Log in | Register

Pulse oximetry and high-dose vasopressors: a comparison between forehead reflectance and finger transmission sensors

Nicolas Nesseler| Jean-Vincent Frénel| Yoann Launey| Jeff Morcet| Yannick Mallédant| Philippe Seguin
Physiological and Technical Notes
Volume 38, Issue 10 / October , 2012

Pages 1718 - 1722

Abstract

Purpose

Pulse oximetry (SpO2) measured at finger site via transmission mode may fail in situations of hypoperfusion. Forehead sensors using reflectance technology might be useful in these circumstances. We hypothesized that reflectance SpO2 would be more accurate than finger SpO2 in patients with severe shock.

Methods

A prospective observational study was conducted in an intensive care unit of a university hospital of patients in shock who were treated with high norepinephrine and/or epinephrine doses (≥0.1 μg kg−1 min−1). When blood gas determinations were requested, forehead SpO2 and finger SpO2 values were simultaneous recorded. Agreement between SpO2 measurements with arterial saturation (SaO2), obtained by blood analysis with a co-oximeter, was assessed using the Bland–Altman method. The number of outliers, defined by the formula SaO2 − SpO2 > ±3 %, indicated the proportion of measurements considered to be clinically unacceptable.

Results

Thirty-two patients were enrolled in the study. With the forehead sensor no reading failure occurred, and 140 paired data sets (forehead SpO2 vs. SaO2) were obtained. Bias and precision were +1.0 and +2.5 %, respectively, and the limits of agreement ranged from −4.0 to 6.0 %. The finger sensor failed to give a value in four cases, thus providing 136 paired data sets (finger SpO2 vs. SaO2) for analysis. Bias and precision were +1.4 and +4.8 %, respectively, and the limits of agreement ranged from −8.0 to 10.9 %. There were 21 (15 %) outliers for the forehead sensor and 43 (32 %) for the finger sensor (P < 0.001).

Conclusions

Forehead SpO2 measurements were more accurate than finger SpO2 when compared with SaO2 in critically ill patients requiring high-dose vasopressor therapy and should therefore be the preferred method considered.

Keywords

References

  1. Seguin P, Le Rouzo A, Tanguy M, Guillou YM, Feuillu A, Malledant Y (2000) Evidence for the need of bedside accuracy of pulse oximetry in an intensive care unit. Crit Care Med 28:703–706
    • View reference on PubMed
    • View reference on publisher's website
  2. Jubran A (2004) Pulse oximetry. Intensive Care Med 30:2017–2020
  3. Severinghaus JW, Kelleher JF (1992) Recent developments in pulse oximetry. Anesthesiology 76:1018–1038
    • View reference on PubMed
    • View reference on publisher's website
  4. Sinex JE (1999) Pulse oximetry: principles and limitations. Am J Emerg Med 17:59–67
    • View reference on PubMed
    • View reference on publisher's website
  5. Eisenkraft JB (2006) Forehead pulse oximetry: friend and foe. Anesthesiology 105:1075–1077
    • View reference on PubMed
    • View reference on publisher's website
  6. Palve H (1992) Reflection and transmission pulse oximetry during compromised peripheral perfusion. J Clin Monit 8:12–15
    • View reference on PubMed
    • View reference on publisher's website
  7. Casati A, Squicciarini G, Baciarello M, Putzu M, Salvadori A, Fanelli G (2007) Forehead reflectance oximetry: a clinical comparison with conventional digit sensors during laparotomic and laparoscopic abdominal surgery. J Clin Monit Comput 21:271–276
    • View reference on PubMed
    • View reference on publisher's website
  8. Sugino S, Kanaya N, Mizuuchi M, Nakayama M, Namiki A (2004) Forehead is as sensitive as finger pulse oximetry during general anesthesia. Can J Anaesth 51:432–436
    • View reference on PubMed
    • View reference on publisher's website
  9. Wax DB, Rubin P, Neustein S (2009) A comparison of transmittance and reflectance pulse oximetry during vascular surgery. Anesth Analg 109:1847–1849
    • View reference on PubMed
    • View reference on publisher's website
  10. MacLeod DB, Cortinez LI, Keifer JC, Cameron D, Wright DR, White WD, Moretti EW, Radulescu LR, Somma J (2005) The desaturation response time of finger pulse oximeters during mild hypothermia. Anaesthesia 60:65–71
    • View reference on PubMed
    • View reference on publisher's website
  11. Fernandez M, Burns K, Calhoun B, George S, Martin B, Weaver C (2007) Evaluation of a new pulse oximeter sensor. Am J Crit Care 16:146–152
    • View reference on PubMed
  12. Schallom L, Sona C, McSweeney M, Mazuski J (2007) Comparison of forehead and digit oximetry in surgical/trauma patients at risk for decreased peripheral perfusion. Heart Lung 36:188–194
    • View reference on PubMed
    • View reference on publisher's website
  13. Agashe GS, Coakley J, Mannheimer PD (2006) Forehead pulse oximetry: headband use helps alleviate false low readings likely related to venous pulsation artifact. Anesthesiology 105:1111–1116
    • View reference on PubMed
    • View reference on publisher's website
  14. Carstensen B (2004) Comparing and predicting between several methods of measurement. Biostatistics 5:399–413
    • View reference on PubMed
    • View reference on publisher's website
  15. Ibanez J, Velasco J, Raurich JM (1991) The accuracy of the Biox 3700 pulse oximeter in patients receiving vasoactive therapy. Intensive Care Med 17:484–486
  16. Van de Louw A, Cracco C, Cerf C, Harf A, Duvaldestin P, Lemaire F, Brochard L (2001) Accuracy of pulse oximetry in the intensive care unit. Intensive Care Med 27:1606–1613
  17. Wilson BJ, Cowan HJ, Lord JA, Zuege DJ, Zygun DA (2010) The accuracy of pulse oximetry in emergency department patients with severe sepsis and septic shock: a retrospective cohort study. BMC Emerg Med 10:9
    • View reference on PubMed
    • View reference on publisher's website
  18. Smithline HA, Rudnitzky N, Macomber S (2010) Blank FS Pulse oximetry using a disposable finger sensor placed on the forehead in hypoxic patients. J Emerg Med 39:121–125
    • View reference on PubMed
    • View reference on publisher's website
  19. Landry DW, Oliver JA (2001) The pathogenesis of vasodilatory shock. N Engl J Med 345:588–595
    • View reference on PubMed
    • View reference on publisher's website
  20. Secker C, Spiers P (1997) Accuracy of pulse oximetry in patients with low systemic vascular resistance. Anaesthesia 52:127–130
    • View reference on PubMed
    • View reference on publisher's website
  21. Lamhaut L, Apriotesei R, Combes X, Lejay M, Carli P, Vivien B (2011) Comparison of the accuracy of noninvasive hemoglobin monitoring by spectrophotometry (SpHb) and HemoCue®) with automated laboratory hemoglobin measurement. Anesthesiology 115:548–554
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement