Hyperoxemia in Newborn Infants: Detection by Pulse Oximetry

PEDIATRICS ◽  
1989 ◽  
Vol 84 (2) ◽  
pp. 226-230
Author(s):  
Hans-Ulrich Bucher ◽  
Sergio Fanconi ◽  
Peter Baeckert ◽  
Gabriel Duc
Keyword(s):  
Pulse Oximetry ◽  
Pulse Oximeter ◽  
Arterial Oxygen Saturation ◽  
Newborn Infants ◽  
Arterial Oxygen Tension ◽  
Arterial Oxygen ◽  
Mechanically Ventilated ◽  
Arterial Blood ◽  
Transcutaneous Monitoring ◽  
Alarm Limit

Pulse oximetry has been proposed as a non-invasive continuous method for transcutaneous monitoring of arterial oxygen saturation of hemoglobin (tcSO2) in the newborn infant. The reliability of this technique in detecting hyperoxemia is controversial, because small changes in saturation greater than 90% are associated with relatively large changes in arterial oxygen tension (PaO2). The purpose of this study was to assess the reliability of pulse oximetry using an alarm limit of 95% tcSO2 in detecting hyperoxemia (defined as PaO2 greater than 90 mm Hg) and to examine the effect of varying the alarm limit on reliability. Two types of pulse oximeter were studied alternately in 50 newborn infants who were mechanically ventilated with indwelling arterial lines. Three arterial blood samples were drawn from every infant during routine increase of inspired oxygen before intratracheal suction, and PaO2 was compared with tcSO2. The Nellcor N-100 pulse oximeter identified all 26 hyperoxemic instances correctly (sensitivity 100%) and alarmed falsely in 25 of 49 nonhyperoxemic instances (specificity 49%). The Ohmeda Biox 3700 pulse oximeter detected 13 of 35 hyperoxemic instances (sensitivity 37%) and alarmed falsely in 7 of 40 nonhyperoxemic instances (specificity 83%). The optimal alarm limit, defined as a sensitivity of 95% or more associated with maximal specificity, was determined for Nellcor N-100 at 96% tcSO2 (specificity 38%) and for Ohmeda Biox 3700 at 89% tcSO2 (specificity 52%). It was concluded that pulse oximeters can be highly sensitive in detecting hyperoxemia provided that type-specific alarm limits are set and a low specificity is accepted.

Pulse Oximetry: An Alternative Method for the Assessment of Oxygenation in Newborn Infants

PEDIATRICS ◽  
1987 ◽  
Vol 79 (4) ◽  
pp. 524-528
Author(s):  
Michael S. Jennis ◽  
Joyce L. Peabody
Keyword(s):  
Pulse Oximetry ◽  
Pulse Oximeter ◽  
Arterial Oxygen Saturation ◽  
Newborn Infants ◽  
Fetal Hemoglobin ◽  
Arterial Oxygen ◽  
Skin Injury ◽  
Reliable Technique ◽  
Arterial Blood

Continuous monitoring of oxygenation in sick newborns is vitally important. However, transcutaneous Po2 measurements have a number of limiations. Therefore, we report the use of the pulse oximeter for arterial oxygen saturation (Sao2) determination in 26 infants (birth weights 725 to 4,000 g, gestational ages 24 to 40 weeks, and postnatal ages one to 49 days). Fetal hemoglobin determinations were made on all infants and were repeated following transfusion. Sao2, readings from the pulse oximeter were compared with the Sao2 measured in vitro on simultaneously obtained arterial blood samples. The linear regression equation for 177 paired measurements was: y = 0.7x + 27.2; r = .9. However, the differences between measured Sao2 and the pulse oximeter Sao2 were significantly greater in samples with > 50% fetal hemoglobin when compared with samples with < 25% fetal hemoglobin (P < .001). The pulse oximeter was easy to use, recorded trends in oxygenation instantaneously, and was not associated with skin injury. We conclude that pulse oximetry is a reliable technique for the continuous, noninvasive monitoring of oxygenation in newborn infants.

scholarly journals Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinshu Katayama ◽  
Jun Shima ◽  
Ken Tonai ◽  
Kansuke Koyama ◽  
Shin Nunomiya
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Prospective Observational Study ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Arterial Blood Gas ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Arterial Blood ◽  
Ventilated Patients

AbstractRecently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable.Trial registration UMIN000027671. Registered 7 June 2017.

Continuous Monitoring of Arterial Oxygen Tension Using a Catheter-Tip Polarographic Electrode in Infants

PEDIATRICS ◽  
1976 ◽  
Vol 57 (2) ◽  
pp. 244-250
Author(s):  
M. Conway ◽  
G. M. Durbin ◽  
D. Ingram ◽  
N. McIntosh ◽  
D. Parker ◽  
...  
Keyword(s):  
Oxygen Tension ◽  
Continuous Monitoring ◽  
Newborn Infants ◽  
Arterial Oxygen Tension ◽  
Oxygen Electrode ◽  
Arterial Oxygen ◽  
Respiratory Illnesses ◽  
Arterial Blood ◽  
Reliable Instrument ◽  
Catheter Tip

An oxygen electrode mounted in the tip of an umbilical artery catheter was used in 36 newborn infants with severe respiratory illnesses, 28 of whom survived. Thirty-seven electrodes were used. The median age at insertion was 4 hours (range, 30 minutes to 122 hours). Three electrodes failed to work and they were removed or replaced, and two could not be properly evaluated. Thirty-two electrodes functioned satisfactorily for 10 to 190 hours (mean, 75 hours) after a one-point calibration against blood sampled through the catheter. Twenty-two did not need recalibrating before they were removed after 10 to 190 hours (mean, 88 hours). Four of the remaining ten electrodes were recalibrated once after 33 to 97 hours and then functioned until removed 15 to 55 hours later. The other six electrodes failed after 32 to 105 hours (mean, 49 hours). Complications were few. A total of 356 arterial blood samples, obtained after the initial calibration and before any recalibration was necessary, gave a correlation coefficient of 0.93 (P &lt; .0001) against an independent system for measuring arterial oxygen tension (Pao2) (Radiometer Type E.5046 oxygen electrode). We conclude that the catheter-tip electrode is a safe and reliable instrument for continuously recording Pao2 in newborn infants which much simplifies the management of serious respiratory illnesses.

scholarly journals Sequestro Leucocitário de Oxigénio

2016 ◽  
Vol 29 (5) ◽  
pp. 343
Author(s):  
Miguel Pinto da Costa ◽  
Henrique Pimenta Coelho
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Arterial Oxygen Saturation ◽  
Gas Analysis ◽  
Lymphocytic Leukemia ◽  
Red Blood Cell Transfusion ◽  
Clinical State ◽  
Arterial Oxygen ◽  
Low Oxygen ◽  
Arterial Blood

<p>The authors present a case of a 60-year-old male patient, previously diagnosed with B-cell chronic lymphocytic leukemia, who was admitted to the Emergency Room with dyspnea. The initial evaluation revealed severe anemia (Hgb = 5.0 g/dL) with hyperleukocytosis (800.000/µL), nearly all of the cells being mature lymphocytes, a normal chest X-ray and a low arterial oxygen saturation (89%; pulse oximetry). After red blood cell transfusion, Hgb values rose (9.0 g/dL) and there was a complete reversion of the dyspnea. Yet, subsequent arterial blood gas analysis, without the administration of supplemental oxygen, systematically revealed very low oxygen saturation values (~ 46%), which was inconsistent with the patient’s clinical state and his pulse oximetry values (~ 87%), and these values were not corrected by the administration of oxygen via non-rebreather mask. The investigation performed allowed to establish the diagnosis of oxygen leukocyte larceny, a phenomenon which conceals the true oxygen saturation due to peripheral consumption by leukocytes.</p>

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

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.

Pulse Oximetry: Theory and Applications for Noninvasive Monitoring

1992 ◽  
Vol 38 (9) ◽  
pp. 1601-1607 ◽  
Author(s):  
Y Mendelson
Keyword(s):  
Pulse Oximetry ◽  
Near Infrared ◽  
Arterial Oxygen Saturation ◽  
Theoretical Background ◽  
Blood Oxygenation ◽  
Advanced Technology ◽  
Arterial Oxygen ◽  
Arterial Blood ◽  
Technological Advances ◽  
Pulse Oximeters

Abstract Noninvasive measurement of arterial oxygen saturation (SaO2) by pulse oximetry is widely acknowledged to be one of the most important technological advances in monitoring clinical patients. Pulse oximeters compute SaO2 by measuring differences in the visible and near infrared absorbances of fully oxygenated and deoxygenated arterial blood. Unlike clinical blood gas analyzers, which require a sample of blood from the patient and can provide only intermittent measurement of patient oxygenation, pulse oximeters provide continuous, safe, and instantaneous measurement of blood oxygenation. Here I review the theoretical background behind this advanced technology, instrumentation requirements, practical instrument calibration, common features of commercial pulse oximeters, specific clinical applications, and performance limitations of pulse oximeters.

OXYGEN THERAPY IN THE NEWBORN INFANT

PEDIATRICS ◽  
1971 ◽  
Vol 47 (6) ◽  
pp. 1086-1087
Author(s):  
Jerold F. Lucey ◽  
Marvin Cornblath ◽  
Stanley N. Graven ◽  
Sheldon B. Korones ◽  
L. Stanley James ◽  
...  
Keyword(s):  
Oxygen Concentration ◽  
Oxygen Tension ◽  
Newborn Infant ◽  
Newborn Infants ◽  
Arterial Oxygen Tension ◽  
Arterial Oxygen ◽  
Retrolental Fibroplasia ◽  
Arterial Blood ◽  
Increased Risk ◽  
Inspired Oxygen

The following recommendations will appear in the revision of the manual, Standards and Recommendations for Hospital Care of Newborn Infants, scheduled for publication early in 1971. Because the Committee felt a sense of urgency to provide these recommendations to pediatricians, family physicians, and other health professionals caring for newborn infants, they are being published prior to appearance of the manual. The statement has had extensive review by a large number of experts not on the Committee, and their comments and suggestions have been followed in the preparation of the final draft. It was also reviewed and approved by the Committee on Drugs of the Academy at their meeting in San Francisco October 24, 1970. When a newborn infant needs extra oxygen, it must be administered with great care because there is a causal relationship between a higher than normal oxygen tension in arterial blood (60 to 100 mm Hg) and retrolental fibroplasia (retinopathy of prematurity). When the normal O2 tension is exceeded, there is an increased risk of retrolental fibroplasia. The upper limit of arterial oxygen tension and its duration which are safe for these infants is not known. It is probable that even concentrations of 40% of inspired oxygen (formerly considered safe) could be dangerous for some infants. An inspired oxygen concentration of 40% may be insufficient for infants with cardiorespiratory disease to raise the oxygen tension of arterial blood to a normal level. In such instances, an inspired oxygen concentration of 60%, 80%, or higher may be necessary.

scholarly journals Accuracy of Samsung Smartphone Integrated Pulse Oximetry Meets Full FDA Clearance Standards for Clinical Use

2021 ◽  
Author(s):  
Sara H. Browne ◽  
Mike Bernstein ◽  
Philip E. Bickler
Keyword(s):  
Pulse Oximetry ◽  
Blood Sample ◽  
Pulse Oximeter ◽  
Assessment Tool ◽  
Arterial Oxygen ◽  
Blood Oxygen Saturation ◽  
Arterial Blood ◽  
Patients At Risk ◽  
The Uk ◽  
At Home

AbstractBackgroundPulse oximetry is used as an assessment tool to gauge the severity of COVID-19 infection and identify patients at risk of poor outcomes. 1,2,3,4 The pandemic highlights the need for accurate pulse oximetry, particularly at home, as infection rates increase in multiple global regions including the UK, USA and South Africa 5. Over 100 million Samsung smartphones containing dedicated biosensors (Maxim Integrated Inc, San Jose, CA) and preloaded Apps to perform pulse oximetry, are in use globally. We performed detailed in human hypoxia testing on the Samsung S9 smartphone to determine if this integrated hardware meets full FDA/ISO requirements for clinical pulse oximetry.MethodsThe accuracy of integrated pulse oximetry in the Samsung 9 smartphone during stable arterial oxygen saturations (SaO2) between 70% and 100% was evaluated in 12 healthy subjects. Inspired oxygen, nitrogen, and carbon dioxide partial pressures were monitored and adjusted via a partial rebreathing circuit to achieve stable target SaO2 plateaus between 70% and 100%. Arterial blood samples were taken at each plateau and saturation measured on each blood sample using ABL-90FLEX blood gas analyzer. Bias, calculated from smartphone readings minus the corresponding arterial blood sample, was reported as root mean square deviation (RMSD).FindingsThe RMSD of the over 257 data points based on blood sample analysis obtained from 12 human volunteers tested was 2.6%.InterpretationEvaluation of the smartphone pulse oximeter performance is within requirements of <3.5% RMSD blood oxygen saturation (SpO2) value for FDA/ISO clearance for clinical pulse oximetry. This is the first report of smartphone derived pulse oximetry measurements that meet full FDA/ISO accuracy certification requirements. Both Samsung S9 and S10 contain the same integrated pulse oximeter, thus over 100 million smartphones in current global circulation could be used to obtain clinically accurate spot SpO2 measurements to support at home assessment of COVID-19 patients.

scholarly journals Study of Oxygen Saturation by Pulse Oximetry and Arterial Blood Gas in ICU Patients: A Descriptive Cross-sectional Study

2020 ◽  
Vol 58 (230) ◽  
Author(s):  
Nabin Rauniyar ◽  
Shyam Pujari ◽  
Pradeep Shrestha
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Arterial Oxygen Saturation ◽  
Cross Sectional Study ◽  
Arterial Oxygen ◽  
Blood Gas ◽  
Cross Sectional ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Mean

Introduction: Pulse oximetery is expected to be an indirect estimation of arterial oxygen saturation. However, there often are gaps between SpO2 and SaO2. This study aims to study on arterial oxygen saturation measured by pulse oximetry and arterial blood gas among patients admitted in intensive care unit. Methods: It was a hospital-based descriptive cross-sectional study in which 101 patients meeting inclusion criteria were studied. SpO2 and SaO2 were measured simultaneously. Mean±SD of SpO2 and SaO2 with accuracy, sensitivity and specificity were measured. Results: According to SpO2 values, out of 101 patients, 26 (25.7%) were hypoxemic and 75 (74.25%) were non–hypoxemic. The mean±SD of SaO2 and SpO2 were 93.22±7.84% and 92.85±6.33% respectively. In 21 patients with SpO2<90%, the mean±SD SaO2 and SpO2 were 91.63±4.92 and 87.42±2.29 respectively. In 5 patients with SpO2 < 80%, the mean ± SD of SaO2 and SpO2 were: 63.40±3.43 and 71.80±4.28, respectively. In non–hypoxemic group based on SpO2 values, the mean±SD of SpO2 and SaO2 were 95.773±2.19% and 95.654±3.01%, respectively. The agreement rate of SpO2 and SaO2 was 83.2%, and sensitivity and specificity of PO were 84.6% and 83%, respectively. Conclusions: Pulse Oximetry has high accuracy in estimating oxygen saturation with sp02>90% and can be used instead of arterial blood gas.

scholarly journals Accuracy and precision of pulse oximeter at different sensor locations in patients with heart failure

2021 ◽  
Vol 16 ◽  
Author(s):  
Alaa Thabet Hassan ◽  
Soher Mostafa Ahmed ◽  
Azza Salah AbdelHaffeez ◽  
Sherif A.A. Mohamed
Keyword(s):  
Heart Failure ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Pulse Oximeter ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
St Segment Elevation ◽  
Accuracy And Precision ◽  
St Segment ◽  
Patients With Heart Failure

Background: Despite its wide use in clinical practice, few studies had assessed the role of pulse oximetry in patients with heart failure. We aimed to evaluate the accuracy and precision of the pulse oximeter in patients with heart failure and to determine this accuracy at three different sensor locations.Methods: Comparison of pulse oximetry reading (SpO2) with arterial oxygen saturation (SaO2) was reported in 3 groups of patients with heart failure (HF); those with ejection fraction (EF) >40%, those with EF <40%, and those with acute HF (AHF) with ST and non-ST segment elevation acute myocardial infarction (STEMI and non-STEMI).Results: A total of 235 patients and 90 control subjects were enrolled. There were significant differences in O2 saturation between control and patients’ groups when O2 saturation is measured at the finger and toe, but not the ear probes; p=0.029, p=0.049, and 0.051, respectively. In HF with EF>40% and AHF with O2 saturations >90%, finger oximetry is the most accurate and reliable, while in HF with EF<40% and in patients with AHF with O2 saturations <90%, ear oximetry is the most accurate.Conclusion: Pulse oximetry is a reliable tool in assessing oxygen saturation in patients with heart failure of different severity. In HF with EF>40% and in AHF with O2 saturations >90%, finger oximetry is the most accurate and reliable, while in HF with EF<40% and in patients with AHF with O2 saturations <90%, ear oximetry is the most accurate. Further studies are warranted.

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