Use Of Pulse Oximeter Research Articles

Разработка и исследование программно-аппаратного комплекса для мониторирования состояния домашнего животного

This article analyzes the current state and a potential use of pulseoximeters in veterinary medicine. Promising optical methods such as optical coherence tomography, pulseoximeter, and hyperspectral imaging have been clinically introduced into human medicine. But even though human and small animal medicine shares a personalized modern approach, biophotonics is still rarely used in veterinary medicine. Pulseoximeters are most often used when monitoring the condition of an animal during general anesthesia. Prospective optical devices for small animals, such as dogs and cats, should be reliable and resistant to damage (for example, due to bites or chewing), offering convenient and short measurements. The potential of using pulseoximeters for pet monitoring has yet to be explored. In this paper, we considered two methods of measurement, namely lumen oximetry and reflection oximetry. Based on the literature sources, we can conclude that the method of optical reflection oximetry has the same diagnostic value as the method of lumen oximetry and therefore can be used for veterinary pulseoximeters without losing the accuracy of pulse measurement and blood oxygenation. According to the results of the existing devices review, it was found that they mainly use the lumen oximetry method. This method is convenient for performing measurements in animals under anesthesia, but it is problematic for use on actively moving animals. The purpose of this work is to develop a new model of pulseoximeter for animals. A new type of the device based on an earlier unused method is proposed, and its advantages and disadvantages are described. Components for creation are proposed and a scheme based on these components is constructed.

Measuring accuracy of plethysmography based respiratory rate measurement using pulse oximeter at a tertiary hospital in India

BackgroundChildhood pneumonia continues to be a major infectious killer in India. WHO recommended respiratory rate and oxygen saturation (SpO2) measurements are not well implemented in Indian public health outpatient facilities with the result that treatment decision-making rely on subjective assessments from variably trained and supervised healthcare providers. The introduction of a multi-modal pulse oximeter (POx) that gives reliable measurements would mitigate incorrect diagnosis. In light of future potential use of pulse oximeter in peripheral health centres, it becomes important to measure accuracy of respiratory rate and oxygen saturation of such an instrument. The current study measures accuracy of plethysmography based respiratory rate (RR) using a pulse oximeter (Masimo Rad-G) by comparing it with a gold standard (pediatrician) measurement.Study designA cross sectional study was conducted in the OPD and emergency ward of Kalawati Saran Children’s Hospital over a 2 week period wherein a convenience sample of 97 children (2 to 59 months) were assessed by a pediatrician as part of routine assessment alongside independent measure by a consultant using pulse oximeter. The level of agreement between plethymography based RR and pediatrician measure was analyzed along with sensitivity and specificity of fast breathing of plethymography based RR measure.ResultsBoth methods of measurement show strong association (97%, p < 0.001) and observed values, falling on line of unity, obtained either from pulse oximeter or by pediatrician are very close to each other. Fast breathing measured by POx has a sensitivity of 95% and specificity of nearly 94%.ConclusionThe current study provides evidence of the accuracy of a plethysmography based RR using a pulse oximeter which can potentially be of use in planning of pneumonia management in public health facilities.

Neonatal resuscitation guideline adherence: simulation study and framework for improvement

We wanted to assess newborn life support (NLS) knowledge and guideline adherence, and provide strategies to improve (neonatal) resuscitation guideline adherence. Pediatricians completed 17 multiple-choice questions (MCQ). They performed a simulated NLS scenario, using a high-fidelity manikin. The literature was systematically searched for publications regarding guideline adherence. Forty-six pediatricians participated: 45 completed the MCQ, 34 performed the scenario. Seventy-one percent (median, IQR 56–82) of the MCQ were answered correctly. Fifty-six percent performed inflation breaths ≤ 60 s, 24% delivered inflation breaths of 2–3 s, and 85% used adequate inspiratory pressures. Airway patency was ensured 83% (IQR 76–92) of the time. Median events/min, compression rate, and percentage of effective compressions were 138/min (IQR 130–145), 120/min (IQR 114–120), and 38% (IQR 24–48), respectively. Other adherence percentages were temperature management 50%, auscultation of initial heart rate 100%, pulse oximeter use 94%, oxygen increase 74%, and correct epinephrine dose 82%. Ten publications were identified and used for our framework. The framework may inspire clinicians, educators, researchers, and guideline developers in their attempt to improve resuscitation guideline adherence. It contains many feasible strategies to enhance professionals’ knowledge, skills, self-efficacy, and team performance, as well as recommendations regarding equipment, environment, and guideline development/dissemination.Conclusion: NLS guideline adherence among pediatricians needs improvement. Our framework is meant to promote resuscitation guideline adherence.What is Known:• Inadequate newborn life support (NLS) may contribute to (long-term) pulmonary and cerebral damage.• Video-based assessment of neonatal resuscitations has shown that deviations from the NLS guideline occur frequently; this assessment method has its audiovisual shortcomings.What is New:• The resuscitation quality metrics provided by our high-fidelity manikin suggest that the adherence of Dutch general pediatricians to the NLS guideline is suboptimal.• We constructed a comprehensive framework, containing multiple strategies to improve (neonatal) resuscitation guideline adherence.

Accurate and safe pulse oximeter use

Today, tools, the product of biomedical technology, are routinely used in healthcare practices. Accurate and effective use of these devices which provide convenience for practice and assessment of patient will provide reliable results about the patient. The use of technological devices has become widespread in nursing practice areas. Pulse oximeter, which is a technological tool, is used for the measurement of oxygen saturation which is considered among the vital signs of nursing practice. Errors made during the use of the pulse oximeter which enables the patient to be followed effectively can lead to incorrect measurements and false progress of the patient's follow-up and treatment process. It is very important for nurses to know the use of pulse oximeter devices which have become more common in recent years and the factors affecting the reliability of oxygen saturation values measured in pulse oximeter in terms of medical treatment, nursing care and patient safety. In this review, factors that may affect the reliability of the measurement of oxygen saturation with pulse oximeter and related patient safety measurements are discussed. &#x0D; ​Extended English summary is in the end of Full Text PDF (TURKISH) file.&#x0D; &#x0D; Özet&#x0D; Günümüzde sağlık bakım uygulamalarında teknolojik cihazlar rutin olarak kullanılmaktadır. Uygulamada ve hastanın değerlendirilmesinde kolaylık sağlayan bu cihazlarının doğru ve etkin bir şekilde kullanılması hasta hakkında güvenilir sonuçlar sağlayacaktır. Hemşirelik uygulama alanlarında da teknolojik cihazların kullanımı yaygınlaşmıştır. Temel hemşirelik uygulamaları içerisinde yer alan yaşamsal bulguların değerlendirilmesi açısından oldukça önemli olan oksijen satürasyonunun ölçümü için teknolojik bir araç olan pulse oksimetre cihazı kullanılmaktadır. Hastanın etkin bir şekilde takip edilmesini sağlayan pulse oksimetre cihazının kullanımı sırasında yapılan hatalar, yanlış ölçüm sonuçlarına ve bu doğrultuda hastanın takip ve tedavi sürecinin yanlış ilerlemesine sebep olabilmektedir. Hemşirelerin, son yıllarda kullanımı giderek yaygın hale gelen pulse oksimetre cihazlarının kullanımını ve pulse oksimetrede ölçülen oksijen satürasyonu değerinin güvenilirliğini etkileyen faktörleri bilmesi tıbbi tedavi, hemşirelik bakımı ve hasta güvenliği açısından oldukça önemlidir. Bu derlemede, pulse oksimetre ile oksijen satürasyon ölçümü sırasında ölçümün güvenilirliğini etkileyebilecek faktörler ve bunlara yönelik hasta güvenliği önlemleri ele alınmıştır.

Variability in the use of pulse oximeters with children in Kenyan hospitals: A mixed-methods analysis

Pulse oximetry, a relatively inexpensive technology, has the potential to improve health outcomes by reducing incorrect diagnoses and supporting appropriate treatment decisions. There is evidence that in low- and middle-income countries, even when available, widespread uptake of pulse oximeters has not occurred, and little research has examined why. We sought to determine when and with which children pulse oximeters are used in Kenyan hospitals, how pulse oximeter use impacts treatment provision, and the barriers to pulse oximeter use. We analyzed admissions data recorded through Kenya's Clinical Information Network (CIN) between September 2013 and February 2016. We carried out multiple imputation and generated multivariable regression models in R. We also conducted interviews with 30 healthcare workers and staff from 14 Kenyan hospitals to examine pulse oximetry adoption. We adapted the Integrative Model of Behavioural Prediction to link the results from the multivariable regression analyses to the qualitative findings. We included 27,906 child admissions from 7 hospitals in the quantitative analyses. The median age of the children was 1 year, and 55% were male. Three-quarters had a fever, over half had a cough; other symptoms/signs were difficulty breathing (34%), difficulty feeding (34%), and indrawing (32%). The most common diagnoses were pneumonia, diarrhea, and malaria: 45%, 35%, and 28% of children, respectively, had these diagnoses. Half of the children obtained a pulse oximeter reading, and of these, 10% had an oxygen saturation level below 90%. Children were more likely to receive a pulse oximeter reading if they were not alert (odds ratio [OR]: 1.30, 95% confidence interval (CI): 1.09, 1.55, p = 0.003), had chest indrawing (OR: 1.28, 95% CI: 1.17, 1.40, p < 0.001), or a very high respiratory rate (OR: 1.27, 95% CI: 1.13, 1.43, p < 0.001), as were children admitted to certain hospitals, at later time periods, and when a Paediatric Admission Record (PAR) was used (OR PAR used compared with PAR not present: 2.41, 95% CI: 1.98, 2.94, p < 0.001). Children were more likely to be prescribed oxygen if a pulse oximeter reading was obtained (OR: 1.42, 95% CI:1.25, 1.62, p < 0.001) and if this reading was below 90% (OR: 3.29, 95% CI: 2.82, 3.84, p < 0.001). The interviews indicated that the main barriers to pulse oximeter use are inadequate supply, broken pulse oximeters, and insufficient training on how, when, and why to use pulse oximeters and interpret their results. According to the interviews, variation in pulse oximeter use between hospitals is because of differences in pulse oximeter availability and the leadership of senior doctors in advocating for pulse oximeter use, whereas variation within hospitals over time is due to repair delays. Pulse oximeter use increased over time, likely because of the CIN's feedback to hospitals. When pulse oximeters are used, they are sometimes used incorrectly and some healthcare workers lack confidence in readings that contradict clinical signs. The main limitations of the study are that children with high levels of missing data were not excluded, interview participants might not have been representative, and the interviews did not enable a detailed exploration of differences between counties or across senior management groups. There remain major challenges to implementing pulse oximetry-a cheap, decades old technology-into routine care in Kenya. Implementation requires efficient and transparent procurement and repair systems to ensure adequate availability. Periodic training, structured clinical records that include prompts, the promotion of pulse oximetry by senior doctors, and monitoring and feedback might also support pulse oximeter use. Our findings can inform strategies to support the use of pulse oximeters to guide prompt and effective treatment, in line with the Sustainable Development Goals. Without effective implementation, the potential benefits of pulse oximeters and possible hospital cost-savings by targeting oxygen therapy might not be realized.

A model for oxygen conservation associated with titration during pediatric oxygen therapy.

BackgroundContinuous oxygen treatment is essential for managing children with hypoxemia, but access to oxygen in low-resource countries remains problematic. Given the high burden of pneumonia in these countries and the fact that flow can be gradually reduced as therapy progresses, oxygen conservation through routine titration warrants exploration.AimTo determine the amount of oxygen saved via titration during oxygen therapy for children with hypoxemic pneumonia.MethodsBased on published clinical data, we developed a model of oxygen flow rates needed to manage hypoxemia, assuming recommended flow rate at start of therapy, and comparing total oxygen used with routine titration every 3 minutes or once every 24 hours versus no titration.ResultsTitration every 3 minutes or every 24 hours provided oxygen savings estimated at 11.7% ± 5.1% and 8.1% ± 5.1% (average ± standard error of the mean, n = 3), respectively. For every 100 patients, 44 or 30 kiloliters would be saved—equivalent to 733 or 500 hours at 1 liter per minute.ConclusionsOngoing titration can conserve oxygen, even performed once-daily. While clinical validation is necessary, these findings could provide incentive for the routine use of pulse oximeters for patient management, as well as further development of automated systems.

Pulse oximetry screening for critical congenital heart disease in planned out of hospital births and the incidence of critical congenital heart disease in the Plain community.

ObjectiveThis study evaluated pulse oximetry screening (POS) for critical congenital heart disease (CCHD) in planned out of hospital births with special attention to births in Plain communities (Amish, Mennonite and similar).DesignWisconsin out of hospital births in 2013 and 2014 were evaluated. Care providers were supplied with and trained in the use of pulse oximeters for CCHD screening. State records were reviewed to identify deaths and hospital admissions due to CCHD in this population.ResultsDetailed information on POS was available in 1,616 planned out of hospital births. 799 were from the Plain community. 1,584 babies (98%) passed their POS, 16 infants (1%) failed, and 16 (1%) were not screened. 5 infants from the Plain community had CCHD, 3 were detected by POS.ConclusionPOS for CCHD can be successfully implemented outside the hospital setting and plays a particularly important role in communities with high rates of CCHD and where formal prenatal screening is uncommon.

Hypoxaemia in Mozambican children &lt;5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models

To determine the prevalence of hypoxaemia among under-five children admitted to hospital with clinical severe pneumonia and to assess the performance to diagnose hypoxaemia of models based on clinical signs. We conducted a hospital-based survey in a district hospital from Southern Mozambique. A total of 825 children were recruited after obtaining an informed consent. The prevalence of hypoxaemia on admission was 27.9%, and 19.8% of these children died (OR compared with non-hypoxaemic children 3.22, 95% CI 1.98-5.21, P < 0.001). The model with larger area under the ROC curve (AUC-ROC) to predict hypoxaemia included cyanosis or thoracoabdominal breathing or respiratory rate ≥70 breaths per minute. None of the models performed well when tested in different case scenarios of oxygen availability through mathematical modelling, with over 50% of hypoxaemic children not receiving oxygen even in favourable case scenarios. Clinical signs alone or in combination are not suitable to diagnose hypoxaemia. The use of pulse oximeters should be strongly encouraged.

Five years after the Spanish neonatal resuscitation survey. Are we improving?

Introduction An analysis is presented of delivery room (DR) neonatal resuscitation practices in Spanish hospitals. Methods A questionnaire was sent by e-mail to all hospitals attending deliveries in Spain. Results A total of 180 questionnaires were sent, of which 155 were fully completed (86%). Less than half (71, 46%) were level I or II hospitals, while 84 were level III hospital (54%). In almost three-quarters (74.2%) of the centres, parents and medical staff were involved in the decision on whether to start resuscitation or withdraw it. A qualified resuscitation team (at least two members) was available in 80% of the participant centres (63.9% level I–II, and 94.0% level III, P < .001). Neonatal resuscitation courses were held in 90.3% of the centres. The availability of gas blenders, pulse oximeters, manual ventilators, and plastic wraps was higher in level III hospitals. Plastic wraps for pre-term hypothermia prevention were used in 63.9% of the centres (40.8% level I–II and 83.3% level III, P < .001). Term newborn resuscitation was started on room air in 89.7% of the centres. A manual ventilator (T-piece) was the device used in most cases when ventilation was required (42.3% level I–II and 78.6% level III, P < .001). Early CPAP in preterm infants was applied in 91.7% of the tertiary hospitals. In the last 5 years some practices have improved, such as neonatal resuscitation training, pulse oximeter use, or early CPAP support. Conclusions There is an improvement in some practices of neonatal resuscitation. Significant differences have been found regarding the equipment or practices in the DR, when comparing hospitals of different levels of care.

Does pulse oximeter use impact health outcomes? A systematic review

ObjectiveDo newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters are used to inform...

Encuesta española de reanimación neonatal 5 años después. ¿Vamos mejorando?

IntroductionAn analysis is presented of delivery room (DR) neonatal resuscitation practices in Spanish hospitals. MethodsA questionnaire was sent by e-mail to all hospitals attending deliveries in Spain. ResultsA total of 180 questionnaires were sent, of which 155 were fully completed (86%). Less than half (71, 46%) were level i or ii hospitals, while 84 were level iii hospital (54%). In almost three-quarters (74.2%) of the centres, parents and medical staff were involved in the decision on whether to start resuscitation or withdraw it. A qualified resuscitation team (at least two members) was available in 80% of the participant centres (63.9% level i-ii, and 94.0% level iii, P<.001). Neonatal resuscitation courses were held in 90.3% of the centres. The availability of gas blenders, pulse oximeters, manual ventilators, and plastic wraps was higher in level iii hospitals. Plastic wraps for pre-term hypothermia prevention were used in 63.9% of the centres (40.8% level i-iiand 83.3% level iii, P<.001). Term newborn resuscitation was started on room air in 89.7% of the centres. A manual ventilator (T-piece) was the device used in most cases when ventilation was required (42.3% level i-iiand 78.6% level iii, P<.001). Early CPAP in preterm infants was applied in 91.7% of the tertiary hospitals. In last 5 years some practices have improved, such neonatal resuscitation training, pulse oximeter use, or early CPAP support. ConclusionsThere is an improvement in some practices of neonatal resuscitation. Significant differences have been found as regards the equipment or practices in the DR, when comparing hospitals of different levels of care.

Pulse oximetry in the pre-hospital setting

In order to sustain life respiratory gases are essential. The ability of the paramedic to monitor these gases is key to high-quality, effective, prehospital care. Pulse oximetry provides the pre-hospital care provider with a resource that enables them to monitor patients when they are in the field. The standard method for monitoring peripheral arterial oxygen saturation is pulse oximetry. It is common that supplemental oxygen is given to target levels of oxygen saturation, assisted by the use of pulse oximeters. Other methodologies are available that allow the monitoring of carbon dioxide through capnography and carbon monoxide through CO-oximetry. A pulse oximeter is a non-invasive product that assists the paramedic in assessing the haemoglobin content in a patient's blood.

Pulse oximetry in low-resource settings

Educational aims To increase awareness about the issues of making pulse oximetry available in low-resource settings To increase awareness of the World Health Organization Surgical Safety checklist and how this has triggered the concept of Global Oximetry. To discuss the relevance of increasing availability of pulse oximetry to areas other than operating theatres (such as medical wards) in hospitals in low-resource settings. Summary Pulse oximetry is used to detect hypoxaemia. It is widely used in both the pre-hospital and hospital settings in developed countries and has become a basic standard of care. There are substantial differences in healthcare between developed and developing countries and it has been recorded that surgery is associated with a much higher number of complications and deaths occurring in resource-limited settings. To address this issue, the World Health Organization (WHO) introduced the Safe Surgery Saves Lives Programme in 2007. With this programme, the WHO Surgical Safety Checklist was launched. Included in this checklist is the step to ensure that a pulse oximeter is on the patient and functioning. WHO now has the Global Pulse Oximetry Project, an initiative to promote the use of pulse oximeters in every operating room in the world. The Lifebox project is a charity that aims to help the supply of pulse oximeters at low cost to anaesthesia providers in low-resource settings. Increasing availability of pulse oximetry in low-resource settings is relevant to all physicians because hypoxaemia is a common complication of many illnesses, particularly pneumonia. Pneumonia impacts developing countries disproportionately, and accounts for over 2 million deaths a year worldwide. Hypoxaemia is a recognised risk factor for death, correlates with disease severity and is difficult to detect clinically until cyanosis is present. Oximetry plays an essential role in early detection of hypoxaemia and in guiding oxygen therapy, which is often a scarce resource.

Management of pulse oximeter probe–induced finger injuries in children: report of two consecutive cases and review of the literature

Pulse oximetry is a standard noninvasive procedure for monitoring arterial oxygen saturation. Finger injuries related to pulse oximeter use have been reported as chemical or thermal burns, sun-tanning, pressure erosion, sensory loss, and gangrene. The mechanisms of these complications have not been definitively explained; but pressure ischemia, prolonged use, overheating of the probe, inappropriate use of the probe, and short circuiting are considered to be the main factors. We describe 2 cases of pulse oximeter probe–induced finger injuries, propose the possible mechanisms and factors related to the injury, and discuss the management.

963 Variation of Delivery Room Resuscitation Practice in the Uk

Background: Advances in neonatal intensive care have improved outcomes for term and preterm infants. Delivery room (DR) management of newborn infants remains basic although recent advances include the use of air for resuscitation, plastic wraps/bags for temperature preservation, DR CPAP and pulse oximetry. No data exist on DR management of newborns in the UK. Aim: Establish current DR management of newborn infants in the UK. Methods: A telephone/email/postal survey of DR management in UK neonatal units during 2009. 192 units were surveyed and 171 (89%) responded (65 Level III and 106 Level II/I units). Comparisons were made between level III (intensive care) and level II/I units (high dependency/special care). Results: There were differences in DR management with level III units using significantly more ventilation devices with PEEP (95% vs 88%, P< 0.05) and delivery room CPAP (43% vs 16%, P< 0.0001). Significantly more level III units commenced resuscitation in air (49% vs 30%, P=0.01) and fewer used 100% oxygen (12% vs 40%, P< 0.0001). The use of pulse oximeters (III=23% vs II/I=12%), plastic wraps/bags (III=97% vs II/I=96%), DR surfactant (III=92% vs II/I=83%) and elective intubation of preterm infants (III=83% vs II/I=73%) were not statistically different. Conclusions: These important data highlight significant variance of DR management for newborn infants in the UK with level III units adopting a more evidence-based practice. Furthermore, these data differ markedly from those reported in other developed countries. These discrepancies between resuscitation guidelines, DR management and poor evidence-base need urgent attention. Funded by Action Medical Research.

Two-Stage Approach for Detection and Reduction of Motion Artifacts in Photoplethysmographic Data

Corruption of photopleythysmograms (PPGs) by motion artifacts has been a serious obstacle to the reliable use of pulse oximeters for real-time, continuous state-of-health monitoring. In this paper, we propose an automated, two-stage PPG data processing method to minimize the effects of motion artifacts. The technique is based on our prior work related to motion artifact detection (stage 1) [R. Krishnan, B. Natarajan, and S. Warren, "Analysis and detection of motion artifacts in photoplethysmographic data using higher order statistics,'' in Proc. IEEE Int. Conf. Acoust., Speech, Signal Process. (ICASSP 2008), Las Vegas, Nevada, Apr. 2008, pp. 613-616] and motion artifact reduction (stage 2) [R. Krishnan, B. Natarajan, and S. Warren, "Motion artifact reduction in photoplethysmography using magnitude-based frequency domain independent component analysis,'' in Proc. 17th Int. Conf. Comput. Commun. Network, St. Thomas, Virgin Islands, Aug. 2008, pp. 1-5]. Regarding stage 1, we present novel and consistent techniques to detect the presence of motion artifact in PPGs given higher order statistical information present in the data. We analyze these data in the time and frequency domains (FDs) and identify metrics to distinguish between clean and motion-corrupted data. A Neyman-Pearson detection rule is formulated for each of the metrics. Furthermore, by treating each of the metrics as observations from independent sensors, we employ hard fusion and soft fusion techniques presented in [Z. Chair and P. Varshney, "Optimal data fusion in multiple sensor detection systems,'' IEEE Trans. Aerosp. Electron. Syst., AES, vol. 1, no. 1, pp. 98-101, Jan. 1986] and [C. C. Lee and J. J. Chao, "Optimum local decision space partitioning for distributed detection,'' IEEE Trans. Aerosp. Electron. Syst., AES, vol. 25, no. 7, pp. 536-544, Jul. 1989], respectively, in order to fuse individual decisions into a global system decision. For stage two, we propose a motion artifact reduction method that is effective even in the presence of severe subject movement. The approach involves an enhanced preprocessing unit consisting of a motion detection unit (MDU, developed in this paper), period estimation unit, and Fourier series reconstruction unit. The MDU identifies clean data frames versus those corrupted with motion artifacts. The period estimation unit determines the fundamental frequency of a corrupt frame. The Fourier series reconstruction unit reconstructs the final preprocessed signal by utilizing the spectrum variability of the pulse waveform. Preprocessed data are then fed to a magnitude-based FD independent component analysis unit. This helps reduce motion artifacts present at the frequencies of the reconstruction components. Experimental results are presented to demonstrate the efficacy of the overall motion artifact reduction method.

The Performance of Six Pulse Oximeters in the Environment of Neuronavigation

Although the use of pulse oximeters may be regarded a standard of care for monitoring anesthesia procedures, these monitors may be susceptible to various kinds of disturbances. Recently, it was suggested that neuronavigation equipment may interfere with pulse oximeter accuracy. In this study, we evaluated the effect of a neurosurgical image guidance system on the performance of six different pulse oximeters. Two simple shielding methods were evaluated. Twenty healthy, adult, nonsmoking volunteers were equipped with six different pulse oximeters on both hands. Baseline values for heart rate, arterial oxygen saturation, and signal quality were assessed. After activation of the Brain Lab VectorVision Neuronavigation System, the effects on signal quality and saturation recognition were evaluated. Measurements were repeated using two different shielding techniques, a cotton blanket and aluminum sheets. Activation of the image guidance system resulted in a significant disturbance of signal quality and saturation detection, which was partially reversible by both shielding techniques. Significant differences were noted among the six brands of pulse oximeters for signal quality (P < 0.001) and saturation recognition (P < 0.001), and for the response to shielding methods (P < 0.001). Coverage of the probes with aluminum foil resulted an in undisturbed saturation recognition in all subjects with almost all monitors. Infrared pulse waves from neurosurgical navigation equipment may interfere with pulse oximeter measurements. Shielding the probe with aluminum foil sufficiently eliminated the infrared interference.

Validity Of Heart Rate Obtained Via Pulse Oximetry

In addition to monitoring oxygen saturation in those with chronic obstructive pulmonary disease (COPD), pulse oximetry is used to monitor heart rate (HR) during exercise testing and training. However, evidence validating the use of pulse oximeters for HR monitoring is lacking. PURPOSE The purpose of this study was to evaluate the validity of two commercially available pulse oximeters for the measurement of HR as compared to heart rates determined from an electrocardiogram (ECG). METHODS HR was measured in 33 COPD patients (age=68.7±10.7 yrs) at rest, during a graded exercise test, and during recovery. The Ohmeda pulse oximeter (Biox 3740; Louisville, CO) was placed on the right hand throughout the test, and the Respironics pulse oximeter (Model 950; Kennesaw, GA) was placed on the left hand. HR was also determined from a 12-lead ECG. RESULTS HR values from oximetry were significantly correlated to the ECG HR, Ohmeda (r=0.892, p < 0.001) and Respironics (r=0.722, p < 0.001). The ECG HR (102.3±24.3) was not significantly different from Ohmeda HR (98.1±24.2), nor was the ECG HR (102.3±24.4) significantly different from the Respironics HR (96.4±21.9). Inspection of Bland-Altman plots revealed a mean difference between the ECG and Ohmeda of 4.2 (95% CI: −18.0 to 26.2), and a mean difference between the ECG and Respironics of 5.9 (95% CI: −28.3 to 40.0). CONCLUSIONS Despite significant correlations and no significant mean differences between HR measures obtained from the pulse oximeters and those from the ECG, the Bland-Altman analysis suggests a large level of disagreement between the HR from the two pulse oximeters and the ECG HR. Therefore, use of these pulse oximeters for monitoring HR should be limited. Supported by NIH grants HL53755 and AG10484.

Validity Of Heart Rate Obtained Via Pulse Oximetry

In addition to monitoring oxygen saturation in those with chronic obstructive pulmonary disease (COPD), pulse oximetry is used to monitor heart rate (HR) during exercise testing and training. However, evidence validating the use of pulse oximeters for HR monitoring is lacking. PURPOSE The purpose of this study was to evaluate the validity of two commercially available pulse oximeters for the measurement of HR as compared to heart rates determined from an electrocardiogram (ECG). METHODS HR was measured in 33 COPD patients (age=68.7±10.7 yrs) at rest, during a graded exercise test, and during recovery. The Ohmeda pulse oximeter (Biox 3740; Louisville, CO) was placed on the right hand throughout the test, and the Respironics pulse oximeter (Model 950; Kennesaw, GA) was placed on the left hand. HR was also determined from a 12-lead ECG. RESULTS HR values from oximetry were significantly correlated to the ECG HR, Ohmeda (r=0.892, p < 0.001) and Respironics (r=0.722, p < 0.001). The ECG HR (102.3±24.3) was not significantly different from Ohmeda HR (98.1±24.2), nor was the ECG HR (102.3±24.4) significantly different from the Respironics HR (96.4±21.9). Inspection of Bland-Altman plots revealed a mean difference between the ECG and Ohmeda of 4.2 (95% CI: −18.0 to 26.2), and a mean difference between the ECG and Respironics of 5.9 (95% CI: −28.3 to 40.0). CONCLUSIONS Despite significant correlations and no significant mean differences between HR measures obtained from the pulse oximeters and those from the ECG, the Bland-Altman analysis suggests a large level of disagreement between the HR from the two pulse oximeters and the ECG HR. Therefore, use of these pulse oximeters for monitoring HR should be limited. Supported by NIH grants HL53755 and AG10484.

Trends in hospital-based management of acute asthma from a teaching hospital in South Asia

The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved care included frequent use of pulse oximeter, preference of inhaled over systemic bronchodilators and increased use of systemic steroids. Significant deficiencies were identified in hospital-based management of acute asthma. Most aspects of asthma care continued to fall short of asthma guidelines.