Continuous intra-arterial oximetry, pulse oximetry, and co-oximetry during cardiac surgery.
This study evaluated arterial catheter oximetry versus pulse oximetry in eight patients (ASA III-IV) who underwent cardiac surgery. Co-oximeter saturation values served as the standard. Arterial oxygen saturation was determined simultaneously with these three methods at 162 prospectively defined points of measurement before, during, and after cardiopulmonary bypass (CPB). At the same times before and after CPB, arterial, pulmonary arterial, and central venous pressures, and cardiac output determinations were recorded. Saturation readings were obtained in more than 99% of measurements with catheter oximetry and in only 59% to 84% of measurements with pulse oximetry. Failure of pulse oximetry correlated with low mean arterial pressures and low cardiac outputs, but not with high systemic vascular resistance. The mean saturation values determined by catheter oximetry as well as by pulse oximetry differed from the mean values obtained by co-oximetry by less than 1% (= bias). The standard deviations of the individual differences between readings of catheter or pulse oximetry and readings of co-oximetry (= precision) were +/- 0.5% to +/- 1.0% for catheter oximetry and +/- 1.0% to +/- 1.2% for pulse oximetry. In summary, catheter oximetry was superior to pulse oximetry with regard to obtaining readings and to reliability of the obtained readings. Invasiveness and high costs influence the decision as to whether to use catheter oximetry, but if reliable and precise measurements of saturation are important at any time during surgery, pulse oximetry is an insufficient method and co-oximetry is a time-consuming method of analysis, whereas catheter oximetry is quick, reliable, and precise.