PubMed · 8057874
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M Perrella, L Rossi-Bernardi. 1994. Hemoglobin-liganded intermediates.. https://doi.org/10.1016/0076-6879(94)32059-4
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An error identified in a 1993 textbook of military medicine led to an investigation of derivations of the Coburn-Forster-Kane equation (CFKE) for predicting carboxyhemoglobin (COHb) levels. Reviews of the scientific literature, military documents, and personal interviews revealed that errors were made in earlier derivations of the CFKE. One flawed derivation was used by the U.S. Army until 1985, and another is still used by the National Institute for Occupational Safety and Health (NIOSH). The original and later CFKE derivations are reviewed and errors in the equations are identified. The effect of the errors is discussed.
INTRODUCTION: Measurement of oxygen saturation by pulse oximetry (SpO2) is frequently performed during exercise testing of patients with COPD to monitor for hypoxemia. The purpose of this study was to assess the accuracy and precision of pulse oximetry during exercise. We hypothesized that the SpO2 would more closely reflect oxygen saturation as measured by co-oximetry (SaO2) when it was corrected for carboxyhemoglobin (COHb). We also hypothesized that SpO2 would more closely reflect SaO2 when the pulse rate by oximeter was equivalent to the heart rate by ECG. Finally, we hypothesized that SpO2 would be a better measure of SaO2 at maximal workloads than at rest or submaximal workloads. METHODS: Eight white men with severe COPD (mean +/- SD FEV1, 0.91 +/- 0.37) underwent progressive, symptom-limited exercise testing by cycle ergometry. SaO2 was measured from arterial blood at each workload using a co-oximeter. SpO2 and pulse rate were obtained by a pulse oximeter (Ohmeda 3700). Heart rate was continuously monitored by ECG. RESULTS: Reliable oximetric values as determined by a dicrotic notch in each waveform and adequate signal intensity were obtained in all eight patients. SpO2 was a moderately accurate measure of SaO2 (bias, 1.7%; precision, 2.9). The bias actually increased (4.1%) when SpO2 was corrected for COHb. Accuracy of SpO2 was not improved when pulse rate by oximetry and heart rate by ECG were equivalent, nor was the accuracy improved at maximal workloads relative to submaximal workloads during the exercise test. CONCLUSION: Oxygen saturation as measured by pulse oximetry (SpO2) in patients with COPD undergoing exercise testing is not sufficiently accurate to replace SaO2 as the gold standard for oxygen saturation.
A 30% carboxyhemoglobin solution was encapsulated with a membrane composed of crosslinked hemoglobin as a potential artificial red blood cell by adding a 25 microL droplet of 30% carboxyhemoglobin solution in phosphate buffer to a buffer-saturated toluene solution of a homobifunctional crosslinking agent. Disuccinimidyl glutarate, disuccinimidyl suberate, and terephthaldicarboxaldehyde proved successful in crosslinking hemoglobin at concentrations of 0.05%, 0.08%, and 4.3%, respectively (saturated levels in buffer-saturated toluene). Disuccinimidyl glutarate exhibited maximal crosslinking of 11.0% in approximately 30 minutes. Disuccinimidyl suberate and terephthaldicarboxaldehyde required at least 12 hours to form a viable sphere and crosslinked 39.4% and 37.8% of the hemoglobin in 18 hours. Membrane integrity was assessed by determining the permeability of uncrosslinked hemoglobin through the membrane as a function of time.