Is Pulse Oximetry Reliable in Detecting Hyperoxemia in the Neonate?

Alarm settings for the Marquette 8000 pulse oximeter to prevent hyperoxic and hypoxic episodes

“…In the present study, 95% SpO 2 was both the upper and lower alarm limit required to prevent 95% of hyperoxic and hypoxic episodes. Similar to other studies on various brands of oximeters, 8 , 12 , 16 the alarm limits suggested for the Marquette 8000 oximeter are associated with relatively low specificities (43%, 54%, respectively), contributing to a high rate of false alarms.…”

“…From previous studies, it is clear that there are considerable differences in bias and precision between brands of oximeters 7 , 8 , 12 , 14 –17 . For the Nellcor N‐100, an alarm limit of 96% SpO 2 12 detected at least 95% of all hyperoxic episodes (PaO 2 >90 mmHg), whereas for the Ohmeda Biox 3700 an alarm limit of 89% SpO 2 12 – 90% SpO 2 8 was required to achieve this goal. There are few studies which discuss the lower alarm limits for the prevention of hypoxic episodes in neonates 9 , 15 –17 .…”

“…Instead, each brand of oximeter has inbuilt algorithms derived from studies on varying population samples 7 , 13 which may differ markedly from a cohort of sick neonates. This has resulted in considerable differences in bias and precision between brands of oximeters that can alter the alarm limits required to reliably detect both hypoxic and hyperoxic episodes 7 , 8 , 12 , 14 –17 . Therefore, it is necessary to validate each brand of oximeter in a suitable clinical setting to determine the oxygen saturations at which the alarms must be set.…”

“…The need for upper limits to prevent hyperoxic episodes has guided most previous work in this field 8 , 9 , 12 , 14 –17 . Only recently have studies focused on developing an alarm range to prevent both hyperoxic and hypoxic episodes 9 , 15 –17 .…”

“…7,8,12,14-17 Therefore, it is necessary to validate each brand of oximeter in a suitable clinical setting to determine the oxygen saturations at which the alarms must be set.The need for upper limits to prevent hyperoxic episodes has guided most previous work in this field. 8,9,12,[14][15][16][17] Only recently have studies focused on developing an alarm range to prevent both hyperoxic and hypoxic episodes. 9,15-17 To date, none of these studies have reported on the Marquette 8000 pulse oximeter which is currently used in a number of neonatal intensive care units.…”