Clinical investigation of a new combined pulse oximetry and carbon dioxide tension sensor in adult anaesthesia.

OBJECTIVE: To test the accuracy of a new combined oxygen saturation and cutaneous carbon dioxide tension (SPO2-PCO2) sensor in a routine adult clinical environment. This probe provides a non-invasive and continuous monitoring of the arterial oxyhaemoglobin saturation, arterial carbon dioxide tension and pulse rate at the ear lobe. The sensor is intended to measure both relevant respiration/ventilation parameters in one single probe.
METHODS: Ten adult patients were consecutively studied during general anaesthesia. During the first 5 min after sensor placement at the ear lobe, arterial blood samples were drawn each minute. Carbon dioxide tension and oxygen saturation measurements were obtained simultaneously at 1-min intervals. After this period, patients were hyper-, normo- and hypoventilated. After 15 min at each setting, the simultaneously obtained cutaneous and arterial carbon dioxide tension values were compared.
RESULTS: A total of 80 comparisons between ear lobe SpO2-PCO2 measurement, finger clip pulse oximetry and arterial blood gas values were analysed. Three minutes after sensor placement, there were no significant differences between ear probe (cutaneous) and arterial carbon dioxide tensions (p = 0.367). Comparison of arterial with cutaneous carbon dioxide values demonstrated an excellent linear correlation (r2 = 0.92), and showed a standard error of estimate (SDEE) of 0.26 kPa (1.95 mmHg) only. The mean difference was -0.08 kPa (-0.60 mmHg) with a limits of agreement range of -0.38 kPa to +0.22 kPa (-2.85 mmHg to +1.65 mmHg). Concerning oxygen saturation measurements, the absolute SpO2 value deviated 1% or less from standard pulse oximetry.
CONCLUSIONS: During general anaesthesia, postoperative recovery and critical care treatment, both monitoring of oxygenation and ventilation is important. Since pulse oximetry estimates only arterial oxygen saturation, periodic blood sampling is still necessary to determine the patient's arterial carbon dioxide status. We could demonstrate that the difference between cutaneous and arterial PCO2 was clinically unimportant, and therefore we conclude that the two methods of estimating the patient's carbon dioxide status may be used interchangeably. Our results demonstrated that 3 min after sensor placement, the new SpO2-PCO2 sensor prototype proved to be a reliable tool for continuous non-invasive monitoring of oxygenation and ventilation.