Accuracy of Pulse Oximetry in Children

作者：Ross Patrick A^*; Newth Christopher J L; Khemani Robinder G

来源：Pediatrics, 2014, 133(1): 22-29.

DOI：10.1542/peds.2013-1760

• oximetry
• hypoxia
• heart defects
• congenital heart disease/defects
• pediatric
• mechanical ventilation

OBJECTIVE: For children with cyanotic congenital heart disease or acute hypoxemic respiratory failure, providers frequently make decisions based on pulse oximetry, in the absence of an arterial blood gas. The study objective was to measure the accuracy of pulse oximetry in the saturations from pulse oximetry (Sp0(2)) range of 65% to 97%.
METHODS: This institutional review board-approved prospective, multicenter observational study in 5 PICUs included 225 mechanically ventilated children with an arterial catheter. With each arterial blood gas sample, Sp0(2) from pulse oximetry and arterial oxygen saturations from CO-oximetry (Sa0(2)) were simultaneously obtained if the Sp0(2) was <= 97%.
RESULTS: The lowest Sp0(2) obtained in the study was 65%. In the range of Sp0(2) 65% to 97%, 1980 simultaneous values for Sp0(2) and Sa0(2) were obtained. The bias (Sp0(2) - Sa0(2)) varied through the range of Sp0(2) values. The bias was greatest in the Sp0(2) range 81% to 85% (336 samples, median 6%, mean 6.6%, accuracy root mean squared 9.1%). Sp0(2) measurements were close to Sa0(2) in the Sp0(2) range 91% to 97% (901 samples, median 1%, mean 1.5%, accuracy root mean squared 4.2%).
CONCLUSIONS: Previous studies on pulse oximeter accuracy in children present a single number for bias. This study identified that the accuracy of pulse oximetry varies significantly as a function of the Sp0(2) range. Saturations measured by pulse oximetry on average overestimate Sa0(2) from CO-oximetry in the Sp0(2) range of 76% to 90%. Better pulse oximetry algorithms are needed for accurate assessment of children with saturations in the hypoxemic range.

• 出版日期2014-1