Comparison of a new forehead reflectance pulse oximeter sensor with a conventional digit sensor in pediatric patients

During conditions of poor perfusion, the accuracy of conventional extremity-based pulse oximeters may be limited. Limited evidence suggests that forehead perfusion may be better preserved during such periods, but pediatric experience with newer forehead reflectance sensors is limited. We prospectively compared the accuracy of a forehead reflectance sensor, the Max-Fast, with a new-generation digit sensor in pediatric patients.

Pediatric patients > 10 kg and who had arterial catheters were eligible for enrollment. Blood oxygen saturation was simultaneously measured with forehead and digit sensors, and compared to corresponding CO-oximetry-measured arterial oxygen saturation values (S(aO2)) taken at the same times. We used Bland-Altman analysis to calculate the bias and precision of the forehead sensor and the digit sensor relative to the S(aO2) values.

We obtained 116 sample sets from 28 patients. The S(aO2) values ranged from 84.1% to 99.2%. The bias and precision of the forehead-to-S(aO2) difference were 0.6% and 2.7%, respectively, versus 1.4% and 2.6%, respectively, for the digit-to-S(aO2) difference (p < 0.05). Bias and precision were 0.7% and 2.6% versus 1.7% and 2.3% for the forehead and digit sensors, respectively, (p < 0.05) in patients who received vasoactive medications, compared with 0.5% and 2.8% versus 1.1% and 2.8% (p = not significant), respectively, in patients who did not receive vasoactive medications.

The Max-Fast sensor estimated S(aO2) as accurately as did a new-generation digit sensor in well-perfused pediatric patients.