Anupam Kumar Singh1, Malvinder Singh Sahi2, Bablesh Mahawar3, Sajjan Rajpurohit4. 1. Senior Resident, Department of Cardiology, NDMC Medical College Hindu Rao Hospital, New Delhi, India. 2. Senior Consultant Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India. 3. Consultant Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India. 4. Consultant, Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
Abstract
INTRODUCTION: Pulse oximetry is a widely used tool, unfortunately there is a paucity of data investigating its accuracy in Intensive Care Units (ICU) and if they are able to meet mandated FDA criteria as claimed by them in critically ill patients. AIM: To assess bias, precision and accuracy of pulse oximeters used in ICU and factors affecting them. MATERIALS AND METHODS: A prospective cohort study, including 129 patients admitted to the ICU of a tertiary referral centre. Pulse oximetry and blood gas were done simultaneously. Pulse oximetry was done using two pulse oximetres: Nonin and Philips. All physiological variables like haemoglobin, lactate, use of vasopressors and blood pressure were recorded. Bland Altman curves were constructed to determine bias and limits of agreement. Effect of physiological variables on bias and difference between performance characteristics of bias was determined using SPSS. RESULTS: Pulse oximetry overestimated arterial oxygen saturation (SaO2) by 1.44%. There was negative correlation between bias and SaO2 (r=-0.32) and positive correlation with lactate (r=0.16). The Philips pulse oximeter had significant higher bias and variability than Nonin pulse oximeter. (2.49±2.99 versus 0.46±1.68, mean difference = 1.98, 95% C.I. = 1.53 - 2.43, p-value <0.001). CONCLUSION: Pulse oximetry overestimates SaO2. Bias tends to increase with rising lactate and hypoxia. There is heterogeneity in performance of various pulse oximetry devices in ICU.
INTRODUCTION: Pulse oximetry is a widely used tool, unfortunately there is a paucity of data investigating its accuracy in Intensive Care Units (ICU) and if they are able to meet mandated FDA criteria as claimed by them in critically illpatients. AIM: To assess bias, precision and accuracy of pulse oximeters used in ICU and factors affecting them. MATERIALS AND METHODS: A prospective cohort study, including 129 patients admitted to the ICU of a tertiary referral centre. Pulse oximetry and blood gas were done simultaneously. Pulse oximetry was done using two pulse oximetres: Nonin and Philips. All physiological variables like haemoglobin, lactate, use of vasopressors and blood pressure were recorded. Bland Altman curves were constructed to determine bias and limits of agreement. Effect of physiological variables on bias and difference between performance characteristics of bias was determined using SPSS. RESULTS: Pulse oximetry overestimated arterial oxygen saturation (SaO2) by 1.44%. There was negative correlation between bias and SaO2 (r=-0.32) and positive correlation with lactate (r=0.16). The Philips pulse oximeter had significant higher bias and variability than Nonin pulse oximeter. (2.49±2.99 versus 0.46±1.68, mean difference = 1.98, 95% C.I. = 1.53 - 2.43, p-value <0.001). CONCLUSION: Pulse oximetry overestimates SaO2. Bias tends to increase with rising lactate and hypoxia. There is heterogeneity in performance of various pulse oximetry devices in ICU.
Authors: Janine Pilcher; Laura Ploen; Steve McKinstry; George Bardsley; Jimmy Chien; Lesley Howard; Sharon Lee; Lutz Beckert; Maureen Swanney; Mark Weatherall; Richard Beasley Journal: BMC Pulm Med Date: 2020-01-09 Impact factor: 3.317
Authors: Lee S Nguyen; Marion Helias; Lisa Raia; Estelle Nicolas; Paul Jaubert; Sarah Benghanem; Zakaria Ait Hamou; Pierre Dupland; Julien Charpentier; Frédéric Pène; Alain Cariou; Jean-Paul Mira; Jean-Daniel Chiche; Mathieu Jozwiak Journal: Sci Rep Date: 2022-01-27 Impact factor: 4.379
Authors: An-Kwok Ian Wong; Marie Charpignon; Han Kim; Christopher Josef; Anne A H de Hond; Jhalique Jane Fojas; Azade Tabaie; Xiaoli Liu; Eduardo Mireles-Cabodevila; Leandro Carvalho; Rishikesan Kamaleswaran; R W M A Madushani; Lasith Adhikari; Andre L Holder; Ewout W Steyerberg; Timothy G Buchman; Mary E Lough; Leo Anthony Celi Journal: JAMA Netw Open Date: 2021-11-01