Evaluation of different near-infrared spectroscopy technologies for assessment of tissue oxygen saturation during a vascular occlusion test

Abstract

An increasing number of NIRS devices are used to provide measurements of peripheral tissue oxygen saturation (SO). The aim of the present study is to test the hypothesis that despite technological differences between devices, similar trend values will be obtained during a vascular occlusion test. The devices compared are NIRO-200NX, which measures SO and oxyhemoglobin by spatially resolved spectroscopy and the Beer-Lambert law, respectively, and INVOS 5100C and Foresight Elite, which both measure SO with the Beer-Lambert law, enhanced with the spatial resolution technique. Forty consenting adults scheduled for CABG surgery were recruited. The respective sensors of the three NIRS devices were applied over the brachioradial muscle. Before induction of anesthesia, 3 min of ischemia were induced by inflating a blood pressure cuff at the upper arm, whereafter cuff pressure was rapidly released. Tissue oxygenation measurements included baseline, minimum and maximum values, desaturation and resaturation slopes, and rise time. Comparisons between devices were performed with the Kruskal-Wallis test with post hoc Mann-Whitney pairwise comparisons. Agreement was evaluated using Bland-Altman plots. Oxyhemoglobin measured with NIRO responded faster than the other NIRS technologies to changes in peripheral tissue oxygenation (20 vs. 27-40 s, p ≤ 0.01). When comparing INVOS with Foresight, oxygenation changes were prompter (upslope 311 [92-523]%/min vs. 114[65-199]%/min, p ≤ 0.01) and more pronounced (minimum value 36 [21-48] vs. 45 [40-51]%, p ≤ 0.01) with INVOS. Significant differences in tissue oxygen saturation measurements were observed, both within the same device as between different devices using the same measurement technology.

Performance comparison of the MOXY and PortaMon near-infrared spectroscopy muscle oximeters at rest and during exercise

“…The minimum and maximum raw TSI values reported for the PortaMon (Δ43.7%) are similar to that previously reported for the NIRO 200-NX 22,50 following an arterial occlusion applied at the upper arm (Δ33%). This finding is unsurprising given that both the NIRO 200-NX and PortaMon both use SRS methods.…”

“…This contrasts with a recent study measuring TSI following 3 min arterial occlusion comparing in older adult patients (66 AE 9 year) scheduled for elective coronary artery bypass grafting surgery. 22 In these older patients, 3 min occlusion was not enough to decrease TSI to a stable fixed baseline, probably due to a decrease in muscle oxygen consumption in this group compared to ours.…”

“…However, the larger dynamic range reported by the MOXY (Δ74.3%) surpasses that of alternative SR devices such as the FORE-SIGHT elite (Δ46%) and INVOS5100C (Δ36%). 22 This illustrates the difficulty in comparing different SR devices, which use different algorithms and are likely sensitive to differences in the source:detector separation even when determining basic calibration ranges. The INVOS (3 and 4 cm) and FORESIGHT (2.5 and 5 cm) use significantly larger source:detector separations than the MOXY (1.2 and 2.5 cm) and, given their clinical interests, their algorithm development has likely focused more on brain than muscle measurements.…”

“…21 The predominant commercial incarnation of this SR method historically is the Medtronic INVOS™ and more recently the FORE-SIGHT ELITE ® and the Nonin EQUANOX™ systems. Although one can assume that two different devices both using the SRS measurements will generally report similar muscle oxygen saturations, the same cannot be assumed between devices using SR methods, given the variety of algorithms in use, 22 nor of course between an SRS device and an SR device. 23 SRS systems have been widely used in exercise physiology and sports science.…”

Journal of Clinical Monitoring and Computing 2017/2018 end of year summary: monitoring—and provocation—of the microcirculation and tissue oxygenation

“…In the December 2017 issue of this journal, it was hypothesized by Steenhaut et al [6] that despite differences in measurement techniques between different NIRS monitors, StO 2 trends induced by a VOT should be similar among these devices. The authors performed VOT’s in patients scheduled for coronary artery bypass surgery (n = 40) and measured StO 2 using three devices (INVOS, Foresight, NIRO-200NX) from three manufacturers (Covidien, Casmed and Hamamatsu, respectively).…”