The Accuracy of Pulse Spectroscopy for Detecting Hypoxemia and Coexisting Methemoglobin or Carboxyhemoglobin

Kulcke, Axel; Feiner, John; Menn, Ingolf; Holmer, Amadeus; Hayoz, J.; Bickler, Philip E.

doi:10.1213/ane.0000000000001219

Cited by 12 publications

(11 citation statements)

References 22 publications

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“…Based on studies in humans in which MetHb was purposely increased by administration of nitrates, an acute increase in MetHb in excess of 15% typically will cause low blood pressure (especially postural hypotension) and headache. More severe symptoms are present above 20%[ 11 ]. Using a logistic fit model and a receiver operating characteristic (ROC) curve analysis, we found that the area under the ROC curve to detect ≥20% MetHb was 86%.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, the method is a potentially valuable screening tool for detecting life-threatening levels of COHb or MetHb. However, the method we describe currently lacks the precision of laboratory CO-oximeters or pulse CO-oximeters cabable of assessing COHb and MetHb levels in blood or non-invasively through the skin[ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…These instruments are expensive (typically >$20,000) and require costly calibration and standardization reagents, making them cost-prohibitive in resource-poor settings. More recently, Masimo Inc. (Irvine CA, USA) has introduced a line of pulse CO-oximeters (Rainbow ® ) that non-invasively estimate COHb and MetHb with good sensitivity and specificity[ 11 – 15 ]. Pulse CO-oximeters are also expensive, with instruments costing >$5000 and limited-use probes costing >$100 each.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of detection of carboxyhemoglobin and methemoglobin in human and bovine blood with an inexpensive, pocket-size infrared scanner

Bickler

Rhodes

2018

PLoS ONE

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Detecting life-threatening common dyshemoglobins such as carboxyhemoglobin (COHb, resulting from carbon monoxide poisoning) or methemoglobin (MetHb, caused by exposure to nitrates) typically requires a laboratory CO-oximeter. Because of cost, these spectrophotometer-based instrument are often inaccessible in resource-poor settings. The aim of this study was to determine if an inexpensive pocket infrared spectrometer and smartphone (SCiO®Pocket Molecular Sensor, Consumer Physics Ltd., Israel) accurately detects COHb and MetHb in single drops of blood. COHb was created by adding carbon monoxide gas to syringes of heparinized blood human or cow blood. In separate syringes, MetHb was produced by addition of sodium nitrite solution. After incubation and mixing, fractional concentrations of COHb or MetHb were measured using a Radiometer ABL-90 Flex® CO-oximeter. Fifty microliters of the sample were then placed on a microscope slide, a cover slip applied and scanned with the SCiO spectrometer. The spectrograms were used to create simple linear models predicting [COHb] or [MetHb] based on spectrogram maxima, minima and isobestic wavelengths. Our model predicted clinically significant carbon monoxide poisoning (COHb ≥15%) with a sensitivity of 93% and specificity of 88% (regression r2 = 0.63, slope P<0.0001), with a mean bias of 0.11% and an RMS error of 21%. Methemoglobinemia severe enough to cause symptoms (>20% MetHb) was detected with a sensitivity of 100% and specificity of 71% (regression r2 = 0.92, slope P<0.001) mean bias 2.7% and RMS error 21%. Although not as precise as a laboratory CO-oximeter, an inexpensive pocket-sized infrared scanner/smartphone detects >15% COHb or >20% MetHb on a single drop of blood with enough accuracy to be useful as an initial clinical screening. The SCiO and similar relatively low cost spectrometers could be developed as inexpensive diagnostic tools for developing countries.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy of detection of carboxyhemoglobin and methemoglobin in human and bovine blood with an inexpensive, pocket-size infrared scanner

Bickler

Rhodes

2018

PLoS ONE

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“…In clinical settings and generally for living patients, a noninvasive alternative to venous or arterial blood COHb measurement by a BGA or CO-oximetry that has been widely investigated is pulse CO-oximetry [39][40][41][42][43].…”

Section: Analytical Techniquesmentioning

confidence: 99%

What are the limitations of methods to measure carbon monoxide in biological samples?

Oliverio

Varlet

2019

Forensic Toxicol

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Carbon monoxide (CO) is one of the most important toxic gases in the atmosphere. Its high affinity for hemoglobin made carboxyhemoglobin (COHb) the most appropriate biomarker for CO poisonings. COHb is measured using spectrophotometric (UV-spectrophotometry, CO-oximetry) or gas chromatographic (GC) methods hyphenated with flame ionization or mass spectrometry detectors. However, inconsistencies in many cases were reported between measured values and reported symptoms, raising doubts over the suitability of COHb as biomarker together with the accuracy and reliability of its measurement methods. Therefore, we aimed to review the accuracy of current methods to measure CO and to determine their sources of error and their effects on the interpretation process. MethodsA detailed search of PubMed was performed in November 2018 using relevant keywords. After exclusion criteria, 46 articles out of 191 initial hits were carefully reviewed. ResultsWhile optical methods are highly affected by changes of blood quality due to degradation of the samples during storage, GC methods are less affected. However, measurement of COHb does not quantify free CO, which is mainly responsible for toxicity mechanisms other than hypoxia such as inhibition of hemoproteins, thus underestimating the true CO burden. Therefore, measurement of COHb is insufficiently accurate for CO poisoning diagnosis. ConclusionsAn alternative biomarker is required, such as determining the total amount of carbon monoxide in blood. Even though further research is required, we recommend toxicologists to consider all sources of error that can alter COHb concentrations and, in more challenging cases, they should use GC-MS methods to confirm the results obtained by spectrophotometry.

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“…It has been demonstrated that the concentration of carboxyhaemoglobin (HbCO) in arterial blood is closely related not only to the concentration and duration of CO inhalation but also to the difference of detection methods and patients' physical condition. [2][3][4] Some studies also reported that extensive demyelination could be detected in brain in many patients with CO poisoning, which determined the occurrence, the severity and the prognosis of DEACMP. 5,6 Nevertheless, the pathogenesis is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Fasudil alleviates brain damage in rats after carbon monoxide poisoning through regulating neurite outgrowth inhibitor/oligodendrocytemyelin glycoprotein signalling pathway

Wang

Guo

et al. 2019

Basic Clin Pharma Tox

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Carbon monoxide (CO) poisoning can lead to many serious neurological symptoms. Currently, there are no effective therapies for CO poisoning. In this study, rats exposed to CO received hyperbaric oxygen therapy, and those in the Fasudil group were given additional Fasudil injection once daily. We found that the escape latency in CO poisoning group (CO group) was significantly prolonged, the T1/Ttotal was obviously decreased, and the mean escape time and the active escape latency were notably extended compared with those in normal control group (NC group, P < 0.05). After administration of Fasudil, the escape latency was significantly shortened, T1/Ttotal was gradually increased as compared with CO group (>1 week, P < 0.05). Ultrastructural damage of neurons and blood‐brain barrier of rats was serious in CO group, while the structural and functional integrity of neuron and mitochondria maintained relatively well in Fasudil group. Moreover, we also noted that the expressions of neurite outgrowth inhibitor (Nogo), oligodendrocyte‐myelin glycoprotein (OMgp) and Rock in brain tissue were significantly increased in CO group, and the elevated levels of the three proteins were still observed at 2 months after CO poisoning. Fasudil markedly reduced their expressions compared with those of CO group (P < 0.05). In summary, the activation of Nogo‐OMgp/Rho signalling pathway is associated with brain injury in rats with CO poisoning. Fasudil can efficiently down‐regulate the expressions of Nogo, OMgp and Rock proteins, paving a way for the treatment of acute brain damage after CO poisoning.

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The Accuracy of Pulse Spectroscopy for Detecting Hypoxemia and Coexisting Methemoglobin or Carboxyhemoglobin

Abstract: Pulse spectroscopy accurately detects hypoxemia, MetHb, and COHb. The technology also accurately detects these dysfunctional hemoglobins during hypoxemia. Future releases of this device may have an improved SpO2 algorithm that is more robust with methemoglobinemia.

Cited by 12 publications

References 22 publications

Accuracy of detection of carboxyhemoglobin and methemoglobin in human and bovine blood with an inexpensive, pocket-size infrared scanner

Accuracy of detection of carboxyhemoglobin and methemoglobin in human and bovine blood with an inexpensive, pocket-size infrared scanner

What are the limitations of methods to measure carbon monoxide in biological samples?

Fasudil alleviates brain damage in rats after carbon monoxide poisoning through regulating neurite outgrowth inhibitor/oligodendrocytemyelin glycoprotein signalling pathway

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