Pulse oximeter accuracy and precision affected by sensor location in cyanotic children

Sedaghat-Yazdi, Farshad; Torres, Adalberto; Fortuna, Randall S.; Geiss, Dale M.

doi:10.1097/pcc.0b013e3181727967

Cited by 19 publications

(23 citation statements)

References 24 publications

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“…To the best of our knowledge, only a limited number of studies have investigated the accuracy of pulse oximetry in children with critical congenital heart disease, all of which showed that accuracy is impaired as SaO 2 falls. 6,12,[16][17][18][19] SpO 2 both overestimates and underestimates SaO 2 , with a tendency towards overestimation, which is consistent with the results of our study. Many studies have included children with non-cardiac causes of acute hypoxia, not the chronic hypoxia seen in children with critical congenital heart disease.…”

Section: Discussionsupporting

confidence: 91%

Accuracy of the Masimo SET^® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease

et al. 2015

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Section: Discussionsupporting

confidence: 91%

Accuracy of the Masimo SET^® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease

et al. 2015

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“…However, other studies had different results based on patients’ condition [ 7 , 25 – 27 ]. In this regard, Fernandez et al (2007), in a method-comparison study, assessed the agreement between SpO2 values by digit-based and forehead pulse oximeters in low cardiac index patients, they suggested using forehead probe in these patients since the peripheral blood flow and body temperature are decreased [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sedaghat Yazdi et al (2008) examined the effect of placement on the accuracy and reliability of the pulse oximeter sensor in children with cyanotic heart disease and found that if the SaO2 ≤ 90%, the foot sensor had the worst accuracy and reliability. Further, regardless of SaO2 amount, there was no difference between finger and toe sensor in terms of accuracy and reliability [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of pulse oximetry in detection of oxygen saturation in patients admitted to the intensive care unit of heart surgery: comparison of finger, toe, forehead and earlobe probes

et al. 2018

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BackgroundHeart surgery patients are more at risk of poor peripheral perfusion, and peripheral capillary oxygen saturation (SpO2) measurement is regular care for continuous analysis of blood oxygen saturation in these patients. With regard to controversial studies on accuracy of the current pulse oximetry probes and lack of data related to patients undergoing heart surgery, the present study was conducted to determine accuracy of pulse oximetry probes of finger, toe, forehead and earlobe in detection of oxygen saturation in patients admitted to intensive care units for coronary artery bypass surgery.MethodsIn this clinical trial, 67 patients were recruited based on convenience sampling method among those admitted to intensive care units for coronary artery bypass surgery. The SpO2 value was measured using finger, toe, forehead and earlobe probes and then compared with the standard value of arterial oxygen saturation (SaO2). Data were entered into STATA-11 software and analyzed using descriptive, inferential and Bland-Altman statistical analyses.ResultsHighest and lowest correlational mean values of SpO2 and SaO2 were related to finger and earlobe probes, respectively. The highest and lowest agreement of SpO2 and SaO2 were related to forehead and earlobe probes.ConclusionThe SpO2 of earlobe probes due to lesser mean difference, more limited confidence level and higher agreement ration with SaO2 resulted by arterial blood gas (ABG) analysis had higher accuracy. Thus, it is suggested to use earlobe probes in patients admitted to the intensive care unit for coronary artery bypass surgery.Trial registrationRegistration of this trial protocol has been approved in Iranian Registry of Clinical Trials at 2018–03-19 with reference IRCT20100913004736N22. “Retrospectively registered.”

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“…However, these earlier manuscripts indicate SpO 2 may systematically overestimate measured arterial oxygen saturation from ABG sampling. 3,4 The SpO 2 overestimation may also be dependent on location of measurement, 4,5 perfusion to the extremity where the pulse oximeter is located, and skin color. 6,7 The population of children with lower baseline oxygen saturations is growing.…”

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confidence: 99%

Accuracy of Pulse Oximetry in Children

2014

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WHAT'S KNOWN ON THIS SUBJECT: Saturations from pulse oximetry (SpO 2 ) may overestimate arterial oxygen saturations measured by CO-oximetry (SaO 2 ). The overestimation can be affected by location of measurement, perfusion, and skin color. Previous studies are limited by small numbers of observations in a hypoxemic range. WHAT THIS STUDY ADDS:This large sample of hypoxemic patients identified that SpO 2 typically overestimates SaO 2 . Bias and precision varied throughout the SpO 2 range. The SpO 2 range of 81% to 85% had the greatest bias: median SpO 2 6% higher than SaO 2 measured by CO-oximetry. abstract OBJECTIVE: For children with cyanotic congenital heart disease or acute hypoxemic respiratory failure, providers frequently make decisions based on pulse oximetry, in the absence of an arterial blood gas. The study objective was to measure the accuracy of pulse oximetry in the saturations from pulse oximetry (SpO 2 ) range of 65% to 97%. METHODS:This institutional review board-approved prospective, multicenter observational study in 5 PICUs included 225 mechanically ventilated children with an arterial catheter. With each arterial blood gas sample, SpO 2 from pulse oximetry and arterial oxygen saturations from CO-oximetry (SaO 2 ) were simultaneously obtained if the SpO 2 was #97%. RESULTS:The lowest SpO 2 obtained in the study was 65%. In the range of SpO 2 65% to 97%, 1980 simultaneous values for SpO 2 and SaO 2 were obtained. The bias (SpO 2 -SaO 2 ) varied through the range of SpO 2 values. The bias was greatest in the SpO 2 range 81% to 85% (336 samples, median 6%, mean 6.6%, accuracy root mean squared 9.1%). SpO 2 measurements were close to SaO 2 in the SpO 2 range 91% to 97% (901 samples, median 1%, mean 1.5%, accuracy root mean squared 4.2%).CONCLUSIONS: Previous studies on pulse oximeter accuracy in children present a single number for bias. This study identified that the accuracy of pulse oximetry varies significantly as a function of the SpO 2 range. Saturations measured by pulse oximetry on average overestimate SaO 2 from CO-oximetry in the SpO 2 range of 76% to 90%. Better pulse oximetry algorithms are needed for accurate assessment of children with saturations in the hypoxemic range. KEY WORDS oximetry, hypoxia, heart defects, congenital heart disease/ defects, pediatric, mechanical ventilation ABBREVIATIONS ABG-arterial blood gas ABG/SpO 2 pairs-simultaneous measurement of ABG and SpO 2 AHRF-acute hypoxemic respiratory failure A rms -accuracy root mean squared CCHD-cyanotic congenital heart disease FDA-US Food and Drug Administration SaO 2 -arterial oxygen saturations from CO-oximetry SpO 2 -saturations from pulse oximetry

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Pulse oximeter accuracy and precision affected by sensor location in cyanotic children

Abstract: The Philips M1020A pulse oximeter and Nellcor MAX-N sensors were less accurate and precise when used on the sole of the foot or palm of the hand of a child with an Sao2 <90%.

Cited by 19 publications

References 24 publications

Accuracy of the Masimo SET^® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease

Accuracy of the Masimo SET^® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease

Accuracy of pulse oximetry in detection of oxygen saturation in patients admitted to the intensive care unit of heart surgery: comparison of finger, toe, forehead and earlobe probes

Accuracy of Pulse Oximetry in Children

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Pulse oximeter accuracy and precision affected by sensor location in cyanotic children

Abstract: The Philips M1020A pulse oximeter and Nellcor MAX-N sensors were less accurate and precise when used on the sole of the foot or palm of the hand of a child with an Sao2 <90%.

Cited by 19 publications

References 24 publications

Accuracy of the Masimo SET® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease

Accuracy of the Masimo SET® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease

Accuracy of pulse oximetry in detection of oxygen saturation in patients admitted to the intensive care unit of heart surgery: comparison of finger, toe, forehead and earlobe probes

Accuracy of Pulse Oximetry in Children

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Accuracy of the Masimo SET^® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease

Accuracy of the Masimo SET^® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease