Abstract
Background Pulse oximetry (SpO 2 ) is used to monitor oxygen saturation levels to avoid hypoxaemia in children. Sensor manufacturers claim high sensitivity, specificity and accuracy. Few studies have evaluated accuracy and precision of SpO 2 in children. Methods This prospective, observational study was conducted in a 36-bed mixed medical/surgical paediatric intensive care unit. All children <16 years old with an arterial line were eligible. Paired SpO 2 readings obtained with a Masimo and a Nellcor sensor were prospectively matched and validated to the arterial haemoglobin oxygen saturation (SaO 2 ). Bias between SpO 2 and SaO 2 (SpO 2 -SaO 2 ), accuracy root mean square (A rms ), sensitivity, specificity and kappa agreement were calculated for sensors. Multivariable regression analysis was conducted to determine the relationship between clinical variables and bias in paired sensor readings. Findings There were 929 participants with 16,839 readings (9,382 simultaneous Masimo and Nellcor). Nineteen percent of paired values had SaO 2 <88%. Bias increased with decreasing SaO 2 . Both sensors failed to achieve FDA’s A rms requirement in all ranges. Of the 15.5% patients with ‘true hypoxaemia’ (SaO 2 <88%), 28.6% (n=1165) were not correctly identified by pulse oximetry. Variables associated with higher odds of bias included sepsis, respiratory distress and post-cardiac arrest; increasing lactate; vasoconstrictor use; lower SaO 2 and low admission weight. Interpretation Both tested sensors, with current algorithms, are not precise enough for a PICU setting. Sensor readings in patients with respiratory disease, sepsis and cardiac arrest should be used with caution.
P0372 / #410: TRANSCUTANEOUS OXYGEN SATURATION ACCURACY IN CRITICALLY ILL CHILDREN