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PubMed1987

Estimation of oxygen utilization by dual oximetry.

Total body oxygen utilization coefficient was estimated using continuous pulse and pulmonary artery oximetry (dual oximetry) in 17 patients with respiratory failure. Change in arterial and mixed venous oxygen saturations was induced by altering airway pressure. Continuous measurement of mixed venous oxygen saturation provided an accurate and linear estimate of oxygen utilization coefficient (r = -0.92), the true values being overestimated by 0.05 +/- 0.06 (mean +/- SD). Addition of pulse oximetry improved the correlation (r = 0.93) and decreased the difference between absolute values (0.02 +/- 0.06). Oxygen utilization coefficient can be estimated reliably in an online fashion using pulmonary artery oximetry. However, the use of dual oximetry will further improve the estimate.

Adult↗
PubMed1992

Continuous dual oximetry in surgical critical care. Indications and limitations.

Continuous dual oximetry combines pulse and venous oximetry to provide real-time information about oxygen utilization and pulmonary function. The authors undertook this study to examine the accuracy, utility, and limitations of the technique in surgical critical care. Twelve critically ill patients underwent placement of a modified pulmonary artery catheter and a pulse oximeter, both connected to an on-line computer. Paired blood gas and oximeter measurements were recorded every 4 to 6 hours, with a minimum of six sets per patient. Blood-gas-derived shunt fraction correlated well with oximeter-derived ventilation-perfusion index (r = 0.78, p less than 0.01). Further, the continuous oxygen extraction ratio (O2EI) and mixed venous oxygen saturation (SpvO2) correlated with the oxygen utilization coefficient (O2EI:r = 0.6, p less than 0.01; SpvO2, r = 0.76, p less than 0.01). Computer modeling of ventilation-perfusion index found limitations in accuracy that occur at high arterial oxygen saturations and when pulse oximetry errors are present. The authors conclude that (1) Continuous dual oximetry offers a significant advantage over routine blood gas analysis for monitoring cardiopulmonary parameters in critically ill patients because of its real-time display; (2) Oximeter-derived determinations parallel traditional parameters; and (3) The most significant technical limitations occur primarily at high arterial saturations and with pulse oximetry errors.

Adolescent↗
PubMed1988

Efficacy of pulse oximetry and capnometry in postoperative ventilatory weaning.

We examined the ability of capnometry and pulse oximetry to identify potential respiratory problems by comparing oxyhemoglobin saturation (O2Sat) as measured by pulse oximetry and end-tidal CO2 (PetCO2) with arterial blood gas (ABG) determinations in 40 mechanically ventilated ICU patients. Hemoglobin saturation as measured by pulse oximetry correlated significantly with PaO2 (r = .65, p less than .0001); more importantly, an oximeter O2 Sat less than 95% showed 100% sensitivity in identifying hypoxemia (i.e., PaO2 less than 70 torr). PetCO2 tended to correlate strongly with PaCO2 for individual patients, but not when evaluated as a screening tool for identifying ventilatory abnormalities in the overall group (r = .52, p less than .0001). A PetCO2 less than 26 torr identified hypocarbia (defined as PaCO2 less than 30 torr) with a sensitivity of 85%. However, a PetCO2 of greater than 40 torr predicted hypercarbia (PaCO2 greater than 45 torr) with a sensitivity of only 28%. The efficacy of pulse oximetry and capnometry in monitoring respiratory status during postoperative ventilatory weaning was examined in a subset of 24 patients who had undergone elective cardiac surgery. All patients were weaned by intermittent mandatory ventilation, but each was assigned randomly to either a control group monitored with periodic ABG sampling or to an experimental group, monitored by following PetCO2 and O2 Sat via pulse oximetry. In the experimental group, ABG values were obtained on ICU admission, but thereafter only if a) O2 Sat less than 95%, b) PetCO2 less than 26 or greater than 40 torr, or c) felt to be clinically indicated by ICU staff.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Effect of carboxyhemoglobin on the accuracy of mixed venous oximetry monitors in dogs.

OBJECTIVE: To assess the accuracy of mixed venous hemoglobin oxygen saturation estimated, using in vivo pulmonary artery reflectance oximetry with ranging concentrations of carboxyhemoglobin. DESIGN: Criterion standard, a comparison of an alternative test to the "gold standard." SETTING: Laboratory animal facility of a large university. SUBJECTS: Five mongrel dogs. INTERVENTIONS: Anesthetized dogs were mechanically ventilated to normocarbia and instrumented with arterial catheters and pulmonary artery oximetry catheters. The dogs were ventilated with increasing inspired concentrations of carbon monoxide, and blood samples were analyzed for fractional concentrations of oxyhemoglobin and carboxyhemoglobin. Carboxyhemoglobin levels ranged from 0% to 70%. At each level of carboxyhemoglobin, FIO2 was varied from 0.21 to 0.09. Co-oximeter readings were compared with mixed venous oxygen saturation measurements of the pulmonary artery oximetry catheter. MEASUREMENTS AND MAIN RESULTS: Mixed venous oxygen saturation measurements from the pulmonary artery oximetry catheter system progressively overestimated fractional oxyhemoglobin in the presence of carboxyhemoglobin. This catheter's mixed venous oxygen saturation reading could be corrected for the presence of carboxyhemoglobin by a derived formula. Regression analysis for corrected mixed venous oxygen saturation (calculated) vs. fractional oxyhemoglobin yields a slope and intercept of 0.98 and -1.01, respectively, with a correlation coefficient of .98. The bias and precision values for fractional oxyhemoglobin vs. mixed venous oxygen saturation (calculated) are 1.9 and 2.2 (n = 66), with bias representing the degree of systematic error or deviation from the true measurement, and precision representing the confidence limits (or standard deviation) for individual variations from the true measurement. CONCLUSIONS: Mixed venous oxygen saturation monitoring does not detect the presence of carboxyhemoglobin and progressively overestimates fractional oxyhemoglobin as carboxyhemoglobin increases. Mixed venous oxygen saturation values of the standard pulmonary artery oximetry catheter approximately equal functional hemoglobin saturation. Bench co-oximeter blood analysis is required in patients suspected of having increased carboxyhemoglobin levels.

Algorithms↗
PubMed2000

Clinical experience with cerebral oximetry in stroke and cardiac arrest.

OBJECTIVE: To address the ability and reliability of the INVOS 3100A (Somanetics, Troy, MI) cerebral oximeter to detect cerebral desaturation in patients and the interpretation of cerebral oximetry measurements using the INVOS 3100A in stroke and cardiac arrest. DESIGN: Case reports of two patients. SETTING: Neurologic Intensive Care Unit of a University Hospital. PATIENTS: Two patients suffering occlusive strokes of the middle cerebral artery. One later suffered a cardiac arrest. RESULTS: The first case, a patient who suffered cardiac arrest while undergoing continuous cerebral oximetry, clearly demonstrated the ability of the INVOS 3100A to detect rapid tissue vascular oxyhemoglobin desaturation in the brain during circulatory arrest. In the second case, oximetry readings were obtained in a patient with a right internal carotid artery occlusion and an infarct in the middle cerebral artery territory. The circulation of the anterior cerebral artery (ACA) territory was intact. Stable xenon-computed tomography of local cerebral blood flow showed no perfusion in the infarct, and oximetry readings were between 60 and 65. In the border zone between the middle cerebral artery and the ACA, readings of 35 to 40 were obtained, and over the ACA territory, the readings were in the 60s. CONCLUSIONS: Oximetry by near infrared spectroscopy reflects the balance between regional oxygen supply and demand. In dead or infarcted nonmetabolizing brain, saturation may be near normal because of sequestered cerebral venous blood in capillaries and venous capacitance vessels and contribution from overlying tissue. In regionally or globally ischemic, but metabolizing brain, saturation decreases because oxygen supply is insufficient to meet metabolic demand. These observations are supported by previously reported "normal" readings in unperfused or dead brains.

Aged↗
PubMedDate not supplied

How accurate is pulse oximetry in patients with burn injuries?

Pulse oximetry is a noninvasive method of measuring arterial oxygen saturation. The value of oximetry in patients with burn injuries has been questioned because of a theoretic inaccuracy in the presence of carboxyhemoglobin. We studied pulse oximetry in 27 intubated patients with burn injuries to determine the accuracy of the method and then to determine whether oximetry could replace indwelling catheters presently used for arterial blood gas analysis. Oximeter and arterial blood gas saturation data correlated closely, with a coefficient of 0.820. The pulse oximeter predicted "adequate" ventilation in 78% of patients with a readout of 99% or above. The arterial PO2 was greater than or equal to 90 torr in 90% of patients with oximetric readouts greater than or equal to 98% and in 10% of patients with readouts less than 95%. Pulse oximetry is an accurate adjunct in the management of patients with burn injuries and in addition provides continuous real-time data not available with arterial blood gas sampling.

Adolescent↗
PubMed1996

Fetal oximetry monitoring: a new wonder or another mirage?

This review provides recent data and clinical opinions on a new technology in assessing fetal well-being during labor, the fetal pulse oximeter. Fetal pulse oximetry is potentially superior to electronic fetal heart rate monitoring because it allows direct assessment of both fetal oxygen status and fetal tissue perfusion. Several studies during recent years have demonstrated that fetal pulse oximetry during labor is feasible and accurate. On the other hand, these very same studies have demonstrated a few potential disadvantages and limitations of fetal oximetry. The main limitation seems to be a wide range of normal values. The correlation of fetal oximetry during labor with perinatal outcome and long-term newborn outcome has not yet been determined. In summary, fetal pulse oximetry during labor merits further randomized prospective studies, especially with regard to improvement of perinatal outcome.

Bias↗
PubMedDate not supplied

Post-anesthesia care unit nurses' knowledge of pulse oximetry.

The purpose of this study was to assess post-anesthesia care unit (PACU) nurses' knowledge of pulse oximetry. A convenience sample of 19 nurses completed a 32-item questionnaire that included a 20-item true-false test on pulse oximetry. Overall, nurses demonstrated a knowledge deficit in pulse oximetry. Competency in the use of pulse oximetry is vital to ensure a positive clinical outcome. Nurse educators are responsible for identifying knowledge deficits among staff and implementing strategies to correct these deficits. It is incumbent on nurse educators to provide research-based education on pulse oximetry and opportunities to participate in continuing education.

Adult↗
PubMed1992

Do fetal pulse oximetry readings at delivery correlate with cord blood oxygenation and acidaemia?

OBJECTIVE: To assess the accuracy of a pulse oximeter in the fetus. DESIGN: A prospective descriptive study, comparing oxygenation and acidaemia of cord blood with oxygen saturation in the arteries of the fetal scalp measured by a pulse oximeter just before delivery. The data were collected using an experimental pulse oximeter and a sensor specifically adapted to cope with the problems of fetal pulse oximetry. SETTING: The labour ward in a teaching hospital. SUBJECTS: Thirty seven Caucasian fetuses presenting by the vertex in normal uncomplicated labour. MAIN OUTCOME MEASURE: Fetal pulse oximetry reading shortly before birth, umbilical cord oxygenation and pH, and Apgar scores. RESULTS: Data of sufficient quality were obtained from 28 fetuses. There was a highly significant correlation between pulse oximetry reading and umbilical vein oxygen saturation r = 0.59, P = < 0.001). There was also a significant correlation between the pulse oximeter reading and cord blood pH (vein: r = 0.57, P = 0.002, artery: r = 0.63, P = 0.001). Apgar scores were not related to the oximetry results. CONCLUSION: Pulse oximetry readings reflect fetal oxygenation at birth.

Apgar Score↗
PubMed1996

Cerebral oximetry and stroke distance: the future of emergency department monitoring?

OBJECTIVE: To illustrate the possible role of cerebral oximetry and stroke distance as measured by Doppler ultrasound in monitoring the critically ill patient non-invasively in the emergency department. METHODS: Five critically ill patients were monitored with either cerebral oximetry or both cerebral oximetry and stroke distance (the distance travelled by blood in the aorta with each ventricular contraction), as measured by Doppler ultrasound of the aortic arch. CONCLUSIONS: Stroke distance as measured by Doppler ultrasound was a good clinical indication of reduced stroke volume and hence of cardiac output. Cerebral oximetry appears to be a useful measure of tissue hypoxia in patients in whom pulse oximetry is either unrecordable or unreliable.

Adolescent↗
PubMedDate not supplied

Does the hemoglobin concentration in fetal blood interfere with the accuracy of fetal reflection pulse oximetry?

OBJECTIVE: Our goal was to investigate the influence of the fetal hemoglobin (Hb) concentration on the accuracy of reflection pulse oximetry. METHODS: 179 fetuses were monitored by a reflection pulse oximetry system (RPOX MK2). Pulse oximetry measurements (SO2POX) were compared with the oxygen saturation and pH of umbilical artery and vein (UA-, UV-SaO2) immediately after delivery. Correlation and linear regression analyses were performed. Because it is unknown whether low or high Hb concentrations might interfere with the SO2POX measurements, the influence of the Hb level on the correlations was evaluated by weighting the linear regression in both ways; by Hb concentrations as weighting factor and as an inverse weighting factor (1/Hb). RESULTS: There was a significant correlation between SO2POX and UV-SaO2 (for the last 10 min of delivery, r = 0.45, p < 0.0005) but not with pH or UA-SaO2. Linear regression analysis between SO2POX and UV-SaO2 showed a multiple R of 0.45. Hb concentration in fetal blood ranged from 9.2 to 20.5 mg/dl. The weighted regression indicated a multiple RHb of 0.49, which did not differ by the inverse weighting (multiple Rinverse Hb: 0.49). CONCLUSIONS: Pulse oximetry measurements seem to reflect oxygen saturation in fetal blood, however further improvement is necessary. The Hb concentration in fetal blood does not interfere with the accuracy of fetal pulse oximetry and need not be taken into consideration in calibration curves.

Female↗
PubMed1993

A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea.

In order to determine whether measurement of arterial oxygen saturation (SaO2) could identify patients with obstructive sleep apnea (OSA), 98 consecutive patients referred for assessment of snoring and/or daytime somnolence were assessed clinically and then underwent both unsupervised oximetry in their homes and formal polysomnography. Clinical assessment identified patients with an apnea+hypopnea index (AHI) > or = 15 events per hour with a sensitivity of 79% and a specificity of 50%. Home oximetry analyzed by counting the number of arterial oxygen desaturations recorded was inferior to clinical assessment. For desaturations of 2% or more from baseline, desaturation index (DI) > or = 15 per hour identified patients with AHI > or = 15 with sensitivity 65% and specificity 74%; for 3% desaturations, sensitivity was 51% and specificity 90%; and for 4% desaturations, sensitivity was 40% and specificity 98%. From the oximetry data, the percentage of time spent at SaO2 below 90% (CT90) was also calculated. CT90 > or = 1% identified patients with AHI > or = 15 with sensitivity 93% and specificity 51%; for patients with AHI > or = 15 ultimately given nasal continuous positive airway pressure (CPAP), the sensitivity of a CT90 > or = 1% was 100%. We concluded that home oximetry with CT90 < 1% practically excludes clinically significant OSA. Conversely, home oximetry with DI > or = 15 for 4% desaturations makes OSA likely: the positive predictive value for OSA is 83% if the pretest probability of OSA is 30% and over 90% if the pretest probability is at least 50%.

Adult↗
PubMed1992

Can pulse oximetry be used to measure systolic blood pressure?

This study evaluates the use of pulse oximetry to accurately monitor systolic arterial blood pressure in 100 healthy volunteers. Determination of arterial blood pressure using oximetry was made at the disappearance of visual display upon blood pressure cuff inflation, at the reappearance of visual display upon cuff deflation, and by averaging the two. The blood pressures obtained by pulse oximetry were compared with the arterial blood pressures obtained by Korotokoff sounds and noninvasive blood pressure equipment. Good agreement was obtained when the average of oximetry-based systolic blood pressure estimates at the disappearance and reappearance of the waveform were compared with Korotokoff sound pressures and noninvasive equipment pressures. Thus pulse oximetry can be used to measure systolic arterial blood pressure. This technique is specifically important for patients with Takayasu's syndrome (pulseless disease) where conventional techniques often fail to monitor systolic arterial blood pressure.

Adult↗
PubMed1992

A comparison of three pulmonary artery oximetry catheters in intensive care unit patients.

OBJECTIVE: To compare the clinical performance of three pulmonary artery oximetry catheters (Oximetrix 3, SAT-2, and HEMOPRO2) in intensive care unit (ICU) patients. DESIGN: Unblinded comparison of performance over 24 h using an IL-282 CO-oximeter as a criterion standard. SETTING: Multispecialty adult ICU at a university teaching hospital. PATIENTS: Thirty critically ill patients selected from those requiring hemodynamic monitoring for medical management. MEASUREMENTS AND MAIN RESULTS: By all measures, performance of the Oximetrix 3 and SAT-2 systems were comparable; bias +/- precision were -1.98 +/- 3.07 and +1.80 +/- 3.49, respectively, vs -2.28 +/- 5.24 for the HEMOPRO2. The Oximetrix 3 and SAT-2 systems demonstrated consistent performance over the range of saturations tested, though Oximetrix 3 tended to underestimate and SAT-2 tended to overestimate the CO-oximeter value. The HEMOPRO2 underestimated the CO-oximetry-derived saturation, although this was not constant across the range of values tested. The 95 percent confidence limits based on intrasubject variability were similar (+/- 4.59, +/- 5.66, and +/- 6.56 for the Oximetrix 3, SAT-2, and HEMOPRO2, respectively); however, the 95 percent confidence limits based on total variability, while similar for Oximetrix 3 (+/- 6.03) and SAT-2 (+/- 6.86), were larger for the HEMOPRO2 (+/- 10.30). The expected SD was similar for the three systems (2.03, 2.50, and 2.90 for the Oximetrix 3, SAT-2, and HEMOPRO2 systems, respectively). None of the systems equaled or exceeded (p greater than 0.05) the manufacturers' published specifications, which, in all cases, are listed as +/- 2 percent (saturation; 1 SD) when compared with bench oximetry. CONCLUSIONS: Although each system measures mixed venous oxygen saturation, the Oximetrix 3 and SAT-2 systems demonstrate closer agreement with CO-oximetry. However, none of these catheters provided statistically significant evidence that they would perform within +/- 2 percent of CO-oximetry. As a continuous monitor used to detect changes or trends, any of the three may be acceptable.

Calibration↗
PubMed1992

Pulse oximetry in the postoperative care of cardiac surgical patients. A randomized controlled trail.

STUDY OBJECTIVE: To demonstrate the utility of pulse oximetry in detecting clinically unapparent episodes of arterial desaturation in postoperative cardiac surgical patients and to evaluate the effect of pulse oximetry on ordering arterial blood gas analyses. DESIGN: Prospective, randomized, partially blinded comparison. SETTING: Cardiothoracic surgical intensive care unit. PATIENTS: 35 patients following elective cardiac surgical procedures. INTERVENTIONS: All patients were monitored continuously with pulse oximetry throughout their ICU course. In group 1 patients, the SpO2 data were available at the bedside. In group 2 patients, the SpO2 data were masked at the bedside and monitored at a remote location. MEASUREMENTS AND RESULTS: Utilization of pulse oximetry allowed a significant reduction in arterial blood gas utilization in group 1 (group 1: 12.4 +/- 7.5 blood gas analyses per ICU admission vs group 2: 23.1 +/- 8.8; p = 0.0007) without adverse events. Clinically unapparent desaturations were detected in 7 of 15 patients in group 2. CONCLUSIONS: Pulse oximetry improves patient safety through the detection of clinically unapparent episodes of desaturation and can allow a reduction in the number of blood gas analyses utilized without adverse effects to the patient. This may allow a potential cost savings to the patient.

Cardiac Surgical Procedures↗
PubMed1986

Ear oximetry to detect apnea and differentiate rapid eye movement (REM) and non-REM (NREM) sleep. Screening for the sleep apnea syndrome.

Ear oximetry is commonly employed in screening patients for the sleep apnea syndrome, but the lack of objective information regarding the duration of sleep, including the presence of rapid-eye-movement (REM) sleep, is a major limitation. Based on the premise that both apnea and sleep-state-dependent changes in ventilation give rise to distinctive patterns in the arterial oxygen saturation, we developed a systematic technique to analyze ear oximetric tracings for wakefulness, REM sleep, and non-REM (NREM) sleep. Fifty-four patients were studied by both all-night polysomnography and ear oximetry. A careful comparison of ear oximetric data for sleep states and apnea was then made, using polysomnography as the correct classification to determine sensitivity, specificity, predictive value positive, and predictive value negative of the ear oximetric tracings. When classification of sleep state was compared, ear oximetry correctly classified 280.5 (82 percent) of 340.9 hours of sleep that was either REM or NREM sleep. The sensitivity for classifying NREM sleep was 0.85, for REM sleep was 0.70, and for wakefulness was 0.49. The sensitivity by ear oximetry for apnea was 0.80, with a predictive value negative of 0.87. We conclude that although polysomnography must be performed for definitive evaluation, ear oximetry is a valuable screening test for sleep apnea because the presence or absence of apnea can be determined, total duration of sleep can be estimated, and NREM vs REM sleep can be differentiated.

Adult↗
PubMed1987

Titration of continuous positive airway pressure by real-time dual oximetry.

The clinical utility of combined pulse and pulmonary artery oximetry (dual oximetry) in titrating continuous positive airway pressure (CPAP) therapy was tested in 17 patients with acute respiratory failure. The level of CPAP was altered in 2.5 cmH2O increments and decrements, while conventional measurements of cardiopulmonary function and continuous dual oximetry were performed. Then, optimum CPAP levels were selected using both techniques independently. The difference in optimum CPAP determined by the two methods was 0 cmH2O in ten of 17 patients, less than or equal to 2.5 cmH2O in 14 of 17 patients, and 5.0 to 7.5 cmH2O in the remaining three patients. When a difference existed, CPAP level determined with dual oximetry was consistently lower than the level selected by conventional means. The results indicate that the estimates of venous admixture and oxygen utilization coefficient obtained using dual oximetry provide sufficient information for rapid and accurate titration of CPAP in the majority of patients with acute respiratory failure.

Acute Disease↗
PubMed2000

[Regional transcranial oximetry with near infrared spectroscopy (NIRS) in comparison with measuring oxygen saturation in the jugular bulb in infants and children for monitoring cerebral oxygenation].

Using a dual channel near infrared (NIR) in vivo optical spectroscopy (INVOS) system (INVOS 3100A, Somanetics Corp. Troy, MI, USA) we investigated the relationship between jugular venous oxygen saturation (SjvO2) and regional cerebral oxygen saturation (rSO2) in 30 infants and children (mean age 4.5 years) with congenital heart disease undergoing cardiac catheterisation. The NIRS-SomaSensor (emitter and dual receiver probe) was applied at a standardised right fronto-temporal location (over the right frontal cortex) on the infant's head and covered with an adhesive flexible bandage. Using NIR light (730 and 810 nm) and two source-detector spacings (3 and 4 cm from the transmitter), percentage values of rSO2 were calculated from detected haemoglobin saturations. Simultaneously, jugular venous oxygen saturation (SjvO2) monitoring was performed via a catheter placed in the right internal jugular vein with its tip positioned in the jugular bulb, as verified by fluoroscopy. To compare the reliability of NIRS measurement characteristics, jugular venous blood was analysed for SjvO2 as a reference measure of global cerebral oxygenation, by co-oximetry (OSM3-Hemoximeter, Radiometer Copenhagen, Denmark). Other measured variables included pulse oximetry, arterial blood pressure, and venous and arterial oxygen saturations. Over a jugular venous oxygen saturation range of 31-83%, a significant positive linear correlation was found between rSO2 (NIRS measurement) and SjvO2 (jugular bulb oximetry) (r = 0.93, p < 0.001). No significant correlation was observed between rSO2 values and arterial blood saturation or pulse oximetry. The quantitative correlation between rSO2 (haemoglobin oxygenation in a small hemi-elliptical area of the brain) and reference SjvO2 measurement (method for monitoring global cerebral oxygenation) suggests that NIRS measurement with subtraction algorithm should identify predominantly intracranial saturation in the pediatric age group, and will tend to reflect global oxygenation under physiological conditions. Transcranial oximetry using dual receiving channel NIRS offers a noninvasive, real-time, reliable and practicable means of monitoring cerebral haemoglobin oxygenation changes infants and children with cyanotic and noncyanotic congenital heart disease.

Adolescent↗