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Tongue oximetry in children with extensive thermal injury: comparison with peripheral oximetry
C J Coté1, A L Daniels, M Connolly
1Department of Anaesthesia, Harvard Medical School, Massachusetts General Hospital, Boston.
Insights
A modified tongue pulse oximeter offers extended monitoring time in pediatric patients with thermal injuries, functioning effectively even during peripheral vasoconstriction.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Biomedical Engineering
Background:
- Pulse oximetry is crucial for monitoring oxygen saturation during anesthesia.
- Peripheral pulse oximetry can be unreliable in pediatric patients with thermal injuries due to vasoconstriction and electrocautery interference.
Purpose of the Study:
- To evaluate the efficacy of a modified tongue pulse oximeter probe compared to standard peripheral pulse oximetry in children with thermal injuries.
Main Methods:
- Prospective study involving 10 pediatric patients with thermal injuries.
- Simultaneous monitoring using standard peripheral and modified tongue pulse oximeter probes.
- Data collected over 1,992 minutes of anesthesia time.
Main Results:
- The tongue oximeter provided 563 minutes more monitoring time than peripheral sites.
- Simultaneous function occurred 47% of the time; tongue-only function occurred 28%; peripheral-only function occurred 22%.
- The tongue probe functioned during peripheral vasoconstriction and showed less electrocautery interference.
Conclusions:
- The tongue pulse oximeter is a valuable adjunct for monitoring oxygen saturation in pediatric patients with thermal injuries.
- It is particularly useful when peripheral monitoring is compromised by vasoconstriction or electrocautery.
- However, it is not a substitute for peripheral oximetry due to limitations in application (paralyzed, intubated patients only).
Abstract:
We undertook a prospective study of standard peripheral pulse oximetry versus a modified pulse oximeter probe applied to the tongue in order to determine the efficacy of this alternative monitoring site in children with thermal injuries. Ten patients with a mean age (+/- SD) of 7.5 +/- 4.5 yr were studied on 15 occasions. The mean weight (+/- SD) was 31.4 +/- 13.7 kg and percent surface area burn (+/- SD) was 56 +/- 21%. A total of 1,992 min of anaesthesia time was monitored. Both sites functioned simultaneously 47% of the time; the lingual but not the peripheral site functioned 28% of the time and only the peripheral site and not the lingual functioned 22% of the time. Neither site functioned 3% of the time. The tongue oximeter provided 563 min more monitoring time than the peripheral sites. The tongue oximeter also functioned in children with peripheral vasoconstriction when the peripheral sensor failed and was less susceptible to electrocautery interference. The tongue oximeter is a reasonable adjunct but not a substitute for peripheral oximetry since its application is limited to paralyzed, intubated patients.