Department of Anesthesiology Critical Care Medicine, 4650 Sunset Blvd Mailstop 12, Children's Hospital Los Angeles, Los Angeles, CA 90027.
Pediatrics. 2014 Jan;133(1):22-9. doi: 10.1542/peds.2013-1760. Epub 2013 Dec 16.
For children with cyanotic congenital heart disease or acute hypoxemic respiratory failure, providers frequently make decisions based on pulse oximetry, in the absence of an arterial blood gas. The study objective was to measure the accuracy of pulse oximetry in the saturations from pulse oximetry (SpO2) range of 65% to 97%.
This institutional review board-approved prospective, multicenter observational study in 5 PICUs included 225 mechanically ventilated children with an arterial catheter. With each arterial blood gas sample, SpO2 from pulse oximetry and arterial oxygen saturations from CO-oximetry (SaO2) were simultaneously obtained if the SpO2 was ≤ 97%.
The lowest SpO2 obtained in the study was 65%. In the range of SpO2 65% to 97%, 1980 simultaneous values for SpO2 and SaO2 were obtained. The bias (SpO2 - SaO2) varied through the range of SpO2 values. The bias was greatest in the SpO2 range 81% to 85% (336 samples, median 6%, mean 6.6%, accuracy root mean squared 9.1%). SpO2 measurements were close to SaO2 in the SpO2 range 91% to 97% (901 samples, median 1%, mean 1.5%, accuracy root mean squared 4.2%).
Previous studies on pulse oximeter accuracy in children present a single number for bias. This study identified that the accuracy of pulse oximetry varies significantly as a function of the SpO2 range. Saturations measured by pulse oximetry on average overestimate SaO2 from CO-oximetry in the SpO2 range of 76% to 90%. Better pulse oximetry algorithms are needed for accurate assessment of children with saturations in the hypoxemic range.
对于患有紫绀型先天性心脏病或急性低氧呼吸衰竭的儿童，医生通常会根据脉搏血氧饱和度仪（无动脉血气分析）来做出决策。本研究的目的是测量脉搏血氧饱和度仪在 65%至 97%SpO2 范围内的准确性。
本研究为机构审查委员会批准的前瞻性、多中心观察性研究，纳入了 5 个 PICUs 中 225 例接受机械通气的患儿，这些患儿均存在动脉导管。如果 SpO2≤97%，则在每次动脉血气样本采集时，同时获取脉搏血氧饱和度仪的 SpO2 和 CO-oximetry 的动脉氧饱和度（SaO2）。
本研究获得的最低 SpO2 为 65%。在 65%至 97%SpO2 范围内，共获得了 1980 对 SpO2 和 SaO2 同时测量值。SpO2 与 SaO2 之间的偏差（SpO2-SaO2）随 SpO2 值范围而变化。SpO2 范围在 81%至 85%（336 个样本，中位数 6%，均值 6.6%，准确性均方根 9.1%）时偏差最大。SpO2 范围在 91%至 97%（901 个样本，中位数 1%，均值 1.5%，准确性均方根 4.2%）时，SpO2 测量值与 SaO2 接近。
之前关于儿童脉搏血氧饱和度仪准确性的研究仅提供了一个偏差的单一数值。本研究表明，脉搏血氧饱和度仪的准确性随 SpO2 范围显著变化。在 76%至 90%SpO2 范围内，脉搏血氧饱和度仪测量的饱和度平均高于 CO-oximetry 的 SaO2。需要更好的脉搏血氧饱和度仪算法来准确评估低氧血症患儿的情况。
