Pulseless oximetry a preliminary evaluation

Thomas K. Aldrich, Pragya Gupta, Sean P. Stoy, Anthony J. Carlese, Daniel J. Goldstein

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Pulse oximetry fails when pulsations are weak or absent, common in patients with continuous fl ow left ventricular assist devices (LVADs). We developed a method to measure arterial oxygenation (Sa o 2) noninvasively in pulseless patients with LVADs. METHODS: Th e technique involves 5-to 10-s occlusions of radial and ulnar arteries on one hand. A fi ngertip is transilluminated alternately with light-emitting diodes emitting 660 nm (red) and 905 nm (infrared). During the approximately 1 s aft er release of occlusion, changing attenuance of each wavelength is measured and their red/infrared arterial blood attenuance ratio (R/IR) calculated. We studied fi ve normal subjects breathing hyperoxic, normoxic, or hypoxic gas mixtures to establish a calibration curve, using standard pulse oximetry as the gold standard. We also studied seven pulseless patients with LVADs (two studied twice) at clinically determined oxygenation. RESULTS: Normal subject data showed close correlation of oxygen saturation by pulse oximetry (Sp o 2) with R/IR, (Sp o 2 5 111 2 [26.7 3 R/IR]; R 2 5 0.975). For patients with LVADs, predicted Sa o 2 (from the calibration curve) tended to underestimate measured Sa o 2 (from arterial blood) by a clinically insignifi cant 1.1 1.6 percentage points (mean SD), maximum 3.4 percentage points. CONCLUSIONS: Preliminary results in a small number of patients demonstrate that pulseless oximetry can be used to estimate arterial saturation with acceptable accuracy. A noninvasive oximeter that does not rely on pulsatile fl ow would be a valuable advance in assessing oxygenation in patients with LVADs, for whom the only current option is arterial puncture, which is painful, risks arterial injury, and only provides a snapshot evaluation of oxygenation.

Original languageEnglish (US)
Pages (from-to)1484-1488
Number of pages5
JournalChest
Volume148
Issue number6
DOIs
StatePublished - Dec 1 2015

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Oximetry
Heart-Assist Devices
Calibration
Ulnar Artery
Radial Artery
Punctures
Respiration
Oxygen
Light
Wounds and Injuries

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Pulseless oximetry a preliminary evaluation. / Aldrich, Thomas K.; Gupta, Pragya; Stoy, Sean P.; Carlese, Anthony J.; Goldstein, Daniel J.

In: Chest, Vol. 148, No. 6, 01.12.2015, p. 1484-1488.

Research output: Contribution to journalArticle

Aldrich, TK, Gupta, P, Stoy, SP, Carlese, AJ & Goldstein, DJ 2015, 'Pulseless oximetry a preliminary evaluation', Chest, vol. 148, no. 6, pp. 1484-1488. https://doi.org/10.1378/chest.15-0435
Aldrich, Thomas K. ; Gupta, Pragya ; Stoy, Sean P. ; Carlese, Anthony J. ; Goldstein, Daniel J. / Pulseless oximetry a preliminary evaluation. In: Chest. 2015 ; Vol. 148, No. 6. pp. 1484-1488.
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abstract = "BACKGROUND: Pulse oximetry fails when pulsations are weak or absent, common in patients with continuous fl ow left ventricular assist devices (LVADs). We developed a method to measure arterial oxygenation (Sa o 2) noninvasively in pulseless patients with LVADs. METHODS: Th e technique involves 5-to 10-s occlusions of radial and ulnar arteries on one hand. A fi ngertip is transilluminated alternately with light-emitting diodes emitting 660 nm (red) and 905 nm (infrared). During the approximately 1 s aft er release of occlusion, changing attenuance of each wavelength is measured and their red/infrared arterial blood attenuance ratio (R/IR) calculated. We studied fi ve normal subjects breathing hyperoxic, normoxic, or hypoxic gas mixtures to establish a calibration curve, using standard pulse oximetry as the gold standard. We also studied seven pulseless patients with LVADs (two studied twice) at clinically determined oxygenation. RESULTS: Normal subject data showed close correlation of oxygen saturation by pulse oximetry (Sp o 2) with R/IR, (Sp o 2 5 111 2 [26.7 3 R/IR]; R 2 5 0.975). For patients with LVADs, predicted Sa o 2 (from the calibration curve) tended to underestimate measured Sa o 2 (from arterial blood) by a clinically insignifi cant 1.1 1.6 percentage points (mean SD), maximum 3.4 percentage points. CONCLUSIONS: Preliminary results in a small number of patients demonstrate that pulseless oximetry can be used to estimate arterial saturation with acceptable accuracy. A noninvasive oximeter that does not rely on pulsatile fl ow would be a valuable advance in assessing oxygenation in patients with LVADs, for whom the only current option is arterial puncture, which is painful, risks arterial injury, and only provides a snapshot evaluation of oxygenation.",
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N2 - BACKGROUND: Pulse oximetry fails when pulsations are weak or absent, common in patients with continuous fl ow left ventricular assist devices (LVADs). We developed a method to measure arterial oxygenation (Sa o 2) noninvasively in pulseless patients with LVADs. METHODS: Th e technique involves 5-to 10-s occlusions of radial and ulnar arteries on one hand. A fi ngertip is transilluminated alternately with light-emitting diodes emitting 660 nm (red) and 905 nm (infrared). During the approximately 1 s aft er release of occlusion, changing attenuance of each wavelength is measured and their red/infrared arterial blood attenuance ratio (R/IR) calculated. We studied fi ve normal subjects breathing hyperoxic, normoxic, or hypoxic gas mixtures to establish a calibration curve, using standard pulse oximetry as the gold standard. We also studied seven pulseless patients with LVADs (two studied twice) at clinically determined oxygenation. RESULTS: Normal subject data showed close correlation of oxygen saturation by pulse oximetry (Sp o 2) with R/IR, (Sp o 2 5 111 2 [26.7 3 R/IR]; R 2 5 0.975). For patients with LVADs, predicted Sa o 2 (from the calibration curve) tended to underestimate measured Sa o 2 (from arterial blood) by a clinically insignifi cant 1.1 1.6 percentage points (mean SD), maximum 3.4 percentage points. CONCLUSIONS: Preliminary results in a small number of patients demonstrate that pulseless oximetry can be used to estimate arterial saturation with acceptable accuracy. A noninvasive oximeter that does not rely on pulsatile fl ow would be a valuable advance in assessing oxygenation in patients with LVADs, for whom the only current option is arterial puncture, which is painful, risks arterial injury, and only provides a snapshot evaluation of oxygenation.

AB - BACKGROUND: Pulse oximetry fails when pulsations are weak or absent, common in patients with continuous fl ow left ventricular assist devices (LVADs). We developed a method to measure arterial oxygenation (Sa o 2) noninvasively in pulseless patients with LVADs. METHODS: Th e technique involves 5-to 10-s occlusions of radial and ulnar arteries on one hand. A fi ngertip is transilluminated alternately with light-emitting diodes emitting 660 nm (red) and 905 nm (infrared). During the approximately 1 s aft er release of occlusion, changing attenuance of each wavelength is measured and their red/infrared arterial blood attenuance ratio (R/IR) calculated. We studied fi ve normal subjects breathing hyperoxic, normoxic, or hypoxic gas mixtures to establish a calibration curve, using standard pulse oximetry as the gold standard. We also studied seven pulseless patients with LVADs (two studied twice) at clinically determined oxygenation. RESULTS: Normal subject data showed close correlation of oxygen saturation by pulse oximetry (Sp o 2) with R/IR, (Sp o 2 5 111 2 [26.7 3 R/IR]; R 2 5 0.975). For patients with LVADs, predicted Sa o 2 (from the calibration curve) tended to underestimate measured Sa o 2 (from arterial blood) by a clinically insignifi cant 1.1 1.6 percentage points (mean SD), maximum 3.4 percentage points. CONCLUSIONS: Preliminary results in a small number of patients demonstrate that pulseless oximetry can be used to estimate arterial saturation with acceptable accuracy. A noninvasive oximeter that does not rely on pulsatile fl ow would be a valuable advance in assessing oxygenation in patients with LVADs, for whom the only current option is arterial puncture, which is painful, risks arterial injury, and only provides a snapshot evaluation of oxygenation.

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