Inaccuracy of pulse oximetry in patients with severe tricuspid regurgitation

Stewart, K.G.; Rowbottom, S. J.

doi:10.1111/j.1365-2044.1991.tb09720.x

Cited by 33 publications

(16 citation statements)

References 6 publications

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“…Our observed lowering of the estimate of arterial saturation displayed by the pulse oximeter in patients with low systemic vascular resistance correlates with the findings of previous studies where venous pulsation is increased [1,3]. The low systemic vascular resistances we observed were caused by septicaemia complicated on occasion by other disease (i.e.…”

Section: Discussionsupporting

confidence: 91%

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Accuracy of pulse oximetry in patients with low systemic vascular resistance

Secker

Spiers

1997

Anaesthesia

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SummaryIn order to assess the accuracy of pulse oximeters in patients with septic shock, we compared 80 paired readings of oxygen saturations taken from pulse oximeters and oxygen saturations obtained from co-oximetry in patients receiving intensive therapy with indwelling pulmonary artery flotation catheters. Comparison between groups with low or normal systemic vascular resistance indices showed a small (1.4%) but significant (p < 0.001) underreading of the saturation from the pulse oximeter in the presence of a low systemic vascular resistance. With normal or high systemic vascular resistance pulse oximeter readings correlated well with co-oximetry. We hypothesise that the main cause of this underreading is because the pulse oximeter is sensing pulsatile venous flow due to the opening of arteriovenous channels in the skin in septic states.

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Section: Discussionsupporting

confidence: 91%

“…Pulse oximeters are calibrated by empirical observations in normal adults and all pulse oximeters assume that the only pulsatile absorbance between the light source and the photodetector is that of arterial blood [2]. This assumption may not be correct in clinical cases where significant venous pulsation is seen [3].…”

mentioning

confidence: 99%

Accuracy of pulse oximetry in patients with low systemic vascular resistance

Secker

Spiers

1997

Anaesthesia

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“…The alternating component represents absorption due to the pulsating component of the tissues and is assumed to be entirely of arterial origin. [4].…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the effect of vasodilatation on oxygen saturations measured by pulse oximetry and venous blood gas analysis

et al. 1993

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SummaryMeasurements of arterial oxygen saturation were estimated using a pulse oximeter under conditions of reactive hyperaemia in the arms of 10 volunteers. Oxygen saturation measured by pulse oximetry was significantly lower, and venous oxygen saturation measured by co-oximetry was significantly higher, in the hyperaemic arm than in the other arm. Pulse oximeters analyse the pulsatile component of blood flow and exclude nonpulsatile causes of absorption in estimating arterial oxygen saturation. The pulsatile Component is assumed to be purely of arterial origin. However, other vessels may pulsate when vasodilatation occurs and pulse oximeter saturation readings taken under these conditions may not give a true rejection of arkrial saturation. Key wordsEquipment; pulse oximeter.Pulse oximetry is a commonly used monitoring technique. Many studies have shown that it is accurate when compared with co-oximetry of arterial blood under conditions of normal [I] or reduced blood flow [2]. The purpose of this study was to investigate the accuracy of the device in the presence of a hyperdynamic circulation. MethodsAfter ethics committee approval and informed consent had been obtained, 10 healthy volunteers took part in the study. A 16-gauge venous cannula was inserted into the antecubital fossa of each arm under local anaesthesia. Baseline oxygen saturation measurements (Spo,) were taken from both index fingers using two Ohmeda Biox 3700 pulse oximeters, and a blood sample for co-oximetry was taken from each cannula.A sphygmomanometer cuff was placed around one upper arm and inflated to 100 mmHg above the subject's systolic blood pressure. The cuff was left inflated for 15 rnin and at the end of this period the cuff was deflated. Shortly after cuff deflation there was a period of marked vasodilatation-the hyperaemic period. Blood samples were taken from both venous cannulae, and Spo, measured at both index fingers, every minute for 5 min. After each reading, the finger probes of the two pulse oximeters were moved on to the index finger of the other limb to eliminate any discrepancies that may be caused by machine variability. The blood samples were analysed immediately using a recently calibrated Ciba Corning 2500 co-oximeter.The results were analysed using the sign test. ResultsSpo, in the hyperaemic arm was not significantly different from that in the normal arm 1 rnin after deflation of the cuff. However, after this time, Spo, in the hyperaemic arm was significantly lower than in the normal arm ( Table 1). The saturation of the venous blood from the hyperaemic

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“…19 The reason for this discrepancy was postulated to be due to the pulse oximeter interpreting venous pulsations as arterial.…”

Section: Pulse Oximetrymentioning

confidence: 99%

Monitoring during paediatric cardiac anaesthesia

Purday

1994

Can J Anaesth

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Monitoring of paediatric anaesthesia has become increasingly more complex in recent years (precordial, oesophageal or paratracheal). Specialized monitoring includes the monitoring of mixed venous oxygenation saturation (S~O2) which is being increasingly used within the critical care area. Transoesophageal echocardiography (TOE) has become accepted in adult cardiac surgery particularly in the fields of mitral valve repair and aortic root surgery, where it allows immediate assessment of the adequacy of repair. The place of TOE in congenital heart disease is now becoming more clearly defined. Cerebral function monitoring is an area of a great deal of research and several new monitoring methods are under review. The use of the thromboelastogram in monitoring coagulation has been found to decrease blood and fluid replacement during liver transplantation and its use during cardiac surgery is increasing. Other end organs that are affected by cardiopulmonary bypass (CPB) include the gut; liver and immune system, possibly leading to multi-organ failure in some cases, and interest is being shown in their monitoring.The purpose of this review is to present the recent publications relating to specific areas of both standard and specialized monitoring and indicate areas where these monitors may prove particularly useful to the practitioner involved in the care of paediatric cardiac patients. Routine monitoring ElectrocardiogramThe ECG displays the electrical activity of the heart. Abnormalities in the ECG can reflect alterations in rate or rhythm and changes in the ST segment may incidate underlying ischaemia. The normal ECG in childhood changes with age and shows several differences from the adult, particularly in the first few years of life where the right ventrical mass is dominant. There are several general changes that occur with increasing age (Table I). Heart rate (HR), frontal plane QRS vector (axis), PR interval, R wave heights and T waves are some of the factors that alter with age (Table II) and the reader is referred to a more specialized review for further information. 1,2 In adult cardiac surgery there has been investigation of perioperative myocardial ischaemia, its prognosis, and the best way of detecting it. 3,4 In children, however, there has been little work looking at the ST segment. Bell et al. ~ reported three cases of ST changes in neonates consistent with myocardial ischaemia. The first case involved a child of 26 wk who developed ST changes during awake laryngoscopy and lung retraction that were presumed to be related to myocardial hypoxia, although pulse oximetry readings were not mentioned. In the second case, ST changes improved on starting trinitroglycerine, isoproterenol and dopamine and in the third were related to ectiocardiographic changes. Cherian and Rao 6 associate the ST segment with the adequacy of coronary blood flow during the arterial switch operation for transposition. Observing leads I and V 5 for the left coronary and lead II for the right, greater than 1 mm elevation for more tha...

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Inaccuracy of pulse oximetry in patients with severe tricuspid regurgitation

Cited by 33 publications

References 6 publications

Accuracy of pulse oximetry in patients with low systemic vascular resistance

Accuracy of pulse oximetry in patients with low systemic vascular resistance

An evaluation of the effect of vasodilatation on oxygen saturations measured by pulse oximetry and venous blood gas analysis

Monitoring during paediatric cardiac anaesthesia

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