Proenca Martin, Grossenbacher Olivier, Dasen Stephan, Moser Virginie, Ostojic Daniel, Lemkaddem Alia, Ferrario Damien, Lemay Mathieu, Wolf Martin, Fauchere Jean-Claude, Karen Tanja
Annu Int Conf IEEE Eng Med Biol Soc. 2018 Jul;2018:1502-1505. doi: 10.1109/EMBC.2018.8512504.
The measurement of peripheral oxygen saturation (SpO2) in neonatal intensive care units (NICUs) poses a significant challenge. Motion artifacts due to the patient's limb motion induce many false alarms, which in turn cause an additional workload for the medical staff and anxiety for the parents. We developed a reflectance pulse oximeter dedicated to be placed at the patient's forehead, which is less prone to such artifacts. We trained our algorithms for SpO2 estimation on 8 adult healthy volunteers participating in a controlled desaturation study. We then validated our SpO2 monitoring system on 25 newborn patients monitored in an NICU. We further evaluated the versatility and resilience to low signal-tonoise ratios (SNR) of our solution by testing it on signals acquired in a low-perfusion region (upper right part of the chest) of our adult volunteers. We obtained an SpO2 estimation accuracy ($A _{\mathbf {rms}}$) of 1.9 % and 3.1 % at the forehead and the chest in our adult volunteers, respectively. These performances were obtained after automatic rejection of 0.1 % and 30.0 %, respectively, of low-SNR signals by our dedicated quality index. In the dataset recorded on newborn patients in the NICU, we obtained an accuracy of 3.9 % after automatic rejection of 11.7 % of low-SNR signals by our quality index. These analyses were carried out following the procedures suggested by the ISO 80601-2-61:2011 standard, which specifies a target $A _{\mathbf {rms}} \le $ 4 % for SpO2 monitoring applications. These promising results suggest that reflectance pulse oximeters can achieve clinically acceptable accuracy, while being placed at locations less sensitive to limb motion artifacts - such as the forehead - thereby reducing the amount of SpO2-related false alarms in NICUs.
在新生儿重症监护病房（NICU）中测量外周血氧饱和度（SpO2）是一项重大挑战。患者肢体运动产生的运动伪影会引发许多误报，进而给医护人员带来额外工作量，并使家长感到焦虑。我们开发了一种专门放置在患者前额的反射式脉搏血氧仪，这种位置较不易出现此类伪影。我们在8名参与受控去饱和研究的成年健康志愿者身上训练了用于SpO2估计的算法。然后，我们在NICU中对25名新生儿患者进行监测，验证了我们的SpO2监测系统。我们还通过在成年志愿者胸部低灌注区域（右上部分）采集的信号上进行测试，进一步评估了我们解决方案的通用性和对低信噪比（SNR）的耐受性。在成年志愿者中，我们在前额和胸部获得的SpO2估计精度（$A _{\mathbf {rms}}$）分别为1.9%和3.1%。这些性能是在通过我们专门的质量指标分别自动剔除0.1%和30.0%的低SNR信号后获得的。在NICU中记录的新生儿患者数据集中，通过我们的质量指标自动剔除11.7%的低SNR信号后，我们获得了3.9%的精度。这些分析是按照ISO 80601 - 2 - 61:2011标准建议的程序进行的，该标准规定SpO2监测应用的目标$A _{\mathbf {rms}} \le $ 4%。这些有前景的结果表明，反射式脉搏血氧仪可以达到临床可接受的精度，同时放置在对肢体运动伪影不太敏感的位置，如前额，从而减少NICU中与SpO2相关的误报数量。
