Reliability of conventional and new pulse oximetry in neonatal patients.
Reliability of conventional and new pulse oximetry in neonatal patients.
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DOI：
10.1038/sj.jp.7210740
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发表时间：
2002-07-01
期刊：
影响因子：
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通讯作者：
Fashaw, Lucy M
中科院分区：
文献类型：
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作者：
Hay, William W Jr;Rodden, Donna J;Fashaw, Lucy M
目的：脉搏血氧仪广泛用于NICU，但临床医生通常不相信患者运动期间显示的值，即，可疑的血氧饱和度（SpO（2））和脉率（PR）值。Masimo Corporation（Irvine，CA）开发了脉搏血氧仪，声称可抵抗干扰源。为了验证这一前提，我们将Masimo SET脉搏血氧仪的性能与传统器械Nellcor N-200进行了比较，然后与其他三种新一代脉搏血氧仪Nellcor N-395、NovameClosure MARS和Philips Viridia 24 C进行了比较。研究设计：我们研究了26名接受辅助供氧和/或机械通气的未使用镇静剂的NICU婴儿。通过PC采集床旁监护仪的ECG心率（HR）和两个脉搏血氧仪的SpO（2）和PR，共156小时。在低氧血症（SpO（2）≤ 85%）和/或心动过缓（HR ≤ 80 bpm）报警时分析ECG HR和脉搏血氧仪频谱波形。然后，我们在7名婴儿的类似人群中对Masimo SET与其他三种新一代脉搏血氧仪（Agilent Viridia 24 C、Nellcor N-395和NovameSpark MARS）的性能进行了总计28小时的比较。我们在测试标准中增加了各种脉搏血氧仪跟踪HR急性变化的能力。结果：与Nellcor相比，Masimo SET的误报警减少了86%，持续时间也更短，导致总报警时间减少了92%。Masimo SET还识别出几乎所有心动过缓，而Nellcor为14%。与新一代脉搏血氧仪相比，Masimo SET的假去饱和度、数据丢失和假心动过缓最低，真去饱和度和心动过缓的捕获率也最低。值得注意的是，新一代设备在检测HR变化的能力方面存在很大差异（即，Masimo、Nellcor、Philips和NovameClock在ECG HR变化期间PR冻结的频率分别为0、6、11和46。结论：与传统或其他新一代脉搏血氧仪相比，Masimo SET脉搏血氧仪记录的假SpO（2）和PR警报明显更少，并识别出更多的真实缺氧和心动过缓事件。Masimo SET也最接近地反映了ECG速率，而不考虑HR的加速或减速。推测：在NICU中常规使用Masimo SET脉搏血氧饱和度可以提高临床医生对参数的信心，从而更明智地滴定氧气，并可能减少缺氧（例如，肺高血压）和高氧（例如，早产儿视网膜病）病理学。此外，更值得信赖的技术应等同于更少的确证性动脉血气分析（更少的失血）和更快的机械通气脱机（更少的慢性肺病）。
OBJECTIVES: Pulse oximetry is widely used in the NICU, but clinicians often distrust the displayed values during patient motion, i.e., questionable oxygen saturation (SpO(2)) and pulse rate (PR) values. Masimo Corporation (Irvine, CA) has developed pulse oximetry with claims of resistance to sources of interference. To test this premise, we compared the performance of the Masimo SET pulse oximeter to a conventional device, Nellcor N-200, and then with three other new-generation pulse oximeters, Nellcor N-395, Novametrix MARS, and Philips Viridia 24C.STUDY DESIGN: We studied 26 nonsedated NICU infants who were on supplemental oxygen and/or mechanical ventilation. ECG heart rate (HR) from a bedside monitor and SpO(2) and PR from the two pulse oximeters were captured by a PC for a total of 156 hours. The ECG HR and pulse oximeter spectral waveform were analyzed at alarms for hypoxemia (SpO(2)< or = 85%) and/or bradycardia (HR< or = 80 bpm). We then compared the performance of the Masimo SET to three other new-generation pulse oximeters, Agilent Viridia 24C, Nellcor N-395, and Novametrix MARS, in a similar population of seven infants for a total of 28 hours. We added to the test criteria the ability of the various pulse oximeters to track acute changes in HR.RESULTS: Compared with Nellcor, Masimo SET had 86% fewer false alarms, which also were shorter in duration, resulting in 92% less total alarm time. Masimo SET also identified nearly all bradycardias versus 14% for the Nellcor. Compared with the new-generation pulse oximeters, false desaturations, data drop-outs, and false bradycardias were lowest for Masimo SET, as was the capture of true desaturations and bradycardias. Notably, the new-generation devices differed greatly in their ability to detect changes in HR (i.e., the frequency of frozen PR during times of ECG HR change was 0, 6, 11, and 46 for Masimo, Nellcor, Philips, and Novametrix, respectively).CONCLUSIONS: Masimo SET pulse oximetry recorded markedly fewer false SpO(2) and PR alarms and identified more true hypoxic and bradycardic events than either conventional or other new-generation pulse oximeters. Masimo SET also most closely reflected the ECG rate irrespective of accelerations or decelerations in HR.SPECULATION: Routine use of Masimo SET pulse oximetry in the NICU could improve clinician confidence in the parameter leading to more judicious titration of oxygen with possible reductions in hypoxic (e.g., pulmonary hypertension) and hyperoxic (e.g., retinopathy of prematurity) pathology. Additionally, a more trustworthy technology should equate with fewer confirmatory arterial blood gas analyses (less blood loss), and faster weaning from the mechanical ventilation (less chronic lung disease).