Mtetwa Thembeka K, Snelling Edward P, Buss Peter E, Donaldson Ashleigh C, Roug Annette, Meyer Leith C R
Centre for Veterinary Wildlife Research, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa.
Department of Anatomy and Physiology, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa.
BMC Vet Res. 2024 Jul 16;20(1):319. doi: 10.1186/s12917-024-04179-5.
Monitoring blood oxygenation is essential in immobilised rhinoceros, which are susceptible to opioid-induced hypoxaemia. This study assessed the reliability, clinical performance and trending ability of the Nonin PalmSAT 2500 A pulse oximeter's and the Masimo Radical-7 pulse co-oximeter's dual-wavelength technology, with their probes placed at two measurement sites, the inner surface of the third-eyelid and the scarified ear pinna of immobilised white rhinoceroses. Eight white rhinoceros were immobilised with etorphine-based drug combinations and given butorphanol after 12 min, and oxygen after 40 min, of recumbency. The Nonin and Masimo devices, with dual-wavelength probes attached to the third-eyelid and ear recorded arterial peripheral oxygen-haemoglobin saturation (SpO) at pre-determined time points, concurrently with measurements of arterial oxygen-haemoglobin saturation (SaO), from drawn blood samples, by a benchtop AVOXimeter 4000 co-oximeter (reference method). Reliability of the Nonin and Masimo devices was evaluated using the Bland-Altman and the area root mean squares (ARMS) methods. Clinical performance of the devices was evaluated for their ability to accurately detect clinical hypoxemia using receiver operating characteristic (ROC) curves and measures of sensitivity, specificity, and positive and negative predictive values. Trending ability of the devices was assessed by calculating concordance rates from four-quadrant plots.
Only the Nonin device with transflectance probe attached to the third-eyelid provided reliable SpO measurements across the 70 to 100% saturation range (bias - 1%, precision 4%, ARMS 4%). Nonin and Masimo devices with transflectance probes attached to the third-eyelid both had high clinical performance at detecting clinical hypoxaemia [area under the ROC curves (AUC): 0.93 and 0.90, respectively]. However, the Nonin and Masimo devices with transmission probes attached to the ear were unreliable and provided only moderate clinical performance. Both Nonin and Masimo devices, at both measurement sites, had concordance rates lower than the recommended threshold of ≥ 90%, indicating poor trending ability.
The overall assessment of reliability, clinical performance and trending ability indicate that the Nonin device with transflectance probe attached to the third-eyelid is best suited for monitoring of blood oxygenation in immobilised rhinoceros. The immobilisation procedure may have affected cardiovascular function to an extent that it limited the devices' performance.
监测固定状态下犀牛的血氧饱和度至关重要，因为它们易受阿片类药物引起的低氧血症影响。本研究评估了Nonin PalmSAT 2500 A脉搏血氧仪和Masimo Radical-7脉搏碳氧血红蛋白仪的双波长技术的可靠性、临床性能和趋势分析能力，其探头置于两只固定状态下的白犀牛的两个测量部位，即第三眼睑内表面和划破的耳廓。八只白犀牛使用依托啡肽类药物组合进行固定，并在躺卧12分钟后给予布托啡诺，40分钟后给予氧气。将双波长探头连接到第三眼睑和耳朵的Nonin和Masimo设备在预定时间点记录动脉外周氧合血红蛋白饱和度（SpO），同时通过台式AVOXimeter 4000碳氧血红蛋白仪（参考方法）从采集的血样中测量动脉氧合血红蛋白饱和度（SaO）。使用Bland-Altman和均方根面积（ARMS）方法评估Nonin和Masimo设备的可靠性。使用受试者操作特征（ROC）曲线以及敏感性、特异性、阳性和阴性预测值评估设备准确检测临床低氧血症的临床性能。通过计算四象限图的一致性率来评估设备的趋势分析能力。
仅将透反射探头连接到第三眼睑的Nonin设备在70%至100%饱和度范围内提供了可靠的SpO测量值（偏差-1%，精密度4%，ARMS 4%）。将透反射探头连接到第三眼睑的Nonin和Masimo设备在检测临床低氧血症方面均具有较高的临床性能[ROC曲线下面积（AUC）：分别为0.93和0.90]。然而，将透射探头连接到耳朵的Nonin和Masimo设备不可靠，临床性能仅为中等。在两个测量部位，Nonin和Masimo设备的一致性率均低于推荐阈值≥90%，表明趋势分析能力较差。
对可靠性、临床性能和趋势分析能力的总体评估表明，将透反射探头连接到第三眼睑的Nonin设备最适合监测固定状态下犀牛的血氧饱和度。固定过程可能在一定程度上影响了心血管功能，从而限制了设备的性能。
