Esophageal pulse oximetry utilizing reflectance photoplethysmography

Peripheral perfusion is often poor and barely pulsatile in patients undergoing prolonged major surgery. Hence, the arterial blood oxygen saturation (SpO/sub 2/) readings from commercial finger pulse oximeters can become unreliable or cease when they are most needed. To overcome this limitation, the esophagus has been investigated as an alternative measurement site, as perfusion may be preferentially preserved centrally. A reflectance esophageal pulse oximeter probe, and a processing system implemented in Lab VIEW were developed. The system was evaluated in clinical measurements on 49 cardiothoracic surgery patients. The SpO/sub 2/ values from the esophagus were in good agreement with arterial blood oxygen saturation (SaO/sub 2/) values obtained from blood gas analysis and CO-oximetry. The means (/spl plusmn/SD) of the differences between the esophageal SpO/sub 2/ and SaO/sub 2/ results from blood gas analysis and CO-oximetry were 0.02/spl plusmn/0.88% and -0.73/spl plusmn/0.72%, respectively. In five (10.2%) of the patients, the finger pulse oximeter failed for at least 10 min while the esophageal SpO/sub 2/ readings remained reliable. The results confirm that the esophagus may be used as an alternative monitoring site for pulse oximetry even in patients with compromised peripheral perfusion.

[1]  K. Tremper,et al.  Pulse oximetry. , 1989, Anesthesiology.

[2]  Joachim S. Gravenstein,et al.  Randomized Evaluation of Pulse Oximetry in 20,802 Patients; II: Perioperative Events and Postoperative Complications , 1993, Anesthesiology.

[3]  R. K. Webb,et al.  A comparison of the performance of 20 pulse oximeters under conditions of poor perfusion , 1991, Anaesthesia.

[4]  Douglas G. Altman,et al.  Measurement in Medicine: The Analysis of Method Comparison Studies , 1983 .

[5]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[6]  S. E. Borum.  The successful use of transesophageal pulse oximetry in a patient in whom peripheral pulse oximetry was unobtainable. , 1997, Anesthesia and analgesia.

[7]  P. King,et al.  Design Of Pulse Oximeters , 1998, IEEE Engineering in Medicine and Biology Magazine.

[8]  H Pälve.  Comparison of reflection and transmission pulse oximetry after open‐heart surgery , 1992, Critical care medicine.

[9]  P A Kyriacou,et al.  Investigation of the human oesophagus as a new monitoring site for blood oxygen saturation. , 2001, Physiological measurement.

[10]  D. Reich,et al.  Predictors of Pulse Oximetry Data Failure , 1996, Anesthesiology.

[11]  H. Pälve,et al.  Pulse oximetry during low cardiac output and hypothermia states immediately after open heart surgery. , 1989, Critical care medicine.

[12]  R. Prielipp,et al.  Comparison of a Prototype Esophageal Oximetry Probe with Two Conventional Digital Pulse Oximetry Monitors in Aortocoronary Bypass Patients , 2004, Journal of Clinical Monitoring and Computing.

[13]  J. Severinghaus,et al.  Recent Developments in Pulse Oximetry , 1992, Anesthesiology.

[14]  J Rosenberg,et al.  Nasal pulse oximetry overestimates oxygen saturation , 1990, Anaesthesia.