Operational Evaluation of Pulse Oximetry in NICU Patients with Arterial Access

Gerstmann, Dale R.; Berg, Ryan; Haskell, Ron; Brower, C.; Wood, Kari; Yoder, Brad; Greenway, L; Lassen, Gordon; Ogden, R. Todd; Stoddard, Ronald A.; Minton, Stephen D.

doi:10.1038/sj.jp.7210944

Cited by 41 publications

(31 citation statements)

References 19 publications

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“…Further, the data analytic approach is appropriate for our situation where the underlying true value measured is likely changing. Results are in agreement with previous studies suggesting that bias reported with first-generation pulse oximeters continue to be present in second-and third-generation devices and that inaccuracy at low saturations may be an inherent problem with the dual wavelength pulse oximeter [6,8] . This is further compounded by findings from a recent observational study suggesting that, even when alarm limit policies are implemented in the NICU, the desired SpO 2 remains outside the intended saturation range more than half of the time on average [15] .…”

Section: Discussionsupporting

confidence: 82%

Discrepancies between Arterial Oxygen Saturation and Functional Oxygen Saturation Measured with Pulse Oximetry in Very Preterm Infants

Rosychuk

Hudson-Mason²,

Eklund³

et al. 2011

Neonatology

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Background: Discrepancies between pulse oximetry saturation (SpO₂) and arterial saturation (SaO₂) at low blood oxygenation values have been previously reported with significant variations among instruments and studies. Whether pulse oximeters that attenuate motion artifact are less prone to such discrepancies is not well known. Objective: To prospectively assess the agreement of the Masimo V4 pulse oximeter within the critical 85–95% SpO₂ target range. Patients and Methods: For all consecutive babies with gestational age <33 weeks, postnatal age <7 days, and an umbilical arterial line, SpO₂ was measured continuously and SaO₂ analyzed on an as-needed basis. Bland-Altman techniques provided estimates of the difference (D = SaO₂ – SpO₂), standard deviation (SD), and 95% limits of agreement (D ± 2*SD). Results: There were 1,032 measurements (114 babies) with SpO₂ between 85 and 95%. The 95% limits of agreement were –2.0 ± 5.8, –2.4 ± 9.2, and –1.9 ± 5.3 in the SpO₂ categories 85–95, 85–89, and 91–95%, respectively. For the SpO₂ categories 85–89% and 91–95%, only 52% (53/101) and 59% (523/886) of SpO₂ values, respectively, corresponded to the analogous SaO₂ categories. In the 85–89% SpO₂ category, SaO₂ was lower than 85% in 39 of the 101 (39%) measurements. Conclusion: SaO₂ was lower on average than SpO₂ with an increased bias at lower saturation. The –2.4 ± 9.2 95% limits of agreement for SaO₂ – SpO₂ in the 85–89% SpO₂ category suggest that SpO₂ and SaO₂ are not interchangeable and intermittent SaO₂ assessments are warranted when the targeted SpO₂ is within this range.

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Section: Discussionsupporting

confidence: 82%

Discrepancies between Arterial Oxygen Saturation and Functional Oxygen Saturation Measured with Pulse Oximetry in Very Preterm Infants

Rosychuk

Hudson-Mason²,

Eklund³

et al. 2011

Neonatology

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Section: Limitations and Challenges To Newborn Pulse Oximetry In Detementioning

confidence: 99%

Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement from the AHA and AAP

Mahle¹,

Newburger²,

Matherne³

et al. 2009

Pediatrics

318

237

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BACKGROUND: The purpose of this statement is to address the state of evidence on the routine use of pulse oximetry in newborns to detect critical congenital heart disease (CCHD). METHODS AND RESULTS: A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours. CONCLUSIONS: Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic newborns after 24 hours of life, but before hospital discharge, may detect CCHD. Routine pulse oximetry performed after 24 hours in hospitals that have on-site pediatric cardiovascular services incurs very low cost and risk of harm. Future studies in larger populations and across a broad range of newborn delivery systems are needed to determine whether this practice should become standard of care in the routine assessment of the neonate.

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“…The peak performance of the commercially available oximeters occurs in the range of 92% to 97%. 92 Therefore, in the critical range for oximetry screening (94% to 97%), the variability of the most commonly used oximeters should be negligible. CI indicates confidence interval; DORV, double-outlet right ventricle; HLHS, hypoplastic left heart syndrome; PA, pulmonary atresia; d-TGA, dextro-transposition of the great arteries; TAPVC, total anomalous pulmonary venous connection; Truncus, truncus arteriosus; TA, tricuspid atresia; AA/AS, aortic atresia/aortic stenosis; TOF, tetralogy of Fallot; AVSD, atrioventricular septal defect; CoA, coarctation of the aorta; and PS, pulmonary stenosis.…”

Section: Limitations and Challenges To Newborn Pulse Oximetry In Detementioning

confidence: 99%

Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease

Mahle¹,

Newburger²,

Matherne³

et al. 2009

Circulation

244

134

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Background-The purpose of this statement is to address the state of evidence on the routine use of pulse oximetry in newborns to detect critical congenital heart disease (CCHD). Methods and Results-A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours. Conclusions-Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic

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Operational Evaluation of Pulse Oximetry in NICU Patients with Arterial Access

Abstract: These operational data suggest that with the methodology and devices currently in use, SpO(2) values in most all neonates who require arterial lines inaccurately correlate with measured arterial saturation.

Cited by 41 publications

References 19 publications

Discrepancies between Arterial Oxygen Saturation and Functional Oxygen Saturation Measured with Pulse Oximetry in Very Preterm Infants

Discrepancies between Arterial Oxygen Saturation and Functional Oxygen Saturation Measured with Pulse Oximetry in Very Preterm Infants

Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease: A Scientific Statement from the AHA and AAP

Role of Pulse Oximetry in Examining Newborns for Congenital Heart Disease

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