Accuracy of carboxyhemoglobin detection by pulse CO-oximetry during hypoxemia.
Accuracy of carboxyhemoglobin detection by pulse CO-oximetry during hypoxemia.
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DOI：
10.1213/ane.0b013e31828610a0
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发表时间：
2013-10
影响因子：
5.7
通讯作者：
Bickler PE
中科院分区：
文献类型：
--
作者：
Feiner JR;Rollins MD;Sall JW;Eilers H;Au P;Bickler PE
一氧化碳中毒在大多数国家都是一个严重的问题，一种可靠的快速诊断方法将大大改善病人的护理。在最近引入多波长"脉搏一氧化碳血氧仪"（Masimo Rainbow SET® Radical-7）之前，血液中的碳氧血红蛋白（COHb）水平需要血液采样和实验室分析。本研究的目的是确定是否低氧血症，这可能伴随一氧化碳中毒，干扰准确检测COHb。为12名健康非吸烟成年志愿者配备2个标准脉搏血氧仪手指探头和2个Rainbow探头用于COHb检测。在三种干预期间放置桡动脉导管进行血液采样：1）以递增步骤增加低氧血症，氧饱和度（SaO2）为100 - 80%; 2）正常氧，% COHb递增至12%; 3）COHb升高伴低氧血症，SaO2为100 - 80%。将脉搏血氧仪读数（SpCO）与低氧血症和一氧化碳血红蛋白血症不同增量时的同步动脉血值进行比较（每例受试者约25份样本）。通过计算平均偏差（SpCO- % COHb）、偏差标准差（精密度）和均方根误差（Arms）分析脉搏CO血氧仪性能。Radical 7准确地检测出了COHb水平正常和升高的低氧血症（偏倚平均值± SD：0.44 ± 1.69%（% COHb <4%）和− 0.29 ± 1.64%（% COHb ≥ 4%），P <0.0001，两组分别为1.74%和1.67%）。在常氧和中度缺氧时可准确检测COHb（偏倚平均值± SD：SaO2 ≥ 95%时为− 0.98 ± 2.6，SaO2 <95%时为− 0.7 ± 4.0，P = 0.60，臂2.8% vs. 4.0%），但当SaO2低于~85%时，脉搏CO血氧仪总是给出低信号质量误差，并且不报告SpCO值。在健康志愿者中，Radical 7脉搏CO血氧仪可准确检测COHb水平低和升高的低氧血症，并准确检测碳氧血红蛋白，但仅在SaO2大于约85%时读取SpCO。
Carbon monoxide poisoning is a significant problem in most countries, and a reliable method of quick diagnosis would greatly improve patient care. Until the recent introduction of a multi-wavelength “pulse CO-oximeter” (Masimo Rainbow SET® Radical-7), carboxyhemoglobin (COHb) levels in blood required blood sampling and laboratory analysis. The purpose of this study was to determine if hypoxemia, which can accompany carbon monoxide poisoning, interferes with the accurate detection of COHb. Twelve healthy non-smoking adult volunteers were fitted with 2 standard pulse oximeter finger probes and 2 Rainbow probes for COHb detection. A radial arterial catheter was placed for blood sampling during three interventions: 1) increasing hypoxemia in incremental steps with oxygen saturations (SaO2) of 100-80%; 2) normoxia with incremental increases in %COHb to 12%; and 3) elevated COHb combined with hypoxemia with SaO2 of 100-80%. Pulse oximeter readings (SpCO) were compared with simultaneous arterial blood values at the various increments of hypoxemia and carboxyhemoglobinemia (≈25 samples per subject). Pulse CO-oximeter performance was analyzed by calculating the mean bias (SpCO – %COHb), standard deviation of the bias (precision), and the root mean square error (Arms). The Radical 7 accurately detected hypoxemia with both normal and elevated levels of COHb (bias mean ± SD: 0.44 ± 1.69% at %COHb < 4%, and −0.29 ± 1.64% at %COHb ≥ 4%, P < 0.0001, and Arms 1.74% vs. 1.67%). COHb was accurately detected during normoxia and moderate hypoxia (bias mean ± SD: −0.98 ± 2.6 at SaO2 ≥ 95%, and −0.7 ± 4.0 at SaO2 < 95%, P = 0.60, and Arms 2.8% vs. 4.0%), but when SaO2 fell below ~85%, the pulse CO-oximeter always gave low signal quality errors and did not report SpCO values. In healthy volunteers, the Radical 7 pulse CO-oximeter accurately detects hypoxemia with both low and elevated COHb levels, and accurately detects carboxyhemoglobin, but only reads SpCO when SaO2 is greater than about 85%.