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      Pulse Oximetry with Two Infrared Wavelengths without Calibration in Extracted Arterial Blood

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          Abstract

          Oxygen saturation in arterial blood (SaO 2) provides information about the performance of the respiratory system. Non-invasive measurement of SaO 2 by commercial pulse oximeters (SpO 2) make use of photoplethysmographic pulses in the red and infrared regions and utilizes the different spectra of light absorption by oxygenated and de-oxygenated hemoglobin. Because light scattering and optical path-lengths differ between the two wavelengths, commercial pulse oximeters require empirical calibration which is based on SaO 2 measurement in extracted arterial blood. They are still prone to error, because the path-lengths difference between the two wavelengths varies among different subjects. We have developed modified pulse oximetry, which makes use of two nearby infrared wavelengths that have relatively similar scattering constants and path-lengths and does not require an invasive calibration step. In measurements performed on adults during breath holding, the two-infrared pulse oximeter and a commercial pulse oximeter showed similar changes in SpO 2. The two pulse oximeters showed similar accuracy when compared to SaO 2 measurement in extracted arterial blood (the gold standard) performed in intensive care units on newborns and children with an arterial line. Errors in SpO 2 because of variability in path-lengths difference between the two wavelengths are expected to be smaller in the two-infrared pulse oximeter.

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          Absorption spectra of human fetal and adult oxyhemoglobin, de-oxyhemoglobin, carboxyhemoglobin, and methemoglobin.

          Jacobus P. van Wouwe, A R Buursma, W Zijlstra (1991)
          We determined the millimolar absorptivities of the four clinically relevant derivatives of fetal and adult human hemoglobin in the visible and near-infrared spectral range (450-1000 nm). As expected, spectral absorption curves of similar shape were found, but the small differences between fetal and adult hemoglobin absorptivity were important enough that they should be taken into account in multicomponent analysis of hemoglobin derivatives. Common pulse oximeters, however, involving light of 660 and 940 nm, are so insensitive to the presence of fetal hemoglobin that they can be used safely in neonates. The error in pulse oximetry caused by the presence of carboxyhemoglobin is insubstantial, but methemoglobin gives either an understimation or an overestimation at high or low oxygen saturation, respectively, the turning point being near 70% saturation.
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            Accuracy of pulse oximetry in the intensive care unit.

            A Van de Louw, C Cracco, C Cerf … (2001)
            Pulse oximetry (SpO2) is a standard monitoring device in intensive care units (ICUs), currently used to guide therapeutic interventions. Few studies have evaluated the accuracy of SpO2 in critically ill patients. Our objective was to compare pulse oximetry with arterial oxygen saturation (SaO2) in such patients, and to examine the effect of several factors on this relationship. Observational prospective study. A 26-bed medical ICU in a university hospital. One hundred two consecutive patients admitted to the ICU in whom one or serial arterial blood gas analyses (ABGs) were performed and a reliable pulse oximeter signal was present. For each ABG, we collected SaO2, SpO2, the type of pulse oximeter, the mode of ventilation and requirement for vasoactive drugs. Three hundred twenty-three data points were collected. The mean difference between SpO2 and SaO2 was -0.02% and standard deviation of the differences was 2.1%. From one sample to another, the fluctuations in SpO2 to arterial saturation difference indicated that SaO2 could not be reliably predicted from SpO2 after a single ABG. Subgroup analysis showed that the accuracy of SpO2 appeared to be influenced by the type of oximeter, the presence of hypoxemia and the requirement for vasoactive drugs. Finally, high SpO2 thresholds were necessary to detect significant hypoxemia with good sensitivity. Large SpO2 to SaO2 differences may occur in critically ill patients with poor reproducibility of SpO2. A SpO2 above 94% appears necessary to ensure a SaO2 of 90%.
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              Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation?

              Gavin D Perkins, Daniel McAuley, Simon Giles … (2003)
              Introduction This study investigates the relation between changes in pulse oximeter oxygen saturation (SpO 2) and changes in arterial oxygen saturation (SaO 2) in the critically ill, and the effects of acidosis and anaemia on precision of using pulse oximetry to predict SaO 2. Patients and methods Forty-one consecutive patients were recruited from a nine-bed general intensive care unit into a 2-month study. Patients with significant jaundice (bilirubin >40 μmol/l) or inadequate pulse oximetry tracing were excluded. Results A total of 1085 paired readings demonstrated only moderate correlation (r= 0.606; P < 0.01) between changes in SpO 2 and those in SaO 2, and the pulse oximeter tended to overestimate actual changes in SaO 2. Anaemia increased the degree of positive bias whereas acidosis reduced it. However, the magnitude of these changes was small. Conclusion Changes in SpO 2 do not reliably predict equivalent changes in SaO 2 in the critically ill. Neither anaemia nor acidosis alters the relation between SpO 2 and SaO 2 to any clinically important extent.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Sensors (Basel)
                Journal ID (iso-abbrev): Sensors (Basel)
                Journal ID (publisher-id): sensors
                Title: Sensors (Basel, Switzerland)
                Publisher: MDPI
                ISSN (Electronic): 1424-8220
                Publication date (Electronic): 15 October 2018
                Publication date Collection: October 2018
                Volume: 18
                Issue: 10
                Electronic Location Identifier: 3457
                Affiliations
                [1 ]Department of Physics/Electro-Optics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., 91160 Jerusalem, Israel; ohadyh@ 123456gmail.com (O.Y.H.); mecohen@ 123456g.jct.ac.il (M.C.)
                [2 ]Department of Electro-Optical Engineering, Ben-Gurion University of the Negev. 1 Ben-Gurion Blvd, 8410501 Beer Sheva, Israel; ytshak@ 123456bgu.ac.il
                [3 ]Department of Neonatology, Shaare Zedek Medical Center, Shmuel Bait St 12, 9103102 Jerusalem, Israel; itamarnitzan@ 123456gmail.com (I.N.); yairkasirer@ 123456yahoo.com (Y.K.)
                [4 ]Pediatric Intensive Care Unit, Shaare Zedek Medical Center, Shmuel Bait St 12, 9103102 Jerusalem, Israel; saritsk@ 123456hotmail.com
                [5 ]Department of Electrical and Electronics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., 91160 Jerusalem, Israel; shlomoe@ 123456jct.ac.il
                Author notes
                [* ]Correspondence: nitzan@ 123456g.jct.ac.il ; Tel.: +972-2-6751139
                Author information
                https://orcid.org/0000-0002-4974-9683
                https://orcid.org/0000-0001-8190-1860
                Article
                Publisher ID: sensors-18-03457
                DOI: 10.3390/s18103457
                PMC ID: 6211094
                PubMed ID: 30326552
                SO-VID: 77cca3d7-6cf2-4d2f-968e-1ea896b9c7ff
                Copyright © © 2018 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 14 August 2018
                Date accepted : 08 October 2018
                Categories
                Subject: Article

                ScienceOpen disciplines: Biomedical engineering
                Keywords: oxygen saturation,pulse oximetry,infrared,beer–lambert law,calibration
                Data availability:
                ScienceOpen disciplines: Biomedical engineering
                Keywords: oxygen saturation, pulse oximetry, infrared, beer–lambert law, calibration

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