The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

A COMPARISON OF REFLECTIVE AND TRANSMISSION OXIMETRY IN PEDIATRIC PATIENTS WITH POOR PERFUSION

J. Marcum, MD; L. Auw, RRT; J. Judd, RRT; C. Newth, MD. USC Keck School of Medicine, Children’s Hospital Los Angeles, Departments of Anesthesia Critical Care Medicine and Respiratory Care

Background: Pulse oximetry is ubiquitous to intensive care prompting the term the 5th vital sign. Pediatric patients often present challenges for traditional digital transmission oximetry (DTO) because of movement and poor digital signals.  We compared the accuracy and success of DTO to a new reflective forehead oximeter (RFO) in pediatric patients in the PICU. 

Methods
: Informed consent was obtained from the parents of 6 patients in the PICU. 6 patients were fitted with digital (Max-A) and forehead (Max Fast) sensors connected to Nellcor N-595 oximeters. The forehead sensor was placed above the eyebrow and secured with a headband. Digital disposable sensors were placed on either hand. During routine care, heart rate and saturations from the two monitors were recorded at the time arterial blood oxygen saturation was determined using a co-oximeter. Bland-Altman analysis was utilized to individually compare HR data and oximetry data. All oximetry data was also compared using a one-way ANOVA analysis.

Results: Patients mean age was 5.8 years (1.0 years to 17.0 years) and mean weight was 18.9 kg (8.9 kg to 47.3 kg). During the study, DTO and RFO detected a pulsatile signal in all 6 patients. Bland-Altman analysis of HR revealed no significant difference between DTO and RFO (Bias –1.3, 95% limit –7.1 to 4.4). Bland-Altman analysis also revealed no significant difference between RFO and co-oximetry (Bias –1.7, 95% limit –7.5 to 4.3). Furthermore, one-way ANOVA analysis of RFO, DTO, and co-oximetry revealed no statistical difference between RFO, DTO, and co-oximetry (p=0.1809).

Conclusions:  In this group of pediatric patients, reflective forehead oximetry performs as well as digital transmission oximetry with regard to obtaining a signal. There is no significant difference between HR measurements obtained by RFO or DTO. Additionally, there is no significant difference between oximetry measurements obtained by RFO, DTO, and co-oximetry.

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