Comparison of two new generation pulse oximeters with arterial oxygen saturation in critically ill children

Area of Science:

• Pediatric critical care medicine
• Biomedical engineering
• Medical device technology

Background:

• Pulse oximetry is vital for monitoring oxygen saturation in pediatric intensive care units (PICUs).
• Newer pulse oximeters incorporate enhanced signal extraction technology (SET) to improve accuracy.
• Assessing the clinical performance of these devices against gold standards like arterial blood gas analysis is crucial.

Purpose of the Study:

• To compare the hypoxemia detection performance of a novel pulse oximeter with enhanced signal extraction technology (SET) against a conventional pulse oximeter.
• To correlate pulse oximeter readings (SpO2) with arterial oxygen saturation (SaO2) derived from arterial blood gas analysis.

Main Methods:

• A study involving 48 critically ill pediatric patients with arterial catheters in a tertiary care hospital in India.
• 184 sets of simultaneous SpO2 measurements from both conventional and enhanced SET pulse oximeters and SaO2 measurements were collected.
• Data were analyzed for true and false alarms during normotension, hypotension, and varying degrees of hypoxia.

Main Results:

• The mean SaO2 was 94.4%. Mean SpO2 readings were 94.9% (conventional) and 97.2% (enhanced SET).
• The enhanced SET oximeter detected 15% of true hypoxemic events with one false alarm.
• The conventional oximeter detected 41% of true hypoxemic events but generated six false alarms.

Conclusions:

• Both pulse oximeters demonstrated unsatisfactory performance in detecting hypoxemia in this pediatric intensive care population.
• Pulse oximetry reliability diminishes with increasing hypoxemia and hypotension.
• The sensitivity of pulse oximetry for detecting hypoxemia can be as low as 15%.