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PubMed2004

Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients.

BACKGROUND: A recent study demonstrated that almost 75% of strokes after coronary artery revascularization surgery occur in patients classified preoperatively as low to medium risk. Thus, despite the use of risk classification, most strokes can occur when not expected. We hypothesized that optimization of cerebral oxygen delivery variables by using noninvasive cerebral oximetry could reduce the incidence of stroke. METHODS: Cerebral oximetry was used by all surgeons to monitor cerebral oxygen saturation in all cardiac surgery patients from January 1, 2002, until June 30, 2003 (n = 1034; 18 months, treatment group). Cerebral oxygen delivery was optimized during surgery by modifying oxygen delivery and consumption variables to maintain oximetry values at or near the patient's preinduction baseline. Stroke was defined according to guidelines of the Society of Thoracic Surgeons. The incidence of stroke in the treatment group was compared with that for patients who underwent cardiac surgery between July 1, 2000, and December 31, 2001, (n = 1245; 18 months, control group) before cerebral oximetry was incorporated. RESULTS: Age and sex distribution were similar in the 2 groups. The study group had significantly more patients in New York Heart Association (NYHA) classes III and IV than the control group, and patients in the study group were sicker overall. Despite this difference, the study group overall had fewer permanent strokes (10 [0.97%] versus 25 [2.5%]; P < .044). This difference remained significant when the results were controlled for NYHA class and on-pump or off-pump surgery. When the patients were examined by NYHA class, the proportion of patients requiring prolonged ventilation was significantly smaller in the study group (6.8% versus 10.6%; P < .0014), as was the length of hospital stay (P < .046). CONCLUSIONS: The treatment group, which underwent all cardiac surgeries with optimized cerebral oxygen delivery using cerebral oximetry monitoring, demonstrated a significantly lower incidence of permanent stroke. Because our study is retrospective, a prospective randomized trial is warranted.

Aged↗
PubMedDate not supplied

[Fetal pulse oximetry. Intrapartum foetal hypoxia evaluation. Comparative study with invasive techniques concerning foetal welfare].

UNLABELLED: Pulse oximetry is a technique that continuously measures the blood oxygen saturation (%SpO2); it has become a standard monitoring method in Anaesthesia, Intensive Care, Neonatology, etc; and it can be helpful in Obstetrics during delivery to monitor foetal welfare. Its advantages are that it is minimally invasive and easy to use. Moreover, SpO2 is a good parameter for measuring oxygen carriage. A saturation below 30% during a time period over 10 minutes is correlated with an acid-base equilibrium (ABE) of foetal scalp blood sample below 7.20, and it is predictive of worse perinatal outcomes. The objectives are: 1. The combined use of both techniques (foetal pulse oximetry and ABE), provides equivalent perinatal outcomes but decreases the Caesarean Intrapartum Rate due to suspicion of a loss of foetal welfare. 2. A correlation was found between foetal pulse oximetry and acid-base equilibrium data such as pH, pO2 and EB. SUBJECTS AND METHODS: Data was gathered on two groups of eighty patients. In the first group we carried out a follow up of delivery under serialized pH-metry, and in the other group, control of the foetuses was carried out in a combined form with pHmetry and pulse oximetry. RESULTS: Statistically significant results were obtained concerning delivery in the comparative study of both groups. Following the perinatal results obtained, the data indicates that there are no significant differences between the two groups in the pH values of the umbilical artery or in the Apgar values at one and five minutes after delivery, for which reason both protocols are equally satisfactory. The correlation of the data obtained by pH-metry with those of pulse oximetry was statistically significant. CONCLUSIONS: The combined use of both techniques increases the sensitivity and specificity of the diagnosis of suspected loss of foetal intrapartum wellness, without worsening perinatal outcomes, decreasing the Caesarean Intrapartum Rate due to pathological or non-reassuring foetal electronic monitoring. There is a significant statistical correlation between the results from the foetal pulse oximeter and the values obtained from the foetal scalp blood sample and from the umbilical cord at birth.

Female↗
PubMed2000

Next-generation pulse oximetry. Focusing on Masimo's signal extraction technology.

Pulse oximeters are used to determine trends in patients' blood oxygen saturation and to warn of dangerous saturation levels. But conventional pulse oximetry has some inherent limitations. For example, it has difficulty monitoring patients who are moving or who have poor perfusion; it is also subject to interference from certain visible and infrared light sources. Over the past several years, a number of companies have developed advanced signal-processing techniques that allow pulse oximeters to overcome many of these limitations. We refer to such new technologies as next-generation pulse oximetry. In this Evaluation, we focus on the first next-generation technology to have reached the market: Masimo Corporation's Signal Extraction Technology (SET). We designed our study of Masimo SET to address the main question that needs to be asked of any next-generation technology: How well does it compare to conventional pulse oximetry? Specifically, how well does it perform when a patient is moving or being moved, when a patient is poorly perfused, or when certain types of light strike the sensor while it is attached to or detached from the patient? We also examined one type of sensor used with this product, comparing it to conventional tape-on sensors for comfort and durability. Several other next-generation pulse-oximeter products have become available since we began this study. We are currently evaluating these products and will publish our findings in the near future. A list of the products, including a brief description of each, is included in this article. Pulse oximeters are used to determine trends in patients' blood oxygen saturation and to warn against dangerous saturation levels. These monitors are often vital in helping to ensure patient safety, especially for critically ill patients, pediatric patients, and neonates. But conventional pulse oximetry has some inherent limitations--most significantly, it has difficulty monitoring patients who are moving or who have poor perfusion. Although gradual improvements have been made to the technology, only recently has it advanced to the point where it has really begun to overcome these limitations. A number of manufacturers have developed advanced signal-processing algorithms that allow pulse oximeters to "read through" motion and conditions of poor perfusion. The first of these "next-generation" pulse-oximeter technologies that reached the market was Masimo Corporation's Signal Extraction Technology (SET). We tested that product in this Evaluation. In this Overview, we'll tell you about conventional pulse oximetry and its shortfalls, next-generation technology and how it's designed to improve on the old methods, and how we approached our Evaluation of Masimo SET.

Adult↗
PubMed2002

A characterization of motion affecting pulse oximetry in 350 patients.

As part of an oximetry research effort in which plethysmographic data were collected from moving patients, a wide variety of patient motion affecting pulse oximetry was observed and characterized by the clinical incidence, type, severity and duration of patient motion. 350 patients were observed for movement in clinical settings, including ICU, SICU, MICU, PICU, NICU, OR and PACU, at 4 hospitals and on an ambulance. 20% (70) of the patients exhibited motion. Half (35) of the moving patients were instrumented to record oximetric, plethysmographic and/or acceleration information. 31% of NICU infants moved compared to only 7% of adults in ICUs. The most common noisy oximetry signals were caused by motion characterized by extending/flexing (/kicking in infants) and by clenching/pressing/rubbing. In infants, these motion types accounted for 53% and 11% of motion, respectively. Less common infant motion types were patient cares, shifting body position and cough/cry. The most common adult motions were equally divided among extend/flex, clench/press/rub, twitch/shake and transport motion types. Extend/flex motions typically demonstrated high plethysmographic waveform modulation (71.5% maximum) and high acceleration. Clench/press/rub motions typically also had high modulations, but low G-force. With one high-G exception, twitch/shake motions had little or no effect on oximetry readings. Less common adult motion types affecting pulse oximetry included cough/cry, strain/posture, tremors and tap/bump. Most recorded motions were aperiodic and short-lived, 62% lasting less than 10 seconds, only 5% lasting over 1 minute. NICU patients made the longest lasting continuous series of motions, while adults made 86% of the motions lasting a second or less.

Humans↗
PubMed1991

Quantification of sleep disordered breathing by computerized analysis of oximetry, heart rate and snoring.

Intermittent snoring and cyclic oscillations of heart rate and oxyhaemoglobin saturation (Sao2) are characteristic features of the obstructive sleep apnoea syndrome (OSAS). Thus, overnight recordings of laryngeal sounds and heart rate by a portable device (MESAM) and of Sao2 by oximetry are applicable to screen outpatients for the presence of OSAS. Computerized analysis for time intervals of constant heart rate and intervals between snoring sounds is used by MESAM to quantify respiratory disturbances during sleep. Rapid increases in Sao2 during the postapnoeic hyperventilation period together with the number of desaturations are used by a new software for quantitative analysis of oximetry. To elucidate reliability of results from automatically scored MESAM and oximetry recordings, we compared the four computer calculated respiratory disturbance indices from heart rate (RDIH), snoring (RDIS), resaturations (RDIR) and desaturations (RDID) with the apnoea plus hypopnoea index (AHI) from simultaneously performed polysomnography. The study population consisted of 53 snorers with an AHI of 19.0 +/- 2.6 (median +/- SEM; range 0.7-87.8). Whereas both RDI's from MESAM correlated rather weakly with the AHI from polysomnography (RDIH: r = 0.32, p less than 0.05; RDIS: r = 0.33, p less than 0.05), this correlation was much better for the RDI's from oximetry (RDIR: r = 0.951, RDID: r = 0.93; p much less than 0.0001). Accepting a plus/minus 30 percent difference from the AHI, the RDIR classified 77% of patients correctly, the RDID 62%, the RDIS 32% and the RDIH 23%. In conclusion, results from computerized analysis of oximetry for desaturations and rapid resaturations correlate more closely with polysomnography than those from automatic scoring of MESAM recordings.

Heart Rate↗
PubMed1989

Pulse oximetry: a review of the theory, accuracy, and clinical applications.

Pulse oximetry has emerged as a clinical tool in anesthesia and newborn monitoring within the last 7 years as a result of recent technological and theoretical advances. Oximeters measure the different absorption spectra of oxygenated and deoxygenated hemoglobin. Electronic measures of oxygenation at the peak of the pulse allow computation and display of oxygen saturation of the arterial blood almost instantly. Correlation coefficients between pulse oximetry and direct blood oxygen saturation measurement range from 0.77-0.99 when oxygen saturation is greater than 60%. The method is noninvasive (a clip or tape on a finger), simple to operate, and adaptable to various patient populations. Pulse oximetry monitors continuously and instantaneously, is responsive to change, and is accurate. Factors adversely affecting the accuracy of pulse oximeter output include transducer movement, peripheral vasoconstriction, a nonpulsating vascular bed, hypotension, anemia, changes in systemic vascular resistance, hypothermia, presence of intravascular dyes, and nail polish. Pulse oximetry has been used to monitor oxygen saturation intraoperatively in the adult and neonatal intensive care units and to monitor pregnant patients and their infants at delivery. Once the advantages and limitations of pulse oximetry are recognized, this monitoring technique can play an important role in the care of patients with cardiovascular and respiratory compromise.

Female↗
PubMedDate not supplied

Noninvasive oximetry in the rat.

To aid in the development of rodent models of respiratory dysfunction, the authors evaluated the ability of noninvasive pulse oximetry (SpO2) to continuously monitor oxygen saturation (SaO2) in the rat. In initial studies, a pulse oxyimeter (Nellcor N-100) detected a fall in SaO2 during hypoxia induced by hypobaric decompression or decreasing fractions of inspired oxygen (FIO2). The disposable sensor was placed proximally on the tail. To assess the accuracy of pulse oximetry, arterial blood samples (86 samples from 25 animals) were obtained via a femoral arterial catheter while the FIO2 was varied between 0.08 and 0.40. The blood samples were analyzed with an IL 282 CO-Oximeter for SaO2 and then compared with pulse oximeter values of SaO2. Between saturations of 75% and 95%, the standard deviation (SD) for the difference between the CO-Oximeter and pulse oximeter measurements of SaO2 was +/-5.7%; however, below 70%, mean pulse oximeter estimates were higher than arterial values and the SD for the difference increased. It is concluded that pulse oximetry can detect trends in oxygenation over time in anesthetized and unanesthetized rats and that the accuracy of pulse oximetry is such that between 75% and 95% SaO2 agreement between pulse oximetry and arterial blood sample values of SaO2 is acceptable.

Animals↗
PubMed1988

The effect of nail polish on pulse oximetry.

A randomized, blind study examined the effect of nail polish color on measurement of oxygen saturation by pulse oximetry. Fourteen adult volunteers had blue, green, purple, black, and red nail polish applied to their finger nails. A strip-chart recording of oxygen saturation (Nellcor N100) was made in room air and later interpreted in a blinded fashion. The absorption spectra of the five polishes were determined by spectrophotometry. The spectra of nine other nail polishes and three intravenous dyes also were examined. Black, blue, and green nail polish significantly lowered oximeter readings of oxygen saturation. Blue and green produced greater decreases than purple and red; black produced an intermediate decrease. Some but not all nail polishes absorbed light at the wavelengths used by the pulse oximeter (660 nm and 940 nm). The degree of artifactual desaturation correlated best with the difference between absorbance at 660 nm and absorbance at 940 nm (r = 0.95). Spectrophotometric absorbance data suggest that other colors may interfere with pulse oximetry. On the basis of spectrophotometric data, brown-red nail polish was predicted to interfere with oximetry; subsequent pulse oximetry measurements confirmed the prediction. Nail polish should be removed routinely before pulse oximetry monitoring.

Adult↗
PubMed1994

[Bronchial asthma and desaturation--assessment by pulse oximetry].

In the first study, we used pulse oximetry to continuously measure SpO2 and pulse rate in inpatients with paroxysmal attacks of acute asthma. Desaturation and increases in pulse rate occurred during coughing, urination, defecation, eating, and sleeping. Desaturation was most severe and frequent when peak expiratory flow was in the red zone. When it was in the yellow zone or blue zone, desaturation was less severe and less frequent. In the second study, outpatients experiencing exacerbations of chronic asthma and inpatients experiencing acute asthmatic attacks inhaled of a beta 2-stimulant via an ultrasonic nebulizer and were monitored with pulse oximetry. In the former, SpO2 either did not change or increased, but in the latter SpO2 decreased markedly when patients were in the red zone. Therefore, when patients inhale a bronchodilator during an acute asthmatic attack they should be carefully monitored with pulse oximetry. In the third study, pulse oximetry was used to measure saturation in outpatients who were suspected of having hyperresponsive airways and had undergone an airway hyperresponsiveness test with an Astograph. Almost all of those who had desaturation of more than 4% from were markedly hyperresponsive. The degree of desaturation and the percent change in respiratory resistance were significantly correlated. In conclusion, pulse oximetry can be useful in the short-term and long-term management of asthma tic patients.

Adolescent↗
PubMed1994

The effect of henna paste on oxygen saturation reading obtained by pulse oximetry.

A controlled study was designed to examine the effect of red and black henna on the measurement of oxygen saturation by pulse oximetry. Fifty adult normal female volunteers had their left thumb coloured with red henna (40) or black henna (10). The uncoloured right thumb was used as a control. All measurements were done under room temperature, and the same pulse oximeter was used in all volunteers. In the red henna group there was no difference on oximetry reading between right and left thumb. In contrast, the thumb coloured with black henna gave no reading when compared to the uncoloured right thumb. On the basis of this study, pulse oximetry is not limited by red henna while black henna has a potential of causing major error in the measurement of oxygen saturation by pulse oximetry. In these cases we recommend to use ear oximetry for accurate measurement of oxygen saturation.

Adult↗
PubMed1993

The use of oximetry in determining intestinal blood flow.

The intraoperative evaluation of intestinal ischemia and viability is often subjective and unreliable. The results of recent reports of pulse and surface oximetry have suggested that these techniques may be useful in assessing intestinal blood flow. In the current study, we evaluated and compared the ability of intestinal tissue oxygen saturation (as measured by pulse oximetry) and intestinal surface oxygen tension (as measured by surface oximetry) to determine the actual intestinal tissue blood flow (as measured with a radiolabeled microsphere technique). In five dogs, tissue oxygen saturation, surface oxygen tension and blood flow of the proximal and distal parts of the small intestine were measured under basal conditions. A clamp placed around the root of the superior mesenteric artery was then tightened to decrease the blood flow through this artery (as measured by an ultrasonic flow probe) by 50 percent and then by 75 percent, repeating all measurements after each reduction. The two consecutive reductions in superior mesenteric artery blood flow resulted in an average 54 and 76 percent reduction in tissue blood flow, respectively. As a result of these reductions in tissue blood flow, the average intestinal tissue oxygen saturation (percentage), as determined by pulse oximetry, decreased significantly from a basal value of 93 +/- 1 to 83 +/- 1 (p < 0.05) and then to 76 +/- 1 (p < 0.05) with the two progressive blood flow reductions. Intestinal surface oxygen tension decreased more steeply, from a basal value of 97 +/- 1 to 80 +/- 6 (p < 0.05) and then to 64 +/- 7 millimeters of mercury (p < 0.05) with the same two reductions in tissue blood flow. Both techniques were capable of estimating tissue blood flow, but pulse oximetry was quicker and simpler to use. We conclude that the pulse oximeter has the potential to be of value in the intraoperative assessment of intestinal blood flow.

Animals↗
PubMed1997

The effect of acrylic nails on the measurement of oxygen saturation as determined by pulse oximetry.

Pulse oximetry (Spo2) is a simple, noninvasive method that is widely used to determine oxygen saturation in patients undergoing surgical procedures. Artificial acrylic nails have recently become fashionable to strengthen and lengthen nails. This study investigates the effect of unpolished acrylic nails on the measurement of oxygen saturation by pulse oximetry. Data were collected during a 3-month period. Thirty women, average age 32 years (range 18 to 61 years), were recruited at a high-volume nail salon in northwestern Pennsylvania. A baseline pulse oximetry reading was obtained on each subject's natural, unpolished fingernail using a Nellcor N-20/N-20P portable pulse oximeter (Nellcor Incorporated, Hayward, California). A licensed nail technician applied the acrylic compound to the same finger. After the compound had hardened in approximately 5 minutes, a second reading was obtained on the unpolished acrylic nail. The mean pulse oximetry reading at baseline was 97.33% and after acrylic nail application, 97.58%. Using a paired Student's t test, no statistically significant differences existed between readings. This study demonstrates that unpolished acrylic nails do not affect pulse oximetry measurements of oxygen saturation. Patients may not need to remove unpolished acrylic nails before surgery.

Acrylates↗
PubMed1998

[Screening of sleep apnea/hypopnea syndrome by home pulse oximetry].

We evaluated the diagnostic accuracy and reproducibility of results obtained by home oximetry for the screening of sleep apnea/hypopnea syndrome. Our subjects were 40 patients who underwent home oximetry (12 patients for 1 night, 28 patients for 2 nights) followed by all-night polysomnography. Their mean age was 50.7 +/- 11.2 years; mean body mass index (BMI), 27.6 +/- 4.4 kg/m2; and mean apnea/hypopnea index (AHI), 36.0 +/- 26.0 hr-1. The data obtained by home pulse oximetry were fed into a personal computer, and utilized to calculate the desaturation cycles per hour (oxygen desaturation index (ODI) of 2-4%) and the percentage of time that SpO2 measured less than 90% (T 90). Polysomnography was used to monitor the number of apnea and hypopnea episodes per hour of sleep (AHI). With sleep apnea/hypopnea syndrome defined as AHI > or = 15, the diagnostic sensitivity and specificity of home pulse oximetry were 73.5% and 83.3%, respectively, when ODI-3 > or = 15 was used as the diagnostic standard. Patients who showed false negative results had a lower mean BMI (25.5 +/- 3.0) than those who showed true positive results (28.8 +/- 4.6). The reproducibility of ODI-3 data obtained at home was very high (r = 0.964, n = 28). In conclusion, home pulse oximetry seems to be a very useful tool for the detection of apnea/hypopnea syndrome, but false negative results should be considered a possibility, especially in patients who are not obese.

Adolescent↗
PubMed2006

Influence of digital clubbing on oxygen saturation measurements by pulse-oximetry in cystic fibrosis patients.

OBJECTIVE: To determine the influence of digital clubbing on oxygen saturation by pulse oximetry measurements (SpO2) in Cystic Fibrosis patients. BACKGROUND: Measuring the arterial oxygen saturation at the fingertip by pulse-oximetry is commonly used in the management of CF patients. In these patients, clinical signs of hyperoxia are often observed with oxygen supplies based on digital oximetry readings. This suggests inaccuracies in the digital measurement method, which in its turn may be caused by digital clubbing. In order to study the influence of digital clubbing, measurements between fingertip and forehead sensor were compared in a clubbing and non-clubbing CF-population. The ear sensor measurements are used as a reference variable. METHODS: Two groups were examined. Group 1 consisted of 50 CF patients without digital clubbing (DPD/IPD ratio<1.00). Group 2 consisted of 50 CF patients with digital clubbing (DPD/IPD ratio>1.00). Patients were measured at rest before any treatment and with their daily oxygen supply, if applicable. Saturation was simultaneously measured with three Criticare SpO2 T pulse oximeters, using a fingertip sensor at the right index (transmission oximetry), a forehead sensor at the forehead (reflectance oximetry) and an ear sensor at the right ear. RESULTS: Using the Bland and Altman method no clear difference was found between the saturation measurements of right ear versus forehead sensor in the two groups. When the measurements of right ear versus fingertip sensor are compared there is still no difference for the non-clubbing group. On the contrary, for the clubbing group lower saturation scores were measured by the fingertip probe compared to the right ear measurement. The differences in saturation became greater as the saturation value at fingertip was lower. CONCLUSION: Digital clubbing significantly influences the registrations of the SpO2 measurements by means of a fingertip probe, underestimating the saturation. It can be advised to use the ear sensor as good alternative for these patients.

Adolescent↗
PubMed2003

Predictive value of pulse oximetry and fetal scalp blood pH in the case of meconium-stained amniotic fluid.

OBJECTIVE: To compare the predictive value of intrapartum fetal pulse oximetry to that of fetal scalp blood pH for an abnormal neonatal outcome in the case of thick meconium. STUDY DESIGN: A prospective multicenter observational study was performed from June 1994 to November 1995. Fetal oxygen saturation was monitored using a Nellcor N-400 fetal pulse oximeter in case of abnormal FHR. The last readings of fetal oxygen saturation and fetal scalp blood pH before birth were used to assess the ability of both techniques to predict an abnormal neonatal status. RESULTS: At a 30% cutoff, the negative predictive value of fetal oxygen saturation was not altered in case of meconium when compared to clear amniotic fluid (79 and 83%, respectively). Fetal scalp blood pH at a 7.20 threshold had a poor negative predictive value in case of meconium when compared to clear amniotic fluid (56% versus 88%, respectively). The receiver operator characteristic curve showed similar performance of fetal scalp blood pH and pulse oximetry in cases with clear amniotic fluid. In cases with meconium, the performance of fetal scalp blood pH was poor, whereas that of pulse oximetry remained unchanged. In three cases with meconium below the vocal cords, a drop in fetal oxygen saturation was observed during labor whereas fetal scalp blood pH remained within normal values. CONCLUSION: The predictive value of fetal scalp blood pH is poor in case of meconium, whereas the predictive value of pulse oximetry seems to be unchanged in this situation.

Amniotic Fluid↗
PubMed2004

Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations.

BACKGROUND: Infants hospitalized with bronchiolitis are frequently monitored with a pulse oximeter. However, there is little consensus on an acceptable lower limit of oxygenation. No previous studies have examined how the use of pulse oximetry and supplemental oxygen therapy affects length of stay. OBJECTIVE: To determine the extent to which bronchiolitis hospitalizations are prolonged by a perceived need for supplemental oxygen based on pulse oximetry readings. Design and Patients Retrospective case series of subjects younger than 2 years who were hospitalized with bronchiolitis at an academic medical center. Two investigators independently reviewed the hospitalization records of 73 infants and determined at what point an infant met all discharge criteria except oxygenation. We then calculated the extent to which hospitalizations were prolonged by a perceived need for supplemental oxygen therapy based on pulse oximetry readings alone. RESULTS: Sixty-two infants met inclusion criteria. There was high interrater reliability in determining whether hospitalizations were prolonged (kappa = 0.75). In 16 (26%) of 62 patients (95% confidence interval, 15%-37%), the hospitalization was prolonged because of oxygenation concerns. Length of stay was prolonged an average of 1.6 days (range, 1.1-2.0 days) per hospitalization for these 16 patients, or 0.4 day (range, 0.2-0.6 day) per hospitalization for all 62 patients. CONCLUSIONS: Hospitalizations of some infants with bronchiolitis are prolonged by a perceived need for supplemental oxygen therapy based on pulse oximetry readings. Further investigation into outcomes of different levels and durations of oxygen desaturation is needed and would have the potential to reduce practice variability and shorten the length of stay.

Age Distribution↗
PubMed1984

Superiority of transcutaneous oximetry in noninvasive vascular diagnosis in patients with diabetes.

Transcutaneous oxygen tension Ptco2 is directly related to skin oxygen delivery. Regional transcutaneous oximetry ( RTO ) compares peripheral and truncal (Ptco2), yielding a regional perfusion index indicative of local limb perfusion. The relative diagnostic values of RTO , Doppler ankle-brachial pressure ratio (ABR), pulse volume recording (PVR), and toe pulse reappearance time (PRT/2) were studied in 64 limbs of patients with diabetes. These limbs were clinically classifiable into claudication, rest pain, and gangrene groups. Regional transcutaneous oximetry had a higher diagnostic accuracy than ABR (X2 = 27.47, P less than .001), PVR (X2 = 7.54, P less than .01), and PRT/2 (X2 = 10.99, P less than .001). Regional transcutaneous oximetry was universally applicable and the degree of hypoxia observed correlated with clinical symptoms. Significant hypoxia predicted large-vessel angiographic lesions, many of which were reconstructible . Regional transcutaneous oximetry should be the initial noninvasive test in diabetic peripheral vascular disease.

Aged↗
PubMed1991

Pulse oximetry versus measured arterial oxygen saturation: a comparison of the Nellcor N100 and the Biox III.

Pulse oximetry is noninvasive, fast, and simple, making it a very popular way of assessing oxygenation in pediatric patients. However, there are few studies that establish the accuracy of this technology over a wide range of oxygen saturations in children. This study, done in 47 children aged from 1 day to 16 years with congenital heart disease and undergoing cardiac catheterization, compared the direct measurement of arterial oxygen saturation to values from pulse oximetry. Oxygen saturation was measured by an IL-282 Co-oximeter, which also measured carboxyhemoglobin and methemoglobin, and was compared to values obtained from both a Biox III and Nellcor N100. Both pusle oximeters gave values that closely correlated with the actual saturation (r = 0.91 and 0.93, respectively) with standard errors of the estimate of 4.1 and 3.2%, respectively. For both devices, the error increased with decreasing saturations, being progressively larger below a saturation of 80%. The difference between the actual saturation and that measured by pulse oximetry bore no relationship to the presence of carboxyhemoglobin, methemoglobin, fetal hemoglobin, bilirubin, cardiac index, or age of the patient. In conclusion, pulse oximetry, while a very useful technology in pediatrics, must be interpreted with some caution in children with severe cyanosis.

Adolescent↗