Reliability of Six Pulse Oximeters in Chronic Obstructive Pulmonary Disease

doi:10.1378/chest.99.4.842

Chest

Volume 99, Issue 4, April 1991, Pages 842-846

https://doi.org/10.1378/chest.99.4.842 Get rights and content

Six pulse oximeters with finger probes were studied in three groups of 17 hypoxemic patients with COPD aged 50 to 75 years. Transcutaneous arterial oxygen saturation (SpO₂) was measured with the Nellcor N101 (oximeter 1a), the Ohmeda Biox III (oximeter 1b), the Nellcor N200 (oximeter 2a), the Critikon Oxyshuttle (oximeter 2b), the Radiometer Oxi100 (oximeter 3a), and the Ohmeda Biox 3700 (oximeter 3b). The SpO₂ was compared with SaO₂ measured in simultaneously withdrawn samples of arterial blood (Radiometer OSM2) at three 20-minute steady-state levels of Flo₂ ranging from 0.21 to 0.40 (SaO₂, 62 to 100 percent). The bias (mean SpO₂-SaO₂ difference) and the error in precision (SD of the differences) were both below 4 percent for instruments 1a and 1b and remained below 1.2 and 3 percent, respectively, for the others. A good agreement between SpO₂ and SaO₂, as reflected by the Bartko intraclass correlation coefficient, was observed in instruments 2a, 3a, and 3b. The individual relationships between SpO₂-SaO₂ differences and SaO₂ appeared to be linear and parallel. With four instruments (1a, 1b, 2a, and 2b), the mean slope of this relationship was negative, showing a systematic instrumental error: the lower the SaO₂, the larger the overestimation of SaO₂. The scattering of the data (precision) principally reflects a subject source of error. In most instruments a technical adjustment could greatly improve instrumental errors and accuracy. The correction of the errors due to between-subject variation would require a system of calibration adjustable by the users to each individual.

Section snippets

Materials and Methods

This study was performed in 51 white patients with COPD aged 50 to 75 years. They gave their informed consent to participate in the study, which was approved by the local ethics committee. The patients had been treated in an intensive care unit for at least five days for respiratory failure. Smoking had been stopped during that period. The patients were in a stable cardiorespiratory state and received bronchodilator and antibiotic drugs but no vasopressor drug. Six oximeters, partitioned into

Results

The arterial blood gas levels (PaO₂, PaCO₂, and pH) were similar in the three groups of patients (group 1: 41 ± 7 mm Hg, 50 ± 8 mm Hg, and 7.42 ± 0.03, respectively; group 2: 42 ± 8 mm Hg, 51 ± 9 mm Hg, and 7.43 ± 0.04, respectively; and group 3: 42 ± 7 mm Hg, 51 ± 8 mm Hg, and 7.41 ± 0.04, respectively).

Table 1 summarizes the statistical results for comparison between SpO₂ and SaO₂. For the two older instruments of group 1, bias and precision ranged from 3.1 to 3.9 percent, and the 95 percent

Discussion

Several previous studies concluded with a good agreement between blood SaO₂ and SpO₂ measurements with pulse oximeters in normal man2, 3, 5 and in patients with COPD;4, 15 however, the conclusion of most studies was based on the calculation of correlation coefficients between two methods and a test of significance. This method of comparison is commonly used but is inappropriate to represent the accuracy of a technique.11, 12 A high correlation does not mean that the two methods agree and

References (25)

BG Nickerson et al.
Bias and precision of pulse oximeters and arterial oximeters
Chest
(1988)
AL Ries et al.
Skin color and ear oximetry
Chest
(1989)
JF Kelleher
Pulse oximetry
J Clin Monit
(1989)
N Mackensie
Comparison of a pulse oximeter with an ear oximeter and in-vitro oximeter
J Clin Monit
(1985)
FG Mihm et al.
Noninvasive detection of profound arterial desaturation using a pulse oximetry device
Anesthesiology
(1985)
MB Shippy et al.
A clinical evaluation of the BTI Biox II ear oximeter
Respir Care
(1984)
M Yelderman et al.
Evaluation of pulse oximetry
Anesthesiology
(1983)
WT Cecil et al.
A clinical evaluation of the accuracy of the Nellcor N-100 and Ohmeda 3700 pulse oximeters
J Clin Monit
(1988)
DM Kagle et al.
Evaluation of the Ohmeda 3700 pulse oximeter: steady-state and transient response characteristics
Anesthesiology
(1987)
JW Severinghaus et al.
Errors in 14 pulse oximeters during profound hypoxia
J Clin Monit
(1989)

Y Shimada et al.

Effects of multiple scattering and peripheral circulation on arterial oxygen saturation measured with a pulse-type oximeter

Med Biol Eng Comput

(1984)

KK Tremper et al.

Pulse oximetry

Anesthesiology

(1989)

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Pulse oximetry's monitoring: Advantages and limits
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Introduction – Depuis son apparition dans les blocs opératoires puis les services de réanimation, l'oxymétrie de pouls s'est imposée comme un élément indispensable de la surveillance des patients. Aux yeux du personnel soignant, la SpO₂ mesurée par l'oxymètre est le reflet fidèle de la saturation artérielle en oxygène (SaO₂), garante de la sécurité des patients.
Actualités et points forts – Un bénéfice de l'oxymétrie de pouls en termes de morbidité, mortalité des patients ou amélioration des coûts n'a pourtant jamais été démontré. Au contraire, certaines études ont mis en exergue le manque de précision de la SpO₂ dans des situations fréquentes en réanimation, comme les états de choc ou les hypoxémies sévères.
Perspectives et projets – Plus qu'une remise en question de l'oxymétrie de pouls, qui demeure probablement un outil précieux en réanimation, il faut aboutir à une meilleure connaissance par les cliniciens des avantages et limites de cette technologie, afin d'en tirer le meilleur parti et d'en éviter les pièges.
Pulse oximetry is a standard monitoring device in intensive care and post-anesthesia care units, currently used to guide therapeutic interventions. Nevertheless, the accuracy of pulse oximetry in critical care patients has been poorly studied, and no beneficial effect on morbidity or mortality has been demonstrated. The cost-effectiveness of oximeters has also not been demonstrated. Conversely, several studies showed that the agreement between pulse oximetry and the arterial oxygen saturation, although within the limits ensured by the manufacturers, may not be clinically sufficient, especially in the most unstable patients. Thus, the clinicians should be aware of the advantages and limits of the pulse oximetry, to use it carefully and to avoid unrecognised hypoxemia associated with low SpO₂ targets.
Utility of pulse oximetry in diagnosing pneumonia in nursing home residents
2002, American Journal of the Medical Sciences
Citation Excerpt :
Urosepsis was a less common diagnosis than might be expected in a nursing home, probably because the great majority of the residents are male and indwelling catheters are uncommon. Pulse oximetry has been evaluated by others and correlated strongly with direct measurement of arterial oxygen saturation. 16–18 In the present study, baseline pulse oximetry values for case subjects and control subjects had little variability.
The differential diagnosis of acute infection in elderly nursing home patients is often difficult. This study evaluated pulse oximetry in pneumonia in this population.
A case-control study was performed in a veteran’s nursing home involving 2 analyses: (1) pneumonia patients (case subjects) were compared with patients with nonpulmonary infections (control subjects) at time of acute infection; (2) differences in paired values measured at time of infection versus a noninfected baseline were compared for pneumonia patients and control subjects. Vital signs including pulse oximetry were obtained routinely (at least monthly) and with acute illness.
Oxygen saturations were lower in 45 pneumonia patients than in 22 patients with acute nonpulmonary infections (P < 0.001). An oxygen saturation < 94 gave a sensitivity for pneumonia of 80%, specificity of 91%, and positive predictive value of 95%. The drop in oxygen saturation from the last baseline value was greater in pneumonia patients than in control subjects (P < 0.001). The sensitivity of an oxygen saturation drop >3% from baseline for pneumonia was 73% with specificity and positive predictive values of 100%.
Pulse oximetry may be very helpful in evaluating acutely infected nursing home residents. The present study suggests that in acutely infected nursing home patients, a decrease in oxygen saturation of >3 % from baseline, as well as a single oxygen saturation of <94, should suggest pneumonia. A decrease from baseline of <4 % or a single oxygen saturation of 94 or higher suggests that pneumonia is unlikely.
Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry in adults
1998, Heart and Lung: Journal of Acute and Critical Care
Objective: The purposes of the study were to: (1) describe the aggregate strength of the relationship of arterial oxygen saturation as measured by pulse oximetry with the standard of arterial blood gas analysis as measured by co-oximetry, (2) examine how various factors affect this relationship, and (3) describe an aggregate estimate of the bias and precision between oxygen saturation as measured by pulse oximetry and the standard in vitro measures. Design: A meta-analysis was conducted. Sample: Seventy-four studies from 1976 to 1994 met the inclusion criteria of: (1) adult study population, (2) quantitative analysis of empirical data, and (3) bivariate correlations or bias and precision estimates between pulse oximeter and co-oximeter values. Results: There were a total of 169 oximeter trials on 41 oximeter models from 25 different manufacturers. Studies were conducted in various settings with a variety of subjects, with most being healthy adult volunteers. The weighted mean r, based on 39 studies (62 oximeter trials) for which the r statistic and number of data points were available, was 0.895 (var [r ] = 0.014). Based on 23 studies (82 oximeter trials) for which bias and precision estimates and number of data points were available, the mean absolute bias and precision were 1.999 and 0.233, respectively. Several factors were found to affect the accuracy of pulse oximetry. Conclusion: Pulse oximeters were found to be accurate within 2% (± 1 SD) or 5% (± 2 SD) of in vitro oximetry in the range of 70% to 100% SaO₂. In comparing ear and finger probes, readings from finger probes were more accurate. Pulse oximeters may fail to record accurately the true SaO₂ during severe or rapid desaturation, hypotension, hypothermia, dyshemoglobinemia, and low perfusion states. (Heart Lung^® 1998;27:387-408)
Characteristics of pulse oximetry and arterial blood gas in patients with fibrotic interstitial lung disease
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: Manuscript received July 10; revision accepted October 15.

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Chest

Clinical InvestigationsReliability of Six Pulse Oximeters in Chronic Obstructive Pulmonary Disease

Section snippets

Materials and Methods

Results

Discussion

Chest

Chest

Pulse oximetry

J Clin Monit

Comparison of a pulse oximeter with an ear oximeter and in-vitro oximeter

J Clin Monit

Noninvasive detection of profound arterial desaturation using a pulse oximetry device

Anesthesiology

A clinical evaluation of the BTI Biox II ear oximeter

Respir Care

Evaluation of pulse oximetry

Anesthesiology

A clinical evaluation of the accuracy of the Nellcor N-100 and Ohmeda 3700 pulse oximeters

J Clin Monit

Evaluation of the Ohmeda 3700 pulse oximeter: steady-state and transient response characteristics

Anesthesiology

Errors in 14 pulse oximeters during profound hypoxia

J Clin Monit

Effects of multiple scattering and peripheral circulation on arterial oxygen saturation measured with a pulse-type oximeter

Med Biol Eng Comput

Pulse oximetry

Anesthesiology

Clinical Investigations
Reliability of Six Pulse Oximeters in Chronic Obstructive Pulmonary Disease