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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2012, Vol. 6 Issue (4) : 406-410     DOI: 10.1007/s11684-012-0217-3
RESEARCH ARTICLE |
Esophageal pulse oximetry is more accurate and detects hypoxemia earlier than conventional pulse oximetry during general anesthesia
Guo Chen, Zhaoqiong Zhu*, Jin Liu(), Wei Wei
Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Abstract  

The esophagus is perfused directly by prominent arteries and may provide a more consistent tissue source for pulse oximetry. The goal of this study was to evaluate the sensitivity and accuracy of an esophageal pulse oximetry probe on patients during controlled hypoxemia in comparison to measurements obtained with conventional pulse oximetry (SpulseO2). Forty-five ASA I–II adult patients were included in this prospective observational study. Nellcor digital oximetric probes were placed on finger tips for SpulseO2 before anesthesia. After tracheal intubation, an esophageal probe was placed in the lower segment of the esophagus for esophageal oximetric monitoring (SoesO2). All patients were disconnected from the breathing circuit to establish a controlled hypoxemia, and were re-connected to the breathing circuit and ventilated with 100% oxygen immediately when SoesO2 dropped to 90%. Matched SoesO2 and SpulseO2 readings were recorded when SoesO2 measurements were at 100%, 95%, 90% and the lowest reading. The time for SoesO2 and SpulseO2 to drop from 100% to 95%, 90% and return to 100% was recorded. Oxygen saturation from arterial blood samples (SartO2) was also measured at each time point respectively. The linear correlation coefficient of the regression analysis between SartO2 and SoesO2 was 0.954. The mean±2SD of the difference was 0.3%±4.3% for SoesO2vs. SartO2 and 6.8%±5.6% for SpulseO2vs. SartO2 (P<0.001). The 95% confidence interval for the absolute difference between SoesO2 and SartO2 was 0.3% to 0.7% and 6.2% to 7.4% between SpulseO2 and SartO2. The time to reach 90% saturation measured with SoesO2 was approximately 94 seconds earlier than the SpulseO2 (P<0.001). In conclusion, SoesO2 is more accurate and enables earlier detection of hypoxemia when compared to conventional pulse oximetry during hypoxemia for patients undergoing general anesthesia.

Keywords esophageal pulse oximetry      conventional pulse oximetry      hypoxemia     
Corresponding Authors: Liu Jin,Email:scujinliu@yahoo.com.cn   
Issue Date: 05 December 2012
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-012-0217-3     OR     http://academic.hep.com.cn/fmd/EN/Y2012/V6/I4/406
Fig.1  Photograph of an esophageal pulse probe developed in our department. 1. light generator (light emitting diode); 2.detector; 3. direction marker, which is a black line with the same direction of the light generator and the detector in the probe; 4. temperature probe.
Fig.2  A typical SoesO signal. From top to bottom were the signals of SpulseO and SoesO. In terms of time phases, SoesO wave appeared earlier than SpulseO wave in each circle on the screen.
Fig.3  A) Linear regression analysis comparing SoesO with SartO. = 87 pairs, = 0.954; (B) Linear regression analysis comparing SpulseO with SartO. = 87 pairs, = 0.927; (C) Bland Altman graph comparing the difference between SartO and SoesO versus the mean oxygen saturation by the two methods (D) Bland Altman graph comparing the difference between SartO and SpulseO versus the mean oxygen saturation by the two methods.
Fig.4  (A) Changes of SpulseO and SoesO after disconnection of ventilation and re-ventilation. “Hollow square” represents the data of SoesO; “Gray rhombus” represents the data of SpulseO. * = 87 pairs, <0.001 vs. SpulseO. <0.05 vs. SpulseO. (B) Bland and Altman graph comparing the difference between SpulseO and SoesO versus the mean oxygen saturation by the two methods, = 87 pairs.
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