The accuracy of a near-infrared spectroscopy cerebral oximetry device and its potential value for estimating jugular venous oxygen saturation.
The accuracy of a near-infrared spectroscopy cerebral oximetry device and its potential value for estimating jugular venous oxygen saturation.
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DOI：
10.1213/ane.0000000000000463
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发表时间：
2014-12
影响因子：
5.7
通讯作者：
Vacchiano C
中科院分区：
文献类型：
--
作者：
Ikeda K;MacLeod DB;Grocott HP;Moretti EW;Ames W;Vacchiano C
脑血氧仪测量(SctO2)的一个有趣的潜在临床应用是能够无创性地估计颈静脉球静脉血氧饱和度(SjvO2)。我们在这项研究中的目的是通过采用行业标准协议ISO 9919：2005[www.iso.org](用于脉搏血氧仪)来确定Foresight®(CAS Medical Systems；Branford，CT)用于食品和药物管理局上市前批准的510(K)认证的准确性，并评估SctO2和SpO2测量在无创估计颈静脉血氧饱和度(SnvO2)方面的使用。从20名健康志愿者的桡动脉和颈静脉球部采集血气样本，这些志愿者正在进行100%到70%的渐进性氧减饱和。血样对通过CO血氧仪进行分析，并用于计算在缺氧增加期间的近似混合血管脑血氧饱和度或参考SctO2值(RefSctO2)。将这些参考值与与血气分析同时记录的双眼视力SctO2值进行比较，以确定其准确性。然后使用双侧SctO2和SpO2测量来计算SnvO2值，并将其与SjvO2进行比较。分析中使用了18个受试者的246个动脉样本和253个静脉样本。用动脉血气和静脉血气计算同侧前视SctO2值，其耐受区间(TI)为[−10.7210.90]Lin‘s一致性相关系数(Ccc)，标准差(SE)为0.83±0.073。合并后的数据的CCC为0。81±0.059，总偏倚为[−9.22~9.40]，总偏倚为0.09%，经随机效应分析校正后的均方根值为2.92%。同侧和对侧前视SctO2测量值之间的偏差和变异值因人而异。SjvO2的偏差为0.20%，−的偏差为4.08%。对侧额前视SCtO2值与SjvO2值无相关性(对侧Ccc+SE=0.118.72±0.118，TI=[−14.86 15.2 0]，斜率0.6 6，y截距2 0.36%)。前视脑氧仪能够在正常二氧化碳和不同程度低氧条件下估测额叶组织内的氧饱和度(95%可信区间[−5.60~5.78]，且同侧血液充足)。来自健康志愿者的这些发现还表明，使用由SctO2和SpO2值计算出的SnvO2可能是一种合理的无创性方法来估计SjvO2，从而在临床环境中估计全球脑耗氧量。需要进一步的实验室和临床研究，以确定近红外光谱分析在手术室环境中测定SctO2和SnvO2的临床实用价值。
An intriguing potential clinical use of cerebral oximeter measurements (SctO2) is the ability to noninvasively estimate jugular bulb venous oxygen saturation (SjvO2). Our purpose in this study was to determine the accuracy of the FORE-SIGHT® (CAS Medical Systems; Branford, CT), which is calibrated to a weighted average of 70% (SjvO2) and 30% arterial saturation, for Food and Drug Administration pre-market approval 510 (k) certification by adapting an industry standard protocol, ISO 9919:2005 [www.ISO.org] (used for pulse oximeters) and to evaluate the use of SctO2 and SpO2 measurements to noninvasively estimate jugular venous oxygen saturation (SnvO2). Paired blood gas samples from the radial artery and the jugular venous bulb were collected from 20 healthy volunteers undergoing progressive oxygen desaturation from 100 to 70%. The blood sample pairs were analyzed via co-oximetry and used to calculate the approximate mixed vascular cerebral blood oxygen saturation, or reference SctO2 values (refSctO2), during increasing hypoxia. These reference values were compared to bilateral FORE-SIGHT SctO2 values recorded simultaneously with the blood gas draws to determine its accuracy. Bilateral SctO2 and SpO2 measurements were then used to calculate SnvO2 values which were compared to SjvO2. Two hundred forty-six arterial and 253 venous samples from 18 subjects were used in the analysis. The ipsilateral FORE-SIGHT SctO2 values showed a tolerance interval (TI) of [−10.72 10.90] Lin’s concordance correlation coefficient (CCC) with standard error (SE) of 0.83 ± 0.073 with the refSctO2 values calculated using arterial and venous blood gases. The combined data had a CCC of 0. 81 + 0.059 with TI of [−9.22 9.40] with overall bias was 0.09% and amplitude of the root mean square of error after it was corrected with random effects analysis was 2.92%. The bias and variability values between the ipsilateral and the contralateral FORE-SIGHT SctO2 measurements varied from person to person. The SnvO2 calculated from the ipsilateral SctO2 and SpO2 data showed a CCC + SE of 0.79 ± 0.088, TI = [−14.93 15.33], slope of 0.98, Y-Intercept of 1.14%) with SjvO2 values with a bias of 0.20% and an Arms of 4.08%. The SnvO2 values calculated independently from contralateral forehead FORE-SIGHT SctO2 values were not as correlated with the SjvO2 values (contralateral side CCC + SE = 0.72 ± 0.118, TI = [−14.86 15.20], slope of 0.66 and y-intercept of 20.36%). The FORE-SIGHT cerebral oximeter was able to estimate oxygen saturation within the tissues of the frontal lobe under conditions of normocapnia and varying degrees of hypoxia (with 95% confidence interval of [−5.60 5.78] with ipsilateral blood ample data). These findings from healthy volunteers also suggest that the use of the calculated SnvO2 derived from SctO2 and SpO2 values may be a reasonable noninvasive method of estimating SjvO2 and therefore global cerebral oxygen consumption in the clinical setting. Further laboratory and clinical research is required to define the clinical utility of near-infrared spectroscopy determination of SctO2 and SnvO2 in the operating room setting.