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Bench Level Oximetry: Pulse Oximetry and CoOximetry

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Today pulse oximetry is currently becoming commonplace in ... The probe may have been placed on the ear in an area with the most vascularity. Discussions ... – PowerPoint PPT presentation

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Title: Bench Level Oximetry: Pulse Oximetry and CoOximetry


1
Bench Level Oximetry Pulse Oximetry and
Co-Oximetry
  • Kandi Deshotel
  • Sonya Amratlal
  • RESC 3621 Physiologic Monitoring
  • Tittle M, Flynn M. Correlation of Pulse Oximetry
    and Co-oximetry. Dimensions of Critical Care
    Nursing. 1997 16(2) 88-94.

2
Pulse Oximetry
  • Today pulse oximetry is currently becoming
    commonplace in critical care environments
  • Pulse oximetry is an advancement in noninvasive
    monitoring and assessment of arterial blood
    oxygenation
  • The primary purpose is to verify adequate
    arterial oxygenation to help ensure provision of
    sufficient oxygen delivery to metabolize tissues
  • WARNING IT SHOULD NOT BE CONSIDERED A
    REPLACEMENT FOR ABG ANALYSIS

3
Co-Oximetry
  • Ease of Operation
  • Intuitive use interface
  • Minimal maintenance
  • Sampling versatility
  • Added Measurement Features
  • Fetal Hemoglobin (HbF) correction
  • Turbidity correction

4
The Study
  • The purpose was to assess the correlation of
    arterial oxygen saturation (SaO2) and pulse
    oximetry (SpO2) in 28 ICU patients using the ear
    and finger probes.
  • It is important to know whether the correlation
    of pulse oximetry and co-oximetry measurements of
    arterial saturation can be used to make decisions
    related to the oxygen needs of the patient.

5
The Findings
  • Oxygen Saturation Results
  • The SaO2 ranged from 70.7 to 99.5 with a mean
    of 95.3
  • The SpO2 by ear probe ranged from 74 to 100
    with a mean of 95.6
  • The SpO2 by finger probe ranged from 74 to 100
    with a mean of 96.6

6
The Findings
  • The correlation between SaO2 and SpO2 measured by
    the finger probe was r 0.92
  • The correlation between SaO2 and SpO2 measure by
    ear was r 0.92
  • A significant positive correlation of SpO2
    measured by both the ear and finger probe was
    r.79

7
Discussions
  • Pulse oximetry measured with the finger probe
    appears to correlate better with the SaO2 than
    SpO2 measured with the ear probe
  • Question What are some possible reasons that
    caused this to happen in this specific
    population?
  • The patients were not significantly hypothermic
    nor hypoperfused
  • The probe may have been placed on the ear in an
    area with the most vascularity

8
Discussions
  • The SaO2 of 90 was based on an interpretation of
    SaO2/SpO2 correlation from baseline ABGs.
  • Baseline ABGs varied for each patient however
    was determined at the beginning and based on a
    mean average

9
Limitations
  • The sample was one of convenience, therefore the
    results cannot be generalized to all patients in
    ICU
  • Various ethnic groups were not well represented
  • The sample size was too small containing 28 ICU
    patients, however conducted with 60 data points
  • Only one pulse oximetry model was evaluated

10
Brief on Research 2
  • Conducted to determine accuracy and precision of
    the pulse oximetry during exercise.
  • Eight white men with COPD were selected for this
    research. Studies were conducted with the
    following methods
  • 1) Measurement of SaO2 using a co-oximeter
  • from arterial blood at each workload.
  • 2) SpO2 and pulse rate were measured using
  • a Ohmeda 3700 pulse oximeter.
  • 3) Heart rate was also monitored using ECG

11
The Gold Standard
  • In this figure the linear line is our gold
    standard for SaO2 in correlation with SpO2
    configuration.
  • The dot furthest left on the top blog the
    patients SaO2 had a reading of 95 and a SpO2
    reading of 85.This allows the room for error to
    be 10 --Thats A LOT!
  • The bias of the pulse oximeter measurement
    relative to the SaO2 was 1.7 while the precision
    was 2.9

12
SaO2-SpO2 vs. ECG rate- pulse rate
  • This graphic allows us to see how the accuracy of
    the SpO2 compared with SaO2 did not improve when
    the pulse and heart rate were equivalent,
    relative to when they were not equivalent. (Note
    this conclusion was held whether the SaO2 was
    uncorrected or corrected for COHb levels)
  • This graphic is uncorrected for COHb.
  • Note the horizontal line _at_ 0 is considered to be
    the zero balance

13
Results
  • Oxygen saturation as measures by pulse oximetry
    (SpO2) in patients with COPD undergoing exercise
    testing is not sufficiently accurate to replace
    SaO2 as the golden standard for oxygen
    saturation.
  • Accuracy and precision, as determined by bias and
    SD, are not improved when O2 saturation is
    corrected by COHb, nor are they improved when
    pulse and heart rate are equilavent.

14
Discussion
  • It is critical to understand that the conclusion
    of this study is inaccurate due to the fact of
    the inaccuracy of the Ohmeda 3700, which was
    discovered only after the study had been
    conducted.
  • However, graphs conducted through this research
    show great correlation of what is known to be the
    gold standard for oxygen saturation.

15
Conclusions
  • In the first study of ICU patients the
    correlation on SaO2 and SpO2 showed a positive
    correlation but due to the sample size it was not
    enough to change the Gold Standard.
  • In the second study due to the fact that the
    pulse oximeter was inaccurate the study was bias.
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