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      Pulse oximetry: fundamentals and technology update

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          Abstract

          Oxygen saturation in the arterial blood (SaO 2) provides information on the adequacy of respiratory function. SaO 2 can be assessed noninvasively by pulse oximetry, which is based on photoplethysmographic pulses in two wavelengths, generally in the red and infrared regions. The calibration of the measured photoplethysmographic signals is performed empirically for each type of commercial pulse-oximeter sensor, utilizing in vitro measurement of SaO 2 in extracted arterial blood by means of co-oximetry. Due to the discrepancy between the measurement of SaO 2 by pulse oximetry and the invasive technique, the former is denoted as SpO 2. Manufacturers of pulse oximeters generally claim an accuracy of 2%, evaluated by the standard deviation (SD) of the differences between SpO 2 and SaO 2, measured simultaneously in healthy subjects. However, an SD of 2% reflects an expected error of 4% (two SDs) or more in 5% of the examinations, which is in accordance with an error of 3%–4%, reported in clinical studies. This level of accuracy is sufficient for the detection of a significant decline in respiratory function in patients, and pulse oximetry has been accepted as a reliable technique for that purpose. The accuracy of SpO 2 measurement is insufficient in several situations, such as critically ill patients receiving supplemental oxygen, and can be hazardous if it leads to elevated values of oxygen partial pressure in blood. In particular, preterm newborns are vulnerable to retinopathy of prematurity induced by high oxygen concentration in the blood. The low accuracy of SpO 2 measurement in critically ill patients and newborns can be attributed to the empirical calibration process, which is performed on healthy volunteers. Other limitations of pulse oximetry include the presence of dyshemoglobins, which has been addressed by multiwavelength pulse oximetry, as well as low perfusion and motion artifacts that are partially rectified by sophisticated algorithms and also by reflection pulse oximetry.

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          Most cited references 75

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          Progress of near-infrared spectroscopy and topography for brain and muscle clinical applications.

          This review celebrates the 30th anniversary of the first in vivo near-infrared (NIR) spectroscopy (NIRS) publication, which was authored by Professor Frans Jobsis. At first, NIRS was utilized to experimentally and clinically investigate cerebral oxygenation. Later it was applied to study muscle oxidative metabolism. Since 1993, the discovery that the functional activation of the human cerebral cortex can be explored by NIRS has added a new dimension to the research. To obtain simultaneous multiple and localized information, a further major step forward was achieved by introducing NIR imaging (NIRI) and tomography. This review reports on the progress of the NIRS and NIRI instrumentation for brain and muscle clinical applications 30 years after the discovery of in vivo NIRS. The review summarizes the measurable parameters in relation to the different techniques, the main characteristics of the prototypes under development, and the present commercially available NIRS and NIRI instrumentation. Moreover, it discusses strengths and limitations and gives an outlook into the "bright" future.
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            BTS guideline for emergency oxygen use in adult patients.

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              Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation target studies.

              The optimal oxygen saturation for extremely low birth weight infants in the postnatal period beyond the delivery room is not known. To summarize and discuss the results of the randomized trials, constituting the NEOPROM (Neonatal Oxygenation Prospective Meta-analysis) collaborative study, examining the effect of low versus high functional oxygen saturation targets in the postnatal period in premature infants with gestational age 1.0 favors a high oxygen saturation. RRs for mortality and necrotizing enterocolitis are significantly increased and severe retinopathy of prematurity significantly reduced in low compared to high oxygen saturation target infants. There are no differences regarding physiologic bronchopulmonary dysplasia, brain injury or patent ductus arteriosus between the groups. Based on these results, it is suggested that functional SpO2 should be targeted at 90-95% in infants with gestational age <28 weeks until 36 weeks' postmenstrual age. However, there are still several unanswered questions in this field. © 2013 S. Karger AG, Basel.
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                Author and article information

                Journal
                Med Devices (Auckl)
                Med Devices (Auckl)
                Medical Devices: Evidence and Research
                Medical Devices (Auckland, N.Z.)
                Dove Medical Press
                1179-1470
                2014
                08 July 2014
                : 7
                : 231-239
                Affiliations
                [1 ]Department of Physics/Electro-Optics, Jerusalem College of Technology, Jerusalem, Israel
                [2 ]Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem, Israel
                [3 ]Neonatal/Perinatal Medicine, Cohen Children’s Medical Center of New York/North Shore-LIJ Health System, New Hyde Park, NY, United States
                Author notes
                Correspondence: Meir Nitzan, Department of Physics/Electro-Optics, Jerusalem College of Technology, 21 Havaad Haleumi Street, Givat Mordechai, PO Box 16031, Jerusalem 91160, Israel, Tel +972 2 675 1139, Fax +972 2 675 1045, Email nitzan@ 123456jct.ac.il
                Article
                mder-7-231
                10.2147/MDER.S47319
                4099100
                © 2014 Nitzan et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Review

                Biotechnology

                venous blood, arterial blood, photoplethysmography, pulse oximetry, oxygen saturation

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