准确的SpO2值对于最佳地滴定输送给患者的氧气和遵循氧合指南是至关重要的。关于危重患者脉搏血氧计的真实世界表现的前瞻性数据有限。这项研究的目的是评估住院患者通过几种血氧计测量的SpO2值的准确性和偏倚。我们将稳定的成年人纳入重症监护病房,并使用动脉导管。主要排除标准为SpO2信号差,SpO2>96%。在每个主题中,我们同时评估了四个血氧计:诺因(普利茅斯,MN)嵌入FreeO2设备(Oxynov,QC,加拿大),马西莫(激进7号,欧文,CA),飞利浦(FAST,埃因霍温,荷兰),和Nellcor(N600,Pleasanton,CA).同时抽取动脉血气,收集每个血氧计\'SpO2值。将SpO2值与参考(SaO2值)进行比较以确定偏差和准确性。评估血氧计检测低氧血症的能力以及血氧计对氧滴定的影响。我们纳入了193名受试者(153名男性,平均年龄66·3岁)进行了211组测量。通过Fitzpatrick量表评估的皮肤色素沉着显示96.2%的受试者是浅色皮肤(类型1和类型2)。一个血氧计高估了SaO2(飞利浦,+0·9%),而其他三个人低估了SaO2(Nonin-3·1%,内科尔-0·3%,马西莫-0·2%)。在91·3%的病例中,Nonin血氧计低估了SaO2,而在55·2%的病例中,Philips血氧计高估了SaO2。中度低氧血症(SaO286-90%或PaO255-60mmHg)检测到92%,33%,42%和11%的Nonin病例,Nellcor,分别是Masimo和Philips。我们发现测试的血氧计和动脉血气之间存在明显的偏差和中等准确性,在所研究的人群中。这些差异可能对低氧血症的检测和氧疗的管理具有重要的临床影响。
An accurate SpO2 value is critical in order to optimally titrate oxygen delivery to patients and to follow oxygenation guidelines. Limited prospective data exist on real-world performance of pulse oximeters in critically ill patients. The objective of this study was to assess accuracy and bias of the SpO2 values measured by several oximeters in hospitalized subjects.
We included stable adults in the ICU with an arterial catheter in place. Main exclusion criteria were poor SpO2 signal and SpO2 > 96%. In each subject, we simultaneously evaluated 4 oximeters: Nonin (Plymouth, Minnesota) embedded in the FreeO2 device (OxyNov, Québec City, Québec, Canada), Masimo (Radical-7, Masimo, Irvine, California), Philips (FAST, Philips, Amsterdam, the Netherlands), and Nellcor (N-600, Medtronic, Minneapolis, Minnesota). Arterial blood gases were drawn and simultaneously each oximeters\' SpO2 values were collected. SpO2 values were compared to the reference (arterial oxygen saturation [SaO2 ] value) to determine bias and accuracy. The ability for oximeters to detect hypoxemia and the impact of oximeters on oxygen titration were evaluated.
We included 193 subjects (153 male, mean age 66 y) in whom 211 sets of measurements were performed. The skin pigmentation evaluated by Fitzpatrick scale showed 96.2% of subjects were light skin (types 1 and 2). One
oximeter overestimated SaO2 (Philips, +0.9%), whereas the 3 others underestimated SaO2 (Nonin -3.1%, Nellcor -0.3%, Masimo -0.2%). SaO2 was underestimated with Nonin
oximeter in 91.3% of the cases, whereas it was overestimated in 55.2% of the cases with Philips
oximeter. Moderate hypoxemia (SaO2 86-90% or PaO2 55-60 mm Hg) was detected in 92, 33, 42, and 11% of the cases with Nonin, Nellcor, Masimo, and Philips, respectively.
We found significant bias and moderate accuracy between the tested oximeters and the arterial blood gases in the studied population. These discrepancies may have important clinical impact on the detection of hypoxemia and management of oxygen therapy.