆V ̇ $\dot{V}$ E ) was calculated; three ∆V ̇ $\dot{V}$ E values were plotted against corresponding calculated oxygen saturation (SC O2 ); and linear regression determined PChS (Lmin-1 mmHg-1 %SC O2 -1 ). In all individuals, PChS increased withP ETC O 2 ${P_{{\mathrm{ETC}}{{\mathrm{O}}_{\mathrm{2}}}}}$ , and this relationship was best described by a linear (rather than polynomial) model in 15 of 20. Most participants did not exhibit a hypo- or hyper-additive effect of central chemoreceptors on the peripheral chemoreflex indicating that the interaction was additive.
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Affiliation(s)
- Nasimi A Guluzade
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Joshua D Huggard
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - James Duffin
- Department of Anaesthesia and Pain Management, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Thornhill Research Inc., Toronto, ON, Canada
| | - Daniel A Keir
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
- Toronto General Research Institute, Toronto General Hospital, Toronto, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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Aoki KC, Barrant M, Gai MJ, Handal M, Xu V, Mayrovitz HN. Impacts of Skin Color and Hypoxemia on Noninvasive Assessment of Peripheral Blood Oxygen Saturation: A Scoping Review. Cureus 2023; 15:e46078. [PMID: 37900526 PMCID: PMC10610303 DOI: 10.7759/cureus.46078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Standard pulse oximeters estimate arterial blood saturation (SaO2) non-invasively by emitting and detecting light of a specific wavelength through a cutaneous vascular bed, such as a digit or the ear lobe. The quantity measured at these peripheral sites is designated as oxygen saturation (SpO2). Most reliable pulse oximeters are calibrated from measurements of healthy volunteers using some form of oxygen desaturation method. As the degree of inducible hypoxemia is limited, the calibration below achievable desaturation levels is usually extrapolated, leading to potential measurement error at low SaO2 values, especially in highly pigmented skin. Such skin color-related errors (SCRE) are the topic of this scoping review. Specifically, this study aimed to identify the combined impact of skin color and reduced SaO2 on the non-invasive assessment of SpO2 and report the consequences of potential inaccuracies. Three databases were searched (Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Web of Science) for peer-reviewed prospective and retrospective studies published in English between 2000 and 2022 involving human patients with hypoxemia that included a measure of skin color (Fitzpatrick scale or race/ethnicity). Ten studies met the criteria and were included in the final review. Eight of these studies reported statistically significant higher pulse oximeter readings in darker-skinned patients with hypoxia compared to their arterial blood gas measurements. Occult hypoxia was more prevalent in Black and Hispanic patients than in White patients. Minority patients overall (Black, Asian, and American Indian) were more likely to have a SaO2 < 88% that was not detected by pulse oximetry (occult hypoxemia) during hospitalization. With greater levels of hypoxemia, the differences between SpO2 and SaO2 were greater. If SaO2 was < 90%, then SpO2 was overestimated in all ethnicities but worse in minorities. In conclusion, the bias found in pulse oximeter readings in the skin of color broadly impacts patients with hypoxemia. The failure of SpO2 measuring devices to detect occult hypoxemia can delay the delivery of life-saving treatment to critically ill patients requiring respiratory rehabilitation and supplemental oxygen therapy. This may lead to adverse health outcomes, increased in-hospital mortality, and complications such as organ dysfunction. An improvement in pulse oximeter detection mechanisms that would include all skin pigmentations is therefore much desired to optimize individual healthcare status and minimize disparities in treatment.
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Affiliation(s)
- Kawaiola C Aoki
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Maya Barrant
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Mam Jarra Gai
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Marina Handal
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Vivian Xu
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Harvey N Mayrovitz
- Medical Education and Simulation, Cardiopulmonary Physiology, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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Abraham EA, Verma G, Arafat Y, Acharya S, Kumar S, Pantbalekundri N. Comparative Analysis of Oxygen Saturation by Pulse Oximetry and Arterial Blood Gas in Hypoxemic Patients in a Tertiary Care Hospital. Cureus 2023; 15:e42447. [PMID: 37637606 PMCID: PMC10449267 DOI: 10.7759/cureus.42447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Oxygen saturation is essential for medical care and is closely regulated within the body. Arterial blood gas (ABG) analysis is used to evaluate critically ill individuals' ventilation, oxygenation, acid-base status, and metabolic condition. Pulse oximetry is an easy and non-invasive way to measure the status of oxygen saturation non-invasively in clinical settings and provides a quick and precise assessment of oxygenation and reduces medical errors. SpO2 may not always be a reliable predictor of arterial oxygen saturation (SaO2), and hypoxemic, hemodynamically compromised, and critically ill patients may have lower SpO2 accuracy. A study is needed to assess and compare various oxygen saturation methods. AIMS AND OBJECTIVES The study aimed to compare the oxygen saturation levels measured by pulse oximetry and ABG analysis in hypoxemic patients. The objectives were to compare the values between SaO2, PaO2, and SpO2 values obtained from the patients, and correlate the study parameters among both techniques. MATERIALS AND METHODS The study was conducted from February 2021 to June 2022 among the 102 hypoxemic patients who were admitted to the emergency and surgical intensive care unit (ICU) of Sree Balaji Medical College and Hospital in Chennai. Primary data on ABG analysis and pulse oximetry readings were collected from the study subjects. The patient and their past medical records, physical exam, chest x-ray findings, pulse oximetry, and ABG results were all reviewed. Each patient had their ABG, and pulse oximetry measured simultaneously. A comparison was made between SpO2 and partial pressure of oxygen (PaO2) and arterial oxygen saturation (SaO2) parameters using a paired t-test. The correlation was done against the SpO2 and ABG parameters and assessed for association using the correlation coefficient value; gender was also considered while correlating. RESULTS AND DISCUSSION An observational study was done among 102 study samples to comparatively analyze the oxygen saturation by two methods, namely pulse oximetry and ABG, in hypoxemic patients. While comparing the mean values of SaO2 and SpO2, they were 84.41 ± 4.24 and 80.58 ± 5.77, respectively, and this difference was statistically very significant (p < 0.001). While comparing the mean values of PaO2 and SaO2, they were 61.02 ± 5.01 and 84.41 ± 4.24, respectively, and this difference was statistically significant (p = 0.043). While comparing the mean values of PaO2 and SpO2, they were 61.02 ± 5.01 and 80.58 ± 5.77, respectively, and this difference was statistically significant (p = 0.054). Among the study population, with regard to the correlation factor, there is notably a very high and strong positive correlation between SaO2 and SpO2 and between SpO2 and PaO2. There was a negative correlation between SpO2 and finger abnormalities and between SpO2 and blood pressure. CONCLUSION The ABG method is considered the gold standard. When SpO2 levels fall below 90%, pulse oximetry may not be accurate enough to reliably assess oxygenation. In such cases, where alveolar hypoventilation is suspected, it is recommended to complement pulse oximetry with ABG studies. This is because ABG analysis provides a more comprehensive assessment of oxygenation and acid-base status, which can aid in the diagnosis and management of respiratory conditions.
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Affiliation(s)
- Elen A Abraham
- Department of Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Ghanshyam Verma
- Department of Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Yasar Arafat
- Department of Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Nikhil Pantbalekundri
- Department of Medicine, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Wardha, IND
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Kalra A, Shou BL, Zhao D, Wilcox C, Keller SP, Whitman GJ, Kim BS, Cho SM. Racial and ethnical discrepancy in hypoxemia detection in patients on extracorporeal membrane oxygenation. JTCVS OPEN 2023; 14:145-170. [PMID: 37425474 PMCID: PMC10328809 DOI: 10.1016/j.xjon.2023.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/22/2023] [Accepted: 02/16/2023] [Indexed: 07/11/2023]
Abstract
Objective To determine whether there is racial/ethnical discrepancy between pulse oximetry (SpO2) and oxygen saturation (SaO2) in patients receiving extracorporeal membrane oxygenation (ECMO). Methods This was a retrospective observational study at a tertiary academic ECMO center with adults (>18 years) on venoarterial (VA) or venovenous (VV) ECMO. Datapoints were excluded if oxygen saturation ≤70% or SpO2-SaO2 pairs were not measured within 10 minutes. The primary outcome was the presence of a SpO2-SaO2 discrepancy between different races/ethnicities. Bland-Altman analyses and linear mixed-effects modeling, adjusting for prespecified covariates, were used to assess the SpO2-SaO2 discrepancy between races/ethnicities. Occult hypoxemia was defined as SaO2 <88% with a time-matched SpO2 ≥92%. Results Of 139 patients receiving VA-ECMO and 57 patients receiving VV-ECMO, we examined 16,252 SpO2-SaO2 pairs. The SpO2-SaO2 discrepancy was greater in VV-ECMO (1.4%) versus VA-ECMO (0.15%). In VA-ECMO, SpO2 overestimated SaO2 in Asian (0.2%), Black (0.94%), and Hispanic (0.03%) patients and underestimated SaO2 in White (-0.06%) and nonspecified race (-0.80%) patients. The proportion of SpO2-SaO2 measurements considered occult hypoxemia was 70% from Black compared to 27% from White patients (P < .0001). In VV-ECMO, SpO2 overestimated SaO2 in Asian (1.0%), Black (2.9%), Hispanic (1.1%), and White (0.50%) patients and underestimated SaO2 in nonspecified race patients (-0.53%). In linear mixed-effects modeling, SpO2 overestimated SaO2 by 0.19% in Black patients (95% confidence interval, 0.045%-0.33%, P = .023). The proportion of SpO2-SaO2 measurements considered occult hypoxemia was 66% from Black compared with 16% from White patients (P < .0001). Conclusions SpO2 overestimates SaO2 in Asian, Black, and Hispanic versus White patients, and this discrepancy was greater in VV-ECMO versus VA-ECMO, suggesting the need for physiological studies.
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Affiliation(s)
- Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Benjamin L. Shou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - David Zhao
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
| | - Christopher Wilcox
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
| | - Steven P. Keller
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
| | - Glenn J.R. Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
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Milloy KM, White MG, Chicilo JOC, Cummings KJ, Pfoh JR, Day TA. Assessing central and peripheral respiratory chemoreceptor interaction in humans. Exp Physiol 2022; 107:1081-1093. [PMID: 35766127 DOI: 10.1113/ep089983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 06/16/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? We investigated the interaction between central and peripheral respiratory chemoreceptors in healthy, awake human participants by (a) using a background of step increases in steady-state normoxic fraction of inspired carbon dioxide to alter central chemoreceptor activation and (b) using the transient hypoxia test to target the peripheral chemoreceptors. What is the main finding and its importance? Our data suggests that the central-peripheral respiratory chemoreceptor interaction is additive in minute ventilation and respiratory rate, but hypoadditive in tidal volume. Our study adds important new data in reconciling chemoreceptor interaction in awake healthy humans, and is consistent with previous reports of simple addition in intact rodents and humans. ABSTRACT Arterial blood gas levels are maintained through respiratory chemoreflexes, mediated by central (CCR) in the CNS and peripheral (PCR) chemoreceptors located in the carotid bodies. The interaction between central and peripheral chemoreceptors is controversial, and few studies have investigated this interaction in awake healthy humans, in part due to methodological challenges. We investigated the interaction between the CCRs and PCRs in healthy humans using a transient hypoxia test (three consecutive breaths of 100% N2 ; TT-HVR), which targets the stimulus and temporal domain specificity of the PCRs. TT-HVRs were superimposed upon three randomized background levels of steady-state inspired fraction of normoxic CO2 (FI CO2 ; 0, 0.02 and 0.04). Chemostimuli (calculated oxygen saturation; ScO2 ) and respiratory variable responses (respiratory rate, inspired tidal volume and ventilation; RR , VTI , V̇I ), were averaged from all three TT-HVR trials at each FI CO2 level. Responses were assessed as (a) a change from BL (delta; ∆) and (b) indexed against ∆ScO2 . Aside from a significantly lower ∆VTI response in 0.04 FI CO2 (P = 0.01), the hypoxic rate responses (∆RR or ∆RR /∆ScO2 ; P = 0.46, P = 0.81), hypoxic tidal volume response (∆VTI /∆ScO2 ; P = 0.08) and the hypoxic ventilatory responses (∆V̇I and (∆V̇I /∆ScO2 ; P = 0.09 and P = 0.31) were not significantly different across FI CO2 trials. Our data suggests simple addition between central and peripheral chemoreceptors in V̇I , which is mediated through simple addition in RR responses, but hypo-addition in VTI responses. Our study adds important new data in reconciling chemoreceptor interaction in awake healthy humans, and is consistent with previous reports of simple addition in intact rodents and humans. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kristin M Milloy
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada
| | - Matthew G White
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada
| | - Janelle O C Chicilo
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada
| | | | - Jamie R Pfoh
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada
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Maher P, Zafar H, Mathews K. Oxyhemoglobin concentrations do not support hemoglobinopathy in COVID-19. Respir Med 2021; 187:106597. [PMID: 34481306 PMCID: PMC8405232 DOI: 10.1016/j.rmed.2021.106597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022]
Abstract
Based on computerized modeling studies, it has been postulated that the severe hypoxemia in COVID-19 may result from impaired oxygen carrying capacity on hemoglobin. Standard pulse oximetry may not detect hypoxemia resulting from hemoglobinopathy, therefore hemoglobin co-oximetry is needed to evaluate this divergence. In a clinical data analysis of a multicenter cohort of hospitalized patients with COVID-19, we found a minimal effect, less than 1%, on the correlation between oxyhemoglobin concentration and predicted oxygen saturation in the presence of COVID-19 infection. This effect is unlikely to explain the clinically significant hypoxia in COVID-19 patients.
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Affiliation(s)
- Patrick Maher
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Hamna Zafar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kusum Mathews
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Kalisvaart M, Croome KP, Hernandez-Alejandro R, Pirenne J, Cortés-Cerisuelo M, Miñambres E, Abt PL. Donor Warm Ischemia Time in DCD Liver Transplantation-Working Group Report From the ILTS DCD, Liver Preservation, and Machine Perfusion Consensus Conference. Transplantation 2021; 105:1156-1164. [PMID: 34048418 DOI: 10.1097/tp.0000000000003819] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Donation after circulatory death (DCD) grafts are commonly used in liver transplantation. Attributable to the additional ischemic event during the donor warm ischemia time (DWIT), DCD grafts carry an increased risk for severe ischemia/reperfusion injury and postoperative complications, such as ischemic cholangiopathy. The actual ischemia during DWIT depends on the course of vital parameters after withdrawal of life support and varies widely between donors. The ischemic period (functional DWIT) starts when either Spo2 or blood pressure drop below a certain point and lasts until the start of cold perfusion during organ retrieval. Over the years, multiple definitions and thresholds of functional DWIT duration have been used. The International Liver Transplantation Society organized a Consensus Conference on DCD, Liver Preservation, and Machine Perfusion on January 31, 2020 in Venice, Italy. The aim of this conference was to reach consensus about various aspects of DCD liver transplantation in context of currently available evidence. Here we present the recommendations with regards to the definitions used for DWIT and functional DWIT, the importance of vital parameters after withdrawal of life support, and acceptable thresholds of duration of functional DWIT to proceed with liver transplantation.
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Affiliation(s)
- Marit Kalisvaart
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jacques Pirenne
- Department of Abdominal Transplant Surgery, University Hospital Leuven, Leuven, Belgium
| | - Miriam Cortés-Cerisuelo
- Department of Liver Transplantation, Institute of Liver Studies, King's College Hospital NHS Trust, London, United Kingdom
| | - Eduardo Miñambres
- Transplant Coordination Unit and Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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12
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Rauniyar N, Pujari S, Shrestha P. Study of Oxygen Saturation by Pulse Oximetry and Arterial Blood Gas in ICU Patients: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:789-793. [PMID: 34504355 PMCID: PMC7654494 DOI: 10.31729/jnma.5536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction: Pulse oximetery is expected to be an indirect estimation of arterial oxygen saturation. However, there often are gaps between SpO2 and SaO2. This study aims to study on arterial oxygen saturation measured by pulse oximetry and arterial blood gas among patients admitted in intensive care unit. Methods: It was a hospital-based descriptive cross-sectional study in which 101 patients meeting inclusion criteria were studied. SpO2 and SaO2 were measured simultaneously. Mean±SD of SpO2 and SaO2 with accuracy, sensitivity and specificity were measured. Results: According to SpO2 values, out of 101 patients, 26 (25.7%) were hypoxemic and 75 (74.25%) were non-hypoxemic. The mean±SD of SaO2 and SpO2 were 93.22±7.84% and 92.85±6.33% respectively. In 21 patients with SpO2<90%, the mean±SD SaO2 and SpO2 were 91.63±4.92 and 87.42±2.29 respectively. In 5 patients with SpO2 < 80%, the mean ± SD of SaO2 and SpO2 were: 63.40 ± 3.43 and 71.80±4.28, respectively. In non-hypoxemic group based on SpO2 values, the mean±SD of SpO2 and SaO2 were 95.773±2.19% and 95.654±3.01%, respectively. The agreement rate of SpO2 and SaO2 was 83.2%, and sensitivity and specificity of PO were 84.6% and 83%, respectively. Conclusions: Pulse Oximetry has high accuracy in estimating oxygen saturation with sp02>90% and can be used instead of arterial blood gas.
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Affiliation(s)
- Nabin Rauniyar
- Department of Internal Medicine, Nepal Police Hospital, Nepal
| | - Shyam Pujari
- Department of Internal Medicine, Nepal Police Hospital, Nepal
| | - Pradeep Shrestha
- Department of Internal Medicine, Dhaulagiri Zonal Hospital, Baglung, Nepal
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13
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Arakaki LSL, Ciesielski WA, McMullan DM, Schenkman KA. Noninvasive Cellular Oxygenation Measurement During Graded Hypoxia Using Visible-Near-Infrared Spectroscopy. APPLIED SPECTROSCOPY 2020; 74:1263-1273. [PMID: 32662282 DOI: 10.1177/0003702820938867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In critically ill patients, direct knowledge of intracellular pO2 would allow for identification of cellular hypoxia, which when prolonged leads to organ failure. We have developed a visible-near-infrared optical system that noninvasively measures myoglobin saturation, which is directly related to intracellular pO2, from the surface of the skin. We used an animal model of graded hypoxia from low levels of inspired oxygen (n = 5) and verified that low intracellular pO2 is correlated with high steady-state serum lactate values. In addition, the pO2 gradient between arterial blood and inside muscle cells was 83 mm Hg at 21% O2, but fell to 24 mm Hg at 8% O2. Continuous myoglobin saturation measurement in skeletal muscle displayed the same trends as cerebral oxygenation with no lag in changes over time, demonstrating its relevance as a measure of systemic oxygenation.
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Affiliation(s)
| | - Wayne A Ciesielski
- Department of Pediatrics, 7284University of Washington, Seattle, WA, USA
| | | | - Kenneth A Schenkman
- Department of Pediatrics, 7284University of Washington, Seattle, WA, USA
- Department of Anesthesiology, 7284University of Washington, Seattle, WA, USA
- Department of Bioengineering, 7284University of Washington, Seattle, WA, USA
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14
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Dixon B, MacLeod DB. Assessment of a Non Invasive Brain Oximeter in Volunteers Undergoing Acute Hypoxia. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:183-194. [PMID: 32669881 PMCID: PMC7335769 DOI: 10.2147/mder.s250102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/09/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Research in traumatic brain injury suggests better patient outcomes when invasive oxygen monitoring is used to detect and correct episodes of brain hypoxia. Invasive brain oxygen monitoring is, however, not routinely used due to the risks, costs and technical challengers. We are developing a non-invasive brain oximeter to address these limitations. The monitor uses the principles of pulse oximetry to record a brain photoplethysmographic waveform and oxygen saturations. We undertook a study in volunteers to assess the new monitor. PATIENTS AND METHODS We compared the temporal changes in the brain and skin oxygen saturations in six volunteers undergoing progressive hypoxia to reach arterial saturations of 70%. This approach provides a method to discriminate potential contamination of the brain signal by skin oxygen levels, as the responses in brain and skin oxygen saturations are distinct due to the auto-regulation of cerebral blood flow to compensate for hypoxia. Conventional pulse oximetry was used to assess skin oxygen levels. Blood was also collected from the internal jugular vein and correlated with the brain oximeter oxygen levels. RESULTS At baseline, a photoplethysmographic waveform consistent with that expected from the brain was obtained in five subjects. The signal was adequate to assess oxygen saturations in three subjects. During hypoxia, the brain's oximeter oxygen saturation fell to 74%, while skin saturation fell to 50% (P<0.0001). The brain photoplethysmographic waveform developed a high-frequency oscillation of ~7 Hz, which was not present in the skin during hypoxia. A weak correlation between the brain oximeter and proximal internal jugular vein oxygen levels was demonstrated, R2=0.24, P=0.01. CONCLUSION Brain oximeter oxygen saturations were relatively well preserved compared to the skin during hypoxia. These findings are consistent with the expected physiological responses and suggest skin oxygen levels did not markedly contaminate the brain oximeter signal.
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Affiliation(s)
| | - David B MacLeod
- Human Pharmacology and Physiology Laboratory, Department of Anesthesiology and School of Nursing, Duke University, Durham, NC, USA
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15
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Kundra TS, Thimmarayappa A, Subash SS, Kaur P. Monitoring of limb perfusion after vascular surgery in critical limb ischemia using near-infrared spectroscopy: A prospective observational study. Ann Card Anaesth 2020; 23:429-432. [PMID: 33109799 PMCID: PMC7879884 DOI: 10.4103/aca.aca_137_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Intra and postoperative perfusion monitoring should be used in critical limb ischemia patients undergoing vascular surgery to improve outcomes and reduce costs. While a pulse oximeter can be applied on the affected limb to monitor the arterial saturation of the limb, thus reflecting flow in that limb, we need to focus on other important parameters like muscle oxygen consumption and regional blood flow for a good outcome. Near-infrared spectroscopy (NIRS) can be used in such patients to monitor regional and tissue oxygenation. Methodology: In this prospective observational study, 30 adult patients undergoing infra-inguinal bypass were recruited. All these patients were given combined spinal-epidural anesthesia. In addition to routine monitoring, a pulse oximeter and NIRS electrodes were applied on the affected limb. rsO2, limb spO2, and Doppler signals were noted before the induction of anesthesia (baseline) and postoperatively at 0, 6, and 12 h. Improvement in rsO2 and limb spO2 values after surgery was noted and fall in these values was evaluated. Pearson correlation between rsO2 and limb spO2 was assessed. The data was analyzed using repeated-measures ANOVA. Results: Pearson correlation between rsO2 and limb spO2 was r > 0.8. Two patients had a fall in rsO2 in postoperative period, which co-related with a fall in limb spO2 and decreased/absent Doppler signals. Conclusion: NIRS represents a noninvasive and reliable means to monitor limb perfusion in patients undergoing vascular surgery for rest pain.
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Affiliation(s)
- Tanveer Singh Kundra
- Department of Anaesthesiology, Government Medical College, Patiala, Punjab, India
| | - Ashwini Thimmarayappa
- Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Sunder Singh Subash
- Department of Anaesthesiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Parminder Kaur
- Department of Critical Care, Max Hospital, Mohali, Punjab, India
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16
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Dixon B, Turner R, Christou C. Assessment of a Non-Invasive Brain Oximeter in a Sheep Model of Acute Brain Injury. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:479-487. [PMID: 31824197 PMCID: PMC6900466 DOI: 10.2147/mder.s235804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/20/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Evidence suggests treatments guided by brain oxygen levels improve patient outcomes following severe traumatic brain injury; however, brain oxygen levels are not routinely monitored as an effective non-invasive method has not been established. We undertook a study, in a sheep model of acute brain injury, to assess a new non-invasive brain oximeter. The monitor uses the principles of pulse oximetry to record a pulse and oxygen levels. Methods We studied 8 sheep. An acute increase in intracranial pressure was induced with an injection of blood into the cranial vault. The temporal changes in the brain oximeter, intracranial pressure and cerebral perfusion pressure were recorded. Simultaneous conventional skin pulse oximetry was also recorded to assess the possible influence of skin blood flow on the brain oximeter signal. Results At baseline, a pulsatile waveform consistent with the brain circulation was obtained in 7 animals. The baseline brain pulse was quite distinct from the simultaneous conventional skin pulse and similar in shape to a central venous pressure waveform. Injection of blood into the cranial vault triggered an immediate increase in intracranial pressure and fall in cerebral perfusion pressure, by 60-s cerebral perfusion pressure recovered. The brain oximeter oxygen levels demonstrated similar changes with an immediate fall and recovery by 60 s. Periods of high intracranial pressure were also associated with high-frequency oscillations in the brain pulse waveform; there was, however, no change in the conventional skin pulse oximeter pulse waveform. Conclusion The brain oximeter detected acute changes in both oxygen levels and the brain pulse waveform following an increase in intracranial pressure levels. The brain oximeter could assist clinicians in the management of acute brain injury. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/wbf5tjsC3pw
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Affiliation(s)
| | - Renee Turner
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Chris Christou
- Preclinical Imaging and Research Laboratories, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Ascha M, Bhattacharyya A, Ramos JA, Tonelli AR. Pulse Oximetry and Arterial Oxygen Saturation during Cardiopulmonary Exercise Testing. Med Sci Sports Exerc 2019; 50:1992-1997. [PMID: 29771822 DOI: 10.1249/mss.0000000000001658] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION/PURPOSE Peripheral capillary oxygen saturation (SpO2) is used as surrogate for arterial blood oxygen saturation. We studied the degree of discrepancy between SpO2 and arterial oxygen (SaO2) and identified parameters that may explain this difference. METHODS We included patients who underwent cardiopulmonary exercise testing at Cleveland Clinic. Pulse oximeters with forehead probes measured SpO2 and arterial blood gas samples provided the SaO2 both at rest and peak exercise. RESULTS We included 751 patients, 54 ± 16 yr old with 53% of female gender. Bland-Altman analysis revealed a bias of 3.8% with limits of agreement of 0.3% to 7.9% between SpO2 and SaO2 at rest. A total of 174 (23%) patients had SpO2 ≥ 5% of SaO2, and these individuals were older, current smokers with lower forced expiratory volume in the first second and higher partial pressure of carbon dioxide and carboxyhemoglobin. At peak exercise (n = 631), 75 (12%) SpO2 values were lower than the SaO2 determinations reflecting difficulties in the SpO2 measurement in some patients. The bias between SpO2 and SaO2 was 2.6% with limits of agreement between -2.9% and 8.1%. Values of SpO2 ≥ 5% of SaO2 (n = 78, 12%) were associated with the significant resting variables plus lower heart rate, oxygen consumption, and oxygen pulse. In multivariate analyses, carboxyhemoglobin remained significantly associated with the difference between SpO2 and SaO2 both at rest and peak exercise. CONCLUSIONS In the present study, pulse oximetry commonly overestimated the SaO2. Increased carboxyhemoglobin levels are independently associated with the difference between SpO2 and SaO2, a finding particularly relevant in smokers.
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Affiliation(s)
- Mona Ascha
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Anirban Bhattacharyya
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Jose A Ramos
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
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18
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Kalisvaart M, de Haan JE, Polak WG, N M IJzermans J, Gommers D, Metselaar HJ, de Jonge J. Onset of Donor Warm Ischemia Time in Donation After Circulatory Death Liver Transplantation: Hypotension or Hypoxia? Liver Transpl 2018; 24:1001-1010. [PMID: 30142246 PMCID: PMC6718005 DOI: 10.1002/lt.25287] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/06/2018] [Accepted: 05/26/2018] [Indexed: 12/12/2022]
Abstract
The aim of this study was to investigate the impact of hypoxia and hypotension during the agonal phase of donor warm ischemia time (DWIT) on hepatic ischemia/reperfusion injury (IRI) and complications in donation after circulatory death (DCD) liver transplantation. A retrospective single-center study of 93 DCD liver transplants (Maastricht type III) was performed. DWIT was divided into 2 periods: the agonal phase (from withdrawal of treatment [WoT] until circulatory arrest) and the asystolic phase (circulatory arrest until cold perfusion). A drop to <80% in peripheral oxygenation (SpO2 ) was considered as hypoxia in the agonal phase (SpO2 -agonal) and a drop to <50 mm Hg as hypotension in the agonal phase (SBP-agonal). Peak postoperative aspartate transaminase level >3000 U/L was considered as severe hepatic IRI. SpO2 dropped within 2 minutes after WoT <80%, whereas the systolic blood pressure dropped to <50 mm Hg after 9 minutes, resulting in a longer SpO2 -agonal (13 minutes) than SBP-agonal (6 minutes). In multiple logistic regression analysis, only duration of SpO2 -agonal was associated with severe hepatic IRI (P = 0.006) and not SBP-agonal (P = 0.32). Also, recipients with long SpO2 -agonal (>13 minutes) had more complications with a higher Comprehensive Complication Index during hospital admission (43.0 versus 32.0; P = 0.002) and 90-day graft loss (26% versus 6%; P = 0.01), compared with recipients with a short SpO2 -agonal (≤13 minutes). Furthermore, Cox proportional hazard modeling identified a long SpO2 -agonal as a risk factor for longterm graft loss (hazard ratio, 3.30; 95% confidence interval, 1.15-9.48; P = 0.03). In conclusion, the onset of hypoxia during the agonal phase is related to the severity of hepatic IRI and postoperative complications. Therefore, SpO2 <80% should be considered as the start of functional DWIT in DCD liver transplantation.
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Affiliation(s)
- Marit Kalisvaart
- Department of Surgery, Division of Transplant Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jubi E de Haan
- Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wojciech G Polak
- Department of Surgery, Division of Transplant Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Division of Transplant Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jeroen de Jonge
- Department of Surgery, Division of Transplant Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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19
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Scrimgeour GE, Griksaitis MJ, Pappachan JV, Baldock AJ. The Accuracy of Noninvasive Peripheral Pulse Oximetry After Palliative Cardiac Surgery in Patients With Cyanotic Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2017; 8:32-38. [PMID: 28033078 DOI: 10.1177/2150135116673016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Children with cyanotic congenital heart disease (CCHD) live with oxyhemoglobin saturations that are typically expressed as percentages in the range of 70s and 80s. Peripheral pulse oximetry (measurement of SpO2) performs poorly in this range and yet is widely used to inform clinical decisions in these patients. The reference standard is co-oximetry of arterial samples (SaO2). METHODS In this study, 515 paired measurements of SpO2 and SaO2 were taken from 19 children who had undergone palliative cardiac surgery. RESULTS SpO2 (Masimo SET LNCS Neo pulse oximeter) overestimated oxyhemoglobin saturation in 82% of measurements (mean 4.6% ± 6.6%). There was a strong negative correlation between mean bias and SaO2 ( r = -.96, P = .002, 95% confidence interval: -0.99 to -0.68). CONCLUSION The results raise a concern that critical hypoxemia may go undetected and untreated if pulse oximetry is relied upon as the primary means of assessing oxyhemoglobin saturation in children with CCHD. Strong preference must be given to co-oximetry of arterial samples.
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Affiliation(s)
- Gemma E Scrimgeour
- 1 University of Southampton, Department of Medicine, Southampton, United Kingdom
| | - Michael J Griksaitis
- 2 Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, United Kingdom
| | - John V Pappachan
- 2 Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, United Kingdom
| | - Andrew J Baldock
- 2 Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, United Kingdom
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Pfoh JR, Steinback CD, Vanden Berg ER, Bruce CD, Day TA. Assessing chemoreflexes and oxygenation in the context of acute hypoxia: Implications for field studies. Respir Physiol Neurobiol 2017; 246:67-75. [PMID: 28757365 DOI: 10.1016/j.resp.2017.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
Abstract
Carotid chemoreceptors detect changes in PO2 and elicit a peripheral respiratory chemoreflex (PCR). The PCR can be tested through a transient hypoxic ventilatory response test (TT-HVR), which may not be safe nor feasible at altitude. We characterized a transient hyperoxic ventilatory withdrawal test in the setting of steady-state normobaric hypoxia (13.5-14% FIO2) and compared it to a TT-HVR and a steady-state poikilocapnic hypoxia test, within-individuals. No PCR test magnitude was correlated with any other test, nor was any test magnitude correlated with oxygenation while in steady-state hypoxia. Due to the heterogeneity between the different PCR test procedures and magnitudes, and the confounding effects of alterations in CO2 acting on both central and peripheral chemoreceptors, we developed a novel method to assess prevailing steady-state chemoreflex drive in the context of hypoxia. Quantifying peak hypoxic/hyperoxic responses at low altitude may have minimal utility in predicting oxygenation during ascent to altitude, and here we advance a novel index of chemoreflex drive.
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Affiliation(s)
- Jamie R Pfoh
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada
| | - Craig D Steinback
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada
| | - Emily R Vanden Berg
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada; Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada
| | - Christina D Bruce
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada.
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Singh AK, Sahi MS, Mahawar B, Rajpurohit S. Comparative Evaluation of Accuracy of Pulse Oximeters and Factors Affecting Their Performance in a Tertiary Intensive Care Unit. J Clin Diagn Res 2017; 11:OC05-OC08. [PMID: 28764215 DOI: 10.7860/jcdr/2017/24640.9961] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 03/04/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pulse oximetry is a widely used tool, unfortunately there is a paucity of data investigating its accuracy in Intensive Care Units (ICU) and if they are able to meet mandated FDA criteria as claimed by them in critically ill patients. AIM To assess bias, precision and accuracy of pulse oximeters used in ICU and factors affecting them. MATERIALS AND METHODS A prospective cohort study, including 129 patients admitted to the ICU of a tertiary referral centre. Pulse oximetry and blood gas were done simultaneously. Pulse oximetry was done using two pulse oximetres: Nonin and Philips. All physiological variables like haemoglobin, lactate, use of vasopressors and blood pressure were recorded. Bland Altman curves were constructed to determine bias and limits of agreement. Effect of physiological variables on bias and difference between performance characteristics of bias was determined using SPSS. RESULTS Pulse oximetry overestimated arterial oxygen saturation (SaO2) by 1.44%. There was negative correlation between bias and SaO2 (r=-0.32) and positive correlation with lactate (r=0.16). The Philips pulse oximeter had significant higher bias and variability than Nonin pulse oximeter. (2.49±2.99 versus 0.46±1.68, mean difference = 1.98, 95% C.I. = 1.53 - 2.43, p-value <0.001). CONCLUSION Pulse oximetry overestimates SaO2. Bias tends to increase with rising lactate and hypoxia. There is heterogeneity in performance of various pulse oximetry devices in ICU.
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Affiliation(s)
- Anupam Kumar Singh
- Senior Resident, Department of Cardiology, NDMC Medical College Hindu Rao Hospital, New Delhi, India
| | - Malvinder Singh Sahi
- Senior Consultant Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Bablesh Mahawar
- Consultant Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sajjan Rajpurohit
- Consultant, Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Torres A, Skender KM, Wohrley JD, Aldag JC, Raff GW, Bysani GK, Geiss DM. Pulse Oximetry in Children with Congenital Heart Disease: Effects of Cardiopulmonary Bypass and Cyanosis. J Intensive Care Med 2016; 19:229-34. [PMID: 15296623 DOI: 10.1177/0885066604263819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this prospective, observational study with consecutive sampling was to assess the reliability, bias, and precision of Nellcor N-395 (N) and Masimo SET Radical (M) pulse oximeters in children with cyanotic congenital heart disease and children with congenital heart disease recovering from cardiopulmonary bypass-assisted surgery admitted to a cardiovascular operating suite and pediatric intensive care unit at a tertiary care community hospital. Forty-six children with congenital heart disease were studied in 1 of 2 groups: (1) those recovering from cardiopulmonary bypass with a serum lactic acid > 2 mmol/L, and (2) those with co-oximetry measured saturations (SaO 2) < 90% and no evidence of shock. Measurements of SaO 2 of whole blood were compared to simultaneous pulse oximetry saturations (SpO 2). Data were analyzed to detect significant differences in SpO 2 readout failures between oximeters and average SpO 2 - SaO 2 ± 1 SD for each oximeter. A total of 122 SaO 2 measurements were recorded; the median SaO 2 was 83% (57 - 100%). SpO 2 failures after cardiopulmonary bypass were 41% (25/61) for N versus 10% (6/61) for M ( P < .001). There was a significant difference in bias (ie, average SpO 2 - SaO 2) and precision (± 1 SD) between oximeters (N, 1.1 ± 3.3 vs M, -0.2 ± 4.1; P < .001) in the postcardiopulmonary bypass group but no significant difference in bias and precision between oximeters in the cyanotic congenital heart disease group (N, 2.9 ± 4.6 vs M, 2.8 ± 6.2; P = .848). The Nellcor N-395 pulse oximeter failed more often immediately after cardiopulmonary bypass than did the Masimo SET Radical pulse oximeter. SpO2 measured with both oximeters overestimated SaO2 in the presence of persistent hypoxemia.
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Affiliation(s)
- Adalberto Torres
- University of Illinois College of Medicine at Peoria, Illinois, USA.
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23
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Pfoh JR, Day TA. Considerations for the use of transient tests of the peripheral chemoreflex in humans: the utility is in the question and the context. Exp Physiol 2016; 101:778-9. [DOI: 10.1113/ep085784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Jamie R. Pfoh
- Department of Biology, Faculty of Science and Technology; Mount Royal University; Calgary Alberta Canada T3E 6K6
| | - Trevor A. Day
- Department of Biology, Faculty of Science and Technology; Mount Royal University; Calgary Alberta Canada T3E 6K6
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da Costa JC, Faustino P, Lima R, Ladeira I, Guimarães M. Research: Comparison of the Accuracy of a Pocket versus Standard Pulse Oximeter. Biomed Instrum Technol 2016; 50:190-193. [PMID: 27164204 DOI: 10.2345/0899-8205-50.3.190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Pulse oximetry has become an essential tool in clinical practice. With patient self-management becoming more prevalent, pulse oximetry self-monitoring has the potential to become common practice in the near future. This study sought to compare the accuracy of two pulse oximeters, a high-quality standard pulse oximeter and an inexpensive pocket pulse oximeter, and to compare both devices with arterial blood co-oximetry oxygen saturation. METHODS A total of 95 patients (35.8% women; mean [±SD] age 63.1 ± 13.9 years; mean arterial pressure was 92 ± 12.0 mmHg; mean axillar temperature 36.3 ± 0.4°C) presenting to our hospital for blood gas analysis was evaluated. The Bland-Altman technique was performed to calculate bias and precision, as well as agreement limits. Student's t test was performed. RESULTS Standard oximeter presented 1.84% bias and a precision error of 1.80%. Pocket oximeter presented a bias of 1.85% and a precision error of 2.21%. Agreement limits were -1.69% to 5.37% (standard oximeter) and -2.48% to 6.18% (pocket oximeter). CONCLUSION Both oximeters presented bias, which was expected given previous research. The pocket oximeter was less precise but had agreement limits that were comparable with current evidence. Pocket oximeters can be powerful allies in clinical monitoring of patients based on a self-monitoring/efficacy strategy.
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Murphy D, Pak Y, Cleary JP. Pulse Oximetry Overestimates Oxyhemoglobin in Neonates with Critical Congenital Heart Disease. Neonatology 2016; 109:213-8. [PMID: 26800085 DOI: 10.1159/000442379] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 11/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pulse oximetry is a key part of the clinical evaluation and management of neonates with congenital heart defects. In 2011, the US Department of Health and Human Services recommended use of routine pulse oximetry to screen for critical congenital heart disease (CCHD). Current studies suggest pulse oximetry overestimates arterial oxygen saturation in moderately hypoxemic pediatric patients. Based on variable hypoxemia in neonates with CCHD, concern exists that present pulse oximeter technology may overestimate measured oxyhemoglobin. OBJECTIVES To compare pulse oximetry and oxyhemoglobin values in NICU patients with known CCHD to evaluate the ability of pulse oximetry to reliably predict oxyhemoglobin accounting for potential confounding variables such as heart lesion, saturation range, total hemoglobin concentration, peripheral perfusion, and timing of measurements. METHODS This is a single-center retrospective study. Inclusion criteria were AHA-defined CCHD and umbilical artery blood gas-derived oxyhemoglobin with concurrent pulse oximetry recording during hours of life 0-72. Bland-Altman analysis and the concordance correlation coefficient were used to measure the internal consistency (agreement) between the two measurements. RESULTS 89 patients were evaluated with 599 paired arterial oxyhemoglobin and pulse oximetry recordings. 47% of all pulse oximetry values were ≥95% - the cutoff for CCHD screening. Pulse oximetry overestimated arterial oxyhemoglobin by a mean of 5.4% over all levels of oxygen saturation. Pulse oximetry overestimation was >3 in 65.4% of measurements, >6 in 41.2% of measurements, and >10 in 15.3% of measurements. Hour of life, total hemoglobin, and peripheral perfusion did not significantly affect the degree of overestimation. CONCLUSIONS Our results reinforce the concern that present pulse oximeters overestimate oxyhemoglobin values, contributing to some false-negative CCHD screens and potentially leading to unnecessary escalations in care of those patients with diagnosed CCHD. Improvements in pulse oximetry accuracy and precision in the neonate would benefit both screening and clinical care in the NICU.
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Affiliation(s)
- Daniel Murphy
- Division of Neonatology, Department of Pediatrics, Los Angeles County-Harbor UCLA Medical Center, Torrance, Calif., USA
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Hassan MA, Mendler M, Maurer M, Waitz M, Huang L, Hummler HD. Reliability of pulse oximetry during cardiopulmonary resuscitation in a piglet model of neonatal cardiac arrest. Neonatology 2015; 107:113-9. [PMID: 25471619 DOI: 10.1159/000368178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 09/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pulse oximetry is widely used in intensive care and emergency conditions to monitor arterial oxygenation and to guide oxygen therapy. OBJECTIVE To study the reliability of pulse oximetry in comparison with CO-oximetry in newborn piglets during cardiopulmonary resuscitation (CPR). METHODOLOGY In a prospective cohort study in 30 healthy newborn piglets, cardiac arrest was induced, and thereafter each piglet received CPR for 20 min. Arterial oxygen saturation was monitored continuously by pulse oximetry (SpO2). Arterial blood was analyzed for functional oxygenation (SaO2) every 2 min. SpO2 was compared with coinciding SaO2 values and bias considered whenever the difference (SpO2 - SaO2) was beyond ±5%. RESULTS Bias values were decreased at the baseline measurements (mean: 2.5 ± 4.6%) with higher precision and accuracy compared with values across the experiment. Two minutes after cardiac arrest, there was a marked decrease in precision and accuracy as well as an increase in bias up to 13 ± 34%, reaching a maximum of 45.6 ± 28.3% after 10 min over a mean SaO2 range of 29-58%. CONCLUSION Pulse oximetry showed increased bias and decreased accuracy and precision during CPR in a model of neonatal cardiac arrest. We recommend further studies to clarify the exact mechanisms of these false readings to improve reliability of pulse oximetry during the marked desaturation and hypoperfusion found during CPR.
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Affiliation(s)
- Mohammad Ahmad Hassan
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
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Gwinnutt C. Regional cerebral oxygen saturation monitoring during cardiac arrest. Resuscitation 2014; 85:e129. [DOI: 10.1016/j.resuscitation.2013.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 12/28/2013] [Indexed: 11/25/2022]
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Basu S, Barman S, Shukla R, Kumar A. Effect of oxygen inhalation on cerebral blood flow velocity in premature neonates. Pediatr Res 2014; 75:328-35. [PMID: 24226632 DOI: 10.1038/pr.2013.219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 07/02/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND The study tested the hypothesis that hyperoxemia and hypoxemia differentially alter cerebral blood flow velocity (CBFV) in a gestational age-dependent manner. METHODS Cases comprised 98 neonates with mild respiratory distress, receiving oxygen for >24 h in first 48 h of life. Ninety-eight age- and-weight-matched healthy neonates served as controls. Infants with perinatal asphyxia, shock, sepsis, malformations, acidosis/alkalosis, and hypo/hypercarbia were excluded. Resistance index (RI), pulsatility index (PI), peak systolic flow velocity (PSV), and vascular diameter were measured in internal carotid, vertebral, and middle cerebral arteries by transcranial doppler ultrasonography between 24 and 48 h of life with immediate postdoppler arterial blood gas analysis. For subgroup analysis, neonates were divided by gestational age and PaO2. RESULTS An overall decrease in RI/PI and increase in PSV and vasodilation was observed in cases. Hyperoxemia (PaO2 >90 mm Hg) was more common in premature neonates. Neonates <32 wk showed an increase in CBFV (decreased RI/PI and increased PSV/diameter) in association with hyperoxemia. An opposite response was observed in neonates ≥ 32 wk, where CBFV increased in response to hypoxemia (PaO2 <50 mm Hg) and decreased in hyperoxemia. Increased CBFV showed high predictive accuracy for immediate mortality and intracranial hemorrhage. CONCLUSION Depending on gestational maturity, hyperoxemia or hypoxemia produce differential effects in CBFV.
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Affiliation(s)
- Sriparna Basu
- Division of Neonatology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sandeep Barman
- Division of Neonatology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ramchandra Shukla
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashok Kumar
- Division of Neonatology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Aubertin G, Marguet C, Delacourt C, Houdouin V, Leclainche L, Lubrano M, Marteletti O, Pin I, Pouessel G, Rittié JL, Saulnier JP, Schweitzer C, Stremler N, Thumerelle C, Toutain-Rigolet A, Beydon N. Recommandations pour l’oxygénothérapie chez l’enfant en situations aiguës et chroniques : évaluation du besoin, critères de mise en route, modalités de prescriptions et de surveillance. Rev Mal Respir 2013; 30:903-11. [DOI: 10.1016/j.rmr.2013.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Hemodynamic monitoring is central to the management of critically ill patients in the cardiac intensive care unit (CICU). The goals of hemodynamic monitoring are to anticipate threats and complications before they arise, to gauge the effectiveness of interventions, and to avoid progression to a decompensated shock state. Although there are numerous modalities of hemodynamic monitoring in the CICU, discordance exists between assessments based on physical exam and standard hemodynamic parameters and those based on measurements of cardiac output. This article will review both the standard and advanced hemodynamic monitoring strategies employed in the CICU.
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Affiliation(s)
- Rocky Tsang
- Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex, USA
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Solevåg AL, Dannevig I, Šaltytė-Benth J, Saugstad OD, Nakstad B. Reliability of pulse oximetry in hypoxic newborn pigs. J Matern Fetal Neonatal Med 2013; 27:833-8. [DOI: 10.3109/14767058.2013.842550] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVE To explore if regional cerebral tissue oxygen saturation monitoring by near-infrared spectroscopy (NIRS) is feasible during neonatal resuscitation of very low birth weight (VLBW) infants after birth. STUDY DESIGN Cerebral tissue oxygen saturation was measured by NIRS in 51 VLBW infants (mean gestational age: 27.8 weeks) during the first 10 min after delivery. RESULT A regional cerebral tissue oxygen saturation signal was available after a median (interquartile range) age of 52 (44 to 68) s. In three infants the signal was obtained after 10 min of age. After delivery cerebral tissue oxygen saturation rose continuously from 37 (31 to 49) % at 1 minute of age and reached a steady state in the range of 61 to 84% ∼7 min after birth. Percentiles of cerebral tissue oxygen saturation of this cohort of preterm infants are given. CONCLUSION Cerebral tissue oxygen saturation monitoring is feasible during neonatal resuscitation of VLBW infants within the first minutes of life.
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Aubertin G, Marguet C, Delacourt C, Houdouin V, Leclainche L, Lubrano M, Marteletti O, Pin I, Pouessel G, Rittié JL, Saulnier JP, Schweitzer C, Stremler N, Thumerelle C, Toutain-Rigolet A, Beydon N. Recommandations pour l’oxygénothérapie chez l’enfant en situations aiguës et chroniques : évaluation du besoin, critères de mise en route, modalités de prescription et de surveillance. Arch Pediatr 2012; 19:528-36. [DOI: 10.1016/j.arcped.2012.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 02/26/2012] [Indexed: 10/28/2022]
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Das J, Aggarwal A, Aggarwal NK. Pulse oximeter accuracy and precision at five different sensor locations in infants and children with cyanotic heart disease. Indian J Anaesth 2011; 54:531-4. [PMID: 21224970 PMCID: PMC3016573 DOI: 10.4103/0019-5049.72642] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Since the invention of pulse oximetry by Takuo Aoyagi in the early 1970s, its use has expanded beyond the perioperative care into neonatal, paediatric and adult intensive care units (ICUs). Pulse oximetry is one of the most important advances in respiratory monitoring as its readings (SpO2) are used clinically as an indirect estimation of arterial oxygen saturation (SaO2). Sensors were placed frequently on the sole, palm, ear lobe or toes in addition to finger. On performing an extensive Medline search using the terms “accuracy of pulse oximetry” and “precision of pulse oximetry”, limited data were found in congenital heart disease patients in the immediate post-corrective stage. Also, there are no reports and comparative data of the reliability and precision of pulse oximetry when readings from five different sensor locations (viz. finger, palm, toe, sole and ear) are analysed simultaneously. To fill these lacunae of knowledge, we undertook the present study in 50 infants and children with cyanotic heart disease in the immediate post-corrective stage.
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Affiliation(s)
- Jyotirmoy Das
- Department of Anesthesiology, Fortis Hospital, Shalimar Bagh, New Delhi, India
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Monitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2. Pediatr Crit Care Med 2011; 12:S2-S11. [PMID: 22129545 DOI: 10.1097/pcc.0b013e318220e7ea] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Continuous monitoring of various clinical parameters of hemodynamic and respiratory status in pediatric critical care medicine has become routine. The evidence supporting these practices is examined in this review. METHODOLOGY A search of MEDLINE, EMBASE, PubMed, and the Cochrane Database was conducted to find controlled trials of heart rate, electrocardiography, noninvasive and invasive blood pressure, atrial pressure, end-tidal carbon dioxide, and pulse oximetry monitoring. Adult and pediatric data were considered. Guidelines published by the Society for Critical Care Medicine, the American Heart Association, the American Academy of Pediatrics, and the International Liaison Committee on Resuscitation were reviewed, including further review of references cited. RESULTS AND CONCLUSIONS Use of heart rate, electrocardiography, noninvasive and arterial blood pressure, atrial pressure, pulse oximetry, and end-tidal carbon dioxide monitoring in the pediatric critical care unit is commonplace; this practice, however, is not supported by well-controlled clinical trials. Despite the majority of literature being case series, expert opinion would suggest that use of routine pulse oximetry and end-tidal carbon dioxide is the current standard of care. In addition, literature would suggest that invasive arterial monitoring is the current standard for monitoring in the setting of shock. The use of heart rate, electrocardiography. and atrial pressure monitoring is advantageous in specific clinical scenarios (postoperative cardiac surgery); however, the evidence for this is based on numerous case series only.
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Dugani S, Hodzovic I, Sindhakar S, Nadra A, Dunstan C, Wilkes AR, Mecklenburgh J. Evaluation of a Pulse Oximeter Sensor Tester. J Clin Monit Comput 2011; 25:163-70. [DOI: 10.1007/s10877-011-9283-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 05/05/2011] [Indexed: 11/24/2022]
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Mollard P, Bourdillon N, Letournel M, Herman H, Gibert S, Pichon A, Woorons X, Richalet JP. Validity of arterialized earlobe blood gases at rest and exercise in normoxia and hypoxia. Respir Physiol Neurobiol 2010; 172:179-83. [DOI: 10.1016/j.resp.2010.05.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 05/12/2010] [Accepted: 05/13/2010] [Indexed: 11/16/2022]
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Schoevers J, Scheffer C, Dippenaar R. Low-oxygen-saturation quantification in human arterial and venous circulation. IEEE Trans Biomed Eng 2009; 56:846-54. [PMID: 19272909 DOI: 10.1109/tbme.2008.2006023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Conventional pulse oximetry has limited accuracy in measuring blood oxygen saturation in low-saturation and -perfusion scenarios. This limits the application of pulse oximetry in patients suffering from peripheral vascular afflictions. We present a novel pulse oximetry system that proposes solutions to these low-saturation and -perfusion scenarios by inducing an artificial pulse in the detected photoplethysmograph (PPG). A novel arteriovenous hypothesis was formulated to extract arterial and venous saturation data from the artificial PPG using arterial-to-venous compliance ratios. Sensor wavelengths were selected to provide high- and low-saturation accuracy, followed by an in vitro sensor calibration procedure. System performance was validated by means of an in vivo procedure. In vivo results indicate good accuracy for high saturation, with limited accuracy in low-saturation scenarios. The arteriovenous hypothesis was validated, indicating that venous saturation can be extracted from the artificial PPG. The results indicate that the proposed system might be able to accurately monitor arterial and venous saturation in low- or no-perfusion scenarios. It is recommended that further studies into the system's performance are conducted.
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Affiliation(s)
- Jaco Schoevers
- Department of Mechanical and Mechatronic Engineering, Stellenbosch University, Matieland 7602, South Africa.
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Abstract
OBJECTIVE Children's digits are often too small for proper attachment of oximeter sensors, necessitating sensor placement on the sole of the foot or palm of the hand. No study has determined what effect these sensor locations have on the accuracy and precision of this technology. The objective of this study was to assess the effect of sensor location on pulse oximeter accuracy (i.e., bias) and precision in critically ill children. DESIGN Prospective, observational study with consecutive sampling. SETTING Tertiary care, pediatric intensive care unit. PATIENTS Fifty critically ill children, newborn to 2 yrs of age, with an indwelling arterial catheter. Forty-seven of 50 (94%) patients were postcardiac surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Co-oximeter-measured arterial oxygen saturation (Sao2) was compared with simultaneously obtained pulse oximetry saturations (Spo2). A total of 98 measurements were obtained, 48 measurements in the upper extremities (finger and palm) and 50 measurements in the lower extremities (toe and sole). The median Sao2 was 92% (66% to 100%). There was a significant difference in bias (i.e., average Spo2 - Sao2) and precision (+/-1 sd) when the sole and toe were compared (sole, 2.9 +/- 3.9 vs. toe, 1.6 +/- 2.2, p = .02) but no significant difference in bias and precision between the palm and the finger (palm, 1.4 +/- 3.2 vs. finger, 1.2 +/- 2.3, p = .99). There was a significant difference in bias +/- precision when the Sao2 was <90% compared with when Sao2 was >or=90% in the sole (6.0 +/- 5.7 vs. 1.8 +/- 2.1, p = .002) and palm (4.5 +/- 4.5 vs. 0.7 +/- 2.4, p = .006) but no significant difference in the finger (1.8 +/- 3.8 vs. 1.1 +/- 1.8, p = .95) or toe (1.9 +/- 2.9 vs. 1.6 +/- 1.9, p = .65). CONCLUSIONS The Philips M1020A pulse oximeter and Nellcor MAX-N sensors were less accurate and precise when used on the sole of the foot or palm of the hand of a child with an Sao2 <90%.
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Schallom L, Sona C, McSweeney M, Mazuski J. Comparison of forehead and digit oximetry in surgical/trauma patients at risk for decreased peripheral perfusion. Heart Lung 2007; 36:188-94. [PMID: 17509425 DOI: 10.1016/j.hrtlng.2006.07.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 07/02/2006] [Accepted: 07/17/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Measurement of pulse oximetry (Spo(2)) is often impaired in critically ill patients. Forehead reflectance oximetry, the Max-Fast (Nellcor, Pleasanton, CA), may be less susceptible to poor tissue perfusion and could improve accuracy of oxygen saturation measurement. The objective of this study was to evaluate the use of forehead oximetry measures in critically ill surgical/trauma patients. METHODS A prospective interventional study of 30 critically ill surgical/trauma patients at risk for decreased peripheral perfusion, as evidenced by need for vasopressor support (24 patients), transfusion of more than 6 unit packed cells in 24 hours (two patients), or an inability to obtain consistent saturation from a digit sensor (four patients), compared forehead and digit-based oximeter Spo(2) readings with co-oximetry (Sao(2)) measurements from arterial blood samples. Sao(2) values were converted to functional oxygen saturation (SO(2)) measurements for the final comparison. Patients were fitted with forehead (Nellcor Max-Fast) and digit (Nellcor Max A; digit 1) sensors connected to Nellcor OxiMax N-595 oximeters and a digit sensor (Nellcor Max A; digit 2) connected to a multiparameter monitor (Philips CMS [Andover, MA]). Three measurements of Sao(2) were obtained from each subject over a 24-hour time period, and simultaneous measurements of Spo(2) were recorded from the three monitors. RESULTS The three Spo(2) measurements (forehead, digit 1, and digit 2) were compared with SO(2) values using the Bland-Altman method to assess agreement. Forehead measurements demonstrated a mean bias of -1.39, whereas digit 1 was -2.61 and digit 2 was -3.84. Pearson correlations (r) for forehead, digit 1, and digit 2 with SO(2) were .834, .433, and .254, respectively. There were fewer unsuccessful measurements with the forehead oximetry technique. CONCLUSIONS Forehead sensors improve measurement of oxygen saturation in critically ill surgical/trauma patients at risk for decreased peripheral perfusion.
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Affiliation(s)
- Lynn Schallom
- Barnes-Jewish Hospital, St Louis, Missouri 63110, USA
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41
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Abstract
•Background Pulse oximetry is commonly used to monitor oxygenation in neonates, but cannot detect variations in hemoglobin. Venous and arterial oxygen saturations are rarely monitored. Few data are available to validate measurements of oxygen saturation in neonates (venous, arterial, or pulse oximetric).
•Purpose To validate oxygen saturation displayed on clinical monitors against analyses (with correction for fetal hemoglobin) of blood samples from neonates and to present the oxyhemoglobin dissociation curve for neonates.
•Method Seventy-eight neonates, 25 to 38 weeks’ gestational age, had 660 arterial and 111 venous blood samples collected for analysis.
•Results The mean difference between oxygen saturation and oxyhemoglobin level was 3% (SD 1.0) in arterial blood and 3% (SD 1.1) in venous blood. The mean difference between arterial oxygen saturation displayed on the monitor and oxyhemoglobin in arterial blood samples was 2% (SD 2.0); between venous oxygen saturation displayed on the monitor and oxyhemoglobin in venous blood samples it was 3% (SD 2.1) and between oxygen saturation as determined by pulse oximetry and oxyhemoglobin in arterial blood samples it was 2.5% (SD 3.1). At a Pao2 of 50 to 75 mm Hg on the oxyhemoglobin dissociation curve, oxyhemoglobin in arterial blood samples was from 92% to 95%; oxygen saturation was from 95% to 98% in arterial blood samples, from 94% to 97% on the monitor, and from 95% to 97% according to pulse oximetry.
•Conclusions The safety limits for pulse oximeters are higher and narrower in neonates (95%–97%) than in adults, and clinical guidelines for neonates may require modification.
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Affiliation(s)
- Shyang-Yun Pamela K. Shiao
- The School of Nursing, University of Houston Victoria and University of Houston System at Sugar Land, Sugar Land, Tex (s-ypks), and Texas Childrens Hospital and Baylor College of Medicine, Houston, Tex (c-no)
| | - Ching-Nan Ou
- The School of Nursing, University of Houston Victoria and University of Houston System at Sugar Land, Sugar Land, Tex (s-ypks), and Texas Childrens Hospital and Baylor College of Medicine, Houston, Tex (c-no)
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Burns PM, Driessen B, Boston R, Gunther RA. Accuracy of a third (Dolphin Voyager) versus first generation pulse oximeter (Nellcor N-180) in predicting arterial oxygen saturation and pulse rate in the anesthetized dog. Vet Anaesth Analg 2006; 33:281-95. [PMID: 16916350 DOI: 10.1111/j.1467-2995.2005.00271.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To compare the accuracy of a 3rd (Dolphin Voyager) versus 1st generation pulse oximeter (Nellcor N-180). STUDY DESIGN Prospective laboratory investigation. ANIMALS Eight adult dogs. METHODS In anesthetized dogs, arterial oxygen saturation (SpO(2)) was recorded simultaneously with each pulse oximeter. The oxygen fraction in inspired gas (FiO(2)) was successively reduced from 1.00 to 0.09, with re-saturation (FiO(2) 0.40) after each breathe-down step. After each 3-minute FiO(2) plateau, SpO(2) and pulse rate (PR) were compared with the fractional arterial saturation (SaO(2)) and PR determined by co-oximetry and invasive blood pressure monitoring, respectively. Data analysis included Bland-Altman (B-A) plots, Lin's concordance correlation factor (rho(c)), and linear regression models. RESULTS Over a SaO(2) range of 33-99%, the overall bias (mean SpO(2) - SaO(2)), precision (SD of bias), and accuracy (A(rms)) for the Dolphin Voyager and Nellcor N-180 were 4.3%, 4.4%, and 6.1%, and 3.2%, 3.0%, and 4.3%, respectively. Bias increased at SaO(2) < 90%, more so with the Dolphin Voyager (from 1.6% to 8.6%) than Nellcor N-180 (from 3.2% to 4.5%). The SpO(2) readings correlated significantly with SaO(2) for both the Dolphin Voyager (rho(c) = 0.94) and Nellcor N-180 (rho(c) = 0.97) (p < 0.001). Regarding PR, bias, precision, and accuracy (A(rms)) for the Dolphin Voyager and Nellcor N-180 were -0.5, 4.6, and 4.6 and 1.38, 4.3, and 4.5 beats minute(-1), respectively. Significant correlation existed between pulse oximeter and directly measured PR (Dolphin Voyager: rho(c) = 0.98; Nellcor N-180: rho(c) = 0.99) (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE In anesthetized dogs with adequate hemodynamic function, both instruments record SaO(2) relatively accurately over a wide range of normal saturation values. However, there is an increasing overestimation at SaO(2) < 90%, particularly with the Dolphin Voyager, indicating that 3rd generation pulse oximeters may not perform better than older instruments. The 5.4-fold increase in bias with the Dolphin Voyager at SaO(2) < 90% stresses the importance of a 93-94% SpO(2) threshold to ensure an arterial saturation of >or=90%. In contrast, PR monitoring with both devices is very reliable.
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Affiliation(s)
- Patrick M Burns
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, PA, USA.
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43
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MESH Headings
- Adolescent
- Advanced Cardiac Life Support/instrumentation
- Advanced Cardiac Life Support/methods
- Advanced Cardiac Life Support/standards
- Airway Obstruction/complications
- Airway Obstruction/diagnosis
- Airway Obstruction/therapy
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Australia
- Cardiovascular Agents/therapeutic use
- Catheterization/methods
- Catheterization/standards
- Child
- Child, Preschool
- Clinical Protocols
- Electric Countershock/instrumentation
- Electric Countershock/methods
- Electric Countershock/standards
- Electrocardiography/instrumentation
- Electrocardiography/standards
- Heart Arrest/complications
- Heart Arrest/diagnosis
- Heart Arrest/therapy
- Heart Massage/methods
- Heart Massage/standards
- Humans
- Infant
- Infant, Newborn
- Intubation, Intratracheal/methods
- Intubation, Intratracheal/standards
- Monitoring, Physiologic/methods
- Monitoring, Physiologic/standards
- Oxygen Inhalation Therapy/instrumentation
- Oxygen Inhalation Therapy/methods
- Oxygen Inhalation Therapy/standards
- Pediatrics/methods
- Pediatrics/standards
- Respiration, Artificial/instrumentation
- Respiration, Artificial/methods
- Respiration, Artificial/standards
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Shiao SYPK. Accurate Measurements of Oxygen Saturation in Neonates: Paired Arterial and Venous Blood Analyses. ACTA ACUST UNITED AC 2005. [DOI: 10.1053/j.nainr.2005.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
PURPOSE To examine the accuracy of oxygen saturation (So(2)) in relation to blood oxyhemoglobin (Hbo(2)) measurements with the effects of fetal hemoglobin (HbF) determined and their oxyhemoglobin dissociation curves. METHOD Twenty neonates with gestational ages ranging from 25 to 34 weeks, who had umbilical arterial or venous lines inserted, were investigated. Analyses were performed with 169 arterial and 41 venous blood samples from these infants by employing HbF- and HbA-mode (as controls) blood analyses, using a hemoximeter. RESULTS Without adjusting the effects of HbF when using HbA-mode analyses, mean So(2) measurements were elevated for 5% (+/-1.38) compared with the results of HbF-mode analyses, with 3.5% elevated HbCO levels for the total blood samples. With left-shifted oxyhemoglobin dissociation curves in neonates, for the critical values of oxygen tension values between 50 and 75 mm Hg, arterial Hbo(2) ranged from 94% to 96%, Sao(2) from 97% to 98%, and Spo(2) from 96% to 97% (compared to 85%-94% in healthy adults). CONCLUSIONS The left-shifted oxyhemoglobin curves warrant the importance of accurate measurements of oxygenation status for neonates. Fetal hemoglobin determination is essential for accurate So(2) measurements and the assessment of proper oxygenation status in neonates.
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Gerstmann D, Berg R, Haskell R, Brower C, Wood K, Yoder B, Greenway L, Lassen G, Ogden R, Stoddard R, Minton S. Operational evaluation of pulse oximetry in NICU patients with arterial access. J Perinatol 2003; 23:378-83. [PMID: 12847532 DOI: 10.1038/sj.jp.7210944] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate pulse oximetry in neonates who require arterial access as represented by the clinical data recorded to manage their care. STUDY DESIGN Analysis of simultaneous SpO(2) and SaO(2) from: 7-year historical NICU data (N=31905); 4-month prospective NICU data (N=566); verification data using two hemoximeters (N=52); and NICU data from two collaborating centers (N=95 and 168). The bias function (SpO(2)-SaO(2)) was regressed against the measured "gold" standard, SaO(2). RESULTS A significant negative correlation was found for each of the data sets between the bias function and SaO(2). This bias was similar for devices from several manufacturers (Datex-Ohmeda, Masimo, Nellcor, and Spacelabs). Maximum operational performance occurred with peaks between 92 and 97% SaO(2), but declined markedly above and below this narrow range. In all, 71 to 95% of patients exhibited data with significant bias(.) CONCLUSION These operational data suggest that with the methodology and devices currently in use, SpO(2) values in most all neonates who require arterial lines inaccurately correlate with measured arterial saturation.
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Affiliation(s)
- Dale Gerstmann
- Neonatology Department, Utah Valley Regional Medical Center, Provo, UT, USA
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Shiao SUP. Functional versus fractional oxygen saturation readings: bias and agreement using simulated solutions and adult blood. Biol Res Nurs 2002; 3:210-21. [PMID: 12184664 DOI: 10.1177/10900402003004006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine the bias and agreement between functional oxygen saturation (SO2) and fractional oxyhemoglobin (HbO2) using simulated quality control (QC) solutions and adult blood. Using a hemoximeter, 5 analysts performed at least 5 tests each on QC solutions with 3 different hemoglobin (Hb) levels and on adult blood samples of various oxygen saturation levels representing venous or arterial samples. Bias and the limits of agreement were determined using the technique of Bland and Altman. Using QC solutions with low, normal, and high Hb levels, the bias for SO2 against HbO2 was 20.82 +/- 0.50 (n = 66), 19.14 +/- 0.56 (n = 81), and 19.59 +/- 0.43 (n = 79), respectively, with SO2 reading consistently higher. The correlation between SO2 and HbO2 was -0.49, -0.69, and -0.68, respectively. Using adult blood, the bias for SO2 against HbO2 was 1.29 +/- 0.48 for venous samples (n = 62) and 1.9 +/- 0.19 for fully oxygenated samples (n = 36), and the correlation between SO2 and HbO2 was 1.0 and 0.68, respectively. These findings suggest that the consistency between the measurements of SO2 and HbO2 may be dependent on hemoglobin levels and oxygenation status. Thus, caution is warranted when assuming that the measurements of SO2 and HbO2 are interchangeable.
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Affiliation(s)
- Shyang-Un Pamela Shiao
- School of Nursing at the University of Texas Health Science Center at Houston, 77030, USA.
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Carter BG, Wiwczaruk D, Hochmann M, Osborne A, Henning R. Performance of transcutaneous PCO2 and pulse oximetry monitors in newborns and infants after cardiac surgery. Anaesth Intensive Care 2001; 29:260-5. [PMID: 11439797 DOI: 10.1177/0310057x0102900307] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined the effect of core and skin temperature on the accuracy of two pulse oximeters (Nellcor Symphony and Hewlett Packard saturation module, M1020A) and a transcutaneous PCO2 monitor (Fastrac Transcutaneous monitor) immediately after cardiac surgery in a group of newborns and infants. Seventy-nine sets of data were collected from 46 patients. Core temperatures ranged from 35.3 degrees C to 39.4 degrees C, skin temperatures ranged from 27.0 degrees C to 37.4 degrees C and core-skin temperature gradients ranged from 0.1 degree C to 10.1 degrees C. Data analysis consisted of comparing the difference between transcutaneous PCO2 and arterial PCO2 and the differences between oxygen haemoglobin saturation measured by both pulse oximeters and oxygen haemoglobin saturation measured by co-oximeter to core temperature, skin temperature and core-skin temperature gradients. The mean differences +/- standard deviations and limits of agreement for transcutaneous PCO2 and oxygen haemoglobin saturation measured by the Hewlett Packard and Nellcor pulse oximeters were 0.95 +/- 4.10 mmHg (-7.09 mmHg to 8.99 mmHg), -1.07 +/- 1.84% (-4.68% to 2.54%) and -1.23 +/- 2.23% (-5.60% to 3.14%) respectively. Analysis of correlation coefficients showed that the accuracy of the transcutaneous PCO2 monitor and the pulse oximeters were not affected by core temperature, skin temperature or core-skin temperature gradient in the ranges encountered. We therefore conclude that these devices are acceptably accurate and suitable for use in infants when core and skin temperatures and core-skin temperature gradient are in the range normally found after cardiac surgery.
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Affiliation(s)
- B G Carter
- Neonatal and Paediatric Intensive Care Units, Royal Children's Hospital, Flemington Road, Parkville, Vic. 3052
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49
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Abstract
Hypoxemia is a prevalent problem in the chronically critically ill patient. This article reviews the pathophysiologic mechanisms of hypoxemia in this patient population, discusses how oxygenation is evaluated, and reviews methods for delivery of oxygen. Other topics directly related to oxygen use, such as oxygen toxicity, heliox use, and portable oxygen devices, are included.
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Affiliation(s)
- A C White
- Department of Medicine, Pulmonary and Critical Care Division, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
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50
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Belenguer Muncharaz A, Bisbal Andrés E, Reig Valero R, Mas Font S, Carregui Tusón R, Abizanda Campos R. Relación entre pulsioximetría y determinación de la saturación arterial de oxígeno. Influencia de los fármacos vasoactivos presores sobre la correlación SattcO2-SatO2. Med Intensiva 2001. [DOI: 10.1016/s0210-5691(01)79718-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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