Effects of Divided Attention and Operating Room Noise on Perception of Pulse Oximeter Pitch Changes

Abstract Background: Anesthesiology requires performing visually oriented procedures while monitoring auditory information about a patient’s vital signs. A concern in operating room environments is the amount of competing information and the effects that divided attention has on patient monitoring, such as detecting auditory changes in arterial oxygen saturation via pulse oximetry. Methods: The authors measured the impact of visual attentional load and auditory background noise on the ability of anesthesia residents to monitor the pulse oximeter auditory display in a laboratory setting. Accuracies and response times were recorded reflecting anesthesiologists’ abilities to detect changes in oxygen saturation across three levels of visual attention in quiet and with noise. Results: Results show that visual attentional load substantially affects the ability to detect changes in oxygen saturation concentrations conveyed by auditory cues signaling 99 and 98% saturation. These effects are compounded by auditory noise, up to a 17% decline in performance. These deficits are seen in the ability to accurately detect a change in oxygen saturation and in speed of response. Conclusions: Most anesthesia accidents are initiated by small errors that cascade into serious events. Lack of monitor vigilance and inattention are two of the more commonly cited factors. Reducing such errors is thus a priority for improving patient safety. Specifically, efforts to reduce distractors and decrease background noise should be considered during induction and emergence, periods of especially high risk, when anesthesiologists has to attend to many tasks and are thus susceptible to error.

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Endotracheal suctioning: ventilator vs manual delivery of hyperoxygenation breaths

American Journal of Critical Care ◽

10.4037/ajcc1996.5.3.192 ◽

1996 ◽

Vol 5 (3) ◽

pp. 192-197 ◽

Cited By ~ 5

Author(s):

MJ Grap ◽

C Glass ◽

M Corley ◽

T Parks

Keyword(s):

Clinical Practice ◽

Lung Injury ◽

Arterial Pressure ◽

Oxygen Saturation ◽

Arterial Oxygen ◽

Suction Catheter ◽

Endotracheal Suctioning ◽

Arterial Blood ◽

Before And After ◽

The Impact

BACKGROUND: Despite a large number of studies on endotracheal suctioning, there is little data on the impact of clinically practical hyperoxygenation techniques on physiologic parameters in critically ill patients. OBJECTIVE: To compare the manual and mechanical delivery of hyperoxygenation before and after endotracheal suctioning using methods commonly employed in clinical practice. METHODS: A quasi-experimental design was used, with twenty-nine ventilated patients with a lung injury index of 1.54 (mild-moderate lung injury). Three breaths were given before and after each of two suction catheter passes using both the manual resuscitation bag and the ventilator. Arterial pressure, capillary oxygen saturation, heart rate, and cardiac rhythm were monitored for 1 minute prior to the intervention to obtain a baseline, continuously throughout the procedure, and for 3 minutes afterward. Arterial blood gases were collected immediately prior to the suctioning intervention, immediately after, and at 30, 60, 120, and 180 seconds after the intervention. Data were analyzed with repeated measures analysis of variance. RESULTS: Arterial oxygen partial pressures were significantly higher using the ventilator method. Peak inspiratory pressures during hyperoxygenation were significantly higher with the manual resuscitation bag method. Significant increases were observed in mean arterial pressure during and after suctioning, with both delivery methods, with no difference between methods. Maximal increases in arterial oxygen partial pressure and arterial oxygen saturation occurred 30 seconds after hyperoxygenation, falling to baseline values at 3 minutes for both methods. CONCLUSION: Using techniques currently employed in clinical practice, these findings support the use of the patient's ventilator for hyperoxygenation during suctioning.

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Technical note: Evaluation of a wireless pulse oximeter for measuring arterial oxygen saturation and pulse rate in newborn Holstein Friesian calves

Journal of Dairy Science ◽

10.3168/jds.2017-14266 ◽

2018 ◽

Vol 101 (7) ◽

pp. 6437-6442 ◽

Cited By ~ 2

Author(s):

P. Kanz ◽

S. Krieger ◽

M. Drillich ◽

M. Iwersen

Keyword(s):

Oxygen Saturation ◽

Pulse Rate ◽

Pulse Oximeter ◽

Arterial Oxygen Saturation ◽

Technical Note ◽

Arterial Oxygen ◽

Holstein Friesian

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Is pulse oximeter a reliable tool for non-critically ill patients with COVID-19?

10.22541/au.163250701.15872568/v1 ◽

2021 ◽

Author(s):

Aslıhan Gürün Kaya ◽

Miraç Öz ◽

İREM AKDEMİR KALKAN ◽

Ezgi Gülten ◽

güle AYDIN ◽

...

Keyword(s):

Oxygen Saturation ◽

Pulse Oximeter ◽

Lymphocyte Count ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Arterial Blood Gas ◽

Reactive Protein ◽

Arterial Blood ◽

The Difference ◽

Clinical Conditions

Introduction: Guidelines recommend using a pulse oximeter rather than arterial blood gas (ABG) for COVID-19 patients. However, significant differences can be observed between oxygen saturation measured by pulse oximetry (SpO2) and arterial oxygen saturation (SaO2) in some clinical conditions. We aimed to assess the reliability of pulse oximeter in patients with COVID-19 Methods: We retrospectively reviewed ABG analyses and SpO2 levels measured simultaneously with ABG in patients hospitalized in COVID-19 wards. Results: We categorized total 117 patients into two groups; in whom the difference between SpO2 and SaO2 was 4% (acceptable difference) and >4% (large difference). Large difference group exhibited higher neutrophil count, C-reactive protein, ferritin, fibrinogen, D-dimer and lower lymphocyte count. Multivariate analyses revealed that increased fibrinogen, increased ferritin and decreased lymphocyte count were independent risk factors for large difference between SpO2 and SaO2. The total study group demonstrated the negative bias of 4.02% with the limits of agreement of −9.22% to 1.17%. The bias became significantly higher in patients with higher ferritin, fibrinogen levels and lower lymphocyte count. Conclusion: Pulse oximeters may not be sufficient to assess actual oxygen saturation especially in COVID-19 patients with high ferritin and fibrinogen levels and low lymphocyte count low SpO2 measurements.

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First Evaluation of a Newly Constructed Underwater Pulse Oximeter for Use in Breath-Holding Activities

Frontiers in Physiology ◽

10.3389/fphys.2021.649674 ◽

2021 ◽

Vol 12 ◽

Author(s):

Eric Mulder ◽

Erika Schagatay ◽

Arne Sieber

Keyword(s):

Oxygen Saturation ◽

Pulse Oximeter ◽

Arterial Oxygen Saturation ◽

Dropout Rate ◽

Arterial Oxygen ◽

Breath Holding ◽

Signal Loss ◽

Physiological Variables ◽

Dry Conditions ◽

Pulse Oximeters

Studying risk factors in freediving, such as hypoxic blackout, requires development of new methods to enable remote underwater monitoring of physiological variables. We aimed to construct and evaluate a new water- and pressure proof pulse oximeter for use in freediving research. The study consisted of three parts: (I) A submersible pulse oximeter (SUB) was developed on a ruggedized platform for recording of physiological parameters in challenging environments. Two MAX30102 sensors were used to record plethysmograms, and included red and infra-red emitters, diode drivers, photodiode, photodiode amplifier, analog to digital converter, and controller. (II) We equipped 20 volunteers with two transmission pulse oximeters (TPULS) and SUB to the fingers. Arterial oxygen saturation (SpO2) and heart rate (HR) were recorded, while breathing room air (21% O2) and subsequently a hypoxic gas (10.7% O2) at rest in dry conditions. Bland-Altman analysis was used to evaluate bias and precision of SUB relative to SpO2 values from TPULS. (III) Six freedivers were monitored with one TPULS and SUB placed at the forehead, during a maximal effort immersed static apnea. For dry baseline measurements (n = 20), SpO2 bias ranged between −0.8 and −0.6%, precision between 1.0 and 1.5%; HR bias ranged between 1.1 and 1.0 bpm, precision between 1.4 and 1.9 bpm. For the hypoxic episode, SpO2 bias ranged between −2.5 and −3.6%, precision between 3.6 and 3.7%; HR bias ranged between 1.4 and 1.9 bpm, precision between 2.0 and 2.1 bpm. Freedivers (n = 6) performed an apnea of 184 ± 53 s. Desaturation- and resaturation response time of SpO2 was approximately 15 and 12 s shorter in SUB compared to TPULS, respectively. Lowest SpO2 values were 76 ± 10% for TPULS and 74 ± 13% for SUB. HR traces for both pulse oximeters showed similar patterns. For static apneas, dropout rate was larger for SUB (18%) than for TPULS (<1%). SUB produced similar SpO2 and HR values as TPULS, both during normoxic and hypoxic breathing (n = 20), and submersed static apneas (n = 6). SUB responds more quickly to changes in oxygen saturation when sensors were placed at the forehead. Further development of SUB is needed to limit signal loss, and its function should be tested at greater depth and lower saturation.

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Four Types of Pulse Oximeters Accurately Detect Hypoxia during Low Perfusion and Motion

Anesthesiology ◽

10.1097/aln.0000000000002002 ◽

2018 ◽

Vol 128 (3) ◽

pp. 520-530 ◽

Cited By ~ 15

Author(s):

Aaron Louie ◽

John R. Feiner ◽

Philip E. Bickler ◽

Laura Rhodes ◽

Michael Bernstein ◽

...

Keyword(s):

Root Mean Square Error ◽

Oxygen Saturation ◽

Mean Square Error ◽

Root Mean Square ◽

Pulse Oximeter ◽

Motion Artifacts ◽

Arterial Oxygen ◽

Mean Square ◽

Blood Samples ◽

Pulse Oximeters

Abstract Background Pulse oximeter performance is degraded by motion artifacts and low perfusion. Manufacturers developed algorithms to improve instrument performance during these challenges. There have been no independent comparisons of these devices. Methods We evaluated the performance of four pulse oximeters (Masimo Radical-7, USA; Nihon Kohden OxyPal Neo, Japan; Nellcor N-600, USA; and Philips Intellivue MP5, USA) in 10 healthy adult volunteers. Three motions were evaluated: tapping, pseudorandom, and volunteer-generated rubbing, adjusted to produce photoplethsmogram disturbance similar to arterial pulsation amplitude. During motion, inspired gases were adjusted to achieve stable target plateaus of arterial oxygen saturation (SaO2) at 75%, 88%, and 100%. Pulse oximeter readings were compared with simultaneous arterial blood samples to calculate bias (oxygen saturation measured by pulse oximetry [SpO2] − SaO2), mean, SD, 95% limits of agreement, and root mean square error. Receiver operating characteristic curves were determined to detect mild (SaO2 < 90%) and severe (SaO2 < 80%) hypoxemia. Results Pulse oximeter readings corresponding to 190 blood samples were analyzed. All oximeters detected hypoxia but motion and low perfusion degraded performance. Three of four oximeters (Masimo, Nellcor, and Philips) had root mean square error greater than 3% for SaO2 70 to 100% during any motion, compared to a root mean square error of 1.8% for the stationary control. A low perfusion index increased error. Conclusions All oximeters detected hypoxemia during motion and low-perfusion conditions, but motion impaired performance at all ranges, with less accuracy at lower SaO2. Lower perfusion degraded performance in all but the Nihon Kohden instrument. We conclude that different types of pulse oximeters can be similarly effective in preserving sensitivity to clinically relevant hypoxia.

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Cerebral Arterial Oxygen Saturation Measurements Using a Fiber-Optic Pulse Oximeter

Neurocritical Care ◽

10.1007/s12028-010-9349-y ◽

2010 ◽

Vol 13 (2) ◽

pp. 278-285 ◽

Cited By ~ 7

Author(s):

J. P. Phillips ◽

R. M. Langford ◽

S. H. Chang ◽

K. Maney ◽

P. A. Kyriacou ◽

...

Keyword(s):

Oxygen Saturation ◽

Pulse Oximeter ◽

Fiber Optic ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen

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A Survey to Evaluate the Impact of Ailurophobia on Blood Oxygen Level

Journal of Clinical & Experimental Immunology ◽

10.33140/jcei.04.02.08 ◽

2019 ◽

Vol 4 (2) ◽

Keyword(s):

Oxygen Saturation ◽

Pulse Oximeter ◽

Blood Gas Analysis ◽

Gas Analysis ◽

P Value ◽

Blood Oxygen ◽

Oxygen Level ◽

Blood Oxygen Level ◽

Peripheral Oxygen Saturation ◽

The Impact

The blood oxygen level is a measure of amount of oxygen circulation in the blood. The blood oxygen level test also known as ‘blood gas analysis’ estimates the proper working of the lungs and it performs different measurements. Pulse oximeter, a noninvasive device that helps to detect or estimate the level of carbon dioxide and oxygen saturation in the blood. Normal pulse oximeter reading has a range of 95 to 100 percent. 200 individuals were selected and asked about the fear of cats and their peripheral oxygen saturation was estimated using pulse oximeter device. The results calculated from M Stat software and student’s t-test revealed that there is a significant impact of cat phobia on peripheral oxygen saturation. The calculated p-value was significant depicting the correlation between blood oxygen level and ailurophobia.

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Impact of Carbon Dioxide on Cerebral Oxygenation and Vital Parameters in Stable Preterm and Term Infants Immediately after Birth

Neonatology ◽

10.1159/000519636 ◽

2021 ◽

pp. 1-8

Author(s):

Christina Helene Wolfsberger ◽

Marlies Bruckner ◽

Bernhard Schwaberger ◽

Lukas Peter Mileder ◽

Berndt Urlesberger ◽

...

Keyword(s):

Carbon Dioxide ◽

Oxygen Saturation ◽

Preterm Infants ◽

Gestational Age ◽

Oxygen Extraction ◽

Arterial Oxygen ◽

Secondary Outcome ◽

Tissue Oxygen ◽

Term Infants ◽

The Impact

Introduction: Carbon dioxide (pCO2) induces changes in the tone of cerebral vessels. The aim of the present study was to evaluate the impact of pCO2 on cerebral regional tissue oxygen saturation (crSO2), cerebral fractional tissue oxygen extraction (cFTOE), and cerebral tissue oxygen extraction (cTOE), measured with near-infrared spectroscopy (NIRS), in preterm and term infants 15 min after birth. Methods: Post hoc analyses of secondary outcome parameters of prospective observational studies were performed. Stable preterm and term infants with cerebral NIRS monitoring (INVOS 5100C) until minute 15 after birth and a blood gas analysis, performed between minutes 14–18 after birth, were included. Heart rate (HR) and arterial oxygen saturation (SpO2) were recorded. pCO2 was correlated with crSO2, cFTOE, cTOE, SpO2, HR, and partial pressure of oxygen (pO2). Results: Eleven preterm infants with a median (IQR) gestational age of 34.8 (32.7–36.1) weeks were analyzed. Mean ± SD pCO2 was 53.5 ± 4.2 mm Hg. At minute 15 after birth, crSO2 was 82.6 (74.3–91.3)%, cFTOE 0.15 ± 0.09, cTOE 14.6 ± 8.4%, SpO2 97.4 ± 2.1%, and HR 152 (136–167) bpm. pCO2 correlated negatively with crSO2 (p = 0.012) and positively with cFTOE (p = 0.035) and cTOE (p = 0.037). Eighty-four term infants with a gestational age of 39.0 (38.5–38.9) weeks were analyzed. pCO2 was 53.5 ± 6.3 mm Hg. At minute 15 after birth, crSO2 was 84.4 (80.8–85.1)%, cFTOE 0.14 ± 0.08, cTOE 13.6 ± 7.9%, SpO2 96.5 ± 2.6%, and HR 155 (153–163) bpm. pCO2 did only negatively correlate with pO2 (p = 0.034) in term infants. Conclusion: In preterm infants, higher pCO2 was associated with lower crSO2 and higher cFTOE/cTOE. In term infants, no associations were observed. The present findings suggest that the vasodilatative effect of pCO2 is less pronounced in preterm infants during immediate postnatal transition.

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Performance of the MP570T pulse oximeter in volunteers participating in the controlled desaturation study: a comparison of seven probes

Anesthesia and Pain Medicine ◽

10.17085/apm.20028 ◽

2020 ◽

Vol 15 (3) ◽

pp. 371-377

Author(s):

Byung-Moon Choi ◽

Bong Jin Kang ◽

Ho-Yong Yun ◽

Bokyoung Jeon ◽

Ji-Yeon Bang ◽

...

Keyword(s):

Oxygen Saturation ◽

Pulse Oximeter ◽

Breathing Circuit ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Gas Mixture ◽

Mean Square ◽

Peripheral Oxygen Saturation ◽

Hypoxic Gas Mixture ◽

Finger Probe

Background: The performance of the pulse oximeter was evaluated based on the ISO 80601-2-61:2011 (E) guidelines. This study aimed to determine whether the various finger probes of the MP570T pulse oximeter (MEK-ICS Co., Ltd., Korea) would provide clinically reliable peripheral oxygen saturation (SpO2) readings over a range of 70100% arterial oxygen saturation (SaO2) during non-motion conditions.Methods: Each volunteer (n = 12) was connected to a breathing circuit for the administration of a hypoxic gas mixture. For frequent blood sampling, an arterial cannula was placed in a radial artery. The following seven pulse oximeter probes were simultaneously attached to each volunteer’s fingers: (1) WA-100 reusable finger probe (MEDNIS Co., Ltd., Korea), (2) MDNA disposable finger probe (MEDNIS Co., Ltd.), (3) IS-1011 disposable finger probe (Insung Medical Co., Ltd., Korea), (4) CJ340NA disposable finger probe (CHUN JI IN Medical Co., Ltd., Korea), (5) NellcorTM OxiMax DS-100A reusable finger probe (Medtronic, USA), (6) NellcorTM OxiMax MAX-N disposable finger probe (Medtronic), and (7) OXI-PRO DA disposable finger probe (Bio-Protech Inc., Korea). Results: A total of 275 SpO2-SaO2 pairs were included in the analysis. The accuracy of the root mean square (Arms) of each probe was 2.83%, 3.98%, 3.75%, 6.84%, 3.43%, 5.17%, and 3.84%, respectively.Conclusions: The MP570T pulse oximeter with WA-100 reusable, MDNA disposable, IS-1011 disposable, NellcorTM OxiMax DS-100A reusable, and OXI-PRO DA disposable finger probes meets an acceptable standard of SpO2 accuracy under non-motion conditions.

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