Evaluation of accuracy of portable fingertip pulse oximeter, as compared to that of a hospital oximeter with digital sensor.

PubMed

Pupim, Denise; Iwaki Filho, Liogi; Takeshita, Wilton Mitsunari; Iwaki, Lilian Cristina Vessoni

2013-01-01

The pulse oximeter is a device that noninvasively provides continuous information about the peripheral oxygen saturation (SpO2) rate. This device is utilized in the detection of hypoxemia, due to its able to sense changes in hemoglobin oxygen saturation. The objective of this study was to verify the accuracy of the Choice® Medical MD300C3 Fingertip Pulse Oximeter, as compared to that of a hospital oximeter coupled with a Drager® Infinity Delta monitor, with the purpose of using this first methodology in dental procedures to monitor the peripheral oxygen saturation (SpO2) of patients submitted to dental treatments. Fifty-five adult patients, both genders, were selected in the Santa Casa Hospital of Maringa, Brazil. The volunteers did not present cardiac problems, prosthetic cardiac valves, pacemakers, or pulmonary diseases, and were not pregnant or children. Each patient received a portable fingertip pulse oximeter (PPO) on the middle finger of the left hand and the hospital oximeter (control device) on the forefinger of the same hand. A total of six measurements were developed. The Pearson correlation coefficient and the Bland and Altman method was used to calculate the statistical analysis. No statistically significant difference was found between the measurements taken by the utilized devices. The average of comparative analysis presented by the devices was 0.2337 ± 0.4355 (mean ± SD), suggesting a strong correlation between the obtained results. According to the methodology of the research, the PPO has similar accuracy to the conventional hospital oximeter with digital sensor. The PPO can be used in dental treatments.

Measurement of carboxyhemoglobin and methemoglobin by pulse oximetry: a human volunteer study.

PubMed

Barker, Steven J; Curry, Jeremy; Redford, Daniel; Morgan, Scott

2006-11-01

A new eight-wavelength pulse oximeter is designed to measure methemoglobin and carboxyhemoglobin, in addition to the usual measurements of hemoglobin oxygen saturation and pulse rate. This study examines this device's ability to measure dyshemoglobins in human volunteers in whom controlled levels of methemoglobin and carboxyhemoglobin are induced. Ten volunteers breathed 500 ppm carbon monoxide until their carboxyhemoglobin levels reached 15%, and 10 different volunteers received intravenous sodium nitrite, 300 mg, to induce methemoglobin. All were instrumented with arterial cannulas and six Masimo Rad-57 (Masimo Inc., Irvine, CA) pulse oximeter sensors. Arterial blood was analyzed by three laboratory CO-oximeters, and the resulting carboxyhemoglobin and methemoglobin measurements were compared with the corresponding pulse oximeter readings. The Rad-57 measured carboxyhemoglobin with an uncertainty of +/-2% within the range of 0-15%, and it measured methemoglobin with an uncertainty of 0.5% within the range of 0-12%. The Masimo Rad-57 is the first commercially available pulse oximeter that can measure methemoglobin and carboxyhemoglobin, and it therefore represents an expansion of our oxygenation monitoring capability.

RIPPLE: Scalable Medical Telemetry System for Supporting Combat Rescue

DTIC Science & Technology

2014-01-09

This reduces the burden of transporting multiple systems. For Ripple, we prototyped a system that combined a pulse oximeter , an electrocardiogram, a...o Nonin OEM III Module or Nonin XPOD Pulse Oximeters o Nonin 8000 series PureLight sensors o Shimmer Sensing ECG Board Identify applicable...equipment, e.g. pulse and respiration rate. Advances in wireless communications and miniaturization of electronics has led to the development and

A Prototype of Reflection Pulse Oximeter Designed for Mobile Healthcare.

PubMed

Lu, Zhiyuan; Chen, Xiang; Dong, Zhongfei; Zhao, Zhangyan; Zhang, Xu

2016-09-01

This paper introduces a pulse oximeter prototype designed for mobile healthcare. In this prototype, a reflection pulse oximeter is embedded into the back cover of a smart handheld device to offer the convenient measurement of both heart rate (HR) and SpO2 (estimation of arterial oxygen saturation) for home or mobile applications. Novel and miniaturized circuit modules including a chopper network and a filtering amplifier were designed to overcome the influence of ambient light and interferences that are caused by embedding the sensor into a flat cover. A method based on adaptive trough detection for improved HR and SpO2 estimation is proposed with appropriate simplification for its implementation on mobile devices. A fast and effective photoplethysmogram validation scheme is also proposed. Clinical experiments have been carried out to calibrate and test our oximeter. Our prototype oximeter can achieve comparable performance to a clinical oximeter with no significant difference revealed by paired t -tests ( p = 0.182 for SpO2 measurement and p = 0.496 for HR measurement). The design of this pulse oximeter will facilitate fast and convenient measurement of SpO2 for mobile healthcare.

A comparison of oxygen saturation measurements obtained from a 'blue sensor' with a standard sensor.

PubMed

Mawson, Isabel E; Dawson, Jennifer A; Donath, Susan M; Davis, Peter G

2011-10-01

The study aims to investigate pulse oximetry measurements from a 'blue' pulse oximeter sensor against measurements from a 'standard' pulse oximeter sensor in newly born infants. Immediately after birth, both sensors were attached to the infant, one to each foot. SpO₂ measurements were recorded simultaneously from each sensor for 10 min. Agreement between pairs of SpO₂ measurements were calculated using Bland-Altman analysis. Thirty-one infants were studied. There was good correlation between simultaneous SpO₂ measurements from both sensors (r² = 0.75). However, the mean difference between 'blue' and 'standard' sensors was -1.6%, with wide 95% limits of agreement +18.4 to -21.6%. The range of mean difference between sensors from each infant ranged from -20 to +20. The mean difference between the blue and standard sensor SpO₂ measurements is not clinically important. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Technical note: Evaluation of a wireless pulse oximeter for measuring arterial oxygen saturation and pulse rate in newborn Holstein Friesian calves.

PubMed

Kanz, P; Krieger, S; Drillich, M; Iwersen, M

2018-07-01

Pulse oximetry is a well-established technique in human and veterinary medicine. In farm animals, it could also be a useful tool for the detection of critical conditions relating to oxygen supply and the cardiovascular system. Among other uses, an innovative application could be the monitoring of fetuses during birth. This could help in the early identification of critical situations and support farmers and veterinarians in their decision to start obstetric or life-support interventions. Until now, however, its use in ruminant medicine was still limited to experimental applications. The objective of this study was to evaluate the accuracy of the Radius-7 Wearable Pulse CO-Oximeter (Masimo Corporation, Irvine, CA) for monitoring vital parameters in newborn calves. All measurements were conducted on animals in the lying down position. The sensor of the pulse oximeter was placed in the interdigital space of the calves' front legs and fixed with a homemade latex hoof cover. The pulsoximetric measurements of arterial oxygen saturation (SpO 2 ) in 40 newborn calves were compared with the corresponding results (SaO 2 ) from a portable blood gas analyzer (VetScan iStat1, Abaxis Inc., Union City, CA), which served as the reference. For this, an arterial blood sample was taken from the medial intermediate branch of the caudal auricular artery. In addition, the pulse rate was measured in 10 calves aged between 0 and 7 d with the pulse oximeter and simultaneously with a heart rate belt (Polar Equine Belt, Polar Electro Oy, Kempele, Finland) to determine their level of agreement. Spearman correlation coefficient for oxygen saturation was 93.8% for the pulse oximeter and the blood gas analyzer, and 97.7% for the pulse rate measured with the pulse oximeter and the heart rate belt. Bland-Altman plots revealed an overestimation of SaO 2 by 2.95 ± 6.39% and an underestimation of the pulse rate by -0.41 ± 3.18 beats per minute compared with the corresponding reference methods. In summary, the pulse oximeter is suitable for continuous monitoring of arterial oxygen saturation and pulse in newborn Holstein Friesian calves. For practical use, purpose-built technical equipment is required to attach the sensor to the calves' legs. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Pulse oximeter sensor application during neonatal resuscitation: a randomized controlled trial.

PubMed

Louis, Deepak; Sundaram, Venkataseshan; Kumar, Praveen

2014-03-01

This study was done to compare 2 techniques of pulse oximeter sensor application during neonatal resuscitation for faster signal detection. Sensor to infant first (STIF) and then to oximeter was compared with sensor to oximeter first (STOF) and then to infant in ≥28 weeks gestations. The primary outcome was time from completion of sensor application to reliable signal, defined as stable display of heart rate and saturation. Time from birth to sensor application, time taken for sensor application, time from birth to reliable signal, and need to reapply sensor were secondary outcomes. An intention-to-treat analysis was done, and subgroup analysis was done for gestation and need for resuscitation. One hundred fifty neonates were randomized with 75 to each technique. The median (IQR) time from sensor application to detection of reliable signal was longer in STIF group compared with STOF group (16 [15-17] vs. 10 [6-18] seconds; P <0.001). Time taken for application of sensor was longer with STIF technique than with STOF technique (12 [10-16] vs. 11 [9-15] seconds; P = 0.04). Time from birth to reliable signal did not differ between the 2 methods (STIF: 61 [52-76] seconds; STOF: 58 [47-73] seconds [P = .09]). Time taken for signal acquisition was longer with STIF than with STOF in both subgroups. In the delivery room setting, the STOF method recognized saturation and heart rate faster than the STIF method. The time from birth to reliable signal was similar with the 2 methods.

Design and evaluation of a low-cost smartphone pulse oximeter.

PubMed

Petersen, Christian L; Chen, Tso P; Ansermino, J Mark; Dumont, Guy A

2013-12-06

Infectious diseases such as pneumonia take the lives of millions of children in low- and middle-income countries every year. Many of these deaths could be prevented with the availability of robust and low-cost diagnostic tools using integrated sensor technology. Pulse oximetry in particular, offers a unique non-invasive and specific test for an increase in the severity of many infectious diseases such as pneumonia. If pulse oximetry could be delivered on widely available mobile phones, it could become a compelling solution to global health challenges. Many lives could be saved if this technology was disseminated effectively in the affected regions of the world to rescue patients from the fatal consequences of these infectious diseases. We describe the implementation of such an oximeter that interfaces a conventional clinical oximeter finger sensor with a smartphone through the headset jack audio interface, and present a simulator-based systematic verification system to be used for automated validation of the sensor interface on different smartphones and media players. An excellent agreement was found between the simulator and the audio oximeter for both oxygen saturation and heart rate over a wide range of optical transmission levels on 4th and 5th generations of the iPod TouchTM and iPhoneTM devices.

Design and Evaluation of a Low-Cost Smartphone Pulse Oximeter

PubMed Central

Petersen, Christian L.; Chen, Tso P.; Ansermino, J. Mark; Dumont, Guy A.

2013-01-01

Infectious diseases such as pneumonia take the lives of millions of children in low- and middle-income countries every year. Many of these deaths could be prevented with the availability of robust and low-cost diagnostic tools using integrated sensor technology. Pulse oximetry in particular, offers a unique non-invasive and specific test for an increase in the severity of many infectious diseases such as pneumonia. If pulse oximetry could be delivered on widely available mobile phones, it could become a compelling solution to global health challenges. Many lives could be saved if this technology was disseminated effectively in the affected regions of the world to rescue patients from the fatal consequences of these infectious diseases. We describe the implementation of such an oximeter that interfaces a conventional clinical oximeter finger sensor with a smartphone through the headset jack audio interface, and present a simulator-based systematic verification system to be used for automated validation of the sensor interface on different smartphones and media players. An excellent agreement was found between the simulator and the audio oximeter for both oxygen saturation and heart rate over a wide range of optical transmission levels on 4th and 5th generations of the iPod Touch™ and iPhone™ devices. PMID:24322563

Relationship of Hemoglobin to Arterial Oxygen Desaturation during Aeromedical Evacuation

DTIC Science & Technology

2015-04-02

consent was obtained, a portable pulse oximeter (Rad-57, Masimo Corp., Irvine, CA) was attached to the subject via an adhesive, disposable finger sensor...The oximeter noninvasively measured and recorded arterial SpO2, PR, Hgb, and pulse index every 2 seconds. The oximeter’s screen was covered so as...studied. For this study, subjects deemed safe to fly by the validating flight surgeon were monitored with pulse oximetry from the flight line until arrival

Proof of concept non-invasive estimation of peripheral venous oxygen saturation.

PubMed

Khan, Musabbir; Pretty, Chris G; Amies, Alexander C; Balmer, Joel; Banna, Houda E; Shaw, Geoffrey M; Geoffrey Chase, J

2017-05-19

Pulse oximeters continuously monitor arterial oxygen saturation. Continuous monitoring of venous oxygen saturation (SvO 2 ) would enable real-time assessment of tissue oxygen extraction (O 2 E) and perfusion changes leading to improved diagnosis of clinical conditions, such as sepsis. This study presents the proof of concept of a novel pulse oximeter method that utilises the compliance difference between arteries and veins to induce artificial respiration-like modulations to the peripheral vasculature. These modulations make the venous blood pulsatile, which are then detected by a pulse oximeter sensor. The resulting photoplethysmograph (PPG) signals from the pulse oximeter are processed and analysed to develop a calibration model to estimate regional venous oxygen saturation (SpvO 2 ), in parallel to arterial oxygen saturation estimation (SpaO 2 ). A clinical study with healthy adult volunteers (n = 8) was conducted to assess peripheral SvO 2 using this pulse oximeter method. A range of physiologically realistic SvO 2 values were induced using arm lift and vascular occlusion tests. Gold standard, arterial and venous blood gas measurements were used as reference measurements. Modulation ratios related to arterial and venous systems were determined using a frequency domain analysis of the PPG signals. A strong, linear correlation (r 2  = 0.95) was found between estimated venous modulation ratio (R Ven ) and measured SvO 2 , providing a calibration curve relating measured R Ven to venous oxygen saturation. There is a significant difference in gradient between the SpvO 2 estimation model (SpvO 2  = 111 - 40.6*R) and the empirical SpaO 2 estimation model (SpaO 2  = 110 - 25*R), which yields the expected arterial-venous differences. Median venous and arterial oxygen saturation accuracies of paired measurements between pulse oximeter estimated and gold standard measurements were 0.29 and 0.65%, respectively, showing good accuracy of the pulse oximeter system. The main outcome of this study is the proof of concept validation of a novel pulse oximeter sensor and calibration model to assess peripheral SvO 2 , and thus O 2 E, using the method used in this study. Further validation, improvement, and application of this model can aid in clinical diagnosis of microcirculation failures due to alterations in oxygen extraction.

Oximeter reliability in a subzero environment.

PubMed

Macnab, A J; Smith, M; Phillips, N; Smart, P

1996-11-01

Pulse oximeters optimize care in the pre-hospital setting. As British Columbia ambulance teams often provide care in subzero temperatures, we conducted a study to determine the reliability of 3 commercially-available portable oximeters in a subzero environment. We hypothesized that there is no significant difference between SaO2 readings obtained using a pulse oximeter at room temperature and a pulse oximeter operating at sub-zero temperatures. Subjects were stable normothermic children in intensive care on Hewlett Packard monitors (control unit) at room temperature. The test units were packed in dry ice in an insulated bin (temperature - 15 degrees C to -30 degrees C) and their sensors placed on the subjects, contralateral to the control sensors. Data were collected simultaneously from test and control units immediately following validation of control unit values by co-oximetry (blood gas). No data were unacceptable. Two units (Propaq 106EC and Nonin 8500N) functioned well to < -15 degrees C, providing data comparable to those obtained from the control unit (p < 0.001). The Siemens Micro O2 did not function at the temperatures tested. Monitor users who require equipment to function in subzero environments (military, Coast Guard, Mountain Rescue) should ensure that function is reliable, and could test units using this method.

Pulse oximeter for cyclists in smartphone

NASA Astrophysics Data System (ADS)

Martins, L.; Gaidos, O.; dos Santos, I.

2015-01-01

The monitoring of cyclists during physical activity is an important factor to improve their performance. We discuss a new approaches based on smartphone for monitoring physiological signal wirelessly for cyclists, using a pulse oximeter sensor attached to the rider's forehead. This paper presents a wireless pulse Oximeter that was developed with a Nellcor's module, which uses the Standard Host Interface Protocol (SHIP) for communication with the Bluetooth module and sends data for a Smartphone with Android O.S. Then these data are shown in the screen: the heartbeat and saturation percentage. The application was created with App Inventor and the data are sent to Google Maps via Twitter. The results demonstrate the possibility of developing a successful prototype.

Design of a pulse oximeter for price sensitive emerging markets.

PubMed

Jones, Z; Woods, E; Nielson, D; Mahadevan, S V

2010-01-01

While the global market for medical devices is located primarily in developed countries, price sensitive emerging markets comprise an attractive, underserved segment in which products need a unique set of value propositions to be competitive. A pulse oximeter was designed expressly for emerging markets, and a novel feature set was implemented to reduce the cost of ownership and improve the usability of the device. Innovations included the ability of the device to generate its own electricity, a built in sensor which cuts down on operating costs, and a graphical, symbolic user interface. These features yield an average reduction of over 75% in the device cost of ownership versus comparable pulse oximeters already on the market.

Pulse oximeter accuracy and precision affected by sensor location in cyanotic children.

PubMed

Sedaghat-Yazdi, Farshad; Torres, Adalberto; Fortuna, Randall; Geiss, Dale M

2008-07-01

Children's digits are often too small for proper attachment of oximeter sensors, necessitating sensor placement on the sole of the foot or palm of the hand. No study has determined what effect these sensor locations have on the accuracy and precision of this technology. The objective of this study was to assess the effect of sensor location on pulse oximeter accuracy (i.e., bias) and precision in critically ill children. Prospective, observational study with consecutive sampling. Tertiary care, pediatric intensive care unit. Fifty critically ill children, newborn to 2 yrs of age, with an indwelling arterial catheter. Forty-seven of 50 (94%) patients were postcardiac surgery. None. Co-oximeter-measured arterial oxygen saturation (Sao2) was compared with simultaneously obtained pulse oximetry saturations (Spo2). A total of 98 measurements were obtained, 48 measurements in the upper extremities (finger and palm) and 50 measurements in the lower extremities (toe and sole). The median Sao2 was 92% (66% to 100%). There was a significant difference in bias (i.e., average Spo2 - Sao2) and precision (+/-1 sd) when the sole and toe were compared (sole, 2.9 +/- 3.9 vs. toe, 1.6 +/- 2.2, p = .02) but no significant difference in bias and precision between the palm and the finger (palm, 1.4 +/- 3.2 vs. finger, 1.2 +/- 2.3, p = .99). There was a significant difference in bias +/- precision when the Sao2 was <90% compared with when Sao2 was >or=90% in the sole (6.0 +/- 5.7 vs. 1.8 +/- 2.1, p = .002) and palm (4.5 +/- 4.5 vs. 0.7 +/- 2.4, p = .006) but no significant difference in the finger (1.8 +/- 3.8 vs. 1.1 +/- 1.8, p = .95) or toe (1.9 +/- 2.9 vs. 1.6 +/- 1.9, p = .65). The Philips M1020A pulse oximeter and Nellcor MAX-N sensors were less accurate and precise when used on the sole of the foot or palm of the hand of a child with an Sao2 <90%.

Specificity of software cooperating with an optoelectronic sensor in the pulse oximeter system

NASA Astrophysics Data System (ADS)

Cysewska-Sobusiak, Anna; Wiczynski, Grzegorz; Jedwabny, Tomasz

1995-06-01

Specificity of a software package composed of two parts which control an optoelectronic sensor of the computer-aided system made to realize the noninvasive measurements of the arterial blood oxygen saturation as well as some parameters of the peripheral pulse waveform, has been described. Principles of the transmission variant of the one and only noninvasive measurement method, so-called pulse oximetry, has been utilized. The software co-ordinates the suitable cooperation of an IBM PC compatible microcomputer with the sensor and one specialized card. This novel card is a key part of the whole measuring system which some application fields are extended in comparison to pulse oximeters commonly attainable. The user-friendly MS Windows graphical environment which creates the system to be multitask and non-preemptive, has been used to design the specific part of the programming presented here. With this environment, sophisticated tasks of the software package can be performed without excessive complication.

Reconfigurable intelligent sensors for health monitoring: a case study of pulse oximeter sensor.

PubMed

Jovanov, E; Milenkovic, A; Basham, S; Clark, D; Kelley, D

2004-01-01

Design of low-cost, miniature, lightweight, ultra low-power, intelligent sensors capable of customization and seamless integration into a body area network for health monitoring applications presents one of the most challenging tasks for system designers. To answer this challenge we propose a reconfigurable intelligent sensor platform featuring a low-power microcontroller, a low-power programmable logic device, a communication interface, and a signal conditioning circuit. The proposed solution promises a cost-effective, flexible platform that allows easy customization, run-time reconfiguration, and energy-efficient computation and communication. The development of a common platform for multiple physical sensors and a repository of both software procedures and soft intellectual property cores for hardware acceleration will increase reuse and alleviate costs of transition to a new generation of sensors. As a case study, we present an implementation of a reconfigurable pulse oximeter sensor.

Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender.

PubMed

Feiner, John R; Severinghaus, John W; Bickler, Philip E

2007-12-01

Pulse oximetry may overestimate arterial oxyhemoglobin saturation (Sao2) at low Sao2 levels in individuals with darkly pigmented skin, but other factors, such as gender and oximeter probe type, remain less studied. We studied the relationship between skin pigment and oximeter accuracy in 36 subjects (19 males, 17 females) of a range of skin tones. Clip-on type sensors and adhesive/disposable finger probes for the Masimo Radical, Nellcor N-595, and Nonin 9700 were studied. Semisupine subjects breathed air-nitrogen-CO2 mixtures via a mouthpiece to rapidly achieve 2- to 3-min stable plateaus of Sao2. Comparisons of Sao2 measured by pulse oximetry (Spo2) with Sao2 (by Radiometer OSM-3) were used in a multivariate model to assess the source of errors. The mean bias (Spo2 - Sao2) for the 70%-80% saturation range was 2.61% for the Masimo Radical with clip-on sensor, -1.58% for the Radical with disposable sensor, 2.59% for the Nellcor clip, 3.6% for the Nellcor disposable, -0.60% for the Nonin clip, and 2.43% for the Nonin disposable. Dark skin increased bias at low Sao2; greater bias was seen with adhesive/disposable sensors than with the clip-on types. Up to 10% differences in saturation estimates were found among different instruments in dark-skinned subjects at low Sao2. Multivariate analysis indicated that Sao2 level, sensor type, skin color, and gender were predictive of errors in Spo2 estimates at low Sao2 levels. The data suggest that clinically important bias should be considered when monitoring patients with saturations below 80%, especially those with darkly pigmented skin; but further study is needed to confirm these observations in the relevant populations.

Evaluation of efficacy of a pulse oximeter to assess pulp vitality.

PubMed

Sadique, Mohammed; Ravi, S V; Thomas, Kunjamma; Dhanapal, Prasanth; Simon, Elsy P; Shaheen, Mohammed

2014-06-01

To evaluate the efficacy of pulse oximeter as a pulp vitality tester. The sample group consisted of 60 patients of age 15 to 30 years with normal maxillary anterior teeth. Thirty nonvital teeth with complete endodontic fillings were tested as control group. Systemic oxygen saturation values from the patient's fingers served as the control sample for comparison of pulp oxygen saturation values. Readings were recorded on index fingers first; teeth were then evaluated by placing sensor onto the tooth. Nonvital teeth recorded oxygen saturation values of 0%. The mean value for central incisor was 85.11 (SD ± 2.07), for lateral incisors 80.21 (SD ± 2.03) and for canines 89.55 (SD ± 1.09). Their control values (patient's index fingers) averaged 95.88% (SD ± 0.66). Pearson's correlation analysis showed a correlation of 0.11 for central incisors, 0.19 for lateral incisors and 0.12 for canines. This study confirms that pulse oximeter is effective equipment for pulp vitality testing. Pulse oximeter evidences the actual method of evaluating the pulp vitality compared to contemporary methods. How to cite the article: Sadique M, Ravi SV, Thomas K, Dhanapal P, Simon EP, Shaheen M. Evaluation of efficacy of a pulse oximeter to assess pulp vitality. J Int Oral Health 2014;6(3):70-2.

Smart Oxygen Monitors to Diagnose and Treat Cardiopulmonary Injuries

DTIC Science & Technology

2013-10-01

pulse   oximeter  was  placed.  Oxygenation,  ventilator  and  hemodynamic  parameters  were  manually   recorded...VCO2]:   a. VCO2  can  be  automatically  measured   b. SpO2  sensor  can  use  Masimo   pulse   oximeter     4) The...did   not  reach  the  threshold  of  92%.  Approximately   40  min  into  testing,  the

Hypoxia, Monitoring, and Mitigation System

DTIC Science & Technology

2015-08-01

Oxygen Saturation Measured via Pulse - Oximeter SRS Software Requirements Specification SW Software TI Texas Instruments uPROC Micro-Processor USAARL...Financial) Table of Figures Figure 1: Pulse OX custom module...Tasks 3, 4 and 5 have not been exercised. Sensor definition testing continued on the custom pulse -ox design. Additional refinement on the pulse

Measuring sub-bandage pressure: comparing the use of pressure monitors and pulse oximeters.

PubMed

Satpathy, A; Hayes, S; Dodds, S R

2006-03-01

To test the use of low-cost sub-bandage pressure monitors and pulse oximeters as part of a quality-control measure for graduated compression bandaging in leg ulcer clinics. Twenty-five healthy volunteers (mean age 40 years) providing 50 limbs were bandaged with a four-layer compression bandaging system. The ankle systolic pressure (ASP) was measured using a pulse oximeter (Nellcor NBP-40) before applying the graduated compression bandages. Interface pressure was measured by placing pressure sensors on the skin at three points (2cm above the medial malleolus; the widest part of the calf; and a point midway between them) in the supine and standing positions. The ASP was measured again with the pulse oximeter after the bandage had been applied, and the effect of the bandage on the ASP was recorded. The actual pressure created by the bandage was compared with the required pressure profile. Interface pressures varied with change of position and movement. With the operator blinded to the pressure monitors while applying the bandages, the target pressure of 35-40mmHg at the ankle was achieved in only 36% of limbs ([mean +/- 95% confidence interval]; 32.3 +/- 1.6mmHg [supine]; 38.4 +/- 2.4mmHg [standing position]). With the help of the pressure monitors, the target pressure was achieved in 78% of the limbs. There was no correlation between the pressure monitors and pulse oximeter pressures, demonstrating that the pulse oximeter is not a useful tool for measuring sub-bandage pressures. The results suggest a tool (interface pressure monitors) that is easy to operate should be available as part of quality assurance for treatment, training of care providers and education.

Precision of noninvasive hemoglobin-level measurement by pulse co-oximetry in patients admitted to intensive care units for severe gastrointestinal bleeds.

PubMed

Coquin, Julien; Dewitte, Antoine; Manach, Yannick Le; Caujolle, Marie; Joannes-Boyau, Olivier; Fleureau, Catherine; Janvier, Gérard; Ouattara, Alexandre

2012-09-01

Measurement of total hemoglobin, based on pulse co-oximetry, is a continuous and noninvasive method that has been principally evaluated in healthy volunteers subjected to hemodilution. We tested the hypothesis that its accuracy could adversely affect patients presenting with severe hemorrhage, which is traditionally associated with increased microvascular tone. Observational study. Twelve-bed mixed medico-surgical intensive care unit. Thirty-three patients admitted to our critical care unit for gastrointestinal bleeds were included. A spectrophotometric sensor was positioned on the patient's fingertip and connected to a pulse co-oximeter. During the first 24 hrs following admission, venous hemoglobin level was determined at the laboratory every 8 hrs and was compared with hemoglobin levels displayed on the pulse co-oximeter measurements screen and/or measured from capillary blood using a portable photometer. The primary end point was the percentage of inaccurate measurements, which were defined as >15% difference compared with reference values or their unavailability for any technical reason. Twenty-five (19%) measurements of pulse co-oximeter measurements were unavailable from the screen. Pulse co-oximeter measurements and capillary hemoglobin levels were significantly correlated to venous hemoglobin level. For venous hemoglobin level compared with pulse co-oximeter measurements (n = 105), and for venous hemoglobin level compared with capillary hemoglobin levels (n = 111), the biases were, respectively, 1.0 ± 1.9 g dL and 0.4 ± 1.0 g dL (p < .05). The proportion of inaccurate measurements was significantly higher for pulse co-oximeter measurements (56% vs. 15%, p < .05). Although the use of norepinephrine did not affect concordance parameters, unavailability of measurements was frequently observed (42% vs. 15%, p < .05). Determination of pulse co-oximetry-based hemoglobin in patients presenting with severe gastrointestinal bleeds can be inaccurate, which renders its use to guide transfusion decisions potentially hazardous. The unavailability of measurements, especially during vasopressor infusion, represents another serious limitation for hemorrhagic patients.

A Single-Chip CMOS Pulse Oximeter with On-Chip Lock-In Detection.

PubMed

He, Diwei; Morgan, Stephen P; Trachanis, Dimitrios; van Hese, Jan; Drogoudis, Dimitris; Fummi, Franco; Stefanni, Francesco; Guarnieri, Valerio; Hayes-Gill, Barrie R

2015-07-14

Pulse oximetry is a noninvasive and continuous method for monitoring the blood oxygen saturation level. This paper presents the design and testing of a single-chip pulse oximeter fabricated in a 0.35 µm CMOS process. The chip includes photodiode, transimpedance amplifier, analogue band-pass filters, analogue-to-digital converters, digital signal processor and LED timing control. The experimentally measured AC and DC characteristics of individual circuits including the DC output voltage of the transimpedance amplifier, transimpedance gain of the transimpedance amplifier, and the central frequency and bandwidth of the analogue band-pass filters, show a good match (within 1%) with the circuit simulations. With modulated light source and integrated lock-in detection the sensor effectively suppresses the interference from ambient light and 1/f noise. In a breath hold and release experiment the single chip sensor demonstrates consistent and comparable performance to commercial pulse oximetry devices with a mean of 1.2% difference. The single-chip sensor enables a compact and robust design solution that offers a route towards wearable devices for health monitoring.

A Single-Chip CMOS Pulse Oximeter with On-Chip Lock-In Detection

PubMed Central

He, Diwei; Morgan, Stephen P.; Trachanis, Dimitrios; van Hese, Jan; Drogoudis, Dimitris; Fummi, Franco; Stefanni, Francesco; Guarnieri, Valerio; Hayes-Gill, Barrie R.

2015-01-01

Pulse oximetry is a noninvasive and continuous method for monitoring the blood oxygen saturation level. This paper presents the design and testing of a single-chip pulse oximeter fabricated in a 0.35 µm CMOS process. The chip includes photodiode, transimpedance amplifier, analogue band-pass filters, analogue-to-digital converters, digital signal processor and LED timing control. The experimentally measured AC and DC characteristics of individual circuits including the DC output voltage of the transimpedance amplifier, transimpedance gain of the transimpedance amplifier, and the central frequency and bandwidth of the analogue band-pass filters, show a good match (within 1%) with the circuit simulations. With modulated light source and integrated lock-in detection the sensor effectively suppresses the interference from ambient light and 1/f noise. In a breath hold and release experiment the single chip sensor demonstrates consistent and comparable performance to commercial pulse oximetry devices with a mean of 1.2% difference. The single-chip sensor enables a compact and robust design solution that offers a route towards wearable devices for health monitoring. PMID:26184225

A wireless reflectance pulse oximeter with digital baseline control for unfiltered photoplethysmograms.

PubMed

Li, Kejia; Warren, Steve

2012-06-01

Pulse oximeters are central to the move toward wearable health monitoring devices and medical electronics either hosted by, e.g., smart phones or physically embedded in their design. This paper presents a small, low-cost pulse oximeter design appropriate for wearable and surface-based applications that also produces quality, unfiltered photo-plethysmograms (PPGs) ideal for emerging diagnostic algorithms. The design's "filter-free" embodiment, which employs only digital baseline subtraction as a signal compensation mechanism, distinguishes it from conventional pulse oximeters that incorporate filters for signal extraction and noise reduction. This results in high-fidelity PPGs with thousands of peak-to-peak digitization levels that are sampled at 240 Hz to avoid noise aliasing. Electronic feedback controls make these PPGs more resilient in the face of environmental changes (e.g., the device can operate in full room light), and data stream in real time across either a ZigBee wireless link or a wired USB connection to a host. On-board flash memory is available for store-and-forward applications. This sensor has demonstrated an ability to gather high-integrity data at fingertip, wrist, earlobe, palm, and temple locations from a group of 48 subjects (20 to 64 years old).

HAMS (Hypoxia, Monitoring, and Mitigation System) II Quarterly Progress Report (Technical and Financial)

DTIC Science & Technology

2015-04-10

Peripheral Interface SpO2 Arterial Oxygen Saturation Measured via Pulse - Oximeter SRS Software Requirements Specification SV Stroke Volume SVR Systemic...viewer ....................................................................................................... 9 Figure 3: Pulse OX custom module...analysis approaches will be gathered. Sensors which detect SpO2, pulse / pulse rate, ECG, and skin temperature will be researched and evaluated for

Novel wearable and wireless ring-type pulse oximeter with multi-detectors.

PubMed

Huang, Cheng-Yang; Chan, Ming-Che; Chen, Chien-Yue; Lin, Bor-Shyh

2014-09-19

The pulse oximeter is a popular instrument to monitor the arterial oxygen saturation (SPO2). Although a fingertip-type pulse oximeter is the mainstream one on the market at present, it is still inconvenient for long-term monitoring, in particular, with respect to motion. Therefore, the development of a wearable pulse oximeter, such as a finger base-type pulse oximeter, can effectively solve the above issue. However, the tissue structure of the finger base is complex, and there is lack of detailed information on the effect of the light source and detector placement on measuring SPO2. In this study, the practicability of a ring-type pulse oximeter with a multi-detector was investigated by optical human tissue simulation. The optimal design of a ring-type pulse oximeter that can provide the best efficiency of measuring SPO2 was discussed. The efficiency of ring-type pulse oximeters with a single detector and a multi-detector was also discussed. Finally, a wearable and wireless ring-type pulse oximeter was also implemented to validate the simulation results and was compared with the commercial fingertip-type pulse oximeter.

Novel Wearable and Wireless Ring-Type Pulse Oximeter with Multi-Detectors

PubMed Central

Huang, Cheng-Yang; Chan, Ming-Che; Chen, Chien-Yue; Lin, Bor-Shyh

2014-01-01

The pulse oximeter is a popular instrument to monitor the arterial oxygen saturation (SPO2). Although a fingertip-type pulse oximeter is the mainstream one on the market at present, it is still inconvenient for long-term monitoring, in particular, with respect to motion. Therefore, the development of a wearable pulse oximeter, such as a finger base-type pulse oximeter, can effectively solve the above issue. However, the tissue structure of the finger base is complex, and there is lack of detailed information on the effect of the light source and detector placement on measuring SPO2. In this study, the practicability of a ring-type pulse oximeter with a multi-detector was investigated by optical human tissue simulation. The optimal design of a ring-type pulse oximeter that can provide the best efficiency of measuring SPO2 was discussed. The efficiency of ring-type pulse oximeters with a single detector and a multi-detector was also discussed. Finally, a wearable and wireless ring-type pulse oximeter was also implemented to validate the simulation results and was compared with the commercial fingertip-type pulse oximeter. PMID:25244586

Interference Resilient Sigma Delta-Based Pulse Oximeter.

PubMed

Shokouhian, Mohsen; Morling, Richard; Kale, Izzet

2016-06-01

Ambient light and optical interference can severely affect the performance of pulse oximeters. The deployment of a robust modulation technique to drive the pulse oximeter LEDs can reduce these unwanted effects and increases the resilient of the pulse oximeter against artificial ambient light. The time division modulation technique used in conventional pulse oximeters can not remove the effect of modulated light coming from surrounding environment and this may cause huge measurement error in pulse oximeter readings. This paper presents a novel cross-coupled sigma delta modulator which ensures that measurement accuracy will be more robust in comparison with conventional fixed-frequency oximeter modulation technique especially in the presence of pulsed artificial ambient light. Moreover, this novel modulator gives an extra control over the pulse oximeter power consumption leading to improved power management.

Physiological Monitoring in Diving Mammals

DTIC Science & Technology

2014-09-30

currently developing two different units, one based upon the succesful construction of an oximeter used in Weddel seals (Guyton, Stanek et al. 1995), and...Picolas, Germany) is the only commercial driver with variable pulse duration, an output current up to 500 mA, 3 V forward voltage, frequency response...calibrate the oximeter sensor using human blood. Aim 2: Following the first field season in April, 2013, implantation and data collection using

Nurse opinions and pulse oximeter saturation target limits for preterm infants.

PubMed

Nghiem, Tuyet-Hang; Hagadorn, James I; Terrin, Norma; Syke, Sally; MacKinnon, Brenda; Cole, Cynthia H

2008-05-01

The objectives of this study were to compare pulse oximeter saturation limits targeted by nurses for extremely preterm infants during routine care with nurse opinions regarding appropriate pulse oximeter saturation limits and with policy-specified pulse oximeter saturation limits and to identify factors that influence pulse oximeter saturation limits targeted by nurses. We surveyed nurses in US NICUs with neonatal-perinatal fellowships in 2004. Data collected included pulse oximeter saturation limits targeted by nurses and by NICU policy when present, nurses' opinions about appropriate pulse oximeter saturation limits, and NICU and nurse characteristics. Factors associated with pulse oximeter saturation limits targeted by nurses were identified with hierarchical linear modeling. Among those eligible, 2805 (45%) nurses in 59 (60%) NICUs responded. Forty (68%) of 59 NICUs had a policy that specified a pulse oximeter saturation target range for extremely preterm infants. Among 1957 nurses at NICUs with policies, 540 (28%) accurately identified the upper and lower limits of their NICU's policy and also targeted these values in practice. NICU-specific SDs for individual nurse target limits were less at NICUs with versus without a policy for both upper and lower limits. Hierarchical linear modeling identified presence of pulse oximeter saturation policy, NICU-specific nurse group opinion, and individual nurse opinion as factors significantly associated with individual pulse oximeter saturation target limits. For each percentage point increase in individual opinion upper limit, the individual target upper limit increased by 0.41 percentage point at NICUs with a policy compared with 0.6 percentage point at NICUs with no policy. Presence of policy-specified pulse oximeter saturation limits, nurse group opinion, and individual nurse opinion were independently associated with individual nurse pulse oximeter saturation target limits during routine care of extremely preterm infants. The presence of a policy reduced the influence of individual nurse opinion on targeted pulse oximeter saturation limits and reduced variation among nurse target limits within NICUs.

Design of a finger base-type pulse oximeter

NASA Astrophysics Data System (ADS)

Lin, Bor-Shyh; Huang, Cheng-Yang; Chen, Chien-Yue; Lin, Jiun-Hung

2016-01-01

A pulse oximeter is a common medical instrument used for noninvasively monitoring arterial oxygen saturation (SpO2). Currently, the fingertip-type pulse oximeter is the prevalent type of pulse oximeter used. However, it is inconvenient for long-term monitoring, such as that under motion. In this study, a wearable and wireless finger base-type pulse oximeter was designed and implemented using the tissue optical simulation technique and the Monte Carlo method. The results revealed that a design involving placing the light source at 135°-165° and placing the detector at 75°-90° or 90°-105° yields the optimal conditions for measuring SpO2. Finally, the wearable and wireless finger base-type pulse oximeter was implemented and compared with the commercial fingertip-type pulse oximeter. The experimental results showed that the proposed optimal finger base-type pulse oximeter design can facilitate precise SpO2 measurement.

Design of a finger base-type pulse oximeter.

PubMed

Lin, Bor-Shyh; Huang, Cheng-Yang; Chen, Chien-Yue; Lin, Jiun-Hung

2016-01-01

A pulse oximeter is a common medical instrument used for noninvasively monitoring arterial oxygen saturation (SpO2). Currently, the fingertip-type pulse oximeter is the prevalent type of pulse oximeter used. However, it is inconvenient for long-term monitoring, such as that under motion. In this study, a wearable and wireless finger base-type pulse oximeter was designed and implemented using the tissue optical simulation technique and the Monte Carlo method. The results revealed that a design involving placing the light source at 135°-165° and placing the detector at 75°-90° or 90°-105° yields the optimal conditions for measuring SpO2. Finally, the wearable and wireless finger base-type pulse oximeter was implemented and compared with the commercial fingertip-type pulse oximeter. The experimental results showed that the proposed optimal finger base-type pulse oximeter design can facilitate precise SpO2 measurement.

Performance Evaluation of New-Generation Pulse Oximeters in the NICU: Observational Study.

PubMed

Nizami, Shermeen; Greenwood, Kim; Barrowman, Nick; Harrold, JoAnn

2015-09-01

This crossover observational study compares the data characteristics and performance of new-generation Nellcor OXIMAX and Masimo SET SmartPod pulse oximeter technologies. The study was conducted independent of either original equipment manufacturer (OEM) across eleven preterm infants in a Neonatal Intensive Care Unit (NICU). The SmartPods were integrated with Dräger Infinity Delta monitors. The Delta monitor measured the heart rate (HR) using an independent electrocardiogram sensor, and the two SmartPods collected arterial oxygen saturation (SpO2) and pulse rate (PR). All patient data were non-Gaussian. Nellcor PR showed a higher correlation with the HR as compared to Masimo PR. The statistically significant difference found in their median values (1% for SpO2, 1 bpm for PR) was deemed clinically insignificant. SpO2 alarms generated by both SmartPods were observed and categorized for performance evaluation. Results for sensitivity, positive predictive value, accuracy and false alarm rates were Nellcor (80.3, 50, 44.5, 50%) and Masimo (72.2, 48.2, 40.6, 51.8%) respectively. These metrics were not statistically significantly different between the two pulse oximeters. Despite claims by OEMs, both pulse oximeters exhibited high false alarm rates, with no statistically or clinically significant difference in performance. These findings have a direct impact on alarm fatigue in the NICU. Performance evaluation studies can also impact medical device purchase decisions made by hospital administrators.

Physiological Monitoring in Diving Mammals

DTIC Science & Technology

2015-09-30

obtain the required 70 MHz sine wave, we instead created a 10 MHz rectangle pulse wave and used a 70 MHz band pass filter (KR electronics 2657 sma) to...animals (Table 1) were sedated on the beach and transported to Long Marine Laboratory where the data logger was attached and the oximeter sensor...implanted under injectable sedation. In addition, the implantation procedure of the oximeter was assessed and we carefully noted any indications of trauma

The Sounds of Desaturation: A Survey of Commercial Pulse Oximeter Sonifications.

PubMed

Loeb, Robert G; Brecknell, Birgit; Sanderson, Penelope M

2016-05-01

The pulse oximeter has been a standard of care medical monitor for >25 years. Most manufacturers include a variable-pitch pulse tone in their pulse oximeters. Research has shown that the acoustic properties of variable-pitch tones are not standardized. In this study, we surveyed the properties of pulse tones from 21 pulse oximeters, consisting of 1 to 4 instruments of 11 different models and 8 brands. Our goals were to fully document the sounds over saturation values 0% to 100%, test whether tones become quieter at low saturation values, and create a public repository of pulse oximeter recordings for future use. A convenience sample of commercial pulse oximeters in use at one hospital was studied. Audiovisual recordings of each pulse oximeter's display and sounds were taken while it monitored a simulator starting at a saturation of 100% and slowly decreasing in 1% steps until the saturation reached 0%. Recorded pulse tones were analyzed for spectral frequency and total power. Audio files for each pulse oximeter containing 100 pulse tones, one at every saturation value, were created for inclusion in the repository. Recordings containing 509 to 1053 pulse tones were made from the 21 pulse oximeters. Fundamental frequencies at 100% saturation ranged from 479 to 921 Hz, and fundamental frequencies at 1% saturation ranged from 38 to 404 Hz. The pulse tones from all but one model pulse oximeter contained harmonics. Pulse tone step sizes were linear in 6 models and logarithmic in 6 models. Only 6 pulse oximeter models decreased the pulse tone pitch at every decrease in saturation; all others decreased the pitch at only select saturation thresholds. Five pulse oximeter models stopped decreasing pitch altogether once the saturation reached a certain lower threshold. Pulse tone power (perceived as loudness) changed with saturation level for all pulse oximeters, increasing above baseline as saturation decreased from 100% and decreasing to levels below baseline at low saturation values. Current pulse oximeters use different techniques to address the competing goals of (1) using pitch steps that are large enough to be readily perceived, and (2) conveying saturation values from 0 to 100 within a limited range of sound frequencies. From a clinical perspective, 2 techniques for increasing perceivability (increasing the frequency range and using ratio step sizes) have no drawback, but 2 techniques (not changing pitch at every saturation change and using a lower saturation cutoff) do have potential clinical drawbacks. On the basis of our findings, we have made suggestions for clinicians and manufacturers.

Comparative testing of pulse oximeter probes.

PubMed

van Oostrom, Johannes H; Melker, Richard J

2004-05-01

The testing of pulse oximeter probes is generally limited to the integrity of the electrical circuit and does not include the optical properties of the probes. Few pulse oximeter testers evaluate the accuracy of both the monitor and the probe. We designed a study to compare the accuracy of nonproprietary probes (OSS Medical) designed for use with Nellcor, Datex-Ohmeda, and Criticare pulse oximeter monitors with that of their corresponding proprietary probes by using a commercial off-the-shelf pulse oximeter tester (Index). The Index pulse oximeter tester does include testing of the optical properties of the pulse oximeter probes. The pulse oximeter tester was given a controlled input that simulated acute apnea. Desaturation curves were automatically recorded from the pulse oximeter monitors with a data-collection computer. Comparisons between equivalent proprietary and nonproprietary probes were performed. Data were analyzed by using univariate and multivariate general linear model analysis. Five OSS Medical probe models were statistically better than the equivalent proprietary probes. The remainder of the probes were statistically similar. Comparative and simulation studies can have significant advantages over human studies because they are cost-effective, evaluate equipment in a clinically relevant scenario, and pose no risk to patients, but they are limited by the realism of the simulation. We studied the performance of pulse oximeter probes in a simulated environment. Our results show significant differences between some probes that affect the accuracy of measurement.

Advanced Pulse Oximetry System for Remote Monitoring and Management

PubMed Central

Pak, Ju Geon; Park, Kee Hyun

2012-01-01

Pulse oximetry data such as saturation of peripheral oxygen (SpO2) and pulse rate are vital signals for early diagnosis of heart disease. Therefore, various pulse oximeters have been developed continuously. However, some of the existing pulse oximeters are not equipped with communication capabilities, and consequently, the continuous monitoring of patient health is restricted. Moreover, even though certain oximeters have been built as network models, they focus on exchanging only pulse oximetry data, and they do not provide sufficient device management functions. In this paper, we propose an advanced pulse oximetry system for remote monitoring and management. The system consists of a networked pulse oximeter and a personal monitoring server. The proposed pulse oximeter measures a patient's pulse oximetry data and transmits the data to the personal monitoring server. The personal monitoring server then analyzes the received data and displays the results to the patient. Furthermore, for device management purposes, operational errors that occur in the pulse oximeter are reported to the personal monitoring server, and the system configurations of the pulse oximeter, such as thresholds and measurement targets, are modified by the server. We verify that the proposed pulse oximetry system operates efficiently and that it is appropriate for monitoring and managing a pulse oximeter in real time. PMID:22933841

Advanced pulse oximetry system for remote monitoring and management.

PubMed

Pak, Ju Geon; Park, Kee Hyun

2012-01-01

Pulse oximetry data such as saturation of peripheral oxygen (SpO(2)) and pulse rate are vital signals for early diagnosis of heart disease. Therefore, various pulse oximeters have been developed continuously. However, some of the existing pulse oximeters are not equipped with communication capabilities, and consequently, the continuous monitoring of patient health is restricted. Moreover, even though certain oximeters have been built as network models, they focus on exchanging only pulse oximetry data, and they do not provide sufficient device management functions. In this paper, we propose an advanced pulse oximetry system for remote monitoring and management. The system consists of a networked pulse oximeter and a personal monitoring server. The proposed pulse oximeter measures a patient's pulse oximetry data and transmits the data to the personal monitoring server. The personal monitoring server then analyzes the received data and displays the results to the patient. Furthermore, for device management purposes, operational errors that occur in the pulse oximeter are reported to the personal monitoring server, and the system configurations of the pulse oximeter, such as thresholds and measurement targets, are modified by the server. We verify that the proposed pulse oximetry system operates efficiently and that it is appropriate for monitoring and managing a pulse oximeter in real time.

78 FR 14097 - Pulse Oximeters-Premarket Notification Submissions [510(k)s]; Guidance for Industry and Food and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-04

... (Formerly 2007D-0252)] Pulse Oximeters--Premarket Notification Submissions [510(k)s]; Guidance for Industry... entitled ``Pulse Oximeters--Premarket Notification Submissions [510(k)s].'' This guidance document pertains to non-invasive pulse oximeters intended for prescription use to measure arterial blood oxygen...

[Precision and accuracy of "a pocket" pulse oximeter in Mexico City].

PubMed

Torre-Bouscoulet, Luis; Chávez-Plascencia, Elizabeth; Vázquez-García, Juan Carlos; Pérez-Padilla, Rogelio

2006-01-01

Pulse oximeters are frequently used in the clinical practice and we must known their precision and accuracy. The objective was to evaluate the precision and accuracy of a "pocket" pulse oximeter at an altitude of 2,240 m above sea level. We tested miniature pulse oximeters (Onyx 9,500, Nonin Finger Pulse Oximeter) in 96 patients sent to the pulmonary laboratory for an arterial blood sample. Patients were tested with 5 pulse oximeters placed in each of the fingers of the hand oposite to that used for the arterial puncture. The gold standard was the oxygen saturation of the arterial blood sample. Blood samples had SaO2 of 87.2 +/- 11.0 (between 42.2 and 97.9%). Pulse oximeters had a mean error of 0.28 +/- 3.1%. SaO2 = (1.204 x SpO2) - 17.45966 (r = 0.92, p < 0.0001). Intraclass correlation coefficient between each of five pulse oximeters against the arterial blood standard ranged between 0.87 and 0.99. HbCO (2.4 +/- 0.6) did not affect the accuracy. The miniature oximeter Nonin is precise and accurate at 2,240 m of altitude. The observed levels of HbCO did not affect the performance of the equipment. The oximeter good performance, small size and low cost enhances its clinical usefulness.

Validation of the Nonin 8600V Pulse Oximeter for heart rate and oxygen saturation measurements in rats.

PubMed

Bernard, Susan L; An, Dowon; Glenny, Robb W

2004-05-01

This report validates the use and limitations of the Nonin Pulse Oximeter for measuring heart rate and oxygen saturation in rats. Eight anesthetized Sprague-Dawley rats were intubated and catheterized. Oxygen saturation was directly measured from arterial blood by using a Radiometer OSM3 Hemoximeter adjusted for rat blood as well as indirectly by using the Nonin Pulse Oximeter. Oxygen saturation was changed by varying the level of inhaled oxygen. Heart rate was measured in two ways: 1) by using the signal from the Nonin Pulse Oximeter and 2) by counting the pressure pulses from the transduced blood pressure. There was excellent agreement between heart rate values measured by the Nonin Pulse Oximeter and that measured by counting the pulses from the arterial blood pressure recording. The Nonin Pulse Oximeter underestimated oxygen saturations by about 3% to 5% compared to the Hemoximeter. Overall, the pulse oximeter reflected important trends in oxygen saturations, making it a useful tool for laboratory animal medicine.

Improved accuracy of methemoglobin detection by pulse CO-oximetry during hypoxia.

PubMed

Feiner, John R; Bickler, Philip E

2010-11-01

Methemoglobin in the blood cannot be detected by conventional pulse oximetry and may bias the oximeter's estimate (Spo(2)) of the true arterial functional oxygen saturation (Sao(2)). A recently introduced "pulse CO-oximeter" (Masimo Rainbow SET® Radical-7) that measures SpMet, a noninvasive measurement of the percentage of methemoglobin in arterial blood (%MetHb), was shown to read spuriously high values during hypoxia. In this study we sought to determine whether the manufacturer's modifications have improved the device's ability to detect and accurately measure methemoglobin and deoxyhemoglobin simultaneously. Twelve healthy adult volunteer subjects were fitted with sensors on the middle finger of each hand, and a radial arterial catheter was placed for blood sampling. Intravenous administration of ∼300 mg of sodium nitrite elevated subjects' methemoglobin levels to a 7% to 11% target level, and hypoxia was induced to different levels of Sao(2) (70% to 100%) by varying fractional inspired oxygen. Pulse CO-oximeter readings were compared with arterial blood values measured with a Radiometer ABL800 FLEX multi-wavelength oximeter. Pulse CO-oximeter methemoglobin reading performance was analyzed by the bias (SpMet-%MetHb), and by observing the incidence of meaningful reading errors and predictive value at the various hypoxia levels. Spo(2) bias (Spo(2)--Sao(2)), precision, and root-mean-square error were evaluated during conditions of elevated methemoglobin. Observations spanned 74% to 100% Sao(2) and 0.4% to 14.4% methemoglobin with 307 blood draws and 602 values from the 2 oximeters. Masimo methemoglobin reading bias and precision over the full Sao(2) span was 0.16% and 0.83%, respectively, and was similar across the span. Masimo Spo(2) readings were biased -1.93% across the 70% to 100% Sao(2) range. The Rainbow's methemoglobin readings are acceptably accurate over an oxygen saturation range of 74%-100% and a methemoglobin range of 0%-14%.

Comparison of Cerebral Oximeter and Pulse Oximeter Values in the First 72 Hours in Premature, Asphyctic and Healthy Newborns.

PubMed

Kaya, A; Okur, M; Sal, E; Peker, E; Köstü, M; Tuncer, O; Kırımi, E

2014-12-01

The monitoring of oxygenation is essential for providing patient safety and optimal results. We aimed to determine brain oxygen saturation values in healthy, asphyctic and premature newborns and to compare cerebral oximeter and pulse oximeter values in the first 72 hours of life in neonatal intensive care units. This study was conducted at the neonatal intensive care unit (NICU) of Van Yüzüncü Yil University Research and Administration Hospital. Seventy-five neonatal infants were included in the study (28 asphyxia, 24 premature and 23 mature healthy infants for control group). All infants were studied within the first 72 hours of life. We used a Somanetics 5100C cerebral oximeter (INVOS cerebral/somatic oximeter, Troy, MI, USA). The oxygen saturation information was collected by a Nellcor N-560 pulse oximeter (Nellcor-Puriton Bennet Inc, Pleasanton, CA, USA). In the asphyxia group, the cerebral oximeter average was 76.85 ± 14.1, the pulse oximeter average was 91.86 ± 5.9 and the heart rate average was 139.91 ± 22.3. Among the premature group, the cerebral oximeter average was 79.08 ± 9.04, the pulse oximeter average was 92.01 ± 5.3 and the heart rate average was 135.35 ± 17.03. In the control group, the cerebral oximeter average was 77.56 ± 7.6, the pulse oximeter average was 92.82 ± 3.8 and the heart rate average was 127.04 ± 19.7. Cerebral oximeter is a promising modality in bedside monitoring in neonatal intensive care units. It is complementary to pulse oximeter. It may be used routinely in neonatal intensive care units.

Comparison of Cerebral Oximeter and Pulse Oximeter Values in the First 72 Hours in Premature, Asphyctic and Healthy Newborns

PubMed Central

Kaya, A; Okur, M; Sal, E; Peker, E; Köstü, M; Tuncer, O; Kirimi, E

2014-01-01

ABSTRACT Aim: The monitoring of oxygenation is essential for providing patient safety and optimal results. We aimed to determine brain oxygen saturation values in healthy, asphyctic and premature newborns and to compare cerebral oximeter and pulse oximeter values in the first 72 hours of life in neonatal intensive care units. Methods: This study was conducted at the neonatal intensive care unit (NICU) of Van Yüzüncü Yil University Research and Administration Hospital. Seventy-five neonatal infants were included in the study (28 asphyxia, 24 premature and 23 mature healthy infants for control group). All infants were studied within the first 72 hours of life. We used a Somanetics 5100C cerebral oximeter (INVOS cerebral/somatic oximeter, Troy, MI, USA). The oxygen saturation information was collected by a Nellcor N-560 pulse oximeter (Nellcor-Puriton Bennet Inc, Pleasanton, CA, USA). Results: In the asphyxia group, the cerebral oximeter average was 76.85 ± 14.1, the pulse oximeter average was 91.86 ± 5.9 and the heart rate average was 139.91 ± 22.3. Among the premature group, the cerebral oximeter average was 79.08 ± 9.04, the pulse oximeter average was 92.01 ± 5.3 and the heart rate average was 135.35 ± 17.03. In the control group, the cerebral oximeter average was 77.56 ± 7.6, the pulse oximeter average was 92.82 ± 3.8 and the heart rate average was 127.04 ± 19.7. Conclusion: Cerebral oximeter is a promising modality in bedside monitoring in neonatal intensive care units. It is complementary to pulse oximeter. It may be used routinely in neonatal intensive care units. PMID:25867556

Pulse Oximetry

MedlinePlus

... carrying. By using a small device called a pulse oximeter , your blood oxygen level can be checked without ... and “Oxygen Therapy for Children”) How does a pulse oximeter work? A pulse oximeter comes either as a ...

Concurrent validity of resting pulse-rate measurements: a comparison of 2 smartphone applications, the polar H7 belt monitor, and a pulse oximeter with bluetooth.

PubMed

Cheatham, Scott W; Kolber, Morey J; Ernst, Michael P

2015-05-01

Pulse rate is commonly measured manually or with commercial wrist or belt monitors. More recently, pulse-rate monitoring has become convenient with the use of mobile technology that allows monitoring through a smartphone camera. This optical technology offers many benefits, although the clinimetric properties have not been extensively studied. Observational study of reliability Setting: University kinesiology laboratory. 30 healthy, recreationally active adults. Concurrent measurement of pulse rate using 2 smartphone applications (fingertip, face-scan,) with the Polar H7 belt and pulse oximeter. Average resting pulse rate for 5 min in 3 positions (supine, sitting, and prone). Concurrent validity in supine and standing was good between the 2 applications and the Polar H7 (intraclass correlation coefficient [ICC] .80-.98) and pulse oximeter (ICC .82-.98). For sitting, the validity was good between the fingertip application, Polar H7 (ICC .97), and pulse oximeter (ICC .97). The face-scan application had moderate validity with the Polar H7 (ICC .74) and pulse oximeter (ICC .69). The minimal detectable change (MDC90) between the fingertip application and Polar H7 ranged from 1.38 to 4.36 beats/min (BPM) and from 0.69 to 2.97 BPM for the pulse oximeter with both positions. The MDC90 between the face-scan application and Polar H7 ranged from 11.88 to 12.83 BPM and from 0.59 to 17.72 BPM for the pulse oximeter. The 95% limits of agreement suggest that the fingertip application may vary between 2.40 and 3.59 BPM with the Polar H7 and between 3.40 and 3.42 BPM with the pulse oximeter. The face-scan application may vary between 3.46 and 3.52 BPM with the Polar H7 and between 2.54 and 3.46 BPM with the pulse oximeter. Pulse-rate measurements may be effective using a fingertip application, belt monitor, and pulse oximeter. The fingertip scanner showed superior results compared with the face scanner, which only demonstrated modest validity compared with the Polar H7 and pulse oximeter.

Does pulse oximeter use impact health outcomes? A systematic review

PubMed Central

English, Mike; Shepperd, Sasha

2016-01-01

Objective Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters are used to inform diagnosis and treatment (excluding surgical care) compared with health facilities where pulse oximeters are not used? Design Studies were obtained for this systematic literature review by systematically searching the Database of Abstracts of Reviews of Effects, Cochrane, Medion, PubMed, Web of Science, Embase, Global Health, CINAHL, WHO Global Health Library, international health organisation and NGO websites, and study references. Patients Children 0–19 years presenting for the first time to hospitals, emergency departments or primary care facilities. Interventions Included studies compared outcomes where pulse oximeters were used for diagnosis and/or management, with outcomes where pulse oximeters were not used. Main outcome measures: mortality, morbidity, length of stay, and treatment and management changes. Results The evidence is low quality and hypoxaemia definitions varied across studies, but the evidence suggests pulse oximeter use with children can reduce mortality rates (when combined with improved oxygen administration) and length of emergency department stay, increase admission of children with previously unrecognised hypoxaemia, and change physicians’ decisions on illness severity, diagnosis and treatment. Pulse oximeter use generally increased resource utilisation. Conclusions As international organisations are investing in programmes to increase pulse oximeter use in low-income settings, more research is needed on the optimal use of pulse oximeters (eg, appropriate oxygen saturation thresholds), and how pulse oximeter use affects referral and admission rates, length of stay, resource utilisation and health outcomes. PMID:26699537

Sensor system for non-invasive optical carboxy-and methemoglobin determination

NASA Astrophysics Data System (ADS)

Timm, Ulrich; Gewiss, Helge; Kraitl, Jens; Brock, Beate; Ewald, Hartmut

2017-02-01

The pulse oximetry is a non-invasive method to monitor the oxygen saturation and is clinically used for many years. However this technology has some limitations. In case of the presence of dysfunctional hemoglobin derivatives as carboxyhemoglobin (COHb) or methemoglobin (MetHb) the readings of the pulse oximeter are distorted. This erroneous diagnosis of the patient's status can result in a life threatening situation. This paper will describe a sensor system for noninvasive determination of carboxy- and methemoglobin.

Research: Comparison of the Accuracy of a Pocket versus Standard Pulse Oximeter.

PubMed

da Costa, João Cordeiro; Faustino, Paula; Lima, Ricardo; Ladeira, Inês; Guimarães, Miguel

2016-01-01

Pulse oximetry has become an essential tool in clinical practice. With patient self-management becoming more prevalent, pulse oximetry self-monitoring has the potential to become common practice in the near future. This study sought to compare the accuracy of two pulse oximeters, a high-quality standard pulse oximeter and an inexpensive pocket pulse oximeter, and to compare both devices with arterial blood co-oximetry oxygen saturation. A total of 95 patients (35.8% women; mean [±SD] age 63.1 ± 13.9 years; mean arterial pressure was 92 ± 12.0 mmHg; mean axillar temperature 36.3 ± 0.4°C) presenting to our hospital for blood gas analysis was evaluated. The Bland-Altman technique was performed to calculate bias and precision, as well as agreement limits. Student's t test was performed. Standard oximeter presented 1.84% bias and a precision error of 1.80%. Pocket oximeter presented a bias of 1.85% and a precision error of 2.21%. Agreement limits were -1.69% to 5.37% (standard oximeter) and -2.48% to 6.18% (pocket oximeter). Both oximeters presented bias, which was expected given previous research. The pocket oximeter was less precise but had agreement limits that were comparable with current evidence. Pocket oximeters can be powerful allies in clinical monitoring of patients based on a self-monitoring/efficacy strategy.

The Effects of Hypoxic Hypoxia on Cognitive Performance Decay

DTIC Science & Technology

2015-05-04

time (ms). A pulse oximeter comparison was also conducted comparing a helmet-mounted Nonin vs. Propaq finger-mounted oximeter . Cognitive performance...differences were seen for any of the outcome measures when comparing the recovery phase data to the baseline phase data. Pulse oximeter comparison...9 3.3.2 Pulse Oximeter Data ....................................................................................... 11

Does pulse oximeter use impact health outcomes? A systematic review.

PubMed

Enoch, Abigail J; English, Mike; Shepperd, Sasha

2016-08-01

Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters are used to inform diagnosis and treatment (excluding surgical care) compared with health facilities where pulse oximeters are not used? Studies were obtained for this systematic literature review by systematically searching the Database of Abstracts of Reviews of Effects, Cochrane, Medion, PubMed, Web of Science, Embase, Global Health, CINAHL, WHO Global Health Library, international health organisation and NGO websites, and study references. Children 0-19 years presenting for the first time to hospitals, emergency departments or primary care facilities. Included studies compared outcomes where pulse oximeters were used for diagnosis and/or management, with outcomes where pulse oximeters were not used. mortality, morbidity, length of stay, and treatment and management changes. The evidence is low quality and hypoxaemia definitions varied across studies, but the evidence suggests pulse oximeter use with children can reduce mortality rates (when combined with improved oxygen administration) and length of emergency department stay, increase admission of children with previously unrecognised hypoxaemia, and change physicians' decisions on illness severity, diagnosis and treatment. Pulse oximeter use generally increased resource utilisation. As international organisations are investing in programmes to increase pulse oximeter use in low-income settings, more research is needed on the optimal use of pulse oximeters (eg, appropriate oxygen saturation thresholds), and how pulse oximeter use affects referral and admission rates, length of stay, resource utilisation and health outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

VCSEL based, wearable, continuously monitoring pulse oximeter.

PubMed

Kollmann, Daniel; Hogan, William K; Steidl, Charles; Hibbs-Brenner, Mary K; Hedin, Daniel S; Lichter, Patrick A

2013-01-01

We present the development of a novel pulse oximeter based on low power, low cost, Vertical Cavity Surface Emitting Laser (VCSEL) technology. This new design will help address a need to perform regular measurements of pulse oximetry for patients with chronic obstructive pulmonary disease. VCSELs with wavelengths suitable for pulse oximetry were developed and packaged in a PLCC package for a low cost solution that is easy to integrate into a pulse oximeter design. The VCSELs were integrated into a prototype pulse oximeter that is unobtrusive and suitable for long term wearable use. The prototype achieved good performance compared the Nonin Onyx II pulse oximeter at less than one fifth the weight in a design that can be worn behind the ear like a hearing aid.

Diaphragmatic hernia repair - congenital

MedlinePlus

... how well the lungs are working. A light sensor (called a pulse oximeter) is taped to baby's skin to monitor the oxygen level in the blood. Your baby may be given medicines to control blood pressure and keep them comfortable. Your baby will have ...

Automated Prediction of Early Blood Transfusion and Mortality in Trauma Patients

DTIC Science & Technology

2014-09-24

We hypothesized that analysis of pulse oximeter signals could predict blood transfusion and mortality as accurately as conventional vital signs(VSs...to 3-hour transfusion, MT, and mortality no differently from pulse oximeter signals alone. Pulse oximeter features collected in the first 15 minutes...time is an unrealized goal. We hypothesized that analysis of pulse oximeter signals could predict blood transfusion and mortality as accurately as

Optical surgical navigation system causes pulse oximeter malfunction.

PubMed

Satoh, Masaaki; Hara, Tetsuhito; Tamai, Kenji; Shiba, Juntaro; Hotta, Kunihisa; Takeuchi, Mamoru; Watanabe, Eiju

2015-01-01

An optical surgical navigation system is used as a navigator to facilitate surgical approaches, and pulse oximeters provide valuable information for anesthetic management. However, saw-tooth waves on the monitor of a pulse oximeter and the inability of the pulse oximeter to accurately record the saturation of a percutaneous artery were observed when a surgeon started an optical navigation system. The current case is thought to be the first report of this navigation system interfering with pulse oximetry. The causes of pulse jamming and how to manage an optical navigation system are discussed.

Accuracy of methemoglobin detection by pulse CO-oximetry during hypoxia.

PubMed

Feiner, John R; Bickler, Philip E; Mannheimer, Paul D

2010-07-01

Methemoglobin in the blood cannot be detected by conventional pulse oximetry, although it can bias the oximeter's estimate (Spo2) of the true arterial functional oxygen saturation (Sao2). A recently introduced "Pulse CO-Oximeter" (Masimo Rainbow SET(R) Radical-7 Pulse CO-Oximeter, Masimo Corp., Irvine, CA) is intended to additionally monitor noninvasively the fractional carboxyhemoglobin and methemoglobin content in blood. The purpose of our study was to determine whether hypoxia affects the new device's estimated methemoglobin reading accuracy, and whether the presence of methemoglobin impairs the ability of the Radical-7 and a conventional pulse oximeter (Nonin 9700, Nonin Medical Inc., Plymouth, MN) to detect decreases in Sao2. Eight and 6 healthy adults were included in 2 study groups, respectively, each fitted with multiple sensors and a radial arterial catheter for blood sampling. In the first group, IV administration of approximately 300 mg sodium nitrite increased subjects' methemoglobin level to a 7% to 8% target and hypoxia was induced to different levels of Sao2 (70%-100%) by varying fractional inspired oxygen. In the second group, 15% methemoglobin at room air and 80% Sao2 were targeted. Pulse CO-oximeter readings were compared with arterial blood values measured using a Radiometer multiwavelength hemoximeter. Pulse CO-oximeter methemoglobin reading performance was analyzed by observing the incidence of meaningful reading errors at the various hypoxia levels. This was used to determine the impact on predictive values for detecting methemoglobinemia. Spo2 reading bias, precision, and root mean square error were evaluated during conditions of elevated methemoglobin. Observations spanned 66.2% to 99% Sao2 and 0.6% to 14.4% methemoglobin over the 2 groups (170 blood draws). Masimo methemoglobin reading bias and precision over the full Sao2 span was 7.7% +/- 13.0%. Best accuracy was found in the 95% to 100% Sao2 range (1.9% +/- 2.5%), progressing to its worst in the 70% to 80% range (24.8% +/- 15.6%). Occurrence of methemoglobin readings in error >5% increased over each 5-point decrease in Sao2 (P < 0.05). Masimo Spo2 readings were biased -6.3% +/- 3.0% in the 95% to 100% Sao2 range with 4% to 8.3% methemoglobin. Both the Radical-7 and Nonin 9700 pulse oximeters accurately detected decreases in Sao(2) <90% with 4% to 15% methemoglobin, despite displaying low Spo2 readings when Sao2 was >95%. The Radical-7's methemoglobin readings become progressively more inaccurate as Sao2 decreases <95%, at times overestimating true values by 10% to 40%. Elevated methemoglobin causes the Spo2 readings to underestimate Sao2 similar to conventional 2-wavelength pulse oximeters at high saturation. Spo2 readings from both types of instruments continue to trend downward during the development of hypoxemia (Sao2 <90%) with methemoglobin levels up to 15%.

Determining the best method of Nellcor pulse oximeter sensor application in neonates.

PubMed

Saraswat, A; Simionato, L; Dawson, J A; Thio, M; Kamlin, C O F; Owen, L; Schmölzer, G; Davis, P G

2012-05-01

To identify the optimal sensor application method that gave the quickest display of accurate heart rate (HR) data using the Nellcor OxiMax N-600x pulse oximeter (PO). Stable infants who were monitored with an electrocardiograph were included. Three sensor application techniques were studied: (i) sensor connected to cable, then applied to infant; (ii) sensor connected to cable, applied to investigator's finger, and then to infant; (iii) sensor applied to infant, then connected to cable. The order of techniques tested was randomized for each infant. Time taken to apply the PO sensor, to display data and to display accurate data (HR(PO) = HR(ECG) ± 3 bpm) were recorded using a stopwatch. Forty infants were studied [mean (SD) birthweight, 1455 (872) g; gestational age, 31 (4) weeks; post-menstrual age, 34 (4) weeks]. Method 3 acquired any data significantly faster than methods 1 (p = 0.013; CI, -9.6 to -3.0 sec) and 2 (p = 0.004; CI, -5.9 to -1.2 sec). Method 3 acquired accurate data significantly faster than method 1 (p = 0.016; CI, -9.4 to -1.0 sec), but not method 2 (p = 0.28). Applying the sensor to the infant before connecting it to the cable yields the fastest acquisition of accurate HR data from the Nellcor PO. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

Does the estimation of light attenuation in tissue increase the accuracy of reflectance pulse oximetry at low oxygen saturations in vivo?

PubMed

Kisch-Wedel, H; Bernreuter, P; Kemming, G; Albert, M; Zwissler, B

2009-09-01

A new technique was validated in vivo in reflectance pulse oximetry for measuring low oxygen saturations. Two pairs of light emitter/detector diodes allow for estimation of light attenuation (LA) in tissue, which is assumed to be responsible for the inaccuracy of pulse oximetry at less than 70 % arterial oxygen saturation. For validation, 17 newborn piglets were desaturated stepwise from 21 % to 1.25 % inspiratory oxygen concentration during general anesthesia, and arterial oxygen saturation was measured with the reflectance pulse oximeter adjusted for LA in tissue, with a standard transmission pulse oximeter and a hemoximeter. LA in tissue could be quantified and was different between snout and foreleg (probability level (p) < 0.05). At arterial oxygen saturations above 70 %, the bias between the methods was at 0 %-1 % and the variability 4 %-5 %. From 2 % to 100 % arterial oxygen saturation, the reflectance pulse oximeter estimated oxyhemoglobin saturation more accurately than a conventional transmission pulse oximeter (p < 0.05). At low oxygen saturations below 70 %, the bias and variability of the reflectance pulse oximeter calibration were closer to the hemoximeter measurements than the transmission pulse oximeter (p < 0.05). The variability of the reflectance pulse oximeter was slightly lower than the traditional oximeter by taking into account the LA in tissue (9 % versus 11 % -15 %, ns), and thus, the quality of the individual calibration lines improved (correlation coefficient, p < 0.05).

Physiological Parameter Monitoring from Optical Recordings with a Mobile Phone

PubMed Central

Scully, Christopher G.; Lee, Jinseok; Meyer, Joseph; Gorbach, Alexander M.; Granquist-Fraser, Domhnull; Mendelson, Yitzhak

2012-01-01

We show that a mobile phone can serve as an accurate monitor for several physiological variables, based on its ability to record and analyze the varying color signals of a fingertip placed in contact with its optical sensor. We confirm the accuracy of measurements of breathing rate, cardiac R-R intervals, and blood oxygen saturation, by comparisons to standard methods for making such measurements (respiration belts, ECGs, and pulse-oximeters, respectively). Measurement of respiratory rate uses a previously reported algorithm developed for use with a pulse-oximeter, based on amplitude and frequency modulation sequences within the light signal. We note that this technology can also be used with recently developed algorithms for detection of atrial fibrillation or blood loss. PMID:21803676

HAMS II Quarterly Progress Report (Technical and Financial)

DTIC Science & Technology

2015-01-09

Resistance - Flow Relationships .................................................................................. 10 Figure 3. Pulse Oximeter Front-end...19 Figure 10. Pulse Oximeter versus NIRS...TMS320C5515 DSP Medical Development Kit (MDK) for Pulse Oximeter Implementation. This evaluation system provides the capability to leverage into the

The sound intensity and characteristics of variable-pitch pulse oximeters.

PubMed

Yamanaka, Hiroo; Haruna, Junichi; Mashimo, Takashi; Akita, Takeshi; Kinouchi, Keiko

2008-06-01

Various studies worldwide have found that sound levels in hospitals significantly exceed the World Health Organization (WHO) guidelines, and that this noise is associated with audible signals from various medical devices. The pulse oximeter is now widely used in health care; however the health effects associated with the noise from this equipment remain largely unclarified. Here, we analyzed the sounds of variable-pitch pulse oximeters, and discussed the possible associated risk of sleep disturbance, annoyance, and hearing loss. The Nellcor N 595 and Masimo SET Radical pulse oximeters were measured for equivalent continuous A-weighted sound pressure levels (L(Aeq)), loudness levels, and loudness. Pulse beep pitches were also identified using Fast Fourier Transform (FFT) analysis and compared with musical pitches as controls. Almost all alarm sounds and pulse beeps from the instruments tested exceeded 30 dBA, a level that may induce sleep disturbance and annoyance. Several alarm sounds emitted by the pulse oximeters exceeded 70 dBA, which is known to induce hearing loss. The loudness of the alarm sound of each pulse oximeter did not change in proportion to the sound volume level. The pitch of each pulse beep did not correspond to musical pitch levels. The results indicate that sounds from pulse oximeters pose a potential risk of not only sleep disturbance and annoyance but also hearing loss, and that these sounds are unnatural for human auditory perception.

Evaluation of the Human/Extreme Environment Interaction: Implications for Enhancing Operational Performance and Recovery

DTIC Science & Technology

2014-02-01

and 4 hours during the recovery using a pulse oximeter (Nonin Onyx II 9550, Plymouth, MN). Analysis Skeletal Muscle RNA isolation. An 8-20...Oximetry. Blood oxygen saturation was evaluated before and after exercise, and during recovery at 0:30, 2:30, 4:30, and 6:00 using a pulse oximeter ...cycling for 45 minutes, post exercise, and every hour during the 6-hour recovery using pulse oximeter (Nonin Onyx Finger Pulse Oximeter , Nonin Medical

Monitoring pulse oximetry via radiotelemetry in freely-moving lambs.

PubMed

Reix, Philippe; Dumont, Sylvain; Duvareille, Charles; Cyr, Jonathan; Moreau-Bussière, François; Arsenault, Julie; Praud, Jean-Paul

2005-05-12

This study was aimed at validating the use of a custom-made wireless pulse oximeter in freely moving lambs, using radiotelemetry transmission. First, measurements obtained simultaneously using the new, wireless oximeter and a standard commercially-available pulse oximeter (Nonin 8500) were compared in five lambs during 5min episodes of normoxia, hypoxia and hyperoxia. Correlation between the two oximeters for both SpO(2) and heart rate was very good, regardless of oxygenation conditions. Secondly, the capabilities of our device were assessed during more than 45h of polysomnographic recordings in seven lambs. According to the plethysmographic pulse waveform, reliable SpO(2) values were obtained in more than 85% of recording time. Multiple decreases in SpO(2) were readily observed after spontaneous apneas in preterm lambs. It is concluded that our wireless pulse oximeter performs as reliably as a standard pulse oximeter for monitoring SpO(2) variations in lambs, and offers new perspectives for researchers interested in continuous monitoring of oxygenation throughout sleep stages and wakefulness.

An Eye Oximeter for Combat Casualty Care

DTIC Science & Technology

1999-01-01

concentration. Here a procedure is de- struments such as fingertip pulse oximeters and fi- scribed that allows for the calculation of optimum beroptic...of a neonate due to a pulse oximeter : 20. Trouwborst A. Tenbrinck R, van Woerkens E. Blood gas arterial saturation monitoring. Pediatrics. 1992;89:154...analysis of mixed venous blood during normoxic acute 29. Severinghaus JW, Spellman MJ. Pulse oximeter failure isovolemic hemodilution in pigs. Anesth

Optimal filter bandwidth for pulse oximetry

NASA Astrophysics Data System (ADS)

Stuban, Norbert; Niwayama, Masatsugu

2012-10-01

Pulse oximeters contain one or more signal filtering stages between the photodiode and microcontroller. These filters are responsible for removing the noise while retaining the useful frequency components of the signal, thus improving the signal-to-noise ratio. The corner frequencies of these filters affect not only the noise level, but also the shape of the pulse signal. Narrow filter bandwidth effectively suppresses the noise; however, at the same time, it distorts the useful signal components by decreasing the harmonic content. In this paper, we investigated the influence of the filter bandwidth on the accuracy of pulse oximeters. We used a pulse oximeter tester device to produce stable, repetitive pulse waves with digitally adjustable R ratio and heart rate. We built a pulse oximeter and attached it to the tester device. The pulse oximeter digitized the current of its photodiode directly, without any analog signal conditioning. We varied the corner frequency of the low-pass filter in the pulse oximeter in the range of 0.66-15 Hz by software. For the tester device, the R ratio was set to R = 1.00, and the R ratio deviation measured by the pulse oximeter was monitored as a function of the corner frequency of the low-pass filter. The results revealed that lowering the corner frequency of the low-pass filter did not decrease the accuracy of the oxygen level measurements. The lowest possible value of the corner frequency of the low-pass filter is the fundamental frequency of the pulse signal. We concluded that the harmonics of the pulse signal do not contribute to the accuracy of pulse oximetry. The results achieved by the pulse oximeter tester were verified by human experiments, performed on five healthy subjects. The results of the human measurements confirmed that filtering out the harmonics of the pulse signal does not degrade the accuracy of pulse oximetry.

Optimal filter bandwidth for pulse oximetry.

PubMed

Stuban, Norbert; Niwayama, Masatsugu

2012-10-01

Pulse oximeters contain one or more signal filtering stages between the photodiode and microcontroller. These filters are responsible for removing the noise while retaining the useful frequency components of the signal, thus improving the signal-to-noise ratio. The corner frequencies of these filters affect not only the noise level, but also the shape of the pulse signal. Narrow filter bandwidth effectively suppresses the noise; however, at the same time, it distorts the useful signal components by decreasing the harmonic content. In this paper, we investigated the influence of the filter bandwidth on the accuracy of pulse oximeters. We used a pulse oximeter tester device to produce stable, repetitive pulse waves with digitally adjustable R ratio and heart rate. We built a pulse oximeter and attached it to the tester device. The pulse oximeter digitized the current of its photodiode directly, without any analog signal conditioning. We varied the corner frequency of the low-pass filter in the pulse oximeter in the range of 0.66-15 Hz by software. For the tester device, the R ratio was set to R = 1.00, and the R ratio deviation measured by the pulse oximeter was monitored as a function of the corner frequency of the low-pass filter. The results revealed that lowering the corner frequency of the low-pass filter did not decrease the accuracy of the oxygen level measurements. The lowest possible value of the corner frequency of the low-pass filter is the fundamental frequency of the pulse signal. We concluded that the harmonics of the pulse signal do not contribute to the accuracy of pulse oximetry. The results achieved by the pulse oximeter tester were verified by human experiments, performed on five healthy subjects. The results of the human measurements confirmed that filtering out the harmonics of the pulse signal does not degrade the accuracy of pulse oximetry.

Accuracy of pulse oximeters in estimating heart rate at rest and during exercise.

PubMed Central

Iyriboz, Y; Powers, S; Morrow, J; Ayers, D; Landry, G

1991-01-01

Pulse oximeters are being widely used for non-invasive, simultaneous assessment of haemoglobin oxygen saturation. They are reliable, accurate, relatively inexpensive and portable. Pulse oximeters are often used for estimating heart rate at rest and during exercise. However, at present the data available to validate their use as heart rate monitors are not sufficient. We evaluated the accuracy of two oximeters (Radiometer, ear and finger probe; Ohmeda 3700, ear probe) in monitoring heart rate during incremental exercise by comparing the pulse oximeters with simultaneous ECG readings. Data were collected on eight men (713 heart rate readings) during graded cycle ergometer and treadmill exercise to volitional fatigue. Analysis by linear regression revealed that general oximeter readings significantly correlated with those of ECG (r = 0.91, P less than 0.0001). However, comparison of heart rate at each level of work showed that oximeter readings significantly (P less than 0.05) under-estimated rates above 155 beats/min. These results indicate that the use of pulse oximeters as heart rate monitors during strenuous exercise is questionable. This inaccuracy may well originate from the instability of the probes, sweating, other artefacts during exercise, and measurement of different components in the cardiovascular cycle. PMID:1777787

Usefulness of Pulse Oximeter That Can Measure SpO2 to One Digit After Decimal Point.

PubMed

Yamamoto, Akihiro; Burioka, Naoto; Eto, Aritoshi; Amisaki, Takashi; Shimizu, Eiji

2017-06-01

Pulse oximeters are used to noninvasively measure oxygen saturation in arterial blood (SaO 2 ). Although arterial oxygen saturation measured by pulse oximeter (SpO 2 ) is usually indicated in 1% increments, the value of SaO 2 from arterial blood gas analysis is not an integer. We have developed a new pulse oximeter that can measure SpO 2 to one digit after the decimal point. The values of SpO 2 from the newly developed pulse oximeter are highly correlated with the values of SaO 2 from arterial blood gas analysis (SpO 2 = 0.899 × SaO 2 + 9.944, r = 0.887, P < 0.0001). This device may help improve the evaluation of pathological conditions in patients.

Comparison of heart rate and oxygen saturation measurements from Masimo and Nellcor pulse oximeters in newly born term infants.

PubMed

Dawson, J A; Saraswat, A; Simionato, L; Thio, M; Kamlin, C O F; Owen, L S; Schmölzer, G M; Davis, P G

2013-10-01

To compare heart rate (HR) measurements from Masimo and Nellcor pulse oximeters (POs) against HR measured via a three lead electrocardiograph (ECG) (HRECG ). We also compared peripheral oxygen saturation (SpO2 ) measurements between Nellcor and Masimo oximeters. Term infants born via elective caesarean section were studied. ECG leads were placed on the infant's chest and abdomen. Masimo and Nellcor PO sensors were randomly allocated to either foot. The monitors were placed on a trolley, and data from each monitor screen captured by a video camera. HR, SpO2 measurements and signal quality were extracted. Bland-Altman analysis was used to determine agreement between HR from the ECG and each oximeter, and between SpO2 from the oximeters. We studied 44 infants of whom 4 were resuscitated. More than 8000 pairs of observations were used for each comparison of HR and SpO2. The mean difference (±2SD) between HRECG and HRN ellcor was -0.8 (±11) beats per minute (bpm); between HRECG and HRM asimo was 0.2 (±9) bpm. The mean (±2SD) difference between SpO2Masimo and SpO2Nellcor was -3 (±15)%. The Nellcor PO measured 20% higher than the Masimo PO at SpO2 <70%. Both oximeters accurately measure HR. There was good agreement between SpO2 measurements when SpO2 ≥70%. At lower SpO2 , agreement was poorer. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Comparison of two new generation pulse oximeters with arterial oxygen saturation in critically ill children.

PubMed

Jose, Bipin; Lodha, Rakesh; Kabra, S K

2014-12-01

To compare the performance of two new generation pulse oximeters, one with enhanced signal extraction technology (SET) and other without enhanced SET in detecting hypoxemia and to correlate it with arterial blood gas analysis. Forty-eight patients, admitted to pediatric intensive care unit (PICU) of a teritiary care teaching hospital in India for critical care and support during the study period, who had an arterial catheter in situ were included. Children with those disease conditions known to interfere with pulse oximetry and blood gas analysis were excluded.184 set of observations were made during the study period. Each set had oxygen saturation (SpO2) measured from both the pulse oximeters and the corresponding arterial oxygen saturation (SaO2). The values were compared for occurrence of true and false alarms during periods of normal BP, hypotension and varying degrees of hypoxia. The mean arterial SaO2 in the study was 94.4 % ± 4.9. The mean SpO2 recorded in conventional and enhanced signal extraction technology (SET) pulse oximeters were 94.9 % ± 4.5 and 97.2 % ± 4.7 respectively. Enhanced signal extraction technology pulse oximeter detected 4/27 (15 %) of true hypoxemic events and 1 event was a false alarm. Conventional pulse oximeter detected 11/27 (41 %) true hypoxemic events but recorded 6 false alarms. Both pulse oximeters were not found to be performing satisfactorily in picking up hypoxemia in the study. There was good correlation with mean SpO2 from pulse oximeters and arterial SaO2. The reliability of pulse oximetry decreases with worsening hypoxemia and hypotension, and the sensitivity for picking up hypoxemia can be as low as 15 %.

Adjustable fetal phantom for pulse oximetry

NASA Astrophysics Data System (ADS)

Stubán, Norbert; Niwayama, Masatsugu

2009-05-01

As the measuring head of a fetal pulse oximeter must be attached to the head of the fetus inside the mother's uterus during labor, testing, and developing of fetal pulse oximeters in real environment have several difficulties. A fetal phantom could enable evaluation of pulse oximeters in a simulated environment without the restrictions and difficultness of medical experiments in the labor room. Based on anatomic data we developed an adjustable fetal head phantom with three different tissue layers and artificial arteries. The phantom consisted of two arteries with an inner diameter of 0.2 and 0.4 mm. An electronically controlled pump produced pulse waves in the arteries. With the phantom we investigated the sensitivity of a custom-designed wireless pulse oximeter at different pulsation intensity and artery diameters. The results showed that the oximeter was capable of identifying 4% and 2% changes in diameter between the diastolic and systolic point in arteries of over 0.2 and 0.4 mm inner diameter, respectively. As the structure of the phantom is based on reported anatomic values, the results predict that the investigated custom-designed wireless pulse oximeter has sufficient sensitivity to detect the pulse waves and to calculate the R rate on the fetal head.

Pulse oximeters to self monitor oxygen saturation levels as part of a personalised asthma action plan for people with asthma.

PubMed

Welsh, Emma J; Carr, Robin

2015-09-27

We became aware through talking with people with asthma that some are using pulse oximeters to monitor their own blood oxygen levels during an asthma attack. Pulse oximeters are marketed by some suppliers as essential equipment for the home medicine cabinet. We wanted to find out if reliable evidence is available on use of pulse oximeters to self monitor asthma exacerbations at home. We decided to include only trials that used pulse oximeters as part of a personalised asthma action plan because it is important that decisions are made on the basis of symptoms as well as oxygen saturation, and that patients have a clear protocol to follow when their asthma worsens. To determine whether pulse oximeters used as part of a personalised asthma action plan for people with asthma are safer and more effective than a personalised asthma action plan alone. We searched the Cochrane Airways Group Specialised Register (CAGR), which includes reports identified through systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED) and PsycINFO, and by handsearching. We also searched ClinicalTrials.gov and the World Health Organization (WHO) trials portal. We planned to include randomised controlled trials (RCTs). Participants would have included adults, children or both with a diagnosis of asthma. We planned to include trials in which investigators compared participants who used pulse oximeters to monitor oxygen levels at home during an asthma exacerbation as part of a personalised asthma action plan (PAAP) versus those who used a PAAP without a pulse oximeter. We planned to include studies involving people receiving any treatment regimen provided that no medicine was included as part of the randomisation schedule. We planned to use standard methods as recommended by The Cochrane Collaboration. We found no studies and no evidence to support or refute the use of home pulse oximetry in self management of asthma; therefore, we can make no recommendations about use of a pulse oximeter as part of a PAAP. We found no reliable data to support or refute patient use of pulse oximeters to monitor oxygen saturation levels when experiencing an asthma attack. People should not use a pulse oximeter without seeking advice from a qualified healthcare professional.We identified no compelling rationale for home monitoring of oxygen levels in isolation for most people with asthma. Some people have a reduced perception of the severity of their own breathlessness when exposed to hypoxia. If trials on self monitoring of oxygen levels in the blood by pulse oximeter at home by people with asthma are conducted, the pulse oximeter must be given as part of a personalised asthma action plan.

Low-Cost Embedded Oximeter

NASA Astrophysics Data System (ADS)

Laghrouche, M.; Haddab, S.; Lotmani, S.; Mekdoud, K.; Ameur, S.

2010-01-01

Nowadays, many medical devices have been developed for the purposes of diagnosing and treatment. Wearable sensors and systems have evolved to the point that they can be considered ready for clinical application. The use of wearable monitoring devices that allow continuous or intermittent monitoring of physiological signals is critical for the advancement of both the diagnosis as well as treatment of diseases. Patient vital sign monitoring within hospitals requires the use of noninvasive sensors that are hardwired to bedside monitors. This paper describes the initial bench testing of a wireless wearable pulse oximeter. Arterial oxygen saturation in the patient's blood signal was measured with an optical sensor, and then converted to digital data using a microcontroller system. The digital data were then sent to a receiver where it is in 433 MHz FM/FSK transmitter. At the receiver, the digital data were reconverted to analog signal to be monitored and recorded on the PC.

The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration: The Possible Global Public Health Implications.

PubMed

Lipnick, Michael S; Feiner, John R; Au, Paul; Bernstein, Michael; Bickler, Philip E

2016-08-01

Universal access to pulse oximetry worldwide is often limited by cost and has substantial public health consequences. Low-cost pulse oximeters have become increasingly available with limited regulatory agency oversight. The accuracy of these devices often has not been validated, raising questions about performance. The accuracy of 6 low-cost finger pulse oximeters during stable arterial oxygen saturations (SaO2) between 70% and 100% was evaluated in 22 healthy subjects. Oximeters tested were the Contec CMS50DL, Beijing Choice C20, Beijing Choice MD300C23, Starhealth SH-A3, Jumper FPD-500A, and Atlantean SB100 II. Inspired oxygen, nitrogen, and carbon dioxide partial pressures were monitored and adjusted via a partial rebreathing circuit to achieve 10 to 12 stable target SaO2 plateaus between 70% and 100% and PaCO2 values of 35 to 45 mm Hg. Comparisons of pulse oximeter readings (SpO2) with arterial SaO2 (by Radiometer ABL90 and OSM3) were used to calculate bias (SpO2 - SaO2) mean, precision (SD of the bias), and root mean square error (ARMS). Pulse oximeter readings corresponding to 536 blood samples were analyzed. Four of the 6 oximeters tested showed large errors (up to -6.30% mean bias, precision 4.30%, 7.53 ARMS) in estimating saturation when SaO2 was reduced <80%, and half of the oximeters demonstrated large errors when estimating saturations between 80% and 90%. Two of the pulse oximeters tested (Contec CMS50DL and Beijing Choice C20) demonstrated ARMS of <3% at SaO2 between 70% and 100%, thereby meeting International Organization for Standardization (ISO) criteria for accuracy. Many low-cost pulse oximeters sold to consumers demonstrate highly inaccurate readings. Unexpectedly, the accuracy of some low-cost pulse oximeters tested here performed similarly to more expensive, ISO-cleared units when measuring hypoxia in healthy subjects. None of those tested here met World Federation of Societies of Anaesthesiologists standards, and the ideal testing conditions do not necessarily translate these findings to the clinical setting. Nonetheless, further development of accurate, low-cost oximeters for use in clinical practice is feasible and, if pursued, could improve access to safe care, especially in low-income countries.

In-vivo studies of reflectance pulse oximeter sensor

NASA Astrophysics Data System (ADS)

Ling, Jian; Takatani, Setsuo; Noon, George P.; Nose, Yukihiko

1993-08-01

Reflectance oximetry can offer an advantage of being applicable to any portion of the body. However, the major problem of reflectance oximetry is low pulsatile signal level which prevents prolonged clinical application during extreme situations, such as hypothermia and vasoconstriction. In order to improve the pulsatile signal level of reflectance pulse oximeter and thus its accuracy, three different sensors, with the separation distances (SPD) between light emitting diode (LED) and photodiode being 3, 5, and 7 mm respectively, were studied on nine healthy volunteers. With the increase of the SPD, it was found that both the red (660 nm) and near-infrared (830 nm) pulsatile to average signal ratio (AC/DC) increased, and the standard deviations of (AC/DC)red/(AC/DC)infrared ratio decreased, in spite of the decrease of the absolute signal level. Further clinical studies of 3 mm and 7 mm SPD sensors on seven patients also showed that the (AC/DC)red/(AC/DC)infrared ratio measured by the 7 mm sensor were less disturbed than the 3 mm sensor during the surgery. A theoretical study based on the three-dimensional photon diffusion theory supports the experimental and clinical results. As a conclusion, the 7 mm sensor has the highest signal-to- noise ratio among three different sensors. A new 7 mm SPD reflectance sensor, with the increased number of LEDs around the photodiode, was designed to increase the AC/DC ratio, as well as to increase the absolute signal level.

Prevalence of Prehospital Hypoxemia and Oxygen Use in Trauma Patients

DTIC Science & Technology

2013-10-01

and included participants by applying a study-specific pulse oximeter (Nonin PalmSat 2500; Nonin Medical, Plymouth, Minnesota); this oximeter is...of week. In addition, the heart rate and oxygen saturation mea- sures that were recorded by the study-specific pulse oximeter were downloaded. After...Supplemental Oxygen Administration 95% cr N % Lower Upper Pulse Oximeter Oxygen 86 38.4 32.2 44.9 Saturation :0;90% (Hypoxemia) TBI 22 9.8 6.5 14.3

Efficacy of commercially available wipes for disinfection of pulse oximeter sensors.

PubMed

Nandy, Poulomi; Lucas, Anne D; Gonzalez, Elizabeth A; Hitchins, Victoria M

2016-03-01

This study examined the effectiveness of commercially available disinfecting wipes and cosmetic wipes in disinfecting pulse oximeter sensors contaminated with pathogenic bacterial surrogates. Surrogates of potential biological warfare agents and bacterial pathogens associated with hospital-acquired infections (HAIs) were spotted on test surfaces, with and without an artificial test soil (sebum), allowed to dry, and then cleaned with different commercially available cleaning and disinfecting wipes or sterile gauze soaked in water, bleach (diluted 1:10), or 70% isopropanol. The percentage of microbial survival and an analytical estimation of remaining test soil on devices were determined. Wipes containing sodium hypochlorite as the active ingredient and gauze soaked in bleach (1:10) were the most effective in removing both vegetative bacteria and spores. In the presence of selective disinfectants, sebum had a protective effect on vegetative bacteria, but not on spores. The presence of sebum reduces the cleaning efficiency of some commercially available wipes for some select microbes. Various commercial wipes performed significantly better than the designated cleaning agent (70% isopropanol) in disinfecting the oximetry sensor. Cosmetic wipes were not more effective than the disinfecting wipes in removing sebum. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Accuracy of Pulse Oximeters in Detecting Hypoxemia in Patients with Chronic Thromboembolic Pulmonary Hypertension

PubMed Central

Kohyama, Tomoki; Moriyama, Kiyoshi; Kanai, Riichiro; Kotani, Mariko; Uzawa, Kohji; Satoh, Toru; Yorozu, Tomoko

2015-01-01

Purpose Pulse oximetry is routinely used to continuously and non-invasively monitor arterial oxygen saturation (SaO2). When oxygen saturation by pulse oximeter (SpO2) overestimates SaO2, hypoxemia may be overlooked. We compared the SpO2 - SaO2 differences among three pulse oximeters in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who spent their daily lives in a poor oxygen state. Material and Method This prospective observational study recruited 32 patients with CTEPH undergoing elective cardiac catheterization. As we collected arterial blood samples in the catheter laboratory, SpO2 values were simultaneously recorded. Three pulse oximeters were used on each patient, and SpO2 values were compared with oximetry readings using a blood gas analyzer. To determine the optimal SpO2 value by which to detect hypoxemia (SaO2≦90%), we generated receiver operating characteristic (ROC) curves for each pulse oximeter. Result The root mean square of each pulse oximeter was 1.79 (OLV-3100), 1.64 (N-BS), and 2.50 (Masimo Radical). The mean bias (SpO2 - SaO2) for the 90%–95% saturation range was significantly higher for Masimo Radical (0.19 +/- 1.78% [OLV-3100], 0.18 +/- 1.63% [N-BS], and 1.61 +/- 1.91% [Masimo Radical]; p<0.0001). The optimal SpO2 value to detect hypoxemia (SaO2≦90%) was 89% for OLV-3100, 90% for N-BS, and 92% for Masimo Radical. Conclusion We found that the biases and precision with which to detect hypoxemia differed among the three pulse oximeters. To avoid hypoxemia, the optimal SpO2 should be determined for each pulse oximeter. PMID:25978517

Accuracy of pulse oximeters in detecting hypoxemia in patients with chronic thromboembolic pulmonary hypertension.

PubMed

Kohyama, Tomoki; Moriyama, Kiyoshi; Kanai, Riichiro; Kotani, Mariko; Uzawa, Kohji; Satoh, Toru; Yorozu, Tomoko

2015-01-01

Pulse oximetry is routinely used to continuously and non-invasively monitor arterial oxygen saturation (SaO2). When oxygen saturation by pulse oximeter (SpO2) overestimates SaO2, hypoxemia may be overlooked. We compared the SpO2 - SaO2 differences among three pulse oximeters in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who spent their daily lives in a poor oxygen state. This prospective observational study recruited 32 patients with CTEPH undergoing elective cardiac catheterization. As we collected arterial blood samples in the catheter laboratory, SpO2 values were simultaneously recorded. Three pulse oximeters were used on each patient, and SpO2 values were compared with oximetry readings using a blood gas analyzer. To determine the optimal SpO2 value by which to detect hypoxemia (SaO2≦90%), we generated receiver operating characteristic (ROC) curves for each pulse oximeter. The root mean square of each pulse oximeter was 1.79 (OLV-3100), 1.64 (N-BS), and 2.50 (Masimo Radical). The mean bias (SpO2 - SaO2) for the 90%-95% saturation range was significantly higher for Masimo Radical (0.19 +/- 1.78% [OLV-3100], 0.18 +/- 1.63% [N-BS], and 1.61 +/- 1.91% [Masimo Radical]; p<0.0001). The optimal SpO2 value to detect hypoxemia (SaO2≦90%) was 89% for OLV-3100, 90% for N-BS, and 92% for Masimo Radical. We found that the biases and precision with which to detect hypoxemia differed among the three pulse oximeters. To avoid hypoxemia, the optimal SpO2 should be determined for each pulse oximeter.

[Current status of the development of wireless sensors for medical applications].

PubMed

Moor, C; Braecklein, M; Jörns, N

2005-01-01

Wireless near-field transmission has been a challenge for scientists developing medical sensors for a long time. Here, instruments which measure a patient's ECG, oxygen saturation, blood pressure, peak flow, weight, blood glucose etc. are to be equipped with suitable transmission technology. Application scenarios for these sensors can be found in all medical areas where cable connections are irritating for the doctor, patient and other care personnel. This problem is especially common in sport medicine, sleep medicine, emergency medicine and intensive care. Based on its beneficial properties with regard to power consumption, range, data security and network capability, the worldwide standard radio technology Bluetooth was selected to transmit measurements. Since digital data is sent to a receiving station via Bluetooth, the measurement pre-processing now takes place in the patient sensor itself, instead of being processed by the monitor. In this article, a Bluetooth ECG, Bluetooth pulse oximeter, Bluetooth peak flow meter and Bluetooth event recorder will be introduced. On the one hand, systems can be realized with these devices, which allow patients to be monitored online (ECG, pulse oximeter). These devices can also be integrated in disease management programs (peak flow meter) and can be used to monitor high-risk patients in their home environment (event recorder).

A Novel Electrocardiogram Segmentation Algorithm Using a Multiple Model Adaptive Estimator

DTIC Science & Technology

2002-03-01

2-5 Figure 2-3. Typical Pulse Oximeter Placement [20].....................................................2-5 Figure 2-4...the heart contracts and then decreases when the heart relaxes. The pulse oximeter is typically place on a toe, finger, or earlobe as shown in Figure...2-3. Figure 2-2. Absorption as Light Passes Through the Body [24]. Figure 2-3. Typical Pulse Oximeter Placement [19]. The pulse

Development of a Screening Tool for Sleep Disordered Breathing in Children Using the Phone Oximeter™

PubMed Central

Garde, Ainara; Dehkordi, Parastoo; Karlen, Walter; Wensley, David; Ansermino, J. Mark; Dumont, Guy A.

2014-01-01

Background Sleep disordered breathing (SDB) can lead to daytime sleepiness, growth failure and developmental delay in children. Polysomnography (PSG), the gold standard to diagnose SDB, is a highly resource-intensive test, confined to the sleep laboratory. Aim To combine the blood oxygen saturation (SpO2) characterization and cardiac modulation, quantified by pulse rate variability (PRV), to identify children with SDB using the Phone Oximeter, a device integrating a pulse oximeter with a smartphone. Methods Following ethics approval and informed consent, 160 children referred to British Columbia Children's Hospital for overnight PSG were recruited. A second pulse oximeter sensor applied to the finger adjacent to the one used for standard PSG was attached to the Phone Oximeter to record overnight pulse oximetry (SpO2 and photoplethysmogram (PPG)) alongside the PSG. Results We studied 146 children through the analysis of the SpO2 pattern, and PRV as an estimate of heart rate variability calculated from the PPG. SpO2 variability and SpO2 spectral power at low frequency, was significantly higher in children with SDB due to the modulation provoked by airway obstruction during sleep (p-value ). PRV analysis reflected a significant augmentation of sympathetic activity provoked by intermittent hypoxia in SDB children. A linear classifier was trained with the most discriminating features to identify children with SDB. The classifier was validated with internal and external cross-validation, providing a high negative predictive value (92.6%) and a good balance between sensitivity (88.4%) and specificity (83.6%). Combining SpO2 and PRV analysis improved the classification performance, providing an area under the receiver operating characteristic curve of 88%, beyond the 82% achieved using SpO2 analysis alone. Conclusions These results demonstrate that the implementation of this algorithm in the Phone Oximeter will provide an improved portable, at-home screening tool, with the capability of monitoring patients over multiple nights. PMID:25401696

Development of a screening tool for sleep disordered breathing in children using the phone Oximeter™.

PubMed

Garde, Ainara; Dehkordi, Parastoo; Karlen, Walter; Wensley, David; Ansermino, J Mark; Dumont, Guy A

2014-01-01

Sleep disordered breathing (SDB) can lead to daytime sleepiness, growth failure and developmental delay in children. Polysomnography (PSG), the gold standard to diagnose SDB, is a highly resource-intensive test, confined to the sleep laboratory. To combine the blood oxygen saturation (SpO2) characterization and cardiac modulation, quantified by pulse rate variability (PRV), to identify children with SDB using the Phone Oximeter, a device integrating a pulse oximeter with a smartphone. Following ethics approval and informed consent, 160 children referred to British Columbia Children's Hospital for overnight PSG were recruited. A second pulse oximeter sensor applied to the finger adjacent to the one used for standard PSG was attached to the Phone Oximeter to record overnight pulse oximetry (SpO2 and photoplethysmogram (PPG)) alongside the PSG. We studied 146 children through the analysis of the SpO2 pattern, and PRV as an estimate of heart rate variability calculated from the PPG. SpO2 variability and SpO2 spectral power at low frequency, was significantly higher in children with SDB due to the modulation provoked by airway obstruction during sleep (p-value <0.01). PRV analysis reflected a significant augmentation of sympathetic activity provoked by intermittent hypoxia in SDB children. A linear classifier was trained with the most discriminating features to identify children with SDB. The classifier was validated with internal and external cross-validation, providing a high negative predictive value (92.6%) and a good balance between sensitivity (88.4%) and specificity (83.6%). Combining SpO2 and PRV analysis improved the classification performance, providing an area under the receiver operating characteristic curve of 88%, beyond the 82% achieved using SpO2 analysis alone. These results demonstrate that the implementation of this algorithm in the Phone Oximeter will provide an improved portable, at-home screening tool, with the capability of monitoring patients over multiple nights.

Examination of a Novel Method for Non-Contact, Low-Cost, and Automated Heart-Rate Detection in Ambient Light Using Photoplethysmographic Imaging

DTIC Science & Technology

2014-10-01

a period of time by electrodes attached to the surface of the skin, are used in almost every clinical environment. Pulse oximeters , which measure the...medical devices, for example, pulse oximeters , vascular diagnostics, and digital beat-to-beat blood pressure measurement systems (Allen 2007). PPG is...principle is pulse oximetry. 1.2 Pulse Oximetry A pulse oximeter monitors the blood-oxygen saturation level and pulse rate in the human blood by using

Four Types of Pulse Oximeters Accurately Detect Hypoxia during Low Perfusion and Motion.

PubMed

Louie, Aaron; Feiner, John R; Bickler, Philip E; Rhodes, Laura; Bernstein, Michael; Lucero, Jennifer

2018-03-01

Pulse oximeter performance is degraded by motion artifacts and low perfusion. Manufacturers developed algorithms to improve instrument performance during these challenges. There have been no independent comparisons of these devices. We evaluated the performance of four pulse oximeters (Masimo Radical-7, USA; Nihon Kohden OxyPal Neo, Japan; Nellcor N-600, USA; and Philips Intellivue MP5, USA) in 10 healthy adult volunteers. Three motions were evaluated: tapping, pseudorandom, and volunteer-generated rubbing, adjusted to produce photoplethsmogram disturbance similar to arterial pulsation amplitude. During motion, inspired gases were adjusted to achieve stable target plateaus of arterial oxygen saturation (SaO2) at 75%, 88%, and 100%. Pulse oximeter readings were compared with simultaneous arterial blood samples to calculate bias (oxygen saturation measured by pulse oximetry [SpO2] - SaO2), mean, SD, 95% limits of agreement, and root mean square error. Receiver operating characteristic curves were determined to detect mild (SaO2 < 90%) and severe (SaO2 < 80%) hypoxemia. Pulse oximeter readings corresponding to 190 blood samples were analyzed. All oximeters detected hypoxia but motion and low perfusion degraded performance. Three of four oximeters (Masimo, Nellcor, and Philips) had root mean square error greater than 3% for SaO2 70 to 100% during any motion, compared to a root mean square error of 1.8% for the stationary control. A low perfusion index increased error. All oximeters detected hypoxemia during motion and low-perfusion conditions, but motion impaired performance at all ranges, with less accuracy at lower SaO2. Lower perfusion degraded performance in all but the Nihon Kohden instrument. We conclude that different types of pulse oximeters can be similarly effective in preserving sensitivity to clinically relevant hypoxia.

New hybrid reflectance optical pulse oximetry sensor for lower oxygen saturation measurement and for broader clinical application

NASA Astrophysics Data System (ADS)

Nogawa, Masamichi; Ching, Chong Thong; Ida, Takeyuki; Itakura, Keiko; Takatani, Setsuo

1997-06-01

A new reflectance pulse oximeter sensor for lower arterial oxygen saturation (Sa)2) measurement has been designed and evaluated in animals prior to clinical trials. The new sensor incorporates ten light emitting diode chips for each wavelength of 730 and 880 nm mounted symmetrically and at the radial separation distance of 7 mm around a photodiode chip. The separation distance of 7 mm was chosen to maximize the ratio of the pulsatile to the average plethysmographic signal level at each wavelength. The 730 and 880 wavelength combination was determined to obtain a linear relationship between the reflectance ratio of the 730 and 880 nm wavelengths and Sa)2. In addition to these features of the sensor, the Fast Fourier Transform method was employed to compute the pulsatile and average signal level at each wavelength. The performance of the new reflectance pulse oximeter sensor was evaluated in dogs in comparison to the 665/910 nm sensor. As predicted by the theoretical simulation based on a 3D photon diffusion theory, the 730/880 nm sensor demonstrated an excellent linearity over the SaO2 range from 100 to 30 percent. For the SaO2 range between 100 and 70 percent, the 665/910 and 730/880 sensors showed the standard error of around 3.5 percent and 2.1 percent, respectively, in comparison to the blood samples. For the range between 70 and 30 percent, the standard error of the 730/880 nm sensor was only 2.7 percent, while that of the 665/910 nm sensor was 9.5 percent. The 730/880 sensor showed improved accuracy for a wide range of SaO2 particularly over the range between 70 and 30 percent. This new reflectance sensor can provide noninvasive measurement of SaO2 accurately over the wide saturation range from 100 to 30 percent.

Physiological Monitoring in Diving Mammals

DTIC Science & Technology

2013-09-30

developed based upon the succesful construction of an oximeter used in Weddel seals [1]. A delivery device will be fabricated to allow...The implantation device containing the tag, muscle oximeter sensor and implantation device. Figure 5. Tag housing with subdermal pins. The... oximeter probe with 3 LEDs and photo sensor to estimate muscle O2 saturation. Figure 6. The oximeter sensor implanted into the muscle with the

Oximetry in children recovering from deep hypothermia for cardiac surgery.

PubMed

Macnab, A J; Baker-Brown, G; Anderson, E E

1990-10-01

Although pulse oximetry is a potentially useful diagnostic tool in the treatment of children after major open heart surgery, there are concerns regarding its reliability for measuring oxygen saturation (SaO2) in hypothermic or low perfusion states. To test pulse oximeter reliability in children under these conditions, our study compared 187 SaO2 pulse oximeter readings (Biox 3700) with simultaneous hemoximeter (OSM2, Radiometer) readings from 56 children rewarming after open heart surgery. Ages ranged from 4 months to 18 yr; temperatures ranged from 23.5 degrees to 38 degrees C (toe) and 31.3 degrees to 40.8 degrees C (core). The mean pulse oximeter SaO2 reading was 94.90% (SD 7.18, range 54% to 100%), mean hemoximeter reading was 96.07% (SD 7.06; minimum 54%; maximum 100%). The correlation between the readings was high (r = .88, p less than .005), and was not affected by low core temperature. When oximeter and cardiac monitor pulse rates coincided, the oximeter SaO2 value was within +/- 5% (p less than .05). We conclude that the Biox 3700 oximeter is reliable for noninvasive SaO2 monitoring in mild to moderately hypothermic children after open heart surgery, particularly when oximeter and cardiac heart rates coincide. Further studies are needed to confirm our findings in children with core temperatures less than 31.3 degrees C, and when other oximeters are used.

Hypoxia, Monitoring, and Mitigation System

DTIC Science & Technology

2013-11-01

on measured and predicted data. Given the beat-to-beat method in which oxygen saturation is measured via a pulse oximeter , a certain degree of...1108-12. The incidence of hypoxemia in the immediate postoperative period was determined using a pulse oximeter for continuous monitoring of...Oxygen Saturation Measured via Pulse - Oximeter TAILSS Tactical Aircrew Integrated Life Support System TUC Time of Useful Consciousness USN United

Early Support of Intracranial Perfusion

DTIC Science & Technology

2013-10-01

examine the Pulse Oximeter signal in more detail than is currently possible with infrastructure and equipment available under the current funding...predicts interventions. Sen A, Hu P, Mackenzie C, Jordan S, Dutton R. 18 Correlation between ECG heart rate and pulse oximeter heart rate in...rate and Pulse Oximeter Heart rate in Prehospital aeromedical trauma transfer Proceedings of the American Society of Anesthesiologists. 2008 . Hu

Pulse Oximeter Derived Blood Pressure Measurement in Patients With a Continuous Flow Left Ventricular Assist Device.

PubMed

Hellman, Yaron; Malik, Adnan S; Lane, Kathleen A; Shen, Changyu; Wang, I-Wen; Wozniak, Thomas C; Hashmi, Zubair A; Munson, Sarah D; Pickrell, Jeanette; Caccamo, Marco A; Gradus-Pizlo, Irmina; Hadi, Azam

2017-05-01

Currently, blood pressure (BP) measurement is obtained noninvasively in patients with continuous flow left ventricular assist device (LVAD) by placing a Doppler probe over the brachial or radial artery with inflation and deflation of a manual BP cuff. We hypothesized that replacing the Doppler probe with a finger-based pulse oximeter can yield BP measurements similar to the Doppler derived mean arterial pressure (MAP). We conducted a prospective study consisting of patients with contemporary continuous flow LVADs. In a small pilot phase I inpatient study, we compared direct arterial line measurements with an automated blood pressure (ABP) cuff, Doppler and pulse oximeter derived MAP. Our main phase II study included LVAD outpatients with a comparison between Doppler, ABP, and pulse oximeter derived MAP. A total of five phase I and 36 phase II patients were recruited during February-June 2014. In phase I, the average MAP measured by pulse oximeter was closer to arterial line MAP rather than Doppler (P = 0.06) or ABP (P < 0.01). In phase II, pulse oximeter MAP (96.6 mm Hg) was significantly closer to Doppler MAP (96.5 mm Hg) when compared to ABP (82.1 mm Hg) (P = 0.0001). Pulse oximeter derived blood pressure measurement may be as reliable as Doppler in patients with continuous flow LVADs. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Valsalva maneuver in obstetrics: the influence of peripheral circulatory changes on function of the pulse oximeter.

PubMed

Woods, A M; Queen, J S; Lawson, D

1991-12-01

Strenuous expulsive efforts involving sequential Valsalva maneuvers may result in maternal hypoxemia during the second stage of labor. Pulse oximetry has been used to assess oxygen saturation in laboring parturients, and this study was undertaken to evaluate the performance of the pulse oximeter (Nellcor) during the Valsalva maneuver. In both pregnant patients and nonpregnant volunteers, there were consistent interruptions in the transmission of oxygen saturation data during the Valsalva maneuver. To determine the physiologic events associated with this monitoring interruption, occlusive venous impedance plethysmographs and pulse volume amplitude recordings were obtained in volunteers performing the Valsalva maneuver. A marked decrease in pulse volume amplitude was noted, which adversely affected the oximeter's ability to distinguish physiologic arterial pulsations from background noise. Each Valsalva maneuver was associated with abrupt and transient changes in peripheral vascular volumes, thus presenting the oximeter with a rapidly changing signal for analysis that violated predetermined software criteria for pulse uniformity and caused an interruption in data transmission. The authors conclude that the Valsalva maneuver interferes with the ability of pulse oximeter technology to provide useful oxygen saturation data.

Development and Validation of a Machine Learning Algorithm and Hybrid System to Predict the Need for Life-Saving Interventions in Trauma Patients

DTIC Science & Technology

2014-01-01

were stored at a rate of 1 Hz. In addition, ECg waveform data from a single lead and pleth waveform data from a thumb-mounted pulse oximeter to the...blood oxygenation (SpO2). Combinations of these vital signs were also used to derive other measurements including shock index (SI = Hr/SBP) and pulse ...combining all vital signs, trends, and pulse characteristics recorded by the monitor, and apply- ing a multivariate sensor fusion algorithm that generates

Where do pulse oximeter probes break?

PubMed

Crede, S; Van der Merwe, G; Hutchinson, J; Woods, D; Karlen, W; Lawn, J

2014-06-01

Pulse oximetry, a non-invasive method for accurate assessment of blood oxygen saturation (SPO2), is an important monitoring tool in health care facilities. However, it is often not available in many low-resource settings, due to expense, overly sophisticated design, a lack of organised procurement systems and inadequate medical device management and maintenance structures. Furthermore medical devices are often fragile and not designed to withstand the conditions of low-resource settings. In order to design a probe, better suited to the needs of health care facilities in low-resource settings this study aimed to document the site and nature of pulse oximeter probe breakages in a range of different probe designs in a low to middle income country. A retrospective review of job cards relating to the assessment and repair of damaged or faulty pulse oximeter probes was conducted at a medical device repair company based in Cape Town, South Africa, specializing in pulse oximeter probe repairs. 1,840 job cards relating to the assessment and repair of pulse oximeter probes were reviewed. 60.2 % of probes sent for assessment were finger-clip probes. For all probes, excluding the neonatal wrap probes, the most common point of failure was the probe wiring (>50 %). The neonatal wrap most commonly failed at the strap (51.5 %). The total cost for quoting on the broken pulse oximeter probes and for the subsequent repair of devices, excluding replacement components, amounted to an estimated ZAR 738,810 (USD $98,508). Improving the probe wiring would increase the life span of pulse oximeter probes. Increasing the life span of probes will make pulse oximetry more affordable and accessible. This is of high priority in low-resource settings where frequent repair or replacement of probes is unaffordable or impossible.

Evaluation of SOCOM Wireless Monitor in Trauma Patients

DTIC Science & Technology

2013-02-01

pulse   oximeter  consistently  underestimates  O2   saturation  and   does  not  reliably  follow  changes  in  O2...fingertip   sensor   detects:   arterial   saturation   by   pulse   oximetry   (SpO2),   heart   rate  derived  from  R  wave...prehospital  run  reports.    These  data    suggest  that   the  R

Comparison of Decision Assist and Clinical Judgment of Experts for Prediction of Lifesaving Interventions

DTIC Science & Technology

2015-03-01

min of pulse oximeter photopletysmograph waveforms and extracted features to predict LSIs. We compared this with clinical judgment of LSIs by...Curve (AUROC). We obtained clinical judgment of need for LSI from 405 expert clinicians in135 trauma patients. The pulse oximeter algorithm...15 min of pulse oximeter waveforms predicts the need for LSIs during initial trauma resuscitation as accurately as judgment of expert trauma

Running on Empty? The Compensatory Reserve Index

DTIC Science & Technology

2013-12-01

peripheral perfusion can be displayed by pulse oximeters , with the photoplethysmographic (PPG) signal being derived from the infrared light absorbtion...existing literature on the cor- relation between features of the pulse oximeter PPG waveform and central blood volume,34Y36 led us to hypothesize that...PPG waveforms generated by Masimo and Nonin pulse oximeters , CRI accuracy results have been obtained for 30 high- and low- tolerant LBNP subjects. CRI

Reliability and concurrent validity of a peripheral pulse oximeter and health-app system for the quantification of heart rate in healthy adults.

PubMed

Losa-Iglesias, Marta Elena; Becerro-de-Bengoa-Vallejo, Ricardo; Becerro-de-Bengoa-Losa, Klark Ricardo

2016-06-01

There are downloadable applications (Apps) for cell phones that can measure heart rate in a simple and painless manner. The aim of this study was to assess the reliability of this type of App for a Smartphone using an Android system, compared to the radial pulse and a portable pulse oximeter. We performed a pilot observational study of diagnostic accuracy, randomized in 46 healthy volunteers. The patients' demographic data and cardiac pulse were collected. Radial pulse was measured by palpation of the radial artery with three fingers at the wrist over the radius; a low-cost portable, liquid crystal display finger pulse oximeter; and a Heart Rate Plus for Samsung Galaxy Note®. This study demonstrated high reliability and consistency between systems with respect to the heart rate parameter of healthy adults using three systems. For all parameters, ICC was > 0.93, indicating excellent reliability. Moreover, CVME values for all parameters were between 1.66-4.06 %. We found significant correlation coefficients and no systematic differences between radial pulse palpation and pulse oximeter and a high precision. Low-cost pulse oximeter and App systems can serve as valid instruments for the assessment of heart rate in healthy adults. © The Author(s) 2014.

Medical telesensors

NASA Astrophysics Data System (ADS)

Ferrell, Trinidad L.; Crilly, P. B.; Smith, S. F.; Wintenberg, Alan L.; Britton, Charles L., Jr.; Morrison, Gilbert W.; Ericson, M. N.; Hedden, D.; Bouldin, Donald W.; Passian, A.; Downey, Todd R.; Wig, A. G.; Meriaudeau, Fabrice

1998-05-01

Medical telesensors are self-contained integrated circuits for measuring and transmitting vital signs over a distance of approximately 1-2 meters. The circuits are unhoused and contain a sensor, signal processing and modulation electronics, a spread-spectrum transmitter, an antenna and a thin-film battery. We report on a body-temperature telesensor, which is sufficiently small to be placed on a tympanic membrane in a child's ear. We also report on a pulse-oximeter telesensor and a micropack receiver/long- range transmitter unit, which receives form a telesensor array and analyzes and re-transmits the vital signs over a longer range. Signal analytics are presented for the pulse oximeter, which is currently in the form of a finger ring. A multichip module is presented as the basic signal-analysis component. The module contains a microprocessor, a field=programmable gate array, memory elements and other components necessary for determining trauma and reporting signals.

Hypoxia, Monitoring, and Mitigation System

DTIC Science & Technology

2014-05-01

indicators based on measured and predicted data. Given the beat-to-beat method in which oxygen saturation is measured via a pulse oximeter , a certain...saturation sample values are far below what would be trusted on a pulse oximeter . No indication was given after oxygen mask placement on subjective...determined using a pulse oximeter for continuous monitoring of arterial oxygen saturation (SaO2) in 95 ASA class I or II adult patients breathing room

Cyanotic heart disease

MedlinePlus

... by checking it through the skin with a pulse oximeter Complete blood count (CBC) ECG (electrocardiogram) Looking at ... from the groin ( cardiac catheterization ) Transcutaneous oxygen monitor (pulse oximeter) Echo-Doppler

Ring-shaped pulse oximeter and its application: measurement of SpO2 and blood pressure during sleep and during flight.

PubMed

Kishimoto, Aya; Tochikubo, Osamu; Ohshige, Kenji; Yanaga, Akihiko

2005-01-01

Respiratory and cardiovascular functions show circadian and day-to-day changes. We have developed a wireless ring-shaped pulse oximeter in collaboration with MC Medical Inc. and Advanced Medical Inc. We investigated the accuracy of this pulse oximeter and its application in daily life. Percutaneous arterial oxygen saturation (SpO2) of 47 volunteers was measured simultaneously with the ring-shaped pulse oximeter and a standard pulse oximeter. A total of 103 volunteers underwent measurement of SpO2 for 24 hr, and 11 healthy volunteers underwent measurement of SpO2 and blood pressure (BP) during flight. SpO2 and heart rate (HR) were measured and recorded every 20 sec, cabin barometric pressure and cabin oxygen concentration equivalent to sea level were measured minute-to-minute, and BP was measured every 3 min with a portable BP recorder during each flight. The SpO2 values measured with the ring-shaped pulse oximeter were similar to those measured with the standard method. The mean SpO2 during sleep was significantly lower in the group with high-normal BP or mild hypertension than in the group with normal BP. During flight, the mean change in SpO2 was -2.4 +/- 1.7% during nose-up flight, and 2.1 +/- 2.6% during nose-down flight. There was a significant correlation between change in SpO2 and change in systolic BP during nose-up flight. The wireless ring-shaped pulse oximeter was useful for investigating changes in SpO2 and its effect on BP in daily life during sleep and during air travel.

Simulink based behavioural modelling of a pulse oximeter for deployment in rapid development, prototyping and verification.

PubMed

Shokouhian, M; Morling, R C S; Kale, I

2012-01-01

The pulse oximeter is a well-known device for measuring the level of oxygen in blood. Since their invention, pulse oximeters have been under constant development in both aspects of hardware and software; however there are still unsolved problems that limit their performance [6], [7]. Many fresh algorithms and new design techniques are being suggested every year by industry and academic researchers which claim that they can improve accuracy of measurements [8], [9]. With the lack of an accurate computer-based behavioural model for pulse oximeters, the only way for evaluation of these newly developed systems and algorithms is through hardware implementation which can be both expensive and time consuming. This paper presents an accurate Simulink based behavioural model for a pulse oximeter that can be used by industry and academia alike working in this area, as an exploration as well as productivity enhancement tool during their research and development process. The aim of this paper is to introduce a new computer-based behavioural model which provides a simulation environment from which new ideas can be rapidly evaluated long before the real implementation.

Accuracy of the Lifebox pulse oximeter during hypoxia in healthy volunteers.

PubMed

Dubowitz, G; Breyer, K; Lipnick, M; Sall, J W; Feiner, J; Ikeda, K; MacLeod, D B; Bickler, P E

2013-12-01

Pulse oximetry is a standard of care during anaesthesia in high-income countries. However, 70% of operating environments in low- and middle-income countries have no pulse oximeter. The 'Lifebox' oximetry project set out to bridge this gap with an inexpensive oximeter meeting CE (European Conformity) and ISO (International Organization for Standardization) standards. To date, there are no performance-specific accuracy data on this instrument. The aim of this study was to establish whether the Lifebox pulse oximeter provides clinically reliable haemoglobin oxygen saturation (Sp O2 ) readings meeting USA Food and Drug Administration 510(k) standards. Using healthy volunteers, inspired oxygen fraction was adjusted to produce arterial haemoglobin oxygen saturation (Sa O2 ) readings between 71% and 100% measured with a multi-wavelength oximeter. Lifebox accuracy was expressed using bias (Sp O2 - Sa O2 ), precision (SD of the bias) and the root mean square error (Arms). Simultaneous readings of Sa O2 and Sp O2 in 57 subjects showed a mean (SD) bias of -0.41% (2.28%) and Arms 2.31%. The Lifebox pulse oximeter meets current USA Food and Drug Administration standards for accuracy, thus representing an inexpensive solution for patient monitoring without compromising standards. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Pulse oximeter accuracy and precision at five different sensor locations in infants and children with cyanotic heart disease

PubMed Central

Das, Jyotirmoy; Aggarwal, Amit; Aggarwal, Naresh Kumar

2010-01-01

Since the invention of pulse oximetry by Takuo Aoyagi in the early 1970s, its use has expanded beyond the perioperative care into neonatal, paediatric and adult intensive care units (ICUs). Pulse oximetry is one of the most important advances in respiratory monitoring as its readings (SpO2) are used clinically as an indirect estimation of arterial oxygen saturation (SaO2). Sensors were placed frequently on the sole, palm, ear lobe or toes in addition to finger. On performing an extensive Medline search using the terms “accuracy of pulse oximetry” and “precision of pulse oximetry”, limited data were found in congenital heart disease patients in the immediate post-corrective stage. Also, there are no reports and comparative data of the reliability and precision of pulse oximetry when readings from five different sensor locations (viz. finger, palm, toe, sole and ear) are analysed simultaneously. To fill these lacunae of knowledge, we undertook the present study in 50 infants and children with cyanotic heart disease in the immediate post-corrective stage. PMID:21224970

Pulse oximeter accuracy and precision at five different sensor locations in infants and children with cyanotic heart disease.

PubMed

Das, Jyotirmoy; Aggarwal, Amit; Aggarwal, Naresh Kumar

2010-11-01

Since the invention of pulse oximetry by Takuo Aoyagi in the early 1970s, its use has expanded beyond the perioperative care into neonatal, paediatric and adult intensive care units (ICUs). Pulse oximetry is one of the most important advances in respiratory monitoring as its readings (SpO(2)) are used clinically as an indirect estimation of arterial oxygen saturation (SaO(2)). Sensors were placed frequently on the sole, palm, ear lobe or toes in addition to finger. On performing an extensive Medline search using the terms "accuracy of pulse oximetry" and "precision of pulse oximetry", limited data were found in congenital heart disease patients in the immediate post-corrective stage. Also, there are no reports and comparative data of the reliability and precision of pulse oximetry when readings from five different sensor locations (viz. finger, palm, toe, sole and ear) are analysed simultaneously. To fill these lacunae of knowledge, we undertook the present study in 50 infants and children with cyanotic heart disease in the immediate post-corrective stage.

Effects of U.S. Navy Diver Training on Physiological Parameters, Time of Useful Consciousness and Cognitive Performance During Periods of Normobaric Hypoxia

DTIC Science & Technology

2014-04-01

from the pulse oximeter were integrated, digitized, and displayed graphically in real time in LabView (National Instruments) and logged at 20 Hz...Peripheral oxygenation monitoring: Fg-SpO2 levels were measured using a pulse oximeter placed on the left index finger (ROBD-2; Series 6202, Environics...Tolland, CT). Heart rate monitoring: HR was measured using a pulse oximeter placed on the left index finger (ROBD-2; Series 6202, Environics

F-22 Pilot Heart Rate Response to +Gz and Relationship to Pilot Fitness Using U.S. Air Force Fitness Test Scores

DTIC Science & Technology

2015-08-19

finger-mounted units that produced a significant amount of artifact. The collection method matured to a helmet-mounted pulse oximeter (HMPO) unit...2015-5343. Helmet-mounted pulse oximeter data exist for 5847 sorties. Each sortie contains multiple +Gz exposures and each +Gz exposure is of...AGSM anti-G straining maneuver BMI body mass index CO cardiac output HMPO helmet-mounted pulse oximeter HR heart rate ID identification

Effects of U.S. Navy Diver Training on Physiological Parameters, Time of Useful Consciousness, and Cognitive Performance During Periods of Normobaric Hypoxia

DTIC Science & Technology

2014-04-01

from the pulse oximeter were integrated, digitized, and displayed graphically in real time in LabView (National Instruments) and logged at 20 Hz...Peripheral oxygenation monitoring: Fg-SpO2 levels were measured using a pulse oximeter placed on the left index finger (ROBD-2; Series 6202, Environics...Tolland, CT). Heart rate monitoring: HR was measured using a pulse oximeter placed on the left index finger (ROBD-2; Series 6202, Environics

Oxygen targeting in preterm infants using the Masimo SET Radical pulse oximeter

PubMed Central

Johnston, Ewen D; Boyle, Breidge; Juszczak, Ed; King, Andy; Brocklehurst, Peter; Stenson, Ben J

2011-01-01

Background A pretrial clinical improvement project for the BOOST-II UK trial of oxygen saturation targeting revealed an artefact affecting saturation profiles obtained from the Masimo Set Radical pulse oximeter. Methods Saturation was recorded every 10 s for up to 2 weeks in 176 oxygen dependent preterm infants in 35 UK and Irish neonatal units between August 2006 and April 2009 using Masimo SET Radical pulse oximeters. Frequency distributions of % time at each saturation were plotted. An artefact affecting the saturation distribution was found to be attributable to the oximeter's internal calibration algorithm. Revised software was installed and saturation distributions obtained were compared with four other current oximeters in paired studies. Results There was a reduction in saturation values of 87–90%. Values above 87% were elevated by up to 2%, giving a relative excess of higher values. The software revision eliminated this, improving the distribution of saturation values. In paired comparisons with four current commercially available oximeters, Masimo oximeters with the revised software returned similar saturation distributions. Conclusions A characteristic of the software algorithm reduces the frequency of saturations of 87–90% and increases the frequency of higher values returned by the Masimo SET Radical pulse oximeter. This effect, which remains within the recommended standards for accuracy, is removed by installing revised software (board firmware V4.8 or higher). Because this observation is likely to influence oxygen targeting, it should be considered in the analysis of the oxygen trial results to maximise their generalisability. PMID:21378398

Oxygen targeting in preterm infants using the Masimo SET Radical pulse oximeter.

PubMed

Johnston, Ewen D; Boyle, Breidge; Juszczak, Ed; King, Andy; Brocklehurst, Peter; Stenson, Ben J

2011-11-01

A pretrial clinical improvement project for the BOOST-II UK trial of oxygen saturation targeting revealed an artefact affecting saturation profiles obtained from the Masimo Set Radical pulse oximeter. Saturation was recorded every 10 s for up to 2 weeks in 176 oxygen dependent preterm infants in 35 UK and Irish neonatal units between August 2006 and April 2009 using Masimo SET Radical pulse oximeters. Frequency distributions of % time at each saturation were plotted. An artefact affecting the saturation distribution was found to be attributable to the oximeter's internal calibration algorithm. Revised software was installed and saturation distributions obtained were compared with four other current oximeters in paired studies. There was a reduction in saturation values of 87-90%. Values above 87% were elevated by up to 2%, giving a relative excess of higher values. The software revision eliminated this, improving the distribution of saturation values. In paired comparisons with four current commercially available oximeters, Masimo oximeters with the revised software returned similar saturation distributions. A characteristic of the software algorithm reduces the frequency of saturations of 87-90% and increases the frequency of higher values returned by the Masimo SET Radical pulse oximeter. This effect, which remains within the recommended standards for accuracy, is removed by installing revised software (board firmware V4.8 or higher). Because this observation is likely to influence oxygen targeting, it should be considered in the analysis of the oxygen trial results to maximise their generalisability.

Tricuspid Atresia

MedlinePlus

... help the delivery team plan treatment. A screening pulse oximeter test usually is done on all newborns right ... and help plan treatment. The tests may include: pulse oximeter monitoring a chest X-ray electrocardiogram (also called ...

Hypoxia, Monitoring, and Mitigation System

DTIC Science & Technology

2014-02-01

CO- Oximeter SpO2 Arterial Oxygen Saturation Measured via Pulse - Oximeter TAILSS Tactical Aircrew Integrated Life Support System TUC Time of Useful...SpO2, pulse / pulse rate, ECG, and skin temperature will be researched and evaluated for integration feasibility with a tactile vibrator for alerting

In-vitro model for evaluation of pulse oximetry

NASA Astrophysics Data System (ADS)

Vegfors, Magnus; Lindberg, Lars-Goeran; Lennmarken, Claes; Oberg, P. Ake

1991-06-01

An in vitro model with blood circulating in a silicon tubing system and including an artificial arterial bed is an important tool for evaluation of the pulse oximetry technique. The oxygen saturation was measured on an artificial finger using a pulse oximeter (SpO2) and on blood samples using a hemoximeter (SaO2). Measurements were performed at different blood flows and at different blood hematocrits. An increase in steady as well as in pulsatile blood flow was followed by an increase in pulse oximeter readings and a better agreement between SpO2 and SaO2 readings. After diluting the blood with normal saline (decreased hematocrit) the agreement was further improved. These results indicate that the pulse oximeter signal is related to blood hematocrit and the velocity of blood. The flow-related dependance of SpO2 was also evaluated in a human model. These results provided evidence that the pulse oximeter signal is dependent on vascular changes.

The efficacy of noninvasive hemoglobin measurement by pulse CO-oximetry in neonates.

PubMed

Jung, Young Hwa; Lee, Juyoung; Kim, Han-Suk; Shin, Seung Han; Sohn, Jin A; Kim, Ee-Kyung; Choi, Jung-Hwan

2013-01-01

To evaluate clinical applicability of noninvasive hemoglobin (Hb) measurement with a pulse CO-oximeter in neonates. Prospective comparison study. Neonatal ICU. Fifty-six preterm and term infants with median age = 20 days (range = 1-98 days) and median weight = 1,440 g (range = 530-4,230 g). Hb measurements by Pulse CO-Oximetry (Masimo Radical-7) were recorded immediately prior to venous samplings. The collected data were compared with the corresponding venous Hb level obtained in laboratory testing, and a total of 137 data pairs were analyzed. Noninvasive Hb values measured with a pulse CO-oximeter were significantly correlated with the venous Hb levels (correlation coefficient, r = 0.758; p < 0.001). Hb values measured with a pulse CO-oximeter were higher than those measured with a laboratory hematology analyzer (13.3 ± 2.6g/dL vs. 12.5 ± 3.1g/dL). In terms of the agreement between the laboratory analyzer and the pulse CO-oximeter, 94.8% of the measurements fell within two standard deviations of the mean difference. Noninvasive Hb measurements with Pulse CO-Oximetry provide clinically acceptable accuracy, and they were significantly correlated with laboratory Hb measurement in neonates. In terms of the clinical applicability, noninvasive Hb monitoring with a pulse CO-oximeter could be useful in the early detection of Hb changes in neonates.

Ability of the Masimo pulse CO-Oximeter to detect changes in hemoglobin.

PubMed

Colquhoun, Douglas A; Forkin, Katherine T; Durieux, Marcel E; Thiele, Robert H

2012-04-01

The decision to administer blood products is complex and multifactorial. Accurate assessment of the concentration of hemoglobin [Hgb] is a key component of this evaluation. Recently a noninvasive method of continuously measuring hemoglobin (SpHb) has become available with multi-wavelength Pulse CO-Oximetry. The accuracy of this device is well documented, but the trending ability of this monitor has not been previously described. Twenty patients undergoing major thoracic and lumbar spine surgery were recruited. All patients received radial arterial lines. On the contralateral index finger, a R1 25 sensor (Rev E) was applied and connected to a Radical-7 Pulse CO-Oximeter (both Masimo Corp, Irvine, CA). Blood samples were drawn intermittently at the anesthesia provider's discretion and were analyzed by the operating room satellite laboratory CO-Oximeter. The value of Hgb and SpHb at that time point was compared. Trend analysis was performed by the four quadrant plot technique, testing directionality of change, and Critchley's polar plot method testing both directionality and magnitude of the change in values. Eighty-eight samples recorded at times of sufficient signal quality were available for analysis. Four quadrant plot analysis revealed 94% of data within the quadrants associated with the correct direction change, and 90% of data points lay within the analysis bounds proposed by Critchley. Pulse CO-Oximetry offers an acceptable trend monitor in patients undergoing major spine surgery. Future work should explore the ability of this device to detect large changes in hemoglobin, as well as its applicability in additional surgical and non-surgical patient populations.

Pulse oximeter as a sensor of fluid responsiveness: do we have our finger on the best solution?

PubMed Central

Monnet, Xavier; Lamia, Bouchra; Teboul, Jean-Louis

2005-01-01

The pulse oximetry plethysmographic signal resembles the peripheral arterial pressure waveform, and the degree of respiratory variation in the pulse oximetry wave is close to the degree of respiratory arterial pulse pressure variation. Thus, it is tempting to speculate that pulse oximetry can be used to assess preload responsiveness in mechanically ventilated patients. In this commentary we briefly review the complex meaning of the pulse oximetry plethysmographic signal and highlight the advantages, limitations and pitfalls of the pulse oximetry method. Future studies including volume challenge must be performed to test whether the pulse oximetry waveform can really serve as a nonivasive tool for the guidance of fluid therapy in patients receiving mechanical ventilation in intensive care units and in operating rooms. PMID:16277729

Reliability and Validity of a Smartphone-Paired Pulse Oximeter for Screening of Critical Congenital Heart Defects in Newborns.

PubMed

Huizing, Maurice J; Villamor-Martínez, Eduardo; Chavagne, Ingrid A; Vanagt, Ward Y; Spaanderman, Marc A E; Villamor, Eduardo

2017-01-01

Barriers to widespread implementation of pulse oximetry screening of critical congenital heart defects (CCHD) in newborns include increasing trends of out-of-hospital births and cost of equipment. In recent years, smartphone-compatible pulse oximeters have appeared on the market, but the validity of such devices in the setting of CCHD screening has not been evaluated. To compare the performance in CCHD screening of a smartphone-paired pulse oximeter (Masimo iSpO2-Rx™) and a hospital-grade pulse oximeter (Masimo Radical-7™). Preductal (right hand) and postductal (either foot) saturations were determined in a population of 201 term newborns by 2 independent teams, one using the Radical-7 and the other using the iSpO2-Rx. Bland-Altman analysis was applied to calculate mean bias and 95% limits of agreement between the 2 pulse oximeters. For the preductal oxygen saturation, the mean bias (Radical-7 minus iSpO2-Rx) was -0.08 (SD 1.76) and the lower and upper limits of agreement were -3.52 and 3.36, respectively. For the postductal oxygen saturation, the mean bias was -0.11 (SD 1.68) and the lower and upper limits of agreement were -3.49 and 3.18, respectively. In addition, the iSpO2-Rx provided reliable measurements of saturations below 95% in a group of 12 infants admitted to the neonatal intensive care unit. Our data suggest that CCHD screening with the Masimo iSpO2-Rx is feasible and accurate. The use of reliable smartphone-paired pulse oximeters may contribute to the extension of CCHD screening to home births and low resource settings. © 2017 S. Karger AG, Basel.

Pulse oximeter based mobile biotelemetry application.

PubMed

Işik, Ali Hakan; Güler, Inan

2012-01-01

Quality and features of tele-homecare are improved by information and communication technologies. In this context, a pulse oximeter-based mobile biotelemetry application is developed. With this application, patients can measure own oxygen saturation and heart rate through Bluetooth pulse oximeter at home. Bluetooth virtual serial port protocol is used to send the test results from pulse oximeter to the smart phone. These data are converted into XML type and transmitted to remote web server database via smart phone. In transmission of data, GPRS, WLAN or 3G can be used. The rule based algorithm is used in the decision making process. By default, the threshold value of oxygen saturation is 80; the heart rate threshold values are 40 and 150 respectively. If the patient's heart rate is out of the threshold values or the oxygen saturation is below the threshold value, an emergency SMS is sent to the doctor. By this way, the directing of an ambulance to the patient can be performed by doctor. The doctor for different patients can change these threshold values. The conversion of the result of the evaluated data to SMS XML template is done on the web server. Another important component of the application is web-based monitoring of pulse oximeter data. The web page provides access to of all patient data, so the doctors can follow their patients and send e-mail related to the evaluation of the disease. In addition, patients can follow own data on this page. Eight patients have become part of the procedure. It is believed that developed application will facilitate pulse oximeter-based measurement from anywhere and at anytime.

Effects of skin pigmentation on pulse oximeter accuracy at low saturation.

PubMed

Bickler, Philip E; Feiner, John R; Severinghaus, John W

2005-04-01

It is uncertain whether skin pigmentation affects pulse oximeter accuracy at low HbO2 saturation. The accuracy of finger pulse oximeters during stable, plateau levels of arterial oxygen saturation (Sao2) between 60 and 100% were evaluated in 11 subjects with darkly pigmented skin and in 10 with light skin pigmentation. Oximeters tested were the Nellcor N-595 with the OxiMax-A probe (Nellcor Inc., Pleasanton, CA), the Novametrix 513 (Novametrix Inc., Wallingford, CT), and the Nonin Onyx (Nonin Inc., Plymouth, MN). Semisupine subjects breathed air-nitrogen-carbon dioxide mixtures through a mouthpiece. A computer used end-tidal oxygen and carbon dioxide concentrations determined by mass spectrometry to estimate breath-by-breath Sao2, from which an operator adjusted inspired gas to rapidly achieve 2- to 3-min stable plateaus of desaturation. Comparisons of oxygen saturation measured by pulse oximetry (Spo2) with Sao2 (by Radiometer OSM3) were used in a multivariate model to determine the interrelation between saturation, skin pigmentation, and oximeter bias (Spo2 - Sao2). At 60-70% Sao2, Spo2 (mean of three oximeters) overestimated Sao2 (bias +/- SD) by 3.56 +/- 2.45% (n = 29) in darkly pigmented subjects, compared with 0.37 +/- 3.20% (n = 58) in lightly pigmented subjects (P < 0.0001). The SD of bias was not greater with dark than light skin. The dark-light skin differences at 60-70% Sao2 were 2.35% (Nonin), 3.38% (Novametrix), and 4.30% (Nellcor). Skin pigment-related differences were significant with Nonin below 70% Sao2, with Novametrix below 90%, and with Nellcor at all ranges. Pigment-related bias increased approximately in proportion to desaturation. The three tested pulse oximeters overestimated arterial oxygen saturation during hypoxia in dark-skinned individuals.

Signal-enhancement reflective pulse oximeter with Fresnel lens

NASA Astrophysics Data System (ADS)

Chung, Shuang-Chao; Sun, Ching-Cherng

2016-09-01

In this paper, a new reflective pulse oximeter is proposed and demonstrated with implanting a Fresnel lens, which enhances the reflected signal. An optical simulation model incorporated with human skin characteristics is presented to evaluate the capability of the Fresnel lens. In addition, the distance between the light emitting diode and the photodiode is optimized. Compared with the other reflective oximeters, the reflected signal light detected by the photodiode is enhanced to more than 140%.

The influence of changes in blood flow on the accuracy of pulse oximetry in humans.

PubMed

Vegfors, M; Lindberg, L G; Lennmarken, C

1992-05-01

Oxygen saturation (SpO2) was measured with a pulse oximeter in ten healthy, young men breathing air. A pulse oximeter probe was attached to the second toe and a laser Doppler probe to the first toe of the same foot for measurement of changes in peripheral blood flow. The pulse oximeter and laser Doppler readings were simultaneously compared when the foot was positioned 40 cm (position 1) above heart level, elevated 10 cm (position 2) above heart level and horizontally at heart level (position 3). Using this experimental human model, we achieved various blood flows. The AC and DC optical signals used for determination of oxygen saturation were recorded from the pulse oximeter and analysed. There was a significant increase (P less than 0.05) between position 1 and 3 in blood flow as measured by the laser Doppler flow meter. The corresponding pulse oximeter readings of haemoglobin saturation also increased significantly (P less than 0.05) comparing these two leg positions. Analysing the AC- and DC optical signals, the AC value of infrared light increased considerably, while the AC value of the red light decreased slightly. The DC values of red and infrared light did not change significantly. In summary, when blood flow was decreased, the ratio of red to infrared transmitted light was changed, resulting in a low SpO2 reading.

Development and clinical evaluation of a new sensor design for buccal pulse oximetry in horses.

PubMed

Reiners, J K; Rossdeutscher, W; Hopster, K; Kästner, S B R

2018-03-01

The use of pulse oximetry in horses is limited due to inadequate readings with conventional transmission sensor probes. The objectives of this study were to 1) develop an improved sensor design for horses to be used at an appropriate anatomical site, and 2) evaluate this design in an experimental study. In vivo experiment. A new sensor design for reflectance pulse oximetry at the buccal mucosa was developed. A conventional Nonin 2000SL sensor for transmission pulse oximetry was included into this design. Three different prototypes (N1, N2a, N2b) were constructed and used with the Nonin 2500A Vet pulse oximetry monitor. Thirteen anaesthetised warmblood horses were included into a desaturation protocol (100-70% SaO 2 ). SpO 2 and pulse frequency values were recorded, using SaO 2 calculated from blood gas analysis and invasive pulse frequency measurements as reference methods. Bias and precision were evaluated by calculations of the root mean square deviation (A rms ). The agreement of the methods was tested with Bland-Altman analysis. The quality of the pulse frequency readings determined the quality of the SpO 2 -readings. Good pulse signal strength resulted in a SpO 2 -accuracy comparable to that of the original sensor (Nonin 2000SL: A rms = 3%; N1: A rms = 3.60%; N2b: A rms = 3.46%). Especially at heart rates ≤30 bpm, pulse rate readings that were about twice as high as the reference value occurred. Their exclusion from the dataset resulted in a pulse rate accuracy similar to that of the original sensor. Bland-Altman plots showed limits of agreement typical of pulse oximeters. The pulse frequency accuracy requires further improvement. The usability in clinical cases needs to be tested. The new sensor design has been shown to be suitable for buccal pulse oximetry in horses. © 2017 EVJ Ltd.

Design and Construction of a Microcontroller-Based Ventilator Synchronized with Pulse Oximeter.

PubMed

Gölcük, Adem; Işık, Hakan; Güler, İnan

2016-07-01

This study aims to introduce a novel device with which mechanical ventilator and pulse oximeter work in synchronization. Serial communication technique was used to enable communication between the pulse oximeter and the ventilator. The SpO2 value and the pulse rate read on the pulse oximeter were transmitted to the mechanical ventilator through transmitter (Tx) and receiver (Rx) lines. The fuzzy-logic-based software developed for the mechanical ventilator interprets these values and calculates the percentage of oxygen (FiO2) and Positive End-Expiratory Pressure (PEEP) to be delivered to the patient. The fuzzy-logic-based software was developed to check the changing medical states of patients and to produce new results (FiO2 ve PEEP) according to each new state. FiO2 and PEEP values delivered from the ventilator to the patient can be calculated in this way without requiring any arterial blood gas analysis. Our experiments and the feedbacks from physicians show that this device makes it possible to obtain more successful results when compared to the current practices.

A multiplexed electronic architecture for opto-electronic patch sensor to effectively monitor heart rate and oxygen saturation

NASA Astrophysics Data System (ADS)

Yan, Liangwen; Hu, Sijung; Alharbi, Samah; Blanos, Panagiotis

2018-02-01

To effectively capture human vital signs, a multi-wavelength optoelectronic patch sensor (MOEPS), together with a schematic architecture of electronics, was developed to overcome the drawbacks of present photoplethysmographic (PPG) sensors. To obtain a better performance of in vivo physiological measurement, the optimal illuminations, i.e., light emitting diodes (LEDs) in the MOEPS, whose wavelength is automatically adjusted to each specific subject, were selected to capture better PPG signals. A multiplexed electronic architecture has been well established to properly drive the MOEPS and effectively capture pulsatile waveforms at rest. The protocol was designed to investigate its performance with the participation of 11 healthy subjects aged between 18 and 30. The signals obtained from green (525nm) and orange (595nm) illuminations were used to extract heart rate (HR) and oxygen saturation (SpO2%). These results were compared with data, simultaneously acquired, from a commercial ECG and a pulse oximeter. Considering the difficulty for current devices to attain the SpO2%, a new computing method, to obtain the value of SpO2%, is proposed depended on the green and orange wavelength illuminations. The values of SpO2% between the MOEPS and the commercial Pulse Oximeter devics showed that the results were in good agreement. The values of HR showed close correlation between commercial devices and the MOEPS (HR: r1=0.994(Green); r2=0.992(Orange); r3=0.975(Red); r4=0.990(IR)).

Wearable Wireless Sensor for Multi-Scale Physiological Monitoring

DTIC Science & Technology

2015-10-01

clothes with different colors and patterns. The developed algorithm can still detect the chest movements even if single color clothes are worn...Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT One of the aims of Year 2 of the project was to complete development of a prototype multi...this aim, we have developed a prototype 6-photodetector reflectance-based pulse oximeter and results to date show that good signals can be obtained in

Comparative Evaluation of Accuracy of Pulse Oximeters and Factors Affecting Their Performance in a Tertiary Intensive Care Unit

PubMed Central

Sahi, Malvinder Singh; Mahawar, Bablesh; Rajpurohit, Sajjan

2017-01-01

Introduction Pulse oximetry is a widely used tool, unfortunately there is a paucity of data investigating its accuracy in Intensive Care Units (ICU) and if they are able to meet mandated FDA criteria as claimed by them in critically ill patients. Aim To assess bias, precision and accuracy of pulse oximeters used in ICU and factors affecting them. Materials and Methods A prospective cohort study, including 129 patients admitted to the ICU of a tertiary referral centre. Pulse oximetry and blood gas were done simultaneously. Pulse oximetry was done using two pulse oximetres: Nonin and Philips. All physiological variables like haemoglobin, lactate, use of vasopressors and blood pressure were recorded. Bland Altman curves were constructed to determine bias and limits of agreement. Effect of physiological variables on bias and difference between performance characteristics of bias was determined using SPSS. Results Pulse oximetry overestimated arterial oxygen saturation (SaO2) by 1.44%. There was negative correlation between bias and SaO2 (r=-0.32) and positive correlation with lactate (r=0.16). The Philips pulse oximeter had significant higher bias and variability than Nonin pulse oximeter. (2.49±2.99 versus 0.46±1.68, mean difference = 1.98, 95% C.I. = 1.53 – 2.43, p-value <0.001). Conclusion Pulse oximetry overestimates SaO2. Bias tends to increase with rising lactate and hypoxia. There is heterogeneity in performance of various pulse oximetry devices in ICU. PMID:28764215

Comparative Evaluation of Accuracy of Pulse Oximeters and Factors Affecting Their Performance in a Tertiary Intensive Care Unit.

PubMed

Singh, Anupam Kumar; Sahi, Malvinder Singh; Mahawar, Bablesh; Rajpurohit, Sajjan

2017-06-01

Pulse oximetry is a widely used tool, unfortunately there is a paucity of data investigating its accuracy in Intensive Care Units (ICU) and if they are able to meet mandated FDA criteria as claimed by them in critically ill patients. To assess bias, precision and accuracy of pulse oximeters used in ICU and factors affecting them. A prospective cohort study, including 129 patients admitted to the ICU of a tertiary referral centre. Pulse oximetry and blood gas were done simultaneously. Pulse oximetry was done using two pulse oximetres: Nonin and Philips. All physiological variables like haemoglobin, lactate, use of vasopressors and blood pressure were recorded. Bland Altman curves were constructed to determine bias and limits of agreement. Effect of physiological variables on bias and difference between performance characteristics of bias was determined using SPSS. Pulse oximetry overestimated arterial oxygen saturation (SaO 2 ) by 1.44%. There was negative correlation between bias and SaO 2 (r=-0.32) and positive correlation with lactate (r=0.16). The Philips pulse oximeter had significant higher bias and variability than Nonin pulse oximeter. (2.49±2.99 versus 0.46±1.68, mean difference = 1.98, 95% C.I. = 1.53 - 2.43, p-value <0.001). Pulse oximetry overestimates SaO 2 . Bias tends to increase with rising lactate and hypoxia. There is heterogeneity in performance of various pulse oximetry devices in ICU.

Sex Differences in Cardiovascular and Subjective Stress Reactions: Prospective Evidence in a Realistic Military Setting

DTIC Science & Technology

2014-01-01

procedures were held constant). After the period of quiet rest, the finger pulse oximeter (MedSource International, Mound, MN) was applied to the left...temperature were then recorded with pulse oximeter (Medline Industries, Inc., Mundelein, IL). Following standard guide- lines (Pickering et al., 2005

The Predictive Value of Pulse Oximeters for Pulse Improvement after Angiography in Infants and Children

PubMed Central

Alipour, Mohammad-Reza; Rastegar, Mazyar; Ghaderian, Mehdi; Namayandeh, Seyedeh-Mahdieh; Faraji, Reza; Pezeshkpour, Zohreh

2016-01-01

Background Information from pulse oximeter waves confirms the presence of a pulse and helps obtain waves from tissue when the supplying artery is not readily accessible. Objectives This study determined the predictive value of pulse oximeters for detecting improved arterial pulses after angiography. Patients and Methods This cross-sectional, multi-center study included 467 4-day-old to 12-year-old patients and was conducted from January 2012 to January 2016. Angiographies were performed on 12-year-old or younger children for various medical reasons using venous, arterial, or both types of paths. The posterior malleolar or dorsalis pedis were palpated in punctured lower extremities. In the absence of a pulse, pulse oximetry was performed to identify pulse curves at 1 hour, 6 hours, and 12 hours after each angiography. Results Pulse oximetry displayed the pulses of 319 patients immediately following each angiography. Of these, 262 patients had palpable pulses at 6 hours after angiography (P < 0.0001), while 57 patients had no palpable pulse. Of these 57 patients, 15 had no palpable pulse at 12 hours after angiography (P < 0.0001). The odds of pulse improvement in children 6 hours after catheter angiography were 76% for the arterial path, 90% for the venous path, and 83.2% for both paths. At 12 hours after catheter angiography, these values increased to 91.6% for the arterial path, 100% for the venous path, and 95.9% for both paths. Conclusions The pulse oximeter can display the pulse curve immediately (1 hour) after angiography and indicate pulse improvement at 12 hours maximally following an angiography. In this case, heparin alone may be used instead of thrombolytic agents. PMID:28203338

Role of Noninvasive Hemoglobin Monitoring in Trauma

DTIC Science & Technology

2015-03-25

spectrophotometry-based monitoring technology (Radical-7® Pulse CO- Oximeter ; Masimo Corp., Irvine, CA) that provides continuous hemoglobin...116(1):65-72. 14. Masimo Corp. Radical-7 signal extraction pulse co- oximeter operator’s manual. Irvine (CA): Masimo Corp.; 2007. 15. Bland JM...method similar to conventional pulse oximetry. Transmitted light is captured by photodiode receptor and analyzed to create an analog signal that, in

Monitoring of haemoglobin oxygen saturation in healthy infants using a new generation pulse oximeter which takes motion artifacts into account.

PubMed

Meyts, Isabelle; Reempts, Patrick Van; Boeck, Kris De

2002-12-01

The aim of this study was to establish normal values for overnight oxygen saturation (SpO2) in healthy term infants using an oximeter which takes into account motion artifacts and to compare these to normal values collected with a previous generation oximeter not correcting for motion artifacts. We recorded overnight SpO2 in 26 term, healthy infants (median age 136 days, range 6-364 days) in the home environment using the Nellcor Symphony N 3000 pulse oximeter with an averaging time of 3 s. A sample rate of 5 s was chosen. Motion artifacts were excluded from the analysis. Data were compared with those from a previous study, using the same inclusion and exclusion criteria with the Oxford Medilog. Median (quartiles) SpO2 was 98% (97%-99%). Median percentage of study time below SpO2 94% was 0.2% (0.1%-0.7%); median percentage of study time below SpO2 90% was 0.0% (0.0%-0.01%). Median SpO2with the Oxford oximeter was 97% (96%-98%); percentage of study time below SpO2 94% was 8% (2%-14%); percentage of study time below SpO2 90% was 2% (0%-4%). These data were compared with the Nellcor Symphony data: differences in median SpO2 were significant ( P<0.05); differences in percentage of time below SpO2 94% and 90% were also statistically significant ( P<0.001). we established normal values of oxygen saturation in healthy term infants using the Nellcor Symphony 3000 pulse oximeter. Care should be taken in interpreting values obtained with different types of pulse oximeters.

[New use of pulse-oximeter as a prophylactic Stimulator to the wearer and a lifesaving tools for prevention of hypoxic mishaps].

PubMed

Morioka, Tohru; Terasaki, Hidenori

2014-03-01

Pulse-oximeter has been widely used for the clinical assessment of physical status of a patient and as an alarming tool of hypoxia to medical personnel at the bedside or in the observation center. However, it has never been used for direct stimulation of the wearer. We considered innovation of pulse-oximeter as a prophylactic alarm-oximeter for the wearer. If SPO2 goes down to unfavorable level, the alarm-oximeter starts to send signal through a control box to a stimulator, such as an electrical nerve stimulator, a cold thermal tip, or mechanical device like a vibrator or compressor. The dermal stimulator is usually fixed to the right or left wrist with a Velcro band. The control box is affixed to the wristband by using Velcro. The alarm may be sent to an earphone or speaker with a verbal command like "take a deep breath". Alarm-oximeter will be combined to an oxygen inhaler or mechanical ventilatory assist device, or a drug administration system through electric line or wireless transmitter to start or change its function before the arrival of medical personnel. It will prevent hypoxic mishaps during medical intervention or sleep apnea syndrome. It will be also applicable to stop snoring.

Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: the AVIOx study.

PubMed

Hagadorn, James I; Furey, Anne M; Nghiem, Tuyet-Hang; Schmid, Christopher H; Phelps, Dale L; Pillers, De-Ann M; Cole, Cynthia H

2006-10-01

The objective of this study was to document pulse oximeter saturation levels achieved in the first 4 weeks of life in infants who were born at < 28 weeks' gestation, compared with the levels that were targeted by local policy, and examine factors that are associated with compliance with the target range. Infants who were < 28 weeks' gestation and < or = 96 hours of age were enrolled in a prospective, multicenter cohort study. Oximetry data were collected with masked signal-extraction oximeters for a 72-hour period in each of the first 4 weeks of life. Data were compared with the pulse oximeter saturation target range prescribed by local institutional policy. Factors that were associated with intended range compliance were identified with hierarchical modeling. Fourteen centers from 3 countries enrolled 84 infants with mean +/- SD birth weight of 863 +/- 208 g and gestational age of 26 +/- 1.4 weeks. Oxygen saturation policy limits ranged between 83% and 92% for lower limits and 92% and 98% for upper limits. For infants who received respiratory support, median pulse oximeter saturation level achieved was 95%. Center-specific medial levels were within the intended range at 12 centers. Centers maintained infants within their intended range 16% to 64% of the time but were above range 20% to 73% of the time. In hierarchical modeling, wider target ranges, higher target range upper limits, presence of a policy of setting oximeter alarms close to the target range limits, and lower gestational age were associated with improved target range compliance. Success with maintaining the intended pulse oximeter saturation range varied substantially among centers, among patients within centers, and for individual patients over time. Most noncompliance was above the intended range. Methods for improving compliance and the effect of improved compliance on neonatal outcomes require additional research.

Use of a prototype pulse oximeter for time series analysis of heart rate variability

NASA Astrophysics Data System (ADS)

González, Erika; López, Jehú; Hautefeuille, Mathieu; Velázquez, Víctor; Del Moral, Jésica

2015-05-01

This work presents the development of a low cost pulse oximeter prototype consisting of pulsed red and infrared commercial LEDs and a broad spectral photodetector used to register time series of heart rate and oxygen saturation of blood. This platform, besides providing these values, like any other pulse oximeter, processes the signals to compute a power spectrum analysis of the patient heart rate variability in real time and, additionally, the device allows access to all raw and analyzed data if databases construction is required or another kind of further analysis is desired. Since the prototype is capable of acquiring data for long periods of time, it is suitable for collecting data in real life activities, enabling the development of future wearable applications.

Multiwavelength pulse oximetry in the measurement of hemoglobin fractions

NASA Astrophysics Data System (ADS)

Manzke, Bernd; Schwider, Johannes; Lutter, Norbert O.; Engelhardt, Kai; Stork, Wilhelm

1996-04-01

The two wavelength design of the majority of pulse oximeters assumes only two absorbing hemoglobin fractions, oxyhemoglobin (O2Hb), and reduced hemoglobin (HHb) irrespective of the presence of methemoglobin (MetHb) and carboxyhemoglobin (COHb). If MetHb or COHb is present, it contributes to the pulse-added absorbance signal and will be interpreted as either HHb or O2Hb or some combination of the two. In this paper we describe a noninvasive multi-wavelength pulse oximeter measuring O2Hb, HHb, MetHb, and COHb at a specified accuracy of 1.0%. The system was designed with respect to the results of numerical simulations. It consists of 9 laserdiodes (LDs) and 7 light emitting diodes (LEDs), a 16-bit analog-digital converter (ADC) and has a sampling rate of 16 kHz. The laser didoes and LEDs were coupled into multi-mode fibers and led with a liquid lightguide to the finger clip and then the photodiode. It also presents the results of a clinical study, including a setup with a quartz tungsten halogen lamp (with fiber output) and a diode array spectrometer, a standard pulse oximeter and two in-vitro oximeters (radiometer OSM3 and radiometer ABL 520) as references.

[Design of a pulse oximeter used to low perfusion and low oxygen saturation].

PubMed

Tan, Shuangping; Ai, Zhiguang; Yang, Yuxing; Xie, Qingguo

2013-05-01

This paper presents a new pulse oximeter used to low perfusion at 0.125% and wide oxygen saturation range from 35% to 100%. In order to acquire the best PPG signals, the variable gain amplifier(VGA) is adopted in hardware. The self-developed auto-correlation modeling method is adopted in software and it can extract pulse wave from low perfusion signals and remove motion artifacts partly.

Effects of Simulated Pathophysiology on the Performance of a Decision Support Medical Monitoring System for Early Detection of Hemodynamic Decompensation in Humans

DTIC Science & Technology

2014-10-01

pulse oximeter (Cardiocap/5; Datex-Ohmeda, Louisville, CO). The EKG and pulse oximeter tracings were interfaced with a personal computer for con- tinuous...responses to reduced central venous pressure (CVP) and pulse pressure (PP) elicited during graded lower body negative pressure (LBNP) to those observed...Johnson BD, Curry TB, Convertino VA, & Joyner MJ. The association between pulse pressure and stroke volume during lower body negative pressure and

Intraoperative pulse oximetry: frequency and distribution of discrepant data.

PubMed

Pan, P H; Gravenstein, N

1994-01-01

To determine the types of discrepant data during intraoperative pulse oximetry and their frequency and duration. Prospective study. University medical center. 46 consecutive ASA physical status I-III patients undergoing general anesthesia for elective surgical operations. With an integrated computer algorithm on the pulse oximeter and another computer linked to it, data were screened and the frequency and distribution of the following oximeter signals recorded: absent; low quality or interrupted, as detected by the pulse oximeter algorithm; nonphysiologic, identified by the personal computer as a heart rate change greater than 10 beats per minute within 2 consecutive 2-second samples, with no similar abrupt change reported simultaneously on ECG. The number of episodes per hour of discrepant oximeter data and the duration of the episodes were recorded by phase of anesthesia: induction, maintenance, and emergence. Discrepant data occurred most frequently and lasted longest during emergence (p < 0.05); the majority of episodes of discrepant data during emergence lasted less than 12 seconds. Excluding discrepant data that lasted less than 12 seconds decreased the frequency of discrepant data by 63% and excluding those that lasted less than 30 seconds decreased the frequency of discrepant data by 93%. Pulse oximeters frequently report discrepant data intraoperatively, most frequently during emergence from anesthesia. An alarm delay triggered by discrepant data and lasting 12 to 30 seconds would keep most discrepant data from becoming false alarms and, thus, may reduce distracting sound pollution in the operating room.

Oxygen Saturation in Dental Pulp of Permanent Teeth: Difference between Children/Adolescents and Adults.

PubMed

Stella, João Paulo Fragomeni; Barletta, Fernando Branco; Giovanella, Larissa Bergesch; Grazziotin-Soares, Renata; Tovo, Maximiano Ferreira; Felippe, Wilson Tadeu; Estrela, Carlos

2015-09-01

The objective of this study was to use pulse oximetry to measure oxygen saturation in permanent maxillary central incisors with normal pulp in 2 different age groups: children/adolescents and adults. Blood oxygen saturation levels were measured using a pulse oximeter in 110 maxillary central incisors of 57 individuals, in 1 of 2 possible age bands, as follows: 28 children/adolescents (7-13 years old) and 29 adults (22-36 years old). The following factors were also analyzed: (1) heart rate (beats/min); (2) oxygen saturation rate measured at the patient's index finger, also using a pulse oximeter; (3) tooth crown dimensions; and (4) the time taken by the oximeter to provide a reading. The mean oxygen saturation level in normal central incisors was higher among children/adolescents (84.35%) than adults (77.88%, P = .003). Oxygen saturation rates measured at the patients' fingers were not correlated with saturation obtained at the teeth (r = 0.10). There was no correlation between oxygen saturation readings and tooth dimensions (buccal surface area), heart rate, or oximeter reading time (P > .05). Oxygen saturation values measured in maxillary central incisors using a pulse oximeter revealed differences between children/adolescents and adults, showing that children/adolescents have higher oxygen saturation levels. There was no correlation between oxygen saturation levels in patients' fingers and values from their teeth or between oxygen saturation readings from central incisors and tooth dimensions (buccal surface), heart rate, or oximeter reading time. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Audio spectrum and sound pressure levels vary between pulse oximeters.

PubMed

Chandra, Deven; Tessler, Michael J; Usher, John

2006-01-01

The variable-pitch pulse oximeter is an important intraoperative patient monitor. Our ability to hear its auditory signal depends on its acoustical properties and our hearing. This study quantitatively describes the audio spectrum and sound pressure levels of the monitoring tones produced by five variable-pitch pulse oximeters. We compared the Datex-Ohmeda Capnomac Ultima, Hewlett-Packard M1166A, Datex-Engstrom AS/3, Ohmeda Biox 3700, and Datex-Ohmeda 3800 oximeters. Three machines of each of the five models were assessed for sound pressure levels (using a precision sound level meter) and audio spectrum (using a hanning windowed fast Fourier trans-form of three beats at saturations of 99%, 90%, and 85%). The widest range of sound pressure levels was produced by the Hewlett-Packard M1166A (46.5 +/- 1.74 dB to 76.9 +/- 2.77 dB). The loudest model was the Datex-Engstrom AS/3 (89.2 +/- 5.36 dB). Three oximeters, when set to the lower ranges of their volume settings, were indistinguishable from background operating room noise. Each model produced sounds with different audio spectra. Although each model produced a fundamental tone with multiple harmonic overtones, the number of harmonics varied with each model; from three harmonic tones on the Hewlett-Packard M1166A, to 12 on the Ohmeda Biox 3700. There were variations between models, and individual machines of the same model with respect to the fundamental tone associated with a given saturation. There is considerable variance in the sound pressure and audio spectrum of commercially-available pulse oximeters. Further studies are warranted in order to establish standards.

An ultra-low-power pulse oximeter implemented with an energy-efficient transimpedance amplifier.

PubMed

Tavakoli, M; Turicchia, L; Sarpeshkar, R

2010-02-01

Pulse oximeters are ubiquitous in modern medicine to noninvasively measure the percentage of oxygenated hemoglobin in a patient's blood by comparing the transmission characteristics of red and infrared light-emitting diode light through the patient's finger with a photoreceptor. We present an analog single-chip pulse oximeter with 4.8-mW total power dissipation, which is an order of magnitude below our measurements on commercial implementations. The majority of this power reduction is due to the use of a novel logarithmic transimpedance amplifier with inherent contrast sensitivity, distributed amplification, unilateralization, and automatic loop gain control. The transimpedance amplifier, together with a photodiode current source, form a high-performance photoreceptor with characteristics similar to those found in nature, which allows LED power to be reduced. Therefore, our oximeter is well suited for portable medical applications, such as continuous home-care monitoring for elderly or chronic patients, emergency patient transport, remote soldier monitoring, and wireless medical sensing. Furthermore, our design obviates the need for an A-to-D and digital signal processor and leads to a small single-chip solution. We outline how extensions of our work could lead to submilliwatt oximeters.

Evaluation of Wireless Vital Signs Monitor in Trauma Patients

DTIC Science & Technology

2014-06-01

p=NS These data show that the R wave detection and pulse oximeter in the MWVSM finger probe are more accurate and follow changes better than those... oximeter signal failed to register with the thready pulse characteristic of hemorrhagic shock. This observation suggests that using a forehead and...would be more useful to measure from the forehead (e.g. near infrared spectroscopy (NIRS) or Bispectral EEG (BIS)) or extremity? 2) Does pulse

Investigation of signal processing algorithms for an embedded microcontroller-based wearable pulse oximeter.

PubMed

Johnston, W S; Mendelson, Y

2006-01-01

Despite steady progress in the miniaturization of pulse oximeters over the years, significant challenges remain since advanced signal processing must be implemented efficiently in real-time by a relatively small size wearable device. The goal of this study was to investigate several potential digital signal processing algorithms for computing arterial oxygen saturation (SpO(2)) and heart rate (HR) in a battery-operated wearable reflectance pulse oximeter that is being developed in our laboratory for use by medics and first responders in the field. We found that a differential measurement approach, combined with a low-pass filter (LPF), yielded the most suitable signal processing technique for estimating SpO(2), while a signal derivative approach produced the most accurate HR measurements.

Metrics for Assessing the Reliability of a Telemedicine Remote Monitoring System

PubMed Central

Fox, Mark; Papadopoulos, Amy; Crump, Cindy

2013-01-01

Abstract Objective: The goal of this study was to assess using new metrics the reliability of a real-time health monitoring system in homes of older adults. Materials and Methods: The “MobileCare Monitor” system was installed into the homes of nine older adults >75 years of age for a 2-week period. The system consisted of a wireless wristwatch-based monitoring system containing sensors for location, temperature, and impacts and a “panic” button that was connected through a mesh network to third-party wireless devices (blood pressure cuff, pulse oximeter, weight scale, and a survey-administering device). To assess system reliability, daily phone calls instructed participants to conduct system tests and reminded them to fill out surveys and daily diaries. Phone reports and participant diary entries were checked against data received at a secure server. Results: Reliability metrics assessed overall system reliability, data concurrence, study effectiveness, and system usability. Except for the pulse oximeter, system reliability metrics varied between 73% and 92%. Data concurrence for proximal and distal readings exceeded 88%. System usability following the pulse oximeter firmware update varied between 82% and 97%. An estimate of watch-wearing adherence within the home was quite high, about 80%, although given the inability to assess watch-wearing when a participant left the house, adherence likely exceeded the 10 h/day requested time. In total, 3,436 of 3,906 potential measurements were obtained, indicating a study effectiveness of 88%. Conclusions: The system was quite effective in providing accurate remote health data. The different system reliability measures identify important error sources in remote monitoring systems. PMID:23611640

Portable obstructive sleep apnea detection and mobile monitoring

NASA Astrophysics Data System (ADS)

Demirkol ćakmak, Duygu; Eyüboǧlu, B. Murat

2017-05-01

Obstructive sleep apnea syndrome is becoming a prevalent disease for both adults and children. It is described as the cessation of breath for at least 10 seconds during sleep. Detecting sleep apnea is considered as a troublesome and timeconsuming method, which requires the patients to stay one or more nights in dedicated sleep disorder rooms with sensors physically attached to their body. Undiagnosed thereby untreated sleep apnea patients are under high risk of hypertension, heart attack, traffic accident through fatigue and sleeplessness. In this project, nasal and oral respiratory information is obtained with utilizing thermocouple and oxygen saturation in the blood is obtained with utilizing pulse oximeter. An analog hardware circuit is designed to readout thermocouple and pulse oximeter signals. According to this respiratory and pulse oximetry signals, obstructive sleep apnea is detected in real time with using a software implemented into an ARM based processor. An Android mobile application is developed to record and display the oxygen saturation, heart rate and respiratory signal data during sleep. ARM based processor and mobile application communication is established via Bluetooth interface to reduce cabling on the patient. In summary, a portable, low cost and user friendly device to detect obstructive sleep apnea which is able to share the necessary information to the patients and doctors for the duration of the whole sleep cycle is developed.

Accuracy of carboxyhemoglobin detection by pulse CO-oximetry during hypoxemia.

PubMed

Feiner, John R; Rollins, Mark D; Sall, Jeffrey W; Eilers, Helge; Au, Paul; Bickler, Philip E

2013-10-01

Carbon monoxide poisoning is a significant problem in most countries, and a reliable method of quick diagnosis would greatly improve patient care. Until the recent introduction of a multiwavelength "pulse CO-oximeter" (Masimo Rainbow SET(®) Radical-7), obtaining carboxyhemoglobin (COHb) levels in blood required blood sampling and laboratory analysis. In this study, we sought to determine whether hypoxemia, which can accompany carbon monoxide poisoning, interferes with the accurate detection of COHb. Twelve healthy, nonsmoking, adult volunteers were fitted with 2 standard pulse-oximeter finger probes and 2 Rainbow probes for COHb detection. A radial arterial catheter was placed for blood sampling during 3 interventions: (1) increasing hypoxemia in incremental steps with arterial oxygen saturations (SaO2) of 100% to 80%; (2) normoxia with incremental increases in %COHb to 12%; and (3) elevated COHb combined with hypoxemia with SaO2 of 100% to 80%. Pulse-oximeter (SpCO) readings were compared with simultaneous arterial blood values at the various increments of hypoxemia and carboxyhemoglobinemia (≈25 samples per subject). Pulse CO-oximeter performance was analyzed by calculating the mean bias (SpCO - %COHb), standard deviation of the bias (precision), and the root-mean-square error (A(rms)). The Radical-7 accurately detected hypoxemia with both normal and elevated levels of COHb (bias mean ± SD: 0.44% ± 1.69% at %COHb <4%, and -0.29% ± 1.64% at %COHb ≥4%, P < 0.0001, and A(rms) 1.74% vs 1.67%). COHb was accurately detected during normoxia and moderate hypoxia (bias mean ± SD: -0.98 ± 2.6 at SaO2 ≥95%, and -0.7 ± 4.0 at SaO2 <95%, P = 0.60, and A(rms) 2.8% vs 4.0%), but when SaO2 decreased below approximately 85%, the pulse CO-oximeter always gave low signal quality errors and did not report SpCO values. In healthy volunteers, the Radical-7 pulse CO-oximeter accurately detects hypoxemia with both low and elevated COHb levels, and accurately detects COHb, but only reads SpCO when SaO2 is more than approximately 85%.

[Accuracy of a pulse oximeter during hypoxia].

PubMed

Tachibana, C; Fukada, T; Hasegawa, R; Satoh, K; Furuya, Y; Ohe, Y

1996-04-01

The accuracy of the pulse oximeter was examined in hypoxic patients. We studied 11 cyanotic congenital heart disease patients during surgery, and compared the arterial oxygen saturation determined by both the simultaneous blood gas analysis (CIBA-CORNING 288 BLOOD GAS SYSTEM, SaO2) and by the pulse oximeter (DATEX SATELITE, with finger probe, SpO2). Ninty sets of data on SpO2 and SaO2 were obtained. The bias (SpO2-SaO2) was 1.7 +/- 6.9 (mean +/- SD) %. In cyanotic congenital heart disease patients, SpO2 values were significantly higher than SaO2. Although the reason is unknown, in constantly hypoxic patients, SpO2 values are possibly over-estimated. In particular, pulse oximetry at low levels of saturation (SaO2 below 80%) was not as accurate as at a higher saturation level (SaO2 over 80%). There was a positive correlation between SpO2 and SaO2 (linear regression analysis yields the equation y = 0.68x + 26.0, r = 0.93). In conclusion, the pulse oximeter is useful to monitor oxygen saturation in constantly hypoxic patients, but the values thus obtained should be compared with the values measured directly when hypoxemia is severe.

Photonic textiles for pulse oximetry.

PubMed

Rothmaier, Markus; Selm, Bärbel; Spichtig, Sonja; Haensse, Daniel; Wolf, Martin

2008-08-18

Biomedical sensors, integrated into textiles would enable monitoring of many vitally important physiological parameters during our daily life. In this paper we demonstrate the design and performance of a textile based pulse oximeter, operating on the forefinger tip in transmission mode. The sensors consisted of plastic optical fibers integrated into common fabrics. To emit light to the human tissue and to collect transmitted light the fibers were either integrated into a textile substrate by embroidery (producing microbends with a nominal diameter of 0.5 to 2 mm) or the fibers inside woven patterns have been altered mechanically after fabric production. In our experiments we used a two-wavelength approach (690 and 830 nm) for pulse wave acquisition and arterial oxygen saturation calculation. We have fabricated different specimens to study signal yield and quality, and a cotton glove, equipped with textile based light emitter and detector, has been used to examine movement artifacts. Our results show that textile-based oximetry is feasible with sufficient data quality and its potential as a wearable health monitoring device is promising.

Factors affecting the performance of 5 cerebral oximeters during hypoxia in healthy volunteers.

PubMed

Bickler, Philip E; Feiner, John R; Rollins, Mark D

2013-10-01

Cerebral oximetry is a noninvasive optical technology that measures frontal cortex blood hemoglobin-oxygen saturation. Commercially available cerebral oximeters have not been evaluated independently. Unlike pulse oximeters, there are currently no Food and Drug Administration standards for performance or accuracy. We tested the hypothesis that cerebral oximeters accurately measure a fixed ratio of the oxygen saturation in cerebral mixed venous and arterial blood. We evaluated the performance of 5 commercially available cerebral oximeters: the EQUANOX® 7600 in 3- and 4-wavelength versions (Nonin Medical, Plymouth, MN), FORE-SIGHT® (Casmed, Branford, CT), INVOS® 5100C (Covidien, Boulder, CO), and the NIRO-200NX® (Hamamatsu Photonics, Hamamatsu City, Japan) during stable isocapnic hypoxia in volunteers. Twenty-three healthy adults (14 men, 9 women) had sensors placed on each side of the forehead. The subject's inspired oxygen (FIO2) was then changed to produce 6 steady-state arterial oxygen saturation (SaO2) levels between 100% and 70%, while end-tidal CO2 was maintained constant. At each plateau, simultaneous blood samples from the jugular bulb and radial artery were analyzed with a hemoximeter (OSM-3, Radiometer Medical A/S, Copenhagen, Denmark). Each cerebral oximeter's bias was calculated as the difference between the instrument's reading (cerebral saturation, ScO2) with the weighted saturation of venous and arterial blood (Sa/vO2), as specified by each manufacturer (INVOS: 25% arterial/75% venous; FORE-SIGHT, EQUANOX, and NIRO: 30% arterial/70% venous). Five hundred forty-two comparisons between paired blood samples and oximeter readings were analyzed. The pooled root mean square error was 8.06%, a value higher than for pulse oximeters, which is ±3% by Food and Drug Administration standards. The mean % bias ± SD (precision) and root mean square errors were: FORE-SIGHT 1.76 ± 3.92 and 4.28; INVOS 0.05 ± 9.72 and 9.69; NIRO-200NX -1.13 ± 9.64 and 9.68; EQUANOX-3 λ 2.48 ± 8.12 and 8.47; EQUANOX-4 λ 2.84 ± 6.27 and 6.86. The FORE-SIGHT, NIRO-200NX, and EQUANOX-3 λ had significantly more positive bias at lower SaO2. The amount of bias during hypoxia was reduced when the bias was calculated on the basis of difference between oximeter reading and the arterial and mixed venous saturation difference rather than the weighted average of blood saturation, indicating that differences in the ratio between arterial and venous blood volumes account for some of the positive bias at low saturation. Dark skin pigment tended to produce more negative bias in all instruments but bias was significantly larger than zero only for the FORE-SIGHT oximeter. Bias was significantly more negative in women for INVOS and EQUANOX devices but not for the FORE-SIGHT device. While responsive to desaturation, cerebral oximeters exhibited large variation in reading errors between subjects, with mean bias possibly related to variations in the ratio of arterial and venous blood in the sampling area of the brain. This ratio is probably not fixed, as assumed by the manufacturers, but dynamically changes with hypoxia. Better understanding these factors could improve the performance of cerebral oximeters and help establish saturation or blood flow thresholds for brain well-being.

Methemoglobin measurements are underestimated by the Radical 7 co-oximeter: experience from a series of moderate to severe propanil poisonings.

PubMed

Hulse, Elspeth; Shihana, Fathima; Buckley, Nicholas A

2016-11-01

In Asia methemoglobinemia (MetHb) is commonly caused through self-poisoning with the pesticide propranil. MetHb can cause hypoxia, coma and death, but usually responds to methylene blue. It is therefore vital to have accurate methods to measure blood MetHb to guide appropriate treatments. The gold standard to measure MetHb utilizes a spectrophotometer, but recent bedside tests have been developed e.g., pulse co-oximeter probe and blood color chart. Nine propanil poisoned patients had data collected from hospitals in Sri Lanka during 2008. Several MetHb readings were taken from each patient from admission up to 50 hours using spectrophotometry (Unico UV-Vis model no. 2800), pulse co-oximetry (Radical-7, Masimo, CA), and color chart. The co-oximeter underestimated the MetHb percentage when compared with spectrophotometry and the color chart, especially when the average MetHb was greater than 20%. The color chart demonstrated acceptable accuracy compared with formal spectrophotometry with the majority of values showing no more than 10% difference. This small cohort highlights the potential for extreme inaccuracy of the Radical-7 co-oximeter, especially with a MetHb greater than 20%. Pulse co-oximeters should be required to be validated for the complete range of MetHb prior to regulatory approval.

An analysis on the theory of pulse oximetry by Monte Carlo simulation

NASA Astrophysics Data System (ADS)

Fan, Shangchun; Cai, Rui; Xing, Weiwei; Liu, Changting; Chen, Guangfei; Wang, Junfeng

2008-10-01

The pulse oximetry is a kind of electronic instrument that measures the oxygen saturation of arterial blood and pulse rate by non-invasive techniques. It enables prompt recognition of hypoxemia. In a conventional transmittance type pulse oximeter, the absorption of light by oxygenated and reduced hemoglobin is measured at two wavelength 660nm and 940nm. But the accuracy and measuring range of the pulse oximeter can not meet the requirement of clinical application. There are limitations in the theory of pulse oximetry, which is proved by Monte Carlo method. The mean paths are calculated in the Monte Carlo simulation. The results prove that the mean paths are not the same between the different wavelengths.

A new fibre optic pulse oximeter probe for monitoring splanchnic organ arterial blood oxygen saturation.

PubMed

Hickey, M; Samuels, N; Randive, N; Langford, R; Kyriacou, P A

2012-12-01

A new, continuous method of monitoring splanchnic organ oxygen saturation (SpO(2)) would make the early detection of inadequate tissue oxygenation feasible, reducing the risk of hypoperfusion, severe ischaemia, and, ultimately, death. In an attempt to provide such a device, a new fibre optic based reflectance pulse oximeter probe and processing system were developed followed by an in vivo evaluation of the technology on seventeen patients undergoing elective laparotomy. Photoplethysmographic (PPG) signals of good quality and high signal-to-noise ratio were obtained from the small bowel, large bowel, liver and stomach. Simultaneous peripheral PPG signals from the finger were also obtained for comparison purposes. Analysis of the amplitudes of all acquired PPG signals indicated much larger amplitudes for those signals obtained from splanchnic organs than those obtained from the finger. Estimated SpO(2) values for splanchnic organs showed good agreement with those obtained from the finger fibre optic probe and those obtained from a commercial device. These preliminary results suggest that a miniaturized 'indwelling' fibre optic sensor may be a suitable method for pre-operative and post-operative evaluation of splanchnic organ SpO(2) and their health. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Validation of a Standalone Smartphone Application for Measuring Heart Rate Using Imaging Photoplethysmography.

PubMed

Poh, Ming-Zher; Poh, Yukkee C

2017-08-01

The aim of this study was to determine the accuracy of a freely available smartphone application, Cardiio app (Cardiio, Inc., Cambridge, MA), to measure heart rate from the finger or face using imaging photoplethysmography, by comparing against an FDA-cleared pulse oximeter at rest, and after moderate to vigorous exercise. A total of 40 healthy adults participated in this study. Participants engaged in a period of rest, followed by 3 min of moderate to vigorous intensity cycling on a stationary bicycle. Heart rate measurements were obtained from both the finger and face of participants using the Cardiio app at rest, immediately after exercise, 1-2 min after exercise, and 2-3 min after exercise. Concurrent heart rate readings using an FDA-cleared finger pulse oximeter served as the reference measurement. There was a very strong agreement between heart rate measurements obtained using the Cardiio app and the pulse oximeter, both at rest (r = 0.99 for finger, r = 0.97 for face) and after exercise (r = 0.99 for finger, r = 0.97 for face). At rest, the accuracy of the Cardiio app was ±1.58 beats per minute (bpm) (or ±2.27%) using the finger mode and ±2.28 bpm (or ±3.17%) for the face mode, compared to the pulse oximeter. After moderate to vigorous exercise, the accuracy of the Cardiio app was ±2.97 bpm (or ±2.79%) using the finger mode and ±5.31 bpm (or ±4.50%) for the face mode, compared to the pulse oximeter. The Cardiio app provided accurate heart rate measurements from the finger and face, both at rest and after exercise.

An autoregressive model-based particle filtering algorithms for extraction of respiratory rates as high as 90 breaths per minute from pulse oximeter.

PubMed

Lee, Jinseok; Chon, Ki H

2010-09-01

We present particle filtering (PF) algorithms for an accurate respiratory rate extraction from pulse oximeter recordings over a broad range: 12-90 breaths/min. These methods are based on an autoregressive (AR) model, where the aim is to find the pole angle with the highest magnitude as it corresponds to the respiratory rate. However, when SNR is low, the pole angle with the highest magnitude may not always lead to accurate estimation of the respiratory rate. To circumvent this limitation, we propose a probabilistic approach, using a sequential Monte Carlo method, named PF, which is combined with the optimal parameter search (OPS) criterion for an accurate AR model-based respiratory rate extraction. The PF technique has been widely adopted in many tracking applications, especially for nonlinear and/or non-Gaussian problems. We examine the performances of five different likelihood functions of the PF algorithm: the strongest neighbor, nearest neighbor (NN), weighted nearest neighbor (WNN), probability data association (PDA), and weighted probability data association (WPDA). The performance of these five combined OPS-PF algorithms was measured against a solely OPS-based AR algorithm for respiratory rate extraction from pulse oximeter recordings. The pulse oximeter data were collected from 33 healthy subjects with breathing rates ranging from 12 to 90 breaths/ min. It was found that significant improvement in accuracy can be achieved by employing particle filters, and that the combined OPS-PF employing either the NN or WNN likelihood function achieved the best results for all respiratory rates considered in this paper. The main advantage of the combined OPS-PF with either the NN or WNN likelihood function is that for the first time, respiratory rates as high as 90 breaths/min can be accurately extracted from pulse oximeter recordings.

[Influence of nail polish on pulse oximeter readings of oxygen saturation: a systematic review].

PubMed

Ballesteros-Peña, Sendoa; Fernández-Aedo, Irrintzi; Picón, Artzai; Lorrio-Palomino, Sergio

2015-10-01

Nail polish has traditionally been assumed to absorb light emitted by pulse oximeters and to interfere with the detection and measurement of oxygenated hemoglobin. In a systematic review of the literature we aimed to assess the influence of nail polish on the measurement of oxygen saturation by pulse oximetry (SpO2). A search protocol for online databases (MEDLINE, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, and IBECS [the Spanish health sciences index]) was established to find clinical trials or observational studies published between 1999 and February 2014. Twelve nonrandomized clinical trials were found. Ten were in healthy volunteers. One of the remaining 2 studies was in critical patients undergoing mechanical ventilation, and the other was in patients with stable chronic obstructive pulmonary disease. One study recreated the low oxygen level of high altitudes, while the others were done in normal atmospheric conditions. Differences between pulse oximeters and type of nail polish were found. Nail polish was associated with a statistically significant decrease in SpO2 for at least 1 color in all but 2 studies. However, the differences were within the standard error (±2.0%) of the pulse oximeters used. The authors of the studies all concluded that although nail polish might change SpO2 readings significantly, the variations are not clinically significant.

Quantitative evaluation of photoplethysmographic artifact reduction for pulse oximetry

NASA Astrophysics Data System (ADS)

Hayes, Matthew J.; Smith, Peter R.

1999-01-01

Motion artefact corruption of pulse oximeter output, causing both measurement inaccuracies and false alarm conditions, is a primary restriction in the current clinical practice and future applications of this useful technique. Artefact reduction in photoplethysmography (PPG), and therefore by application in pulse oximetry, is demonstrated using a novel non-linear methodology recently proposed by the authors. The significance of these processed PPG signals for pulse oximetry measurement is discussed, with particular attention to the normalization inherent in the artefact reduction process. Quantitative experimental investigation of the performance of PPG artefact reduction is then utilized to evaluate this technology for application to pulse oximetry. While the successfully demonstrated reduction of severe artefacts may widen the applicability of all PPG technologies and decrease the occurrence of pulse oximeter false alarms, the observed reduction of slight artefacts suggests that many such effects may go unnoticed in clinical practice. The signal processing and output averaging used in most commercial oximeters can incorporate these artefact errors into the output, while masking the true PPG signal corruption. It is therefore suggested that PPG artefact reduction should be incorporated into conventional pulse oximetry measurement, even in the absence of end-user artefact problems.

Safe-to-Fly Testing of the Guardian Angel Integrated Oxygen System (GAIOS)

DTIC Science & Technology

2013-07-01

times during the testing the participant’s blood oxygen saturation percentage was measured by a fingertip pulse oximeter . During the DMOS and...the oxygen flowing to both masks was measured. Several times during the testing the participants’ blood oxygen saturation percentage was measured...by a fingertip pulse oximeter . During the MMOS testing with a ventilator a pararescueman operated the ventilator and breathed from the chamber

Effect of lingual gauze swab placement on pulse oximeter readings in anaesthetised dogs and cats.

PubMed

Mair, A; Martinez-Taboada, F; Nitzan, M

2017-01-14

This study aimed to evaluate the effect of lingual gauze swab placement on pulse oximeter readings in anaesthetised dogs and cats. Following anaesthetic induction, the following pulse oximeter probe configurations were performed: no gauze swab (control), placement of a gauze swab between the tongue and the probe, placement of different thicknesses of gauze swab, placement of red cotton fabric, placement of a sheet of white paper and placement of the probe and gauze swab on different locations on the tongue. Oxygen saturation (SpO 2 ) and peripheral perfusion index (PI) were recorded. Placement of a gauze swab between the pulse oximeter probe and the tongue in anaesthetised dogs and cats resulted in significantly higher SpO 2 values compared with the control group. In dogs, PI values were significantly higher than the control in all groups except the quarter thickness swab group. In cats, PI was significantly higher in the double thickness swab and white paper groups compared with the control. Cats had significantly higher SpO 2 and lower PI values than dogs. The authors propose that increased contact pressure is responsible for significantly higher SpO 2 and PI readings with the use of a lingual gauze swab resulting from changes in transmural pressure and arterial compliance. British Veterinary Association.

Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation?

PubMed

Perkins, Gavin D; McAuley, Daniel F; Giles, Simon; Routledge, Helen; Gao, Fang

2003-08-01

This study investigates the relation between changes in pulse oximeter oxygen saturation (SpO2) and changes in arterial oxygen saturation (SaO2) in the critically ill, and the effects of acidosis and anaemia on precision of using pulse oximetry to predict SaO2. Forty-one consecutive patients were recruited from a nine-bed general intensive care unit into a 2-month study. Patients with significant jaundice (bilirubin >40 micromol/l) or inadequate pulse oximetry tracing were excluded. A total of 1085 paired readings demonstrated only moderate correlation (r= 0.606; P < 0.01) between changes in SpO2 and those in SaO2, and the pulse oximeter tended to overestimate actual changes in SaO2. Anaemia increased the degree of positive bias whereas acidosis reduced it. However, the magnitude of these changes was small. Changes in SpO2 do not reliably predict equivalent changes in SaO2 in the critically ill. Neither anaemia nor acidosis alters the relation between SpO2 and SaO2 to any clinically important extent.

Reduction of motion artifact in pulse oximetry by smoothed pseudo Wigner-Ville distribution

PubMed Central

Yan, Yong-sheng; Poon, Carmen CY; Zhang, Yuan-ting

2005-01-01

Background The pulse oximeter, a medical device capable of measuring blood oxygen saturation (SpO2), has been shown to be a valuable device for monitoring patients in critical conditions. In order to incorporate the technique into a wearable device which can be used in ambulatory settings, the influence of motion artifacts on the estimated SpO2 must be reduced. This study investigates the use of the smoothed psuedo Wigner-Ville distribution (SPWVD) for the reduction of motion artifacts affecting pulse oximetry. Methods The SPWVD approach is compared with two techniques currently used in this field, i.e. the weighted moving average (WMA) and the fast Fourier transform (FFT) approaches. SpO2 and pulse rate were estimated from a photoplethysmographic (PPG) signal recorded when subject is in a resting position as well as in the act of performing four types of motions: horizontal and vertical movements of the hand, and bending and pressing motions of the finger. For each condition, 24 sets of PPG signals collected from 6 subjects, each of 30 seconds, were studied with reference to the PPG signal recorded simultaneously from the subject's other hand, which was stationary at all times. Results and Discussion The SPWVD approach shows significant improvement (p < 0.05), as compared to traditional approaches, when subjects bend their finger or press their finger against the sensor. In addition, the SPWVD approach also reduces the mean absolute pulse rate error significantly (p < 0.05) from 16.4 bpm and 11.2 bpm for the WMA and FFT approaches, respectively, to 5.62 bpm. Conclusion The results suggested that the SPWVD approach could potentially be used to reduce motion artifact on wearable pulse oximeters. PMID:15737241

Pulse oximetry: fundamentals and technology update.

PubMed

Nitzan, Meir; Romem, Ayal; Koppel, Robert

2014-01-01

Oxygen saturation in the arterial blood (SaO2) provides information on the adequacy of respiratory function. SaO2 can be assessed noninvasively by pulse oximetry, which is based on photoplethysmographic pulses in two wavelengths, generally in the red and infrared regions. The calibration of the measured photoplethysmographic signals is performed empirically for each type of commercial pulse-oximeter sensor, utilizing in vitro measurement of SaO2 in extracted arterial blood by means of co-oximetry. Due to the discrepancy between the measurement of SaO2 by pulse oximetry and the invasive technique, the former is denoted as SpO2. Manufacturers of pulse oximeters generally claim an accuracy of 2%, evaluated by the standard deviation (SD) of the differences between SpO2 and SaO2, measured simultaneously in healthy subjects. However, an SD of 2% reflects an expected error of 4% (two SDs) or more in 5% of the examinations, which is in accordance with an error of 3%-4%, reported in clinical studies. This level of accuracy is sufficient for the detection of a significant decline in respiratory function in patients, and pulse oximetry has been accepted as a reliable technique for that purpose. The accuracy of SpO2 measurement is insufficient in several situations, such as critically ill patients receiving supplemental oxygen, and can be hazardous if it leads to elevated values of oxygen partial pressure in blood. In particular, preterm newborns are vulnerable to retinopathy of prematurity induced by high oxygen concentration in the blood. The low accuracy of SpO2 measurement in critically ill patients and newborns can be attributed to the empirical calibration process, which is performed on healthy volunteers. Other limitations of pulse oximetry include the presence of dyshemoglobins, which has been addressed by multiwavelength pulse oximetry, as well as low perfusion and motion artifacts that are partially rectified by sophisticated algorithms and also by reflection pulse oximetry.

Pulse oximeter using a gain-modulated avalanche photodiode operated in a pseudo lock-in light detection mode

NASA Astrophysics Data System (ADS)

Miyata, Tsuyoshi; Iwata, Tetsuo; Araki, Tsutomu

2006-01-01

We propose a reflection-type pulse oximeter, which employs two pairs of a light-emitting diode (LED) and a gated avalanche photodiode (APD). One LED is a red one with an emission wavelength λ = 635 nm and the other is a near-infrared one with that λ = 945 nm, which are both driven with a pulse mode at a frequency f (=10 kHz). Superposition of a transistor-transistor-logic (TTL) gate pulse on a direct-current (dc) bias, which is set so as not exceeding the breakdown voltage of each APD, makes the APD work in a gain-enhanced operation mode. Each APD is gated at a frequency 2f (=20 kHz) and its output signal is fed into a laboratory-made lock-in amplifier that works in synchronous with the pulse modulation signal of each LED at a frequency f (=10 kHz). A combination of the gated APD and the lock-in like signal detection scheme is useful for the reflection-type pulse oximeter thanks to the capability of detecting a weak signal against a large background (BG) light.

An evaluation of pulse oximeters in dogs, cats and horses.

PubMed

Matthews, Nora S; Hartke, Sherrie; Allen, John C

2003-01-01

Evaluation of five pulse oximeters in dogs, cats and horses with sensors placed at five sites and hemoglobin saturation at three plateaus. Prospective randomized multispecies experimental trial. Five healthy dogs, cats and horses. Animals were anesthetized and instrumented with ECG leads and arterial catheters. Five pulse oximeters (Nellcor Puritan Bennett-395, NPB-190, NPB-290, NPB-40 and Surgi-Vet V3304) with sensors at five sites were studied in a 5 x 5 Latin square design. Ten readings (SpO2) were taken at each of three hemoglobin saturation plateaus (98, 85 and 72%) in each animal. Arterial samples were drawn concurrently and hemoglobin saturation was measured with a co-oximeter. Accuracy of saturation measurements was calculated as the root mean squared difference (RMSD), a composite of bias and precision, for each model tested in each species. Accuracy varied widely. In dogs, the RMSD for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 2.7, 2.2, 2.4, 1.7 and 2.7% respectively. Failure to produce readings for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 0, 0, 0.7, 0, and 20%, respectively. The Pearson correlation coefficients for the tongue, toe, ear, lip and prepuce or vulva were 0.95, 0.97, 0.69, 0.87 and 0.95, respectively. In horses, the RMSD for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 3.1, 3.0, 4.7, 3.3 and 2.1%, respectively while rates of failure to produce readings were 10, 21, 0, 17 and 60%, respectively. The Pearson correlation coefficients for the tongue, nostril, ear, lip and prepuce or vulva were 0.98, 0.94, 0.88, 0.93 and 0.94, respectively. In cats, the RMSD for all data for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 5.9, 5.6, 7.9, 7.9 and 10.7%, respectively while failure rates were 0, 0.7, 0, 20 and 32%, respectively. The correlation coefficients for the tongue, rear paw, ear, lip and front paw were 0.54, 0.79,.0.64, 0.49 and 0.57, respectively. For saturations above 90% in cats, the RMSD for the NPB-395, NPB-190, NPB-290, NPB-40 and V3304 were 2.6, 4.4, 4.0, 3.5 and 4.8%, respectively, while failure rates were 0, 1.7, 0, 25 and 43%, respectively. Accuracy and failure rates (failure to produce a reading) varied widely from model to model and from species to species. Generally, among the models tested in the clinically relevant range (90-100%) RMSD ranged from 2-5% while failure rates were highest in the V3304.

Accuracy of a continuous noninvasive hemoglobin monitor in intensive care unit patients.

PubMed

Frasca, Denis; Dahyot-Fizelier, Claire; Catherine, Karen; Levrat, Quentin; Debaene, Bertrand; Mimoz, Olivier

2011-10-01

To determine whether noninvasive hemoglobin measurement by Pulse CO-Oximetry could provide clinically acceptable absolute and trend accuracy in critically ill patients, compared to other invasive methods of hemoglobin assessment available at bedside and the gold standard, the laboratory analyzer. Prospective study. Surgical intensive care unit of a university teaching hospital. Sixty-two patients continuously monitored with Pulse CO-Oximetry (Masimo Radical-7). None. Four hundred seventy-one blood samples were analyzed by a point-of-care device (HemoCue 301), a satellite lab CO-Oximeter (Siemens RapidPoint 405), and a laboratory hematology analyzer (Sysmex XT-2000i), which was considered the reference device. Hemoglobin values reported from the invasive methods were compared to the values reported by the Pulse CO-Oximeter at the time of blood draw. When the case-to-case variation was assessed, the bias and limits of agreement were 0.0±1.0 g/dL for the Pulse CO-Oximeter, 0.3±1.3g/dL for the point-of-care device, and 0.9±0.6 g/dL for the satellite lab CO-Oximeter compared to the reference method. Pulse CO-Oximetry showed similar trend accuracy as satellite lab CO-Oximetry, whereas the point-of-care device did not appear to follow the trend of the laboratory analyzer as well as the other test devices. When compared to laboratory reference values, hemoglobin measurement with Pulse CO-Oximetry has absolute accuracy and trending accuracy similar to widely used, invasive methods of hemoglobin measurement at bedside. Hemoglobin measurement with pulse CO-Oximetry has the additional advantages of providing continuous measurements, noninvasively, which may facilitate hemoglobin monitoring in the intensive care unit.

Accuracy of Carboxyhemoglobin Detection by Pulse CO-Oximetry During Hypoxemia

PubMed Central

Feiner, John R.; Rollins, Mark D.; Sall, Jeffrey; Eilers, Helge; Au, Paul; Bickler, Philip E.

2015-01-01

Background Carbon monoxide poisoning is a significant problem in most countries, and a reliable method of quick diagnosis would greatly improve patient care. Until the recent introduction of a multi-wavelength “pulse CO-oximeter” (Masimo Rainbow SET® Radical-7), carboxyhemoglobin (COHb) levels in blood required blood sampling and laboratory analysis. The purpose of this study was to determine if hypoxemia, which can accompany carbon monoxide poisoning, interferes with the accurate detection of COHb. Methods Twelve healthy non-smoking adult volunteers were fitted with 2 standard pulse oximeter finger probes and 2 Rainbow probes for COHb detection. A radial arterial catheter was placed for blood sampling during three interventions: 1) increasing hypoxemia in incremental steps with oxygen saturations (SaO2) of 100-80%; 2) normoxia with incremental increases in %COHb to 12%; and 3) elevated COHb combined with hypoxemia with SaO2 of 100-80%. Pulse oximeter readings (SpCO) were compared with simultaneous arterial blood values at the various increments of hypoxemia and carboxyhemoglobinemia (≈25 samples per subject). Pulse CO-oximeter performance was analyzed by calculating the mean bias (SpCO – %COHb), standard deviation of the bias (precision), and the root mean square error (Arms). Results The Radical 7 accurately detected hypoxemia with both normal and elevated levels of COHb (bias mean ± SD: 0.44 ± 1.69% at %COHb < 4%, and −0.29 ± 1.64% at %COHb ≥ 4%, P < 0.0001, and Arms 1.74% vs. 1.67%). COHb was accurately detected during normoxia and moderate hypoxia (bias mean ± SD: −0.98 ± 2.6 at SaO2 ≥ 95%, and −0.7 ± 4.0 at SaO2 < 95%, P = 0.60, and Arms 2.8% vs. 4.0%), but when SaO2 fell below ~85%, the pulse CO-oximeter always gave low signal quality errors and did not report SpCO values. Conclusions In healthy volunteers, the Radical 7 pulse CO-oximeter accurately detects hypoxemia with both low and elevated COHb levels, and accurately detects carboxyhemoglobin, but only reads SpCO when SaO2 is greater than about 85%. PMID:23477959

Type 2 Diabetes Screening Test by Means of a Pulse Oximeter.

PubMed

Moreno, Enrique Monte; Lujan, Maria Jose Anyo; Rusinol, Montse Torrres; Fernandez, Paqui Juarez; Manrique, Pilar Nunez; Trivino, Cristina Aragon; Miquel, Magda Pedrosa; Rodriguez, Marife Alvarez; Burguillos, M Jose Gonzalez

2017-02-01

In this paper, we propose a method for screening for the presence of type 2 diabetes by means of the signal obtained from a pulse oximeter. The screening system consists of two parts: the first analyzes the signal obtained from the pulse oximeter, and the second consists of a machine-learning module. The system consists of a front end that extracts a set of features form the pulse oximeter signal. These features are based on physiological considerations. The set of features were the input of a machine-learning algorithm that determined the class of the input sample, i.e., whether the subject had diabetes or not. The machine-learning algorithms were random forests, gradient boosting, and linear discriminant analysis as benchmark. The system was tested on a database of [Formula: see text] subjects (two samples per subject) collected from five community health centers. The mean receiver operating characteristic area found was [Formula: see text]% (median value [Formula: see text]% and range [Formula: see text]%), with a specificity =  [Formula: see text]% for a threshold that gave a sensitivity = [Formula: see text]%. We present a screening method for detecting diabetes that has a performance comparable to the glycated haemoglobin (haemoglobin A1c HbA1c) test, does not require blood extraction, and yields results in less than 5 min.

Accuracy of the Masimo SET® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease.

PubMed

Griksaitis, Michael J; Scrimgeour, Gemma E; Pappachan, John V; Baldock, Andrew J

2016-08-01

Introduction Non-invasive peripheral pulse oximeters are routinely used to measure oxyhaemoglobin saturation (SpO2) in cyanotic congenital heart disease. These probes are calibrated in healthy adult volunteers between arterial saturations of ~75 and 100%, using the gold standard of co-oximetry on arterial blood samples. There are little data to attest their accuracy in cyanotic congenital heart disease. Aims We aimed to assess the accuracy of a commonly used probe in children with cyanotic congenital heart disease. Children with cyanotic congenital heart disease admitted to the Paediatric Intensive Care Unit with an arterial line in situ were included to our study. Prospective simultaneous recordings of SpO2, measured by the Masimo SET® LNCS Neo peripheral probe, and co-oximeter saturations (SaO2) measured by arterial blood gas analysis were recorded. A total of 527 paired measurements of SpO2 and SaO2 (using an ABL800 FLEX analyser) in 25 children were obtained. The mean bias of the pulse oximeter for all SaO2 readings was +4.7±13.8%. The wide standard deviation indicates poor precision. This mean bias increased to +7.0±13.7% at SaO2 recordings <75%. The accuracy root mean square of the recordings was 3.30% across all saturation levels, and this increased to 4.98% at SaO2 <75%. The performance of the Masimo SET® LNCS Neo pulse oximeter is poor when arterial oxyhaemoglobin saturations are below 75%. It tends to overestimate saturations in children with cyanotic congenital heart disease. This may have serious implications for clinical decisions.

[Development of Bluetooth wireless sensors].

PubMed

Moor, C; Schwaibold, M; Roth, H; Schöchlin, J; Bolz, A

2002-01-01

Wireless communication could help to overcome current obstacles in medical devices and could enable medical services to offer completely new scenarios in health care. The Bluetooth technology which is the upcoming global market leader in wireless communication turned out to be perfectly suited not only for consumer market products but also in the medical environment [1]. It offers a low power, low cost connection in the medium range of 1-100 m with a bandwidth of currently 723.2 kbaud. This paper describes the development of a wireless ECG device and a Pulse Oximeter. Equipped with a Bluetooth port, the measurement devices are enabled to transmit data between the sensor and a Bluetooth-monitor. Therefore, CSR's Bluetooth protocol embedded two-processor and embedded single-processor architecture has been used.

Pulse Oximetry Overestimates Oxygen Saturation in COPD.

PubMed

Amalakanti, Sridhar; Pentakota, Mohan Rao

2016-04-01

Measurement of oxygen saturation with a handheld pulse oximeter is widely practiced as a surrogate to invasive arterial blood gas analysis. Oxygen saturation is an important parameter in cases of COPD, but there are insufficient data on the role of pulse oximetry in patients with COPD, moreso in diseases across its spectrum, such as chronic bronchitis and emphysema. We assessed the performance of pulse oximetry in acute respiratory failure of patients with COPD. This was a cross-sectional, observational study. We studied 50 subjects with COPD admitted to the Government General Hospital, a 1,000-bed tertiary referral center in Guntur, India, from June 2013 to July 2013. Simultaneous reading of S(pO2) by a handheld pulse oximeter and S(aO2) by an automated arterial blood gas analyzer were taken. Pulse oximetry was sufficiently sensitive (84.60%) to hypoxemia in respiratory failure to be used in clinical situations. The mean difference (bias) between SaO2 and S(pO2) was -3.98 (95% CI -4.68 to 3.28). There was less sensitivity (82% vs. 85%) and positive predictive value (69% vs. 85%) of the pulse oximeter to respiratory failure in subjects with chronic bronchitis versus emphysema. Pulse oximetry performed poorly in comparison with the invasive arterial blood gas analysis. The variability of the readings was greater in the subjects with chronic bronchitis than in those with emphysema. Copyright © 2016 by Daedalus Enterprises.

Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation?

PubMed Central

Perkins, Gavin D; McAuley, Daniel F; Giles, Simon; Routledge, Helen; Gao, Fang

2003-01-01

Introduction This study investigates the relation between changes in pulse oximeter oxygen saturation (SpO2) and changes in arterial oxygen saturation (SaO2) in the critically ill, and the effects of acidosis and anaemia on precision of using pulse oximetry to predict SaO2. Patients and methods Forty-one consecutive patients were recruited from a nine-bed general intensive care unit into a 2-month study. Patients with significant jaundice (bilirubin >40 μmol/l) or inadequate pulse oximetry tracing were excluded. Results A total of 1085 paired readings demonstrated only moderate correlation (r= 0.606; P < 0.01) between changes in SpO2 and those in SaO2, and the pulse oximeter tended to overestimate actual changes in SaO2. Anaemia increased the degree of positive bias whereas acidosis reduced it. However, the magnitude of these changes was small. Conclusion Changes in SpO2 do not reliably predict equivalent changes in SaO2 in the critically ill. Neither anaemia nor acidosis alters the relation between SpO2 and SaO2 to any clinically important extent. PMID:12930558

Inaccurate pulse CO-oximetry of carboxyhemoglobin due to digital clubbing: case report.

PubMed

Harlan, Nicole; Weaver, Lindell K; Deru, Kayla

2016-01-01

Newer pulse CO-oximeters provide a non-invasive and quick means of measuring oxyhemoglobin, carboxyhemoglobin and methemoglobin. Clubbing has been reported to cause inaccuracy in pulse oximeters. We present a case of inaccurate carboxy-hemoglobin measurement by pulse CO-oximetry due to digital clubbing. An 18-year-old man with a history of cystic fibrosis presented after a suicide attempt by inhalation of exhaust. At the initial emergency department evaluation, his blood carboxyhemoglobin was 33%. He was intubated, placed on 100% oxygen and transferred to our facility. Upon arrival, we placed three different pulse CO-oximeters on different fingers and toes. Carboxyhemoglobin levels measured by these meters ranged from 9%-11%. A venous blood gas drawn on arrival showed a carboxyhemoglobin level of 2.3% after four hours on 100% oxygen by endotracheal tube. Thirty minutes later, we checked arterial blood gas, which revealed a COHb level of 0.9%. Again, non-invasive carboxyhemoglobin measurements read 10%. The patient was treated with hyperbaric oxygen for carbon monoxide poisoning. This case suggests that non-invasive measurements of carboxyhemoglobin should be correlated with the clinic history and with an arterial or venous blood gas oximetry analysis.

A comparative evaluation of adaptive noise cancellation algorithms for minimizing motion artifacts in a forehead-mounted wearable pulse oximeter.

PubMed

Comtois, Gary; Mendelson, Yitzhak; Ramuka, Piyush

2007-01-01

Wearable physiological monitoring using a pulse oximeter would enable field medics to monitor multiple injuries simultaneously, thereby prioritizing medical intervention when resources are limited. However, a primary factor limiting the accuracy of pulse oximetry is poor signal-to-noise ratio since photoplethysmographic (PPG) signals, from which arterial oxygen saturation (SpO2) and heart rate (HR) measurements are derived, are compromised by movement artifacts. This study was undertaken to quantify SpO2 and HR errors induced by certain motion artifacts utilizing accelerometry-based adaptive noise cancellation (ANC). Since the fingers are generally more vulnerable to motion artifacts, measurements were performed using a custom forehead-mounted wearable pulse oximeter developed for real-time remote physiological monitoring and triage applications. This study revealed that processing motion-corrupted PPG signals by least mean squares (LMS) and recursive least squares (RLS) algorithms can be effective to reduce SpO2 and HR errors during jogging, but the degree of improvement depends on filter order. Although both algorithms produced similar improvements, implementing the adaptive LMS algorithm is advantageous since it requires significantly less operations.

Green Light Pulse Oximeter

DOEpatents

Scharf, John Edward

1998-11-03

A reflectance pulse oximeter that determines oxygen saturation of hemoglobin using two sources of electromagnetic radiation in the green optical region, which provides the maximum reflectance pulsation spectrum. The use of green light allows placement of an oximetry probe at central body sites (e.g., wrist, thigh, abdomen, forehead, scalp, and back). Preferably, the two green light sources alternately emit light at 560 nm and 577 nm, respectively, which gives the biggest difference in hemoglobin extinction coefficients between deoxyhemoglobin, RHb, and oxyhemoglobin, HbO.sub.2.

Comparison of the efficacy of a custom-made pulse oximeter probe with digital electric pulp tester, cold spray, and rubber cup for assessing pulp vitality.

PubMed

Dastmalchi, Nafiseh; Jafarzadeh, Hamid; Moradi, Saeed

2012-09-01

The ideal technique for the evaluation of pulp vitality should be noninvasive, painless, objective, reliable, and reproducible. To achieve this, the most routine tests are sensitivity tests. However, a major shortcoming with these tests is that they indirectly indicate pulp vitality by measuring a neural response. Pulse oximetry is a well-established oxygen saturation monitoring technique broadly used in medicine. However, its efficacy as the pulp vitality test should be evaluated. The aim of this study was to design and build a custom-made pulse oximeter dental probe and to evaluate its efficacy in comparison with electric pulp tester, cold spray, and a rubber cup in pulp vitality testing. Twenty-four single-canal mandibular premolars needing endodontic treatment were selected. The patients did not have systemic disease and did not consume drugs. Also, they had no clinically relevant signs of necrosis. The selected teeth were pulpally tested with 4 kinds of tests including pulse oximetry, the electric test, cold spray, and the rubber cup. After endodontic treatment of these teeth, which revealed the actual status of the pulp, the results were analyzed by the kappa test to show the efficacy of these tests. When comparing electric, cold, heat, and pulse oximeter tests with the gold standard, the kappa agreement coefficient was 18%, 18%, 14%, and 91%, respectively. The sensitivity of pulse oximetry, a rubber cup, electric test, and cold spray was 0.93, 0.60, 0.60, and 0.53, respectively. The specificity of these tests was 1.00, 0.55, 0.22, and 0.66, respectively. Pulp testing by using pulse oximetry is more reliable than the electric test, rubber cup, and cold spray. The custom-made pulse oximeter dental probe is an effective and objective method for pulp vitality assessment. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Wearable Pulse Oximetry Measurements on the Torso, Arms, and Legs: A Proof of Concept.

PubMed

Kramer, Marcus; Lobbestael, Aaron; Barten, Emily; Eian, John; Rausch, Gregory

2017-03-01

For decades pulse oximeters designed for use on the head, hands, or feet have provided invaluable estimates of oxygen saturation to medical personal attending to combat casualties. However, traditional placement sites are not ideal for the relatively new paradigm of continuous battlefield telemonitoring. To assess the feasibility of oximetry on nontraditional body sites, 42 healthy volunteers were enrolled, consented, and underwent an industry standard induced-hypoxia study. During the study volunteers used prototype wearable oximeters, designed for the torso, arms, and legs. Subsets (size n) of the volunteers had the wearables placed at the following body sites, and achieved accuracies (A RMS , root-mean-square difference) of the following: calf 1.7% (n = 26); bicep 3.1% (n = 12); forearm 3.4% (n = 11); pectoral 2.9% (n = 42); sternum 2.9% (n = 13). In keeping with regulatory guidance calibrations with an A RMS of less than 3.5% are acceptable for potential future development. Additionally, a new method was developed to enable accurate reporting of respiration rate from the pectoral oximeter, A RMS of 1.1 breaths per minute (n = 10). This study demonstrates the feasibility of monitoring oxygen saturation and respiration rate from nontraditional sites via a wearable pulse oximeter. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Low cost MATLAB-based pulse oximeter for deployment in research and development applications.

PubMed

Shokouhian, M; Morling, R C S; Kale, I

2013-01-01

Problems such as motion artifact and effects of ambient lights have forced developers to design different signal processing techniques and algorithms to increase the reliability and accuracy of the conventional pulse oximeter device. To evaluate the robustness of these techniques, they are applied either to recorded data or are implemented on chip to be applied to real-time data. Recorded data is the most common method of evaluating however it is not as reliable as real-time measurements. On the other hand, hardware implementation can be both expensive and time consuming. This paper presents a low cost MATLAB-based pulse oximeter that can be used for rapid evaluation of newly developed signal processing techniques and algorithms. Flexibility to apply different signal processing techniques, providing both processed and unprocessed data along with low implementation cost are the important features of this design which makes it ideal for research and development purposes, as well as commercial, hospital and healthcare application.

Utility of Vital Signs, Heart-rate Variability and Complexity, and Machine Learning for Identifying the Need for Life-saving Interventions in Trauma Patients

DTIC Science & Technology

2014-08-01

thumb-mounted pulse oximeter to the WVSM were recorded at rates of 230 and 75 Hz, respectively. For intubated patients, respiration waveform data were...also recorded at a rate of 10 Hz using a handheld capnograph/ oximeter (Microcap; Covidien, Mansfield, Mass). Standard vital signs used during trauma...SI = HR/SBP) and pulse pressure (PP = SBP j DBP). All nonelectronic data were manually recorded on an electronic run sheet (RescueNet ePCR; Zoll

Comparison of two new generation pulse oximeters during emergency ambulance transportation.

PubMed

Weber, Ulrike; Tomschik, Elvira; Resch, Irene; Adelmann, Krista; Hasun, Matthias; Mora, Bruno; Malzer, Reinhard; Kober, Alexander

2011-02-01

We wanted to test whether there is a difference between the total number and duration of malfunctions and a correlation between the oxygen saturation and pulse rate values of two new generation pulse oximeters (Masimo 'Radical 7' and Nellcor 'N 600') during emergency ambulance transportation. Patients were monitored with two pulse oximeters ('Radical 7' and 'N 600') on different randomly selected fingers of the same hand during transportation. Data of both devices were recorded continuously by a laptop computer. Fifty-two patients with signs of peripheral vasoconstriction (including 22 patients with a blood pressure ≤100/60) were included. There were 0.21 ± 0.72 (0-4) malfunctions per patient lasting for a mean 113.55 ± 272.55 s in the 'Radical 7' and 0.13 ± 0.49 (0-3) malfunctions per patient with a mean duration of 301.0 ± 426.58 s in the 'N 600'. Oxygen saturation and pulse rate values correlated significantly [r² = 0.9608 (SpO₂), r² = 0.9608 (pulse rate)] between the devices and showed a bias of -0.177770 (SpO₂) and 0.310883 (pulse rate) with a standard deviation of 1.68367 (SpO₂) and 4.46532 (pulse rate) in a Bland-Altman test. Although number and duration of malfunctions did not differ significantly between the devices, they showed a very low number of malfunctions even in hypotensive patients with peripheral vasoconstriction. Oxygen saturation correlated significantly in the two devices investigated at 49.409 time points. In addition, pulse rate also correlated significantly.

Measurement of splanchnic photoplethysmographic signals using a new reflectance fiber optic sensor

NASA Astrophysics Data System (ADS)

Hickey, Michelle; Samuels, Neal; Randive, Nilesh; Langford, Richard M.; Kyriacou, Panayiotis A.

2010-03-01

Splanchnic organs are particularly vulnerable to hypoperfusion. Currently, there is no technique that allows for the continuous estimation of splanchnic blood oxygen saturation (SpO2). As a preliminary to developing a suitable splanchnic SpO2 sensor, a new reflectance fiber optic photoplethysmographic (PPG) sensor and processing system are developed. An experimental procedure to examine the effect of fiber source detector separation distance on acquired PPG signals is carried out before finalizing the sensor design. PPG signals are acquired from four volunteers for separation distances of 1 to 8 mm. The separation range of 3 to 6 mm provides the best quality PPG signals with large amplitudes and the highest signal-to-noise ratios (SNRs). Preliminary calculation of SpO2 shows that distances of 3 and 4 mm provide the most realistic values. Therefore, it is suggested that the separation distance in the design of a fiber optic reflectance pulse oximeter be in the range of 3 to 4 mm. Preliminary PPG signals from various splanchnic organs and the periphery are obtained from six anaesthetized patients. The normalized amplitudes of the splanchnic PPGs are, on average, approximately the same as those obtained simultaneously from the periphery. These observations suggest that fiber optic pulse oximetry may be a valid monitoring technique for splanchnic organs.

The effect of nail polish and acrylic nails on pulse oximetry reading using the Lifebox oximeter in Nigeria.

PubMed

Desalu, I; Diakparomre, O I; Salami, A O; Abiola, A O

2013-12-01

AIMS AND OBJECTIVES - Pulse oximetry is mandatory during anaesthesia, sedation and transfer of critically ill patients. The effect of nail polish and acrylic nails on the accuracy of saturation reading is inconsistent. The Lifebox pulse oximeter is reliable and recommended for low and middle income countries. We investigated its accuracy in the presence of 4 nail colours and acrylic nails SUBJECTS AND METHODS Fifty non-smoking volunteers had their fingers numbered from right to left (little finger of right hand =1 and little finger of left hand =10). Alternate fingers were nails painted with clear, red, brown and black nail polish and the 5th finger had acrylic nail applied. The corresponding finger on the other hand acted as control. The oxygen saturation was determined using the Lifebox pulse oximeter. Results All fingers (100%) with clear nail polish, red nail polish and acrylic nails recorded a saturation value. Each of the mean saturation value for clear nail polish, red nail polish and acrylic nails was not significantly different from the control mean (p= 0.378, 0.427 and 0.921). Only 12% and 64% of nails polished black and brown respectively recorded a saturation value. The mean SpO- for black and brown polish were significantly different from their control mean (p<0.001). CONCLUSION Black and brown polish resulted in a significant decrease in SpO with the Lifebox oximeter. Dark coloured nail polish should be removed prior to SpO2 determination to ensure that accurate readings can be obtained.

The effect of subareolar isosulfan blue injection on pulse oximeter readings.

PubMed

Zengel, Baha; Yararbas, Ulkem; Bingolballi, Ozge; Denecli, Ali Galip

2014-02-01

Besides several side effects including anaphylaxis, blue dyes are also known to cause false pulse oximeter readings. We aimed to examine the effects of subareolar isosulfan blue injection on pulse oximeter (SpO2) readings. The study group included 27 patients undergoing SLNB using both radiocolloid and isosulfan blue. Another group of 27 patients constituted the control group. Pulse oximeter readings were compared. SpO2 decline ≥4 % was defined as significant. All but one (96.2 %) of the patients in the study group showed SpO2 declines, compared to only one patient in the control group. Median ± Interqartile Range (IR) SpO2 decrease was 3.0 ± 4.0 % in the study and 0.0 ± 1.0 % in the control group (p < 0.001). There were significant (≥4 %) SpO2 decreases in 13 (48.1 %) patients in the study group. Statistically significant differences were noted between the two groups in all recordings between 15 and 180 min (p < 0.001). Initial time for SpO2 fall and the time to the lowest SpO2 recording were 10.0 ± 10.0 and 40.0 ± 30.0 min respectively. Using subareolar injection, the frequency of false readings is comparable with intraparenchymal injections, and is higher than intradermal injections. Time to peak SpO2 fall, and the recovery period, are delayed in the subareolar technique.

The measurement of carboxyhemoglobin and methemoglobin using a non-invasive pulse CO-oximeter.

PubMed

Zaouter, Cédrick; Zavorsky, Gerald S

2012-07-01

The pulse CO-oximeter (Rad-57 Masimo Corporation, Irvine, CA) allows non-invasive and instantaneous measurement of carboxyhemoglobin (COHb) and methemoglobin (MetHb) percentage level using a finger probe. However, the accuracy and reliability of the Rad-57 against the gold standard of venous or arterial blood samples have not been clearly established. Thus, the objective of this trial is to evaluate the accuracy and precision of the Rad-57 pulse CO-oximeter by comparing it with venous sampling on the same subjects. Nine healthy subjects were subjected to carbon monoxide such that it raised the COHb to 10-14% on two different days and pooled together. The COHb and MetHb were measured with a blood gas-analyzer and simultaneously with the Rad-57 as the COHb increased from 1.4 to 14%. Results were compared using linear regression and a Bland and Altman method comparison. Mean bias and precision for COHb measured with the Rad-57 was -1% and 2.5%, respectively. The mean bias and precision for MetHb measured with the Rad-57 was 0.0% and 0.3%, respectively. The ability to detect a COHb ≥ 10% occurred in 54% of the samples in which COHb was ≥ 10-14%. In conclusion, the Rad-57 provides a reading that is between -6% and +4% of the true COHb value for 95% of all samples. The Rad-57 seems to be a good substitute as a first screening test of COHb when the pulse CO-oximeter reads <15%. Copyright © 2012 Elsevier B.V. All rights reserved.

Clinical evaluation of the effects of signal integrity and saturation on data availability and accuracy of Masimo SE and Nellcor N-395 oximeters in children.

PubMed

Robertson, Frederick A; Hoffman, George M

2004-03-01

Pulse oximetry manufacturers have introduced technologies that claim improved detection of hypoxemic events. Because improvements in signal processing and data rejection algorithms may differentially affect data reporting, we compared the data reporting and signal heuristic performance and agreement among the Nellcor N-395, Masimo SET, and GE Solar 8000 oximeters under a spectrum of conditions of signal integrity and arterial oxygen saturations. A blinded side-by-side comparison of technologies was performed in 27 patients, and data were analyzed for time of data availability, measures of agreement and signal heuristics, and warnings stratified by signal integrity and SpO(2). The Solar 8000 had less total data dropout than either of the new technologies. Masimo's LoSIQ (signal quality) heuristic rejected less data than Nellcor's MOT/PS (motion/pulse search) flag. When no signal heuristic was displayed, there was little difference in precision and bias between the two newer technologies; however, agreement between devices deteriorated in the presence of SIQ, MOT, or hypoxemia. Both newer devices flagged questionable data, but their use of different rejection algorithms resulted in different probabilities of presenting data. Therefore, with poor SIQ or during hypoxemia, the Nellcor N-395 and Masimo oximeters are not clinically equivalent to each other or to the older Solar 8000 oximeter. We compared new pulse oximeters from Nellcor and Masimo and found that, with good signal conditions, both new devices performed similarly to older technology. Overall, Masimo reported less data as questionable than Nellcor. With poor signal conditions or during hypoxemia, the new devices are not clinically equivalent to each other or to the older technology.

Development of a smartphone-based pulse oximeter with adaptive SNR/power balancing.

PubMed

Phelps, Tom; Haowei Jiang; Hall, Drew A

2017-07-01

Millions worldwide suffer from diseases that exhibit early warnings signs that can be detected by standard clinical-grade diagnostic tools. Unfortunately, such tools are often prohibitively expensive to the developing world leading to inadequate healthcare and high mortality rates. To address this problem, a smartphone-based pulse oximeter is presented that interfaces with the phone through the audio jack, enabling point-of-care measurements of heart rate (HR) and oxygen saturation (SpO 2 ). The device is designed to utilize existing phone resources (e.g., the processor, battery, and memory) resulting in a more portable and inexpensive diagnostic tool than standalone equivalents. By adaptively tuning the LED driving signal, the device is less dependent on phone-specific audio jack properties than prior audio jack-based work making it universally compatible with all smartphones. We demonstrate that the pulse oximeter can adaptively optimize the signal-to-noise ratio (SNR) within the power constraints of a mobile phone (<; 10mW) while maintaining high accuracy (HR error <; 3.4% and SpO 2 error <; 3.7%) against a clinical grade instrument.

[Anesthetic care for fibrobronchoscopy in patients with chronic terminal respiratory insufficiency undergoing evaluation for isolated lung transplantation].

PubMed

Solca, M; Elena, A; Croci, M; Damia, G

1993-01-01

During the first 18 month operation of the isolated lung transplantation program at or Institution, eight patients with terminal chronic respiratory failure underwent fiberoptic bronchoscopy and broncho-alveolar lavage as part of their evaluation for isolated lung transplantation. Four patients had severe obstructive, three restrictive, and one mixed, obstructive and restrictive, disease; all of them were on continuous supplemental oxygen. Procedures were performed under topical anaesthesia, with either light sedation or simple monitored anaesthesia care. Monitoring included non-invasive blood pressure measurement, pulse oximeter and precordial stethoscope. No adverse events were recorded, except in one case, when pulse oximeter reading precipitously dropped below 80%, to a minimum of 68-69%. The procedures was terminated short of its completion, and the patient was briefly assisted with manual bag ventilation on oxygen 100%. Pulse oximeter quickly returned to normal levels (above 90%), and the patient promptly recovered, without complications. The importance of monitored anaesthesia care during fiberoptic bronchoscopy (a usually benign procedure) in critically ill patients is greatly emphasized.

Pulse oximetry-derived respiratory rate in general care floor patients.

PubMed

Addison, Paul S; Watson, James N; Mestek, Michael L; Ochs, James P; Uribe, Alberto A; Bergese, Sergio D

2015-02-01

Respiratory rate is recognized as a clinically important parameter for monitoring respiratory status on the general care floor (GCF). Currently, intermittent manual assessment of respiratory rate is the standard of care on the GCF. This technique has several clinically-relevant shortcomings, including the following: (1) it is not a continuous measurement, (2) it is prone to observer error, and (3) it is inefficient for the clinical staff. We report here on an algorithm designed to meet clinical needs by providing respiratory rate through a standard pulse oximeter. Finger photoplethysmograms were collected from a cohort of 63 GCF patients monitored during free breathing over a 25-min period. These were processed using a novel in-house algorithm based on continuous wavelet-transform technology within an infrastructure incorporating confidence-based averaging and logical decision-making processes. The computed oximeter respiratory rates (RRoxi) were compared to an end-tidal CO2 reference rate (RRETCO2). RRETCO2 ranged from a lowest recorded value of 4.7 breaths per minute (brpm) to a highest value of 32.0 brpm. The mean respiratory rate was 16.3 brpm with standard deviation of 4.7 brpm. Excellent agreement was found between RRoxi and RRETCO2, with a mean difference of -0.48 brpm and standard deviation of 1.77 brpm. These data demonstrate that our novel respiratory rate algorithm is a potentially viable method of monitoring respiratory rate in GCF patients. This technology provides the means to facilitate continuous monitoring of respiratory rate, coupled with arterial oxygen saturation and pulse rate, using a single non-invasive sensor in low acuity settings.

Non-Invasive Measurements of Carboxyhemoglobin and Methemoglobin in Children with Sickle Cell Disease

PubMed Central

Caboot, Jason B.; Jawad, Abbas F.; McDonough, Joseph M.; Bowdre, Cheryl Y.; Arens, Raanan; Marcus, Carole L.; Mason, Thornton B.A.; Smith-Whitley, Kim; Ohene-Frempong, Kwaku; Allen, Julian L.

2012-01-01

SUMMARY Assessment of oxyhemoglobin saturation in patients with sickle cell disease (SCD) is vital for prompt recognition of hypoxemia. The accuracy of pulse oximeter measurements of blood oxygenation in SCD patients is variable, partially due to carboxyhemoglobin (COHb) and methemoglobin (MetHb), which decrease the oxygen content of blood. This study evaluated the accuracy and reliability of a non-invasive pulse co-oximeter in measuring COHb and MetHb percentages (SpCO and SpMet) in children with SCD. We hypothesized that measurements of COHb and MetHb by non-invasive pulse co-oximetry agree within acceptable clinical accuracy with those made by invasive whole blood co-oximetry. Fifty children with SCD-SS underwent pulse co-oximetry and blood co-oximetry while breathing room air. Non-invasive COHb and MetHb readings were compared to the corresponding blood measurements. The pulse co-oximeter bias was 0.1% for COHb and −0.22% for MetHb. The precision of the measured SpCO was ±2.1% within a COHb range of 0.4–6.1%, and the precision of the measured SpMet was ±0.33% within a MetHb range of 0.1–1.1%. Non-invasive pulse co-oximetry was useful in measuring COHb and MetHb levels in children with SCD. Although the non-invasive technique slightly overestimated the invasive COHb measurements and slightly underestimated the invasive MetHb measurements, there was close agreement between the two methods. PMID:22328189

Non-invasive measurements of carboxyhemoglobin and methemoglobin in children with sickle cell disease.

PubMed

Caboot, Jason B; Jawad, Abbas F; McDonough, Joseph M; Bowdre, Cheryl Y; Arens, Raanan; Marcus, Carole L; Mason, Thornton B A; Smith-Whitley, Kim; Ohene-Frempong, Kwaku; Allen, Julian L

2012-08-01

Assessment of oxyhemoglobin saturation in patients with sickle cell disease (SCD) is vital for prompt recognition of hypoxemia. The accuracy of pulse oximeter measurements of blood oxygenation in SCD patients is variable, partially due to carboxyhemoglobin (COHb) and methemoglobin (MetHb), which decrease the oxygen content of blood. This study evaluated the accuracy and reliability of a non-invasive pulse co-oximeter in measuring COHb and MetHb percentages (SpCO and SpMet) in children with SCD. We hypothesized that measurements of COHb and MetHb by non-invasive pulse co-oximetry agree within acceptable clinical accuracy with those made by invasive whole blood co-oximetry. Fifty children with SCD-SS underwent pulse co-oximetry and blood co-oximetry while breathing room air. Non-invasive COHb and MetHb readings were compared to the corresponding blood measurements. The pulse co-oximeter bias was 0.1% for COHb and -0.22% for MetHb. The precision of the measured SpCO was ± 2.1% within a COHb range of 0.4-6.1%, and the precision of the measured SpMet was ± 0.33% within a MetHb range of 0.1-1.1%. Non-invasive pulse co-oximetry was useful in measuring COHb and MetHb levels in children with SCD. Although the non-invasive technique slightly overestimated the invasive COHb measurements and slightly underestimated the invasive MetHb measurements, there was close agreement between the two methods. Copyright © 2012 Wiley Periodicals, Inc.

Accuracy of a third (Dolphin Voyager) versus first generation pulse oximeter (Nellcor N-180) in predicting arterial oxygen saturation and pulse rate in the anesthetized dog.

PubMed

Burns, Patrick M; Driessen, Bernd; Boston, Ray; Gunther, Robert A

2006-09-01

To compare the accuracy of a 3rd (Dolphin Voyager) versus 1st generation pulse oximeter (Nellcor N-180). Prospective laboratory investigation. Eight adult dogs. In anesthetized dogs, arterial oxygen saturation (SpO(2)) was recorded simultaneously with each pulse oximeter. The oxygen fraction in inspired gas (FiO(2)) was successively reduced from 1.00 to 0.09, with re-saturation (FiO(2) 0.40) after each breathe-down step. After each 3-minute FiO(2) plateau, SpO(2) and pulse rate (PR) were compared with the fractional arterial saturation (SaO(2)) and PR determined by co-oximetry and invasive blood pressure monitoring, respectively. Data analysis included Bland-Altman (B-A) plots, Lin's concordance correlation factor (rho(c)), and linear regression models. Over a SaO(2) range of 33-99%, the overall bias (mean SpO(2) - SaO(2)), precision (SD of bias), and accuracy (A(rms)) for the Dolphin Voyager and Nellcor N-180 were 4.3%, 4.4%, and 6.1%, and 3.2%, 3.0%, and 4.3%, respectively. Bias increased at SaO(2) < 90%, more so with the Dolphin Voyager (from 1.6% to 8.6%) than Nellcor N-180 (from 3.2% to 4.5%). The SpO(2) readings correlated significantly with SaO(2) for both the Dolphin Voyager (rho(c) = 0.94) and Nellcor N-180 (rho(c) = 0.97) (p < 0.001). Regarding PR, bias, precision, and accuracy (A(rms)) for the Dolphin Voyager and Nellcor N-180 were -0.5, 4.6, and 4.6 and 1.38, 4.3, and 4.5 beats minute(-1), respectively. Significant correlation existed between pulse oximeter and directly measured PR (Dolphin Voyager: rho(c) = 0.98; Nellcor N-180: rho(c) = 0.99) (p < 0.001). In anesthetized dogs with adequate hemodynamic function, both instruments record SaO(2) relatively accurately over a wide range of normal saturation values. However, there is an increasing overestimation at SaO(2) < 90%, particularly with the Dolphin Voyager, indicating that 3rd generation pulse oximeters may not perform better than older instruments. The 5.4-fold increase in bias with the Dolphin Voyager at SaO(2) < 90% stresses the importance of a 93-94% SpO(2) threshold to ensure an arterial saturation of >or=90%. In contrast, PR monitoring with both devices is very reliable.

Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: a qualitative evaluation from Malawi and Bangladesh

PubMed Central

Boyd, Nicholas; Walker, Isabeau; Zadutsa, Beatiwel; Baqui, Abdullah H; Ahmed, Salahuddin; Islam, Mazharul; Kainja, Esther; Nambiar, Bejoy; Wilson, Iain; McCollum, Eric D

2018-01-01

Objective To gain an understanding of what challenges pulse oximetry for paediatric pneumonia management poses, how it has changed service provision and what would improve this device for use across paediatric clinical settings in low-income countries. Design Focus group discussions (FGDs), with purposive sampling and thematic analysis using a framework approach. Setting Community, front-line outpatient, and hospital outpatient and inpatient settings in Malawi and Bangladesh, which provide paediatric pneumonia care. Participants Healthcare providers (HCPs) from Malawi and Bangladesh who had received training in pulse oximetry and had been using oximeters in routine paediatric care, including community healthcare workers, non-physician clinicians or medical assistants, and hospital-based nurses and doctors. Results We conducted six FGDs, with 23 participants from Bangladesh and 26 from Malawi. We identified five emergent themes: trust, value, user-related experience, sustainability and design. HCPs discussed the confidence gained through the use of oximeters, resulting in improved trust from caregivers and valuing the device, although there were conflicts between the weight given to clinical judgement versus oximeter results. HCPs reported the ease of using oximeters, but identified movement and physically smaller children as measurement challenges. Challenges in sustainability related to battery durability and replacement parts, however many HCPs had used the same device longer than 4 years, demonstrating robustness within these settings. Desirable features included back-up power banks and integrated respiratory rate and thermometer capability. Conclusions Pulse oximetry was generally deemed valuable by HCPs for use as a spot-check device in a range of paediatric low-income clinical settings. Areas highlighted as challenges by HCPs, and therefore opportunities for redesign, included battery charging and durability, probe fit and sensitivity in paediatric populations. Trial registration number NCT02941237. PMID:29382679

Agreement of SpO2, SaO2 and ScO2 in anesthetized cynomolgus monkeys (Macaca fascicularis).

PubMed

Young, Simon S; Skeans, Susan M; Lamca, James E; Chapman, Richard W

2002-07-01

To assess the agreement between three measurements of arterial oxygen saturation (SpO 2 , SaO 2 and ScO 2 ) in anesthetized cynomolgus monkeys. Prospective study. Eleven mature, male cynomolgus monkeys (Macaca fasicularis). Monkeys were anesthetized with intramuscular ketamine followed by intravenous propofol. The trachea of each was intubated and the lungs ventilated. Arterial oxygen saturation was measured with a Nonin 8500 V pulse oximeter, using a lingual clip on the cheek. Arterial blood samples were taken from an indwelling catheter. Inspired oxygen concentration was varied from 12 to 20%, and 88 paired arterial blood samples and saturation measurements were taken. Arterial oxygen saturation in the blood samples was measured using a cooximeter. The saturation was also calculated from the arterial oxygen tension using the Adair equation. The results were compared using Bland and Altman's method. The pulse oximeter readings were 2.7% higher than that of the cooximeter, with a limit of agreement of -3.9 to 9.3%. The pulse oximeter readings were 1.8% higher than the calculated saturation, with a limit of agreement of -6.5% to 10.1%. The cooximeter readings were 0.9% lower than the calculated saturation, with a limit of agreement of -5.6% to 3.8%. The agreement between SpO 2 and other measurements of arterial oxygen saturation in this study is typical for this technique. The bias and limits of agreement are consistent with reports in other species. The Nonin 8500 V is a useful pulse oximeter for clinical use in primates. Copyright © 2002 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

The relative trending accuracy of noninvasive continuous hemoglobin monitoring during hemodialysis in critically ill patients.

PubMed

Yamada, Hiroshi; Saeki, Minako; Ito, Junko; Kawada, Kazuhiro; Higurashi, Aya; Funakoshi, Hiromi; Takeda, Kohji

2015-02-01

The pulse CO-Oximeter (Radical-7; Masimo Corp., Irvine, CA) is a multi-wavelength spectrophotometric method for noninvasive continuous monitoring of hemoglobin (SpHb). Because evaluating the relative change in blood volume (ΔBV) is crucial to avoid hypovolemia and hypotension during hemodialysis, it would be of great clinical benefit if ΔBV could be estimated by measurement of SpHb during hemodialysis. The capability of the pulse CO-Oximeter to monitor ΔBV depends on the relative trending accuracy of SpHb. The purpose of the current study was to evaluate the relative trending accuracy of SpHb by the pulse CO-Oximeter using Crit-Line as a reference device. In 12 patients who received hemodialysis (total 22 sessions) in the intensive care unit, ΔBV was determined from SpHb. Relative changes in blood volume determined from SpHb were calculated according to the equation: ΔBV(SpHb)=[starting SpHb]/[current SpHb] - 1. The absolute values of SpHb and hematocrit measured by Crit-Line (CL-Hct) showed poor correlation. On the contrary, linear regression analysis showed good correlation between ΔBV(SpHb) and the relative change in blood volume measured by Crit-Line [ΔBV(CL-Hct)] (r=0.83; P≤0.001). Bland-Altman analysis also revealed good agreement between ΔBV(SpHb) and ΔBV(CL-Hct) (bias, -0.77%; precision, 3.41%). Polar plot analysis revealed good relative trending accuracy of SpHb with an angular bias of 4.1° and radial limits of agreement of 24.4° (upper) and -16.2° (lower). The results of the current study indicate that SpHb measurement with the pulse CO-Oximeter has good relative trending accuracy.

Measuring arterial oxygenation in a high altitude field environment: comparing portable pulse oximetry with blood gas analysis.

PubMed

Ross, Elliot M; Matteucci, Michael J; Shepherd, Matthew; Barker, Matthew; Orr, Lance

2013-06-01

High altitude environments present unique medical treatment challenges. Medical providers often use small portable pulse oximetry devices to help guide their clinical decision making. A significant body of high altitude research is based on the use of these devices to monitor hypoxia, yet there is a paucity of evidence that these devices are accurate in these environments. We studied whether these devices perform accurately and reliably under true mountain conditions. Healthy unacclimatized active-duty military volunteers participating in mountain warfare training at 2100 m (6900 feet) above sea level were evaluated with several different pulse oximetry devices while in a cold weather, high altitude field environment and then had arterial blood gases (ABG) drawn using an i-STAT for comparison. The pulse oximeter readings were compared with the gold standard ABG readings. A total of 49 individuals completed the study. There was no statistically significant difference between any of the devices and the gold standard of ABG. The best performing device was the PalmSAT (PS) 8000SM finger probe with a mean difference of 2.17% and SD of 2.56 (95% CI, 1.42% to 2.92%). In decreasing order of performance were the PS 8000AA finger probe (mean ± SD, 2.54% ± 2.68%; 95% CI, 1.76% to 3.32%), the PS 8000Q ear probe (2.47% ± 4.36%; 95% CI, 1.21% to 3.75%), the Nonin Onyx 9500 (3.29% ± 3.12%; 95% CI, 2.39% to 4.20%), and finally the PS 8000R forehead reflectance sensor (5.15% ± 2.97%; 95% CI, 4.28% to 6.01%). Based on the results of this study, results of the newer portable pulse oximeters appear to be closely correlated to that of the ABG measurements when tested in true mountain conditions. Copyright © 2013 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Development and validation of a cerebral oximeter capable of absolute accuracy.

PubMed

MacLeod, David B; Ikeda, Keita; Vacchiano, Charles; Lobbestael, Aaron; Wahr, Joyce A; Shaw, Andrew D

2012-12-01

Cerebral oximetry may be a valuable monitor, but few validation data are available, and most report the change from baseline rather than absolute accuracy, which may be affected by individuals whose oximetric values are outside the expected range. The authors sought to develop and validate a cerebral oximeter capable of absolute accuracy. An in vivo research study. A university human physiology laboratory. Healthy human volunteers were enrolled in calibration and validation studies of 2 cerebral oximetric sensors, the Nonin 8000CA and 8004CA. The 8000CA validation study identified 5 individuals with atypical cerebral oxygenation values; their data were used to design the 8004CA sensor, which subsequently underwent calibration and validation. Volunteers were taken through a stepwise hypoxia protocol to a minimum saturation of peripheral oxygen. Arteriovenous saturation (70% jugular bulb venous saturation and 30% arterial saturation) at 6 hypoxic plateaus was used as the reference value for the cerebral oximeter. Absolute accuracy was defined using a combination of the bias and precision of the paired saturations (A(RMS)). In the validation study for the 8000CA sensor (n = 9, 106 plateaus), relative accuracy was an A(RMS) of 2.7, with an absolute accuracy of 8.1, meeting the criteria for a relative (trend) monitor, but not an absolute monitor. In the validation study for the 8004CA sensor (n = 11, 119 plateaus), the A(RMS) of the 8004CA was 4.1, meeting the prespecified success criterion of <5.0. The Nonin cerebral oximeter using the 8004CA sensor can provide absolute data on regional cerebral saturation compared with arteriovenous saturation, even in subjects previously shown to have values outside the normal population distribution curves. Copyright © 2012 Elsevier Inc. All rights reserved.

Development of Non-contact Respiratory Monitoring System for Newborn Using a FG Vision Sensor

NASA Astrophysics Data System (ADS)

Kurami, Yoshiyuki; Itoh, Yushi; Natori, Michiya; Ohzeki, Kazuo; Aoki, Yoshimitsu

In recent years, development of neonatal care is strongly hoped, with increase of the low-birth-weight baby birth rate. Especially respiration of low-birth-weight baby is incertitude because central nerve and respiratory function is immature. Therefore, a low-birth-weight baby often causes a disease of respiration. In a NICU (Neonatal Intensive Care Unit), neonatal respiration is monitored using cardio-respiratory monitor and pulse oximeter at all times. These contact-type sensors can measure respiratory rate and SpO2 (Saturation of Peripheral Oxygen). However, because a contact-type sensor might damage the newborn's skin, it is a real burden to monitor neonatal respiration. Therefore, we developed the respiratory monitoring system for newborn using a FG (Fiber Grating) vision sensor. FG vision sensor is an active stereo vision sensor, it is possible for non-contact 3D measurement. A respiratory waveform is calculated by detecting the vertical motion of the thoracic and abdominal region with respiration. We attempted clinical experiment in the NICU, and confirmed the accuracy of the obtained respiratory waveform was high. Non-contact respiratory monitoring of newborn using a FG vision sensor enabled the minimally invasive procedure.

Heart Rate Assessment Immediately after Birth.

PubMed

Phillipos, Emily; Solevåg, Anne Lee; Pichler, Gerhard; Aziz, Khalid; van Os, Sylvia; O'Reilly, Megan; Cheung, Po-Yin; Schmölzer, Georg M

2016-01-01

Heart rate assessment immediately after birth in newborn infants is critical to the correct guidance of resuscitation efforts. There are disagreements as to the best method to measure heart rate. The aim of this study was to assess different methods of heart rate assessment in newborn infants at birth to determine the fastest and most accurate method. PubMed, EMBASE and Google Scholar were systematically searched using the following terms: 'infant', 'heart rate', 'monitoring', 'delivery room', 'resuscitation', 'stethoscope', 'auscultation', 'palpation', 'pulse oximetry', 'electrocardiogram', 'Doppler ultrasound', 'photoplethysmography' and 'wearable sensors'. Eighteen studies were identified that described various methods of heart rate assessment in newborn infants immediately after birth. Studies examining auscultation, palpation, pulse oximetry, electrocardiography and Doppler ultrasound as ways to measure heart rate were included. Heart rate measurements by pulse oximetry are superior to auscultation and palpation, but there is contradictory evidence about its accuracy depending on whether the sensor is connected to the infant or the oximeter first. Several studies indicate that electrocardiogram provides a reliable heart rate faster than pulse oximetry. Doppler ultrasound shows potential for clinical use, however future evidence is needed to support this conclusion. Heart rate assessment is important and there are many measurement methods. The accuracy of routinely applied methods varies, with palpation and auscultation being the least accurate and electrocardiogram being the most accurate. More research is needed on Doppler ultrasound before its clinical use. © 2015 S. Karger AG, Basel.

A pilot randomized controlled trial of EKG for neonatal resuscitation

PubMed Central

Katheria, Anup; Arnell, Kathy; Brown, Melissa; Hassen, Kasim; Maldonado, Mauricio; Finer, Neil

2017-01-01

Background The seventh edition of the American Academy of Pediatrics Neonatal Resuscitation Program recommends the use of a cardiac monitor in infants that need resuscitation. Previous trials have shown that EKG heart rate is available before pulse rate from a pulse oximeter. To date no trial has looked at how the availability of electrocardiogram (EKG) affects clinical interventions in the delivery room. Objective To determine whether the availability of an EKG heart rate value and tracing to the clinical team has an effect on physiologic measures and related interventions during the stabilization of preterm infants. Design/Methods Forty (40) premature infants enrolled in a neuro-monitoring study (The Neu-Prem Trial: NCT02605733) who had an EKG monitor available were randomized to have the heart rate information from the bedside EKG monitor either displayed or not displayed to the clinical team. Heart rate, oxygen saturation, FiO2 and mean airway pressure from a data acquisition system were recorded every 2 seconds. Results were averaged over 30 seconds and the differences analyzed using two-tailed t-test. Interventions analyzed included time to first change in FiO2, first positive pressure ventilation, first increase in airway pressure, and first intubation. Results There were no significant differences in time to clinical interventions between the blinded and unblinded group, despite the unblinded group having access to a visible heart rate at 66 +/- 20 compared to 114 +/- 39 seconds for the blinded group (p < .0001). Pulse rate from oximeter was lower than EKG heart rate during the first 2 minutes of life, but this was not significant. Conclusion(s) EKG provides an earlier, and more accurate heart rate than pulse rate from an oximeter during stabilization of preterm infants, allowing earlier intervention. All interventions were started earlier in the unblinded EKG group but these numbers were not significant in this small trial. Earlier EKG placement before pulse oximeter placement may affect other interventions, but this needs further study. PMID:29099872

Cardiac gating with a pulse oximeter for dual-energy imaging

NASA Astrophysics Data System (ADS)

Shkumat, N. A.; Siewerdsen, J. H.; Dhanantwari, A. C.; Williams, D. B.; Paul, N. S.; Yorkston, J.; Van Metter, R.

2008-11-01

The development and evaluation of a prototype cardiac gating system for double-shot dual-energy (DE) imaging is described. By acquiring both low- and high-kVp images during the resting phase of the cardiac cycle (diastole), heart misalignment between images can be reduced, thereby decreasing the magnitude of cardiac motion artifacts. For this initial implementation, a fingertip pulse oximeter was employed to measure the peripheral pulse waveform ('plethysmogram'), offering potential logistic, cost and workflow advantages compared to an electrocardiogram. A gating method was developed that accommodates temporal delays due to physiological pulse propagation, oximeter waveform processing and the imaging system (software, filter-wheel, anti-scatter Bucky-grid and flat-panel detector). Modeling the diastolic period allowed the calculation of an implemented delay, timp, required to trigger correctly during diastole at any patient heart rate (HR). The model suggests a triggering scheme characterized by two HR regimes, separated by a threshold, HRthresh. For rates at or below HRthresh, sufficient time exists to expose on the same heartbeat as the plethysmogram pulse [timp(HR) = 0]. Above HRthresh, a characteristic timp(HR) delays exposure to the subsequent heartbeat, accounting for all fixed and variable system delays. Performance was evaluated in terms of accuracy and precision of diastole-trigger coincidence and quantitative evaluation of artifact severity in gated and ungated DE images. Initial implementation indicated 85% accuracy in diastole-trigger coincidence. Through the identification of an improved HR estimation method (modified temporal smoothing of the oximeter waveform), trigger accuracy of 100% could be achieved with improved precision. To quantify the effect of the gating system on DE image quality, human observer tests were conducted to measure the magnitude of cardiac artifact under conditions of successful and unsuccessful diastolic gating. Six observers independently measured the artifact in 111 patient DE images. The data indicate that successful diastolic gating results in a statistically significant reduction (p < 0.001) in the magnitude of cardiac motion artifact, with residual artifact attributed primarily to gross patient motion.

New laser system for highly sensitive clinical pulse oximetry

NASA Astrophysics Data System (ADS)

Hamza, Mostafa; Hamza, Mohammad

1996-04-01

This paper describes the theory and design of a new pulse oximeter in which laser diodes and other compact laser sources are used for the measurement of oxygen saturation in patients who are at risk of developing hypoxemia. The technique depends upon illuminating special sites of the skin of the patient with radiation from modulated laser sources at selected wavelengths. The specific laser wavelengths are chosen based on the absorption characteristics of oxyhemoglobin, reduced hemoglobin and other interfering sources for obtaining more accurate measurements. The laser radiation transmitted through the tissue is detected and signal processing based on differential absorption laser spectroscopy is done in such a way to overcome the primary performance limitations of the conventionally used pulse oximetry. The new laser pulse oximeter can detect weak signals and is not affected by other light sources such as surgical lamps, phototherapy units, etc. The detailed description and operating characteristics of this system are presented.

Automatic classification of apnea/hypopnea events through sleep/wake states and severity of SDB from a pulse oximeter.

PubMed

Park, Jong-Uk; Lee, Hyo-Ki; Lee, Junghun; Urtnasan, Erdenebayar; Kim, Hojoong; Lee, Kyoung-Joung

2015-09-01

This study proposes a method of automatically classifying sleep apnea/hypopnea events based on sleep states and the severity of sleep-disordered breathing (SDB) using photoplethysmogram (PPG) and oxygen saturation (SpO2) signals acquired from a pulse oximeter. The PPG was used to classify sleep state, while the severity of SDB was estimated by detecting events of SpO2 oxygen desaturation. Furthermore, we classified sleep apnea/hypopnea events by applying different categorisations according to the severity of SDB based on a support vector machine. The classification results showed sensitivity performances and positivity predictive values of 74.2% and 87.5% for apnea, 87.5% and 63.4% for hypopnea, and 92.4% and 92.8% for apnea + hypopnea, respectively. These results represent better or comparable outcomes compared to those of previous studies. In addition, our classification method reliably detected sleep apnea/hypopnea events in all patient groups without bias in particular patient groups when our algorithm was applied to a variety of patient groups. Therefore, this method has the potential to diagnose SDB more reliably and conveniently using a pulse oximeter.

Lifebox pulse oximeter implementation in Malawi: evaluation of educational outcomes and impact on oxygen desaturation episodes during anaesthesia.

PubMed

Albert, V; Mndolo, S; Harrison, E M; O'Sullivan, E; Wilson, I H; Walker, I A

2017-06-01

Pulse oximetry is an essential monitor for safe anaesthesia but is often not available in low-income countries. The aim of this study was to determine whether the introduction of pulse oximetry with training was feasible and could reduce the incidence of oxygen desaturation during anaesthesia in a low-income country. Pulse oximeters were donated, with training, to 83 non-physician anaesthetists in Malawi. Knowledge was tested immediately before and after training and at follow-up. Providers were asked to record the lowest peripheral oxygen saturation (SpO 2 ) for the first 100 cases anaesthetised after training. The primary clinical outcome was the proportion of cases with an oxygen desaturation event (SpO 2 < 90%). Seventy-seven of 83 (93%) participants completed all pre- and post-training tests. Pulse oximetry knowledge improved after training from a median (IQR [range]) score of 39 (37-42 [28-48]) to 44 (42-46 [35-50]) and this knowledge was maintained for 8 months (p < 0.001). Oxygen saturation data and provider responses were recorded for 4772 cases. The proportion of oxygen desaturation episodes decreased from 17.2% to 6.5%, representing a 36% reduction in the odds of an oxygen desaturation event in the second 50 cases compared with the first 50 (OR 0.64, 95%CI 0.50-0.82, p < 0.001). We conclude that donation of pulse oximeters, with training, in Malawi was feasible, improved knowledge and reduced the incidence of oxygen desaturation events. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

The effects of Patent Blue dye on peripheral and cerebral oxyhaemoglobin saturations.

PubMed

Ishiyama, T; Kotoda, M; Asano, N; Ikemoto, K; Mitsui, K; Sato, H; Matsukawa, T; Sessler, D I

2015-04-01

We measured the effect of Patent Blue dye on oxyhaemoglobin saturations after injection into breast tissue: 40 women had anaesthesia for breast surgery maintained with sevoflurane or propofol (20 randomly allocated to each). Saturations were recorded with a digital pulse oximeter, in arterial blood samples and with a cerebral tissue oximeter before dye injection and 10, 20, 30, 40, 50, 60, 75, 90, 105 and 120 min afterwards. Patent Blue did not decrease arterial blood oxyhaemoglobin saturation, but it did reduce mean (SD) digital and cerebral oxyhaemoglobin saturations by 1.1 (1.1) % and 6.8 (7.0) %, p < 0.0001 for both. The falsely reduced oximeter readings persisted for at least 2 h. The mean (SD) intra-operative digital pulse oxyhaemoglobin readings were lower with sevoflurane than propofol, 97.8 (1.2) % and 98.8 (1.0) %, respectively, p < 0.0001. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Development of an oximeter for neurology

NASA Astrophysics Data System (ADS)

Aleinik, A.; Serikbekova, Z.; Zhukova, N.; Zhukova, I.; Nikitina, M.

2016-06-01

Cerebral desaturation can occur during surgery manipulation, whereas other parameters vary insignificantly. Prolonged intervals of cerebral anoxia can cause serious damage to the nervous system. Commonly used method for measurement of cerebral blood flow uses invasive catheters. Other techniques include single photon emission computed tomography (SPECT), positron emission tomography (PET), magnetic resonance imaging (MRI). Tomographic methods frequently use isotope administration, that may result in anaphylactic reactions to contrast media and associated nerve diseases. Moreover, the high cost and the need for continuous monitoring make it difficult to apply these techniques in clinical practice. Cerebral oximetry is a method for measuring oxygen saturation using infrared spectrometry. Moreover reflection pulse oximetry can detect sudden changes in sympathetic tone. For this purpose the reflectance pulse oximeter for use in neurology is developed. Reflectance oximeter has a definite advantage as it can be used to measure oxygen saturation in any part of the body. Preliminary results indicate that the device has a good resolution and high reliability. Modern applied schematics have improved device characteristics compared with existing ones.

Development of a wearable wireless body area network for health monitoring of the elderly and disabled

NASA Astrophysics Data System (ADS)

Rushambwa, Munyaradzi C.; Gezimati, Mavis; Jeeva, J. B.

2017-11-01

Novel advancements in systems miniaturization, electronics in health care and communication technologies are enabling the integration of both patients and doctors involvement in health care system. A Wearable Wireless Body Area Network (WWBAN) provides continuous, unobtrusive ambulatory, ubiquitous health monitoring, and provide real time patient’s status to the physician without any constraint on their normal daily life activities. In this project we developed a wearable wireless body area network system that continuously monitor the health of the elderly and the disabled and provide them with independent, safe and secure living. The WWBAN system monitors the following parameters; blood oxygen saturation using a pulse oximeter sensor (SpO2), heart rate (HR) pulse sensor, Temperature, hydration, glucose level and fall detection. When the wearable system is put on, the sensor values are processed and analysed. If any of the monitored parameter values falls below or exceeds the normal range, there is trigger of remote alert by which an SMS is send to a doctor or physician via GSM module and network. The developed system offers flexibility and mobility to the user; it is a real time system and has significance in revolutionizing health care system by enabling non-invasive, inexpensive, continuous health monitoring.

The accuracy of pulse oximetry in emergency department patients with severe sepsis and septic shock: a retrospective cohort study.

PubMed

Wilson, Ben J; Cowan, Hamish J; Lord, Jason A; Zuege, Dan J; Zygun, David A

2010-05-05

Pulse oximetry is routinely used to continuously and noninvasively monitor arterial oxygen saturation (SaO2) in critically ill patients. Although pulse oximeter oxygen saturation (SpO2) has been studied in several patient populations, including the critically ill, its accuracy has never been studied in emergency department (ED) patients with severe sepsis and septic shock. Sepsis results in characteristic microcirculatory derangements that could theoretically affect pulse oximeter accuracy. The purposes of the present study were twofold: 1) to determine the accuracy of pulse oximetry relative to SaO2 obtained from ABG in ED patients with severe sepsis and septic shock, and 2) to assess the impact of specific physiologic factors on this accuracy. This analysis consisted of a retrospective cohort of 88 consecutive ED patients with severe sepsis who had a simultaneous arterial blood gas and an SpO2 value recorded. Adult ICU patients that were admitted from any Calgary Health Region adult ED with a pre-specified, sepsis-related admission diagnosis between October 1, 2005 and September 30, 2006, were identified. Accuracy (SpO2 - SaO2) was analyzed by the method of Bland and Altman. The effects of hypoxemia, acidosis, hyperlactatemia, anemia, and the use of vasoactive drugs on bias were determined. The cohort consisted of 88 subjects, with a mean age of 57 years (19 - 89). The mean difference (SpO2 - SaO2) was 2.75% and the standard deviation of the differences was 3.1%. Subgroup analysis demonstrated that hypoxemia (SaO2 < 90) significantly affected pulse oximeter accuracy. The mean difference was 4.9% in hypoxemic patients and 1.89% in non-hypoxemic patients (p < 0.004). In 50% (11/22) of cases in which SpO2 was in the 90-93% range the SaO2 was <90%. Though pulse oximeter accuracy was not affected by acidoisis, hyperlactatementa, anemia or vasoactive drugs, these factors worsened precision. Pulse oximetry overestimates ABG-determined SaO2 by a mean of 2.75% in emergency department patients with severe sepsis and septic shock. This overestimation is exacerbated by the presence of hypoxemia. When SaO2 needs to be determined with a high degree of accuracy arterial blood gases are recommended.

Masimo Rad-57 Pulse CO-Oximeter for noninvasive carboxyhemoglobin measurement.

PubMed

Suner, Selim; McMurdy, John

2009-03-01

Noninvasive methods of body fluid chemical measurement have been expanding. New technologies are enabling the quantification of different compounds in the blood and interstitial tissues. One example of this is the pulse oximeter, which has facilitated the measurement of oxyhemoglobin rapidly and reliably without the requirement of blood-draws. The Masimo Rad-57 Pulse CO-Oximeter expanded the capabilities of pulse-oximetry to include measurements of carboxyhemoglobin and methemoglobin. This innovation has revolutionized the paradigm for detection of patients with CO poisoning. Previously, clinicians relied on historical information and patient signs and symptoms pointing to the possibility of CO exposure or toxicity. Only then would a blood test be ordered to measure carboxyhemoglobin levels. Since the presentation of CO poisoning is nonspecific and overlaps with many other conditions, and since the presence of environmental CO is often unknown, the detection of this condition was only possible in cases where the presence of CO was obvious or where the symptoms were severe. We now know, from studies conducted using the Rad-57, the only US FDA-approved device for noninvasive measurement of SpCO, that there are a significant number of patients who experience CO exposure but are nonsymptomatic. The Rad-57 provides a clinical justification for screening in the healthcare setting to identify patients with significant CO exposure who would otherwise be undetected.

Feasibility of Prostate Cancer Diagnosis by Transrectal Photoacoustic Imaging

DTIC Science & Technology

2014-05-01

cancer imaging [1]. Currently, most PA imaging systems adopt a nanosecond pulsed laser with high pulse energy because a short light pulse can...health, including prostate cancer detection [3]. A nanosecond pulsed laser with high pulse energy is usually extremely expensive (from tens to...scattering coefficients of 0.04 cm-1 and 8.4 cm-1, respectively, measured with an ISS Oximeter ). An optically and acoustically transparent tube was filled

Assessment of clinical application of pulse oximetry probes in llamas and alpacas.

PubMed

Grubb, Tamara L; Anderson, David E

2017-08-01

The placement and accuracy of pulse oximeter probes can vary markedly among species. For our study, we aimed to assess the accuracy of pulse oximetry and to determine the most clinically useful sites for probe placement in llamas and alpacas. The objectives included an analysis of pulse oximetry probes for accurate assessment of llamas and alpacas and to determine the best placement of the probes to achieve accurate readings. For study 1, saturation of haemoglobin with oxygen was measured in 184 arterial blood gas samples (SaO 2 ) using a co-oximeter and compared to saturation of haemoglobin with oxygen simultaneously measured using a pulse oximeter (S p O 2 ). The bias and precision for the SpO 2 -S a O 2 difference was calculated and plotted on a Bland-Altman plot. For study 2, S p O 2 data was collected 624 times from a variety of sites [tongue (T), nasal septum (NS), lip (L), vulva (V), prepuce (P), ear (E), and scrotum (S)] and recorded based upon a percentage of successful readings. Results for study 1 revealed that S p O 2 was consistently 0 to -6% points different than S a O 2 . The bias and precision of the S p O 2 -S a O 2 difference was -2.6 ± 1.7%. Results for study 2 uncovered that 540 recordings were successful readings and were obtained from the tongue and nasal septum with 97% accuracy, the lip 80%, vulva 62%, prepuce 59%, ear and scrotum < 50%. We concluded that pulse oximetry probes provide reliable estimates of arterial haemoglobin oxygen saturation in llamas and alpacas and is most accurately read when placed on the nasal septum or tongue.

Evaluation of cardiac modulation in children in response to apnea/hypopnea using the Phone Oximeter(™).

PubMed

Dehkordi, Parastoo; Garde, Ainara; Karlen, Walter; Petersen, Christian L; Wensley, David; Dumont, Guy A; Mark Ansermino, J

2016-02-01

Individuals with sleep disordered breathing (SDB) can experience changes in automatic cardiac regulation as a result of frequent sleep fragmentation and disturbance in normal respiration and oxygenation that accompany most apnea/hypopnea events. In adults, these changes are reflected in enhanced sympathetic and reduced parasympathetic activity. In this study, we examined the autonomic cardiac regulation in children with and without SDB, through spectral and detrended fluctuation analysis (DFA) of pulse rate variability (PRV). PRV was measured from pulse-to-pulse intervals (PPIs) of the photoplethysmogram (PPG) recorded from 160 children using the Phone Oximeter(™) in the standard setting of overnight polysomnography. Spectral analysis of PRV showed the cardiac parasympathetic index (high frequency, HF) was lower (p < 0.01) and cardiac sympathetic indices (low frequency, LF and LF/HF ratio) were higher (p < 0.01) during apnea/hypopnea events for more than 95% of children with SDB. DFA showed the short- and long-range fluctuations of heart rate were more strongly correlated in children with SDB compared to children without SDB. These findings confirm that the analysis of the PPG recorded using the Phone Oximeter(™) could be the basis for a new screening tool for assessing PRV in non-clinical environment.

Sleep disordered breathing analysis in a general population using standard pulse oximeter signals.

PubMed

Barak-Shinar, Deganit; Amos, Yariv; Bogan, Richard K

2013-09-01

Obstructive sleep apnea reported as the apnea-hypopnea index (AHI) is usually measured in sleep laboratories using a high number of electrodes connected to the patient's body. In this study, we examined the use of a standard pulse oximeter system with an automated analysis based on the photoplethysmograph (PPG) signal for the diagnosis of sleep disordered breathing. Using a standard and simple device with high accuracy might provide a convenient diagnostic or screening solution for patient evaluation at home or in other out of center testing environments. The study included 140 consecutive patients that were referred routinely to a sleep laboratory [SleepMed Inc.] for the diagnosis of sleep disordered breathing. Each patient underwent an overnight polysomnography (PSG) study according to AASM guidelines in an AASM-accredited sleep laboratory. The automatic analysis is based on photoplethysmographic and saturation signals only. Those two signals were recorded for the entire night as part of the full overnight PSG sleep study. The AHI calculated from the PPG analysis is compared to the AHI calculated from the manual scoring gold standard full PSG. The AHI and total respiratory events measured by the pulse oximeter analysis correlated very well with the corresponding results obtained by the gold standard full PSG. The sensitivity and specificity of AHI = or > 5 and 15 levels measured by the analysis are both above 90 %. The sensitivity and positive predictive value for the detection of respiratory event are both above 84 %. The tested system in this study yielded an acceptable result of sleep disordered breathing compared to the gold standard PSG in patients with moderate to severe sleep apnea. Accordingly and given the convenience and simplicity of the standard pulse oximeter device, the new system can be considered suitable for home and ambulatory diagnosis or screening of sleep disordered breathing patients.

A Conversion Formula for Comparing Pulse Oximeter Desaturation Rates Obtained with Different Averaging Times

PubMed Central

Vagedes, Jan; Bialkowski, Anja; Wiechers, Cornelia; Poets, Christian F.; Dietz, Klaus

2014-01-01

Objective The number of desaturations determined in recordings of pulse oximeter saturation (SpO2) primarily depends on the time over which values are averaged. As the averaging time in pulse oximeters is not standardized, it varies considerably between centers. To make SpO2 data comparable, it is thus desirable to have a formula that allows conversion between desaturation rates obtained using different averaging times for various desaturation levels and minimal durations. Methods Oxygen saturation was measured for 170 hours in 12 preterm infants with a mean number of 65 desaturations <90% per hour of arbitrary duration by using a pulse oximeter in a 2–4 s averaging mode. Using 7 different averaging times between 3 and 16 seconds, the raw red-to-infrared data were reprocessed to determine the number of desaturations (D). The whole procedure was carried out for 7 different minimal desaturation durations (≥1, ≥5, ≥10, ≥15, ≥20, ≥25, ≥30 s) below SpO2 threshold values of 80%, 85% or 90% to finally reach a conversion formula. The formula was validated by splitting the infants into two groups of six children each and using one group each as a training set and the other one as a test set. Results Based on the linear relationship found between the logarithm of the desaturation rate and the logarithm of the averaging time, the conversion formula is: D2 = D1 (T2/T1)c, where D2 is the desaturation rate for the desired averaging time T2, and D1 is the desaturation rate for the original averaging time T1, with the exponent c depending on the desaturation threshold and the minimal desaturation duration. The median error when applying this formula was 2.6%. Conclusion This formula enables the conversion of desaturation rates between different averaging times for various desaturation thresholds and minimal desaturation durations. PMID:24489887

A conversion formula for comparing pulse oximeter desaturation rates obtained with different averaging times.

PubMed

Vagedes, Jan; Bialkowski, Anja; Wiechers, Cornelia; Poets, Christian F; Dietz, Klaus

2014-01-01

The number of desaturations determined in recordings of pulse oximeter saturation (SpO2) primarily depends on the time over which values are averaged. As the averaging time in pulse oximeters is not standardized, it varies considerably between centers. To make SpO2 data comparable, it is thus desirable to have a formula that allows conversion between desaturation rates obtained using different averaging times for various desaturation levels and minimal durations. Oxygen saturation was measured for 170 hours in 12 preterm infants with a mean number of 65 desaturations <90% per hour of arbitrary duration by using a pulse oximeter in a 2-4 s averaging mode. Using 7 different averaging times between 3 and 16 seconds, the raw red-to-infrared data were reprocessed to determine the number of desaturations (D). The whole procedure was carried out for 7 different minimal desaturation durations (≥ 1, ≥ 5, ≥ 10, ≥ 15, ≥ 20, ≥ 25, ≥ 30 s) below SpO2 threshold values of 80%, 85% or 90% to finally reach a conversion formula. The formula was validated by splitting the infants into two groups of six children each and using one group each as a training set and the other one as a test set. Based on the linear relationship found between the logarithm of the desaturation rate and the logarithm of the averaging time, the conversion formula is: D2 = D1 (T2/T1)(c), where D2 is the desaturation rate for the desired averaging time T2, and D1 is the desaturation rate for the original averaging time T1, with the exponent c depending on the desaturation threshold and the minimal desaturation duration. The median error when applying this formula was 2.6%. This formula enables the conversion of desaturation rates between different averaging times for various desaturation thresholds and minimal desaturation durations.

Optimal spacing between transmitting and receiving optical fibres in reflectance pulse oximetry

NASA Astrophysics Data System (ADS)

Hickey, M.; Kyriacou, P. A.

2007-10-01

Splanchnic ischaemia can ultimately lead to cellular hypoxia and necrosis, and may well contribute to the development of multiple organ failures and increased mortality. Therefore, it is of utmost importance to monitor abdominal organ blood oxygen saturation (SpO2). Pulse oximetry has been widely accepted as a reliable method for monitoring oxygen saturation of arterial blood. Animal studies have also shown it to be effective in the monitoring of blood oxygen saturation in the splanchnic region. However, commercially available pulse oximeter probes are not suitable for the continuous assessment of SpO2 in the splanchnic region. Therefore, there is a need for a new sensor technology that will allow the continuous measurement of SpO2 in the splanchnic area pre-operatively, operatively and post-operatively. For this purpose, a new fibre optic sensor and processing system utilising the principle of reflectance pulse oximetry has been developed. The accuracy in the estimation of SpO2 in pulse oximetry depends on the quality and amplitude of the photoplethysmographic (PPG) signal and for this reason an experimental procedure was carried out to examine the effect of the source-detector separation distance on the acquired PPG signals, and to ultimately select an optimal separation for the final design of the fibre-optic probe. PPG signals were obtained from the finger for different separation distances between the emitting and detecting fibres. Good quality PPG signals with large amplitudes and high signal-to-noise ratio were detected in the range of 3mm to 6mm. At separation distances between 1mm and 2mm, PPG signals were erratic with no resemblance to a conventional PPG signal. At separation distances greater than 6mm, the amplitudes of PPG signals were very small and not appropriate for processing. This investigation indicates the suitability of optical fibres as a new pulse oximetry sensor for estimating blood oxygen saturation (SpO2) in the splanchnic region.

Is pulse oximetry an essential tool or just another distraction? The role of the pulse oximeter in modern anesthesia care.

PubMed

Shah, Amit; Shelley, Kirk H

2013-06-01

Since the discovery of anesthetic agents, patient monitoring has been considered one of the core responsibilities of the anesthesiologist. As depicted in Robert Hinckley's famous painting, The First Operation with Ether, one observes William Thomas Green Morton carefully watching over his patient. Since its founding in 1905, 'Vigilance' has been the motto of the American Society of Anesthesiologists (ASA). Over a hundred years have passed, and one would think we would be clear regarding what we are watching for and how we should be watching. On the contrary, the introduction of new technology and outcome research is requiring us to re-examine our fundamental assumptions regarding what is and what is not important in the care of the patient. A vast majority of anesthesiologists would refuse to proceed with an anesthetic without the presence of a pulse oximeter. On the other hand, outcome studies have failed to demonstrate an improvement in patient care with their use. For that matter, it can be argued that outcome studies have yet to demonstrate an unambiguous role for any monitor of any type (i.e. blood pressure cuff or ECG), as outcome studies may fail to capture rare events. Because of the increased safety that has been attributed to pulse oximetry, it is unlikely that further studies can or will be conducted. As we enter a new era of clinical monitoring, with an emphasis on noninvasive cardiovascular monitoring, it might be of benefit to examine the role of the pulse oximeter in clinical care. This article reviews the available evidence for pulse oximetry. Further, it discusses contemporary issues, events, and perceptions that may help to explain how and why pulse oximetry may have been adopted as a standard of care despite the lack of supportive. Lastly, it discusses less obvious benefits of pulse oximetry that may have further implications on the future of anesthesia care and perhaps even automated anesthesia.

Optical noninvasive calculation of hemoglobin components concentrations and fractional oxygen saturation using a ring-scattering pulse oximeter

NASA Astrophysics Data System (ADS)

Abdallah, Omar; Stork, Wilhelm; Muller-Glaser, Klaus

2004-06-01

The deficiencies of the currently used pulse oximeter are discussed in diverse literature. A hazardous pitfalls of this method is that the pulse oximeter will not detect carboxyhemoglobin (COHb) and methemoglobin (metHb) concentrations. This leads to incorrect measurement of oxygen saturation by carbon monoxide poisoning and methemoglobinemia. Also the total hemoglobin concentration will not be considered and can only be measured in-vitro up to now. A second pitfall of the standard pulse oximetry is that it will not be able to show a result by low perfusion of tissues. This case is available inter alia when the patient is under shock or has a low blood pressure. The new non-invasive system we designed measures the actual (fractional) oxygen saturation and hemoglobin concentration. It will enable us also to measure COHb and metHb. The measurement can be applied at better perfused body central parts. Four or more light emitting diodes (LEDs) or laser diodes (LDs) and five photodiodes (PDs) are used. The reflected light signal detected by photodiodes is processed using a modified Lambert-Beer law (I=I0×e-α.d ). According to this law, when a non scattering probe is irradiated with light having the incident intensity I0, the intensity of transmitted light I decays exponentially with the absorption coefficient a of that probe and its thickness d. Modifications of this law have been performed following the theoretical developed models in literature, Monte Carlo simulation and experimental measurement.

Pulse carboxyhemoglobin-oximetry and cigarette smoking.

PubMed

Sokolova-Djokić, L; Milosević, S; Skrbić, R; Salabat, R; Voronov, G; Igić, R

2011-01-01

We used a pulse carbon monoxide (CO)-oximeter to measure the levels of carboxyhemoglobin (COHb) in smokers and non-smokers. Our goal was to determine if this device could not only define smoking status, but also to increase accuracy of self-reported data at various surveys on smoking. Thirty-four healthy volunteers participated in this study. Twenty-two of them were current daily smokers; 12 participants were non-smokers who lived alone or with a nonsmoker, and who worked in non-smoking environment. Nicotine dependency level was determined by the modified Fagerstrom questionnaire. Blood COHb levels were measured with a pulse CO-oximeter (Masimo, Radical 7). The COHb levels in both moderate/heavy smokers and light smokers increased significantly after they smoked a single cigarette. This increase persisted for more than 6 h in the moderate/heavy smokers, while in the light smokers COHb levels returned to the baseline level after one hour. The pulse rate of all smokers increased significantly 20 min after smoking. We conclude that the CO-oximeter can detect smoking by moderate/heavy smokers and light smokers if they smoked 6 h or 20 min earlier, respectively. We concluded that it could be used as a validation test for smoking at the time of admission to the surgical facility and to increase smoking abstinence during preoperative and postoperative periods. This noninvasive, simple and inexpensive test may also be used at various surveys to increase accuracy of self-reports on smoking.

Cardiac gating with a pulse oximeter for dual-energy imaging.

PubMed

Shkumat, N A; Siewerdsen, J H; Dhanantwari, A C; Williams, D B; Paul, N S; Yorkston, J; Van Metter, R

2008-11-07

The development and evaluation of a prototype cardiac gating system for double-shot dual-energy (DE) imaging is described. By acquiring both low- and high-kVp images during the resting phase of the cardiac cycle (diastole), heart misalignment between images can be reduced, thereby decreasing the magnitude of cardiac motion artifacts. For this initial implementation, a fingertip pulse oximeter was employed to measure the peripheral pulse waveform ('plethysmogram'), offering potential logistic, cost and workflow advantages compared to an electrocardiogram. A gating method was developed that accommodates temporal delays due to physiological pulse propagation, oximeter waveform processing and the imaging system (software, filter-wheel, anti-scatter Bucky-grid and flat-panel detector). Modeling the diastolic period allowed the calculation of an implemented delay, t(imp), required to trigger correctly during diastole at any patient heart rate (HR). The model suggests a triggering scheme characterized by two HR regimes, separated by a threshold, HR(thresh). For rates at or below HR(thresh), sufficient time exists to expose on the same heartbeat as the plethysmogram pulse [t(imp)(HR) = 0]. Above HR(thresh), a characteristic t(imp)(HR) delays exposure to the subsequent heartbeat, accounting for all fixed and variable system delays. Performance was evaluated in terms of accuracy and precision of diastole-trigger coincidence and quantitative evaluation of artifact severity in gated and ungated DE images. Initial implementation indicated 85% accuracy in diastole-trigger coincidence. Through the identification of an improved HR estimation method (modified temporal smoothing of the oximeter waveform), trigger accuracy of 100% could be achieved with improved precision. To quantify the effect of the gating system on DE image quality, human observer tests were conducted to measure the magnitude of cardiac artifact under conditions of successful and unsuccessful diastolic gating. Six observers independently measured the artifact in 111 patient DE images. The data indicate that successful diastolic gating results in a statistically significant reduction (p < 0.001) in the magnitude of cardiac motion artifact, with residual artifact attributed primarily to gross patient motion.

Detection of Sleep Disordered Breathing and Its Central/Obstructive Character Using Nasal Cannula and Finger Pulse Oximeter

PubMed Central

Sommermeyer, Dirk; Zou, Ding; Grote, Ludger; Hedner, Jan

2012-01-01

Study Objective: To assess the accuracy of novel algorithms using an oximeter-based finger plethysmographic signal in combination with a nasal cannula for the detection and differentiation of central and obstructive apneas. The validity of single pulse oximetry to detect respiratory disturbance events was also studied. Methods: Patients recruited from four sleep laboratories underwent an ambulatory overnight cardiorespiratory polygraphy recording. The nasal flow and photoplethysmographic signals of the recording were analyzed by automated algorithms. The apnea hypopnea index (AHIauto) was calculated using both signals, and a respiratory disturbance index (RDIauto) was calculated from photoplethysmography alone. Apnea events were classified into obstructive and central types using the oximeter derived pulse wave signal and compared with manual scoring. Results: Sixty-six subjects (42 males, age 54 ± 14 yrs, body mass index 28.5 ± 5.9 kg/m2) were included in the analysis. AHImanual (19.4 ± 18.5 events/h) correlated highly significantly with AHIauto (19.9 ± 16.5 events/h) and RDIauto (20.4 ± 17.2 events/h); the correlation coefficients were r = 0.94 and 0.95, respectively (p < 0.001) with a mean difference of −0.5 ± 6.6 and −1.0 ± 6.1 events/h. The automatic analysis of AHIauto and RDIauto detected sleep apnea (cutoff AHImanual ≥ 15 events/h) with a sensitivity/specificity of 0.90/0.97 and 0.86/0.94, respectively. The automated obstructive/central apnea indices correlated closely with manually scoring (r = 0.87 and 0.95, p < 0.001) with mean difference of −4.3 ± 7.9 and 0.3 ± 1.5 events/h, respectively. Conclusions: Automatic analysis based on routine pulse oximetry alone may be used to detect sleep disordered breathing with accuracy. In addition, the combination of photoplethysmographic signals with a nasal flow signal provides an accurate distinction between obstructive and central apneic events during sleep. Citation: Sommermeyer D; Zou D; Grote L; Hedner J. Detection of sleep disordered breathing and its central/obstructive character using nasal cannula and finger pulse oximeter. J Clin Sleep Med 2012;8(5):527-533. PMID:23066364

Shortening the Feedback Loop for Sleep Apnea Patients Via a Wireless Blood Pulse-Oximetry System

PubMed Central

Stepnowsky, Carl; Blair, Paul; DiNicola, Gia; Lenert, Leslie A

2006-01-01

Much of the clinical care of sleep apnea patients is focused on case identification, diagnosis, and treatment prescription, while follow-up care tends to be intermittent and patient-initiated. There is a clear need for an alternative, cost-effective way to examine sleep apnea treatment efficacy. As part of our research program to improve the clinical care of sleep apnea patients using Internet enabled systems, we have developed a prototype Wireless Blood Pulse-Oximeter System that patients can use in their homes. The oximeter system can be applied by the patient and is based on a data-push mechanism to a secure server that is designed for both patient and provider access. PMID:17238730

Motion resistant pulse oximetry in neonates

PubMed Central

Sahni, R; Gupta, A; Ohira-Kist, K; Rosen, T

2003-01-01

Background: Pulse oximetry is widely used in neonates. However, its reliability is often affected by motion artefact. Clinicians confronted with questionable oxygen saturation (SpO2) values often estimate the reliability by correlating heart rate (HR) obtained with the oximeter with that obtained by electrocardiogram. Objective: To compare the effects of motion on SpO2 and HR measurements made with Masimo signal extraction technology and those made with a Nellcor N-200. Design: Continuous pulse oximetry and HR monitoring were performed in 15 healthy, term infants (mean (SD) birth weight 3408 (458) g) undergoing circumcision, using Masimo and Nellcor pulse oximeters and a standard HR monitor (Hewlett-Packard). Simultaneous minute by minute behavioural activity codes were also assigned. Baseline data were collected for 10 minutes when the infant was quietly asleep and then continued during and after circumcision for a total duration of one hour. The oximeter HR and SpO2 values were compared and related to HR values obtained by ECG during all three periods. The effect of behavioural activity on SpO2 and HR was also evaluated. Results: When compared with results obtained with the Nellcor, the mean SpO2 and HR were higher and the incidence of artefact lower with the Masimo during all three periods. Masimo HR more accurately predicted HR obtained with a standard monitor, with lower residual error. SpO2 and HR values obtained with the Nellcor were lower and more variable during all behavioural states, especially crying, when excessive motion artefact was most likely. Conclusions: The data suggest that Masimo signal extraction technology may offer improvement in pulse oximetry performance, particularly in clinical situations in which extreme motion artefacts are likely. PMID:14602699

Systematic review and meta-analysis of method comparison studies of Masimo pulse co-oximeters (Radical-7™ or Pronto-7™) and HemoCue® absorption spectrometers (B-Hemoglobin or 201+) with laboratory haemoglobin estimation.

PubMed

Hiscock, R; Kumar, D; Simmons, S W

2015-05-01

We assessed agreement in haemoglobin measurement between Masimo pulse co-oximeters (Rad-7™ and Pronto-7™) and HemoCue® photometers (201+ or B-Hemoglobin) with laboratory-based determination and identified 39 relevant studies (2915 patients in Masimo group and 3084 patients in HemoCue group). In the Masimo group, the overall mean difference was -0.03 g/dl (95% prediction interval -0.30 to 0.23) and 95% limits of agreement -3.0 to 2.9 g/dl compared to 0.08 g/dl (95% prediction interval -0.04 to 0.20) and 95% limits of agreement -1.3 to 1.4 g/dl in the HemoCue group. Only B-Hemoglobin exhibited bias (0.53, 95% prediction interval 0.27 to 0.78). The overall standard deviation of difference was larger (1.42 g/dl versus 0.64 g/dl) for Masimo pulse co-oximeters compared to HemoCue photometers. Masimo devices and HemoCue 201+ both provide an unbiased, pooled estimate of laboratory haemoglobin. However, Masimo devices have lower precision and wider 95% limits of agreement than HemoCue devices. Clinicians should carefully consider these limits of agreement before basing transfusion or other clinical decisions on these point-of-care measurements alone.

Algorithms that eliminate the effects of calibration artefact and trial-imposed offsets of Masimo oximeter in BOOST-NZ trial.

PubMed

Zahari, Marina; Lee, Dominic Savio; Darlow, Brian Alexander

2016-10-01

The displayed readings of Masimo pulse oximeters used in the Benefits Of Oxygen Saturation Targeting (BOOST) II and related trials in very preterm babies were influenced by trial-imposed offsets and an artefact in the calibration software. A study was undertaken to implement new algorithms that eliminate the effects of offsets and artefact. In the BOOST-New Zealand trial, oxygen saturations were averaged and stored every 10 s up to 36 weeks' post-menstrual age. Two-hundred and fifty-seven of 340 babies enrolled in the trial had at least two weeks of stored data. Oxygen saturation distribution patterns corresponding with a +3 % or -3 % offset in the 85-95 % range were identified together with that due to the calibration artefact. Algorithms involving linear and quadratic interpolations were developed, implemented on each baby of the dataset and validated using the data of a UK preterm baby, as recorded from Masimo oximeters with the original software and a non-offset Siemens oximeter. Saturation distributions obtained were compared for both groups. There were a flat region at saturations 85-87 % and a peak at 96 % from the lower saturation target oximeters, and at 93-95 and 84 % respectively from the higher saturation target oximeters. The algorithms lowered the peaks and redistributed the accumulated frequencies to the flat regions and artefact at 87-90 %. The resulting distributions were very close to those obtained from the Siemens oximeter. The artefact and offsets of the Masimo oximeter's software had been addressed to determine the true saturation readings through the use of novel algorithms. The implementation would enable New Zealand data be included in the meta-analysis of BOOST II trials, and be used in neonatal oxygen studies.

Evaluation of Standard Versus Nonstandard Vital Signs Monitors in the Prehospital and Emergency Departments: Results and Lessons Learned from a Trauma Patient Care Protocol

DTIC Science & Technology

2014-04-24

single lead and pleth waveform data from a thumb-mounted pulse oximeter to the WVSM were recorded at rates of 230 Hz and 75 Hz, respectively. For...were also used to derive other measurements including shock index (shock index = HR / SBP) and pulse pres- sure ( pulse pressure = SBP j diastolic

Effectiveness of enhanced pulse oximetry sonifications for conveying oxygen saturation ranges: a laboratory comparison of five auditory displays.

PubMed

Paterson, E; Sanderson, P M; Paterson, N A B; Loeb, R G

2017-12-01

Anaesthetists monitor auditory information about a patient's vital signs in an environment that can be noisy and while performing other cognitively demanding tasks. It can be difficult to identify oxygen saturation (SpO2) values using existing pulse oximeter auditory displays (sonifications). In a laboratory setting, we compared the ability of non-clinician participants to detect transitions into and out of an SpO2 target range using five different sonifications while they performed a secondary distractor arithmetic task in the presence of background noise. The control sonification was based on the auditory display of current pulse oximeters and comprised a variable pitch with an alarm. The four experimental conditions included an Alarm Only condition, a Variable pitch only condition, and two conditions using sonifications enhanced with additional sound dimensions. Accuracy to detect SpO2 target transitions was the primary outcome. We found that participants using the two sonifications enhanced with the additional sound dimensions of tremolo and brightness were significantly more accurate (83 and 96%, respectively) at detecting transitions to and from a target SpO2 range than participants using a pitch only sonification plus alarms (57%) as implemented in current pulse oximeters. Enhanced sonifications are more informative than conventional sonification. The implication is that they might allow anaesthetists to judge better when desaturation decreases below, or returns to, a target range. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com

The Effect of Skin Pigmentation on the Accuracy of Pulse Oximetry in Infants with Hypoxemia.

PubMed

Foglia, Elizabeth E; Whyte, Robin K; Chaudhary, Aasma; Mott, Antonio; Chen, Jodi; Propert, Kathleen J; Schmidt, Barbara

2017-03-01

To compare pulse oximetry measurement bias between infants with hypoxemia with either dark skin or light skin with Masimo Radical 7 and Nellcor Oximax. There was no significant difference in systematic bias based on skin pigment for either oximeter. Copyright © 2016 Elsevier Inc. All rights reserved.

Retrospective analysis of pulse oximeter alarm settings in an intensive care unit patient population.

PubMed

Lansdowne, Krystal; Strauss, David G; Scully, Christopher G

2016-01-01

The cacophony of alerts and alarms in a hospital produced by medical devices results in alarm fatigue. The pulse oximeter is one of the most common sources of alarms. One of the ways to reduce alarm rates is to adjust alarm settings at the bedside. This study is aimed to retrospectively examine individual pulse oximeter alarm settings on alarm rates and inter- and intra- patient variability. Nine hundred sixty-two previously collected intensive care unit (ICU) patient records were obtained from the Multiparameter Intelligent Monitoring in Intensive Care II Database (Beth Israel Deaconess Medical Center, Boston, MA). Inclusion criteria included patient records that contained SpO2 trend data sampled at 1 Hz for at least 1 h and a matching clinical record. SpO2 alarm rates were simulated by applying a range of thresholds (84, 86, 88, and 90 %) and delay times (10 to 60 s) to the SpO2 data. Patient records with at least 12 h of SpO2 data were examined for the variability in alarm rate over time. Decreasing SpO2 thresholds and increasing delay times resulted in decreased alarm rates. A limited number of patient records accounted for most alarms, and this number increased as alarm settings loosened (the top 10 % of patient records were responsible for 57.4 % of all alarms at an SpO2 threshold of 90 % and 15 s delay and 81.6 % at an SpO2 threshold of 84 % and 45 s delay). Alarm rates were not consistent over time for individual patients with periods of high and low alarms for all alarm settings. Pulse oximeter SpO2 alarm rates are variable between patients and over time, and the alarm rate and the extent of inter- and intra-patient variability can be affected by the alarm settings. Personalized alarm settings for a patient's current status may help to reduce alarm fatigue for nurses.

Development and optimization of a miniaturized fiber-optic photoplethysmographic sensor

NASA Astrophysics Data System (ADS)

Morley, Aisha; Davenport, John J.; Hickey, Michelle; Phillips, Justin P.

2017-11-01

Photoplethysmography (PPG) is a widely used technique for measuring blood oxygen saturation, commonly using an external pulse oximeter applied to a finger, toe, or earlobe. Previous research has demonstrated the utility of direct monitoring of the oxygen saturation of internal organs, using optical fibers to transmit light between the photodiode/light emitting diode and internal site. However, little research into the optimization and standardization of such a probe has yet been carried out. This research establishes the relationship between fiber separation distance and PPG signal, and between fiber core width and PPG signal. An ideal setup is suggested: 1000-μm fibers at a separation distance of 3 to 3.5 mm, which was found to produce signals around 0.35 V in amplitude with a low variation coefficient.

Aeromedical Evacuation Enroute Critical Care Validation Study

DTIC Science & Technology

2015-02-27

finger pulse oximeter 6515-01-557-1136 Arrow International, Inc. jugular vein puncture kit 6515-01-262-7222 Argon Medical Corporation catheterization...patient 17 Administer oxygen 18 Measure a patients pulse oxygen saturation 19 Measure a patient’s blood pressure 20 Operate the Zoll M Series CCT... pulse 26 Measure a patient’s temperature 27 Advanced cardiac life support 28 Initiate treatment for hypovolemic shock 29 Initiate an IV infusion

Near Infra-Red Spectroscopy to Reduce the Phrophylactic Fasciotomies for and Missed Cases of Acute Compartment Syndrome in Solders Injured in OEF/OIF

DTIC Science & Technology

2011-10-01

accuracy and reliability of a specific NIRS sensor (Equanox 7600 Oximeter, Nonin , Inc, Plymouth, MN) in diagnosing acute compartment syndrome in injured...conduct at the conclusion of this research project. The current FDA approved indication for the Nonin Equanox Oximeter is for "monitoring" regional...Somanetics, Inc to Covidien, Inc. producing a need to find a new NIRS COTS provider ( Nonin , Inc. the NIRS COTS provider for the METRC Acute

Medical Device Plug-and-Play Interoperability Standards and Technology Leadership

DTIC Science & Technology

2015-10-01

implemented connectivity to an EHR as an HL7 FHIR gateway from OpenICE. The monitor we used can measure heart rate from EKG, from the pulse oximeter , or... Pulse 2014:5(6):37-39. 2. Wu PL, Raguraman D, Sha L, Berlin RB, Goldman JM. WiP abstract: A treatment coordination protocol for cyber-physical-human

Rejection of false saturation data in optical pulse-oximeter

NASA Astrophysics Data System (ADS)

Scalise, Lorenzo; Marchionni, Paolo; Carnielli, Virgilio

2010-04-01

Pulse oximetry (PO) is a non-invasive medical device used for monitoring of the arterial oxygen saturation (SaO2) and in particular of haemoglobin oxygenation in blood. Oxygen saturation is commonly used in any setting where the patient blood oxygen saturation is unstable, including Neonatal Intensive Care Unit (NICU). The main factor affecting PO's output data is the presence of voluntary or involuntary motion artifacts or imperfect skin-sensor contact. Various methods have been employed to reject motion artifact but have met with little success. The aim of the present work is to propose a novel measurement procedure for real-time monitoring and validation of the oxygen saturation data as measured in standard pulse oxymeter. The procedure should be able to individuate and reject erroneous saturation data due to incorrect transducer-skin contact or motion artifact. In the case of short sequences of rejected SpO2 data (time duration< 8s), we report on an algorithm able to substitute the sequence of rejected data with the "most-probable" (rescued) SpO2 data. In total we have analyzed 14 patient for a total of 310 hr, 43 min and 15s, equivalent to a total number of samples of 1118595. For our study, we were interested to download heart rate measured with the ECG (HRECG), the heart rate as measured by the pulse oximeter (HRSAT) and the SpO2 value. In order to remove the erroneous SpO2 values reported in the rough data in coincidence of motion artifact (top, right), we have implemented a specific algorithm which provides at the output a new sequence of SpO2 data (validated SpO2 data). With the aim to "rescue" SpO2 value rejected by the previously presented algorithm, we have implemented an algorithm able to provide the "most-probable" SpO2 values in the case of single rejected values or in the case of short sequences of invalidated data (< 8 s). From these data it is possible to observe how in the 6.8% of the observation time the SpO2 data measured by the pulse oximeter are not validated by the use of our method (corresponding to a total time of 16 hr, 8min and 40s). The use of the proposed algorithm aiming to "rescue" data from short sequences of rejected data (< 8s) allows to increase the validated data of the 2.5%t(equivalent to 8hr, 40 min and 16s), allowing a percent of usable data of the 95.7%. Once implemented in clinic, it could be used to identify the period of the day in which the percent of rejected data increase or correlate this data to clinical procedure in order to intensify clinicians and nurses attention.

Onboard tagging for real-time quality assessment of photoplethysmograms acquired by a wireless reflectance pulse oximeter.

PubMed

Li, Kejia; Warren, Steve; Natarajan, Balasubramaniam

2012-02-01

Onboard assessment of photoplethysmogram (PPG) quality could reduce unnecessary data transmission on battery-powered wireless pulse oximeters and improve the viability of the electronic patient records to which these data are stored. These algorithms show promise to increase the intelligence level of former "dumb" medical devices: devices that acquire and forward data but leave data interpretation to the clinician or host system. To this end, the authors have developed a unique onboard feature detection algorithm to assess the quality of PPGs acquired with a custom reflectance mode, wireless pulse oximeter. The algorithm uses a Bayesian hypothesis testing method to analyze four features extracted from raw and decimated PPG data in order to determine whether the original data comprise valid PPG waveforms or whether they are corrupted by motion or other environmental influences. Based on these results, the algorithm further calculates heart rate and blood oxygen saturation from a "compact representation" structure. PPG data were collected from 47 subjects to train the feature detection algorithm and to gauge their performance. A MATLAB interface was also developed to visualize the features extracted, the algorithm flow, and the decision results, where all algorithm-related parameters and decisions were ascertained on the wireless unit prior to transmission. For the data sets acquired here, the algorithm was 99% effective in identifying clean, usable PPGs versus nonsaturated data that did not demonstrate meaningful pulsatile waveshapes, PPGs corrupted by motion artifact, and data affected by signal saturation.

Evaluation of analytic and motion-resistant performance of the Mindray 9006 pulse oximeter.

PubMed

Peng, Liming; Yan, Cunliang; Lu, Hong; Xia, Yong

2007-08-01

The Mindray 9006 is a newly developed pulse oximeter. The performance of noninvasive monitoring of arterial oxygen saturation by pulse oximetry (SpO(2)) and pulse rate (PR) with the Mindray 9006 was evaluated. Twenty healthy volunteers participated in this study. The Mindray 9006 was evaluated according to guidelines including HS3-A, EP5-A, and EP9-A2 published by the CLSI, and ISO 9919. A blinded side-by-side comparison of the Mindray 9006 and the Masimo MS-3 oximeter was also performed. The results demonstrated that the coefficients of variation (CV) of imprecision were less than 1% for SpO(2) and less than 5% for PR analyzed by the Mindray 9006. Comparisons of methods showed there was no significant difference in SpO(2)/PR analysis between the Mindray 9006 with Rapidlab 855 CO-oxymeter or 812 Electrocardiogram (ECG) monitor (p>0.05) and between the Mindray 9006 and Masimo MS-3 (p>0.05). There was good correlation for SpO(2) between the Mindray 9006 and CO-oxymetry or the Masimo MS-3 (r>0.96) and for PR between the Mindray 9006 and ECG or the Masimo MS-3 (r>0.98). The accuracy as the root-mean-square (A(rms)) was less than 3% for both SpO(2) and PR between the Mindray 9006 and CO-oxymetry or between the Mindray 9006 and ECG. Also, there was no significant difference for SpO(2)/PR between the motion and rest conditions (p>0.05). The overall performance of the Mindray 9006 for SpO(2) and PR analysis is excellent and compares favorably with the Masimo MS-3.

Comparison of cerebral tissue oxygenation values in full term and preterm newborns by the simultaneous use of two near-infrared spectroscopy devices: an absolute and a relative trending oximeter

NASA Astrophysics Data System (ADS)

Szczapa, Tomasz; Karpiński, Łukasz; Moczko, Jerzy; Weindling, Michael; Kornacka, Alicja; Wróblewska, Katarzyna; Adamczak, Aleksandra; Jopek, Aleksandra; Chojnacka, Karolina; Gadzinowski, Janusz

2013-08-01

The aim of this study is to compare a two-wavelength light emitting diode-based tissue oximeter (INVOS), which is designed to show trends in tissue oxygenation, with a four-wavelength laser-based oximeter (FORE-SIGHT), designed to deliver absolute values of tissue oxygenation. Simultaneous values of cerebral tissue oxygenation (StO2) are measured using both devices in 15 term and 15 preterm clinically stable newborns on the first and third day of life. Values are recorded simultaneously in two periods between which oximeter sensor positions are switched to the contralateral side. Agreement between StO2 values before and after the change of sensor position is analyzed. We find that mean cerebral StO2 values are similar between devices for term and preterm babies, but INVOS shows StO2 values spread over a wider range, with wider standard deviations than shown by the FORE-SIGHT. There is relatively good agreement with a bias up to 3.5% and limits of agreement up to 11.8%. Measurements from each side of the forehead show better repeatability for the FORE-SIGHT monitor. We conclude that performance of the two devices is probably acceptable for clinical purposes. Both performed sufficiently well, but the use of FORE-SIGHT may be associated with tighter range and better repeatability of data.

Detection of cardiac activity using a 5.8 GHz radio frequency sensor.

PubMed

Vasu, V; Fox, N; Brabetz, T; Wren, M; Heneghan, C; Sezer, S

2009-01-01

A 5.8-GHz ISM-Band radio-frequency sensor has been developed for non-contact measurement of respiration and heart rate from stationary and semi-stationary subjects at a distance of 0.5 to 1.5 meters. We report on the accuracy of the heart rate measurements obtained using two algorithmic approaches, as compared to a reference heart rate obtained using a pulse oximeter. Simultaneous Photoplethysmograph (PPG) and non-contact sensor recordings were recorded over fifteen minute periods for ten healthy subjects (8M/2F, ages 29.6 + or - 5.6 yrs) One algorithm is based on automated detection of individual peaks associated with each cardiac cycle; a second algorithm extracts a heart rate over a 60-second period using spectral analysis. Peaks were also extracted manually for comparison with the automated method. The peak-detection methods were less accurate than the spectral methods, but suggest the possibility of acquiring beat by beat data; the spectral algorithms measured heart rate to within + or -10% for the ten subjects chosen. Non-contact measurement of heart rate will be useful in chronic disease monitoring for conditions such as heart failure and cardiovascular disease.

Arterial input function of an optical tracer for dynamic contrast enhanced imaging can be determined from pulse oximetry oxygen saturation measurements

NASA Astrophysics Data System (ADS)

Elliott, Jonathan T.; Wright, Eric A.; Tichauer, Kenneth M.; Diop, Mamadou; Morrison, Laura B.; Pogue, Brian W.; Lee, Ting-Yim; St. Lawrence, Keith

2012-12-01

In many cases, kinetic modeling requires that the arterial input function (AIF)—the time-dependent arterial concentration of a tracer—be characterized. A straightforward method to measure the AIF of red and near-infrared optical dyes (e.g., indocyanine green) using a pulse oximeter is presented. The method is motivated by the ubiquity of pulse oximeters used in both preclinical and clinical applications, as well as the gap in currently available technologies to measure AIFs in small animals. The method is based on quantifying the interference that is observed in the derived arterial oxygen saturation (SaO2) following a bolus injection of a light-absorbing dye. In other words, the change in SaO2 can be converted into dye concentration knowing the chromophore-specific extinction coefficients, the true arterial oxygen saturation, and total hemoglobin concentration. A simple error analysis was performed to highlight potential limitations of the approach, and a validation of the method was conducted in rabbits by comparing the pulse oximetry method with the AIF acquired using a pulse dye densitometer. Considering that determining the AIF is required for performing quantitative tracer kinetics, this method provides a flexible tool for measuring the arterial dye concentration that could be used in a variety of applications.

Multiple diagnosis based on photoplethysmography: hematocrit, SpO2, pulse, and respiration

NASA Astrophysics Data System (ADS)

Yoon, Gilwon; Lee, Jong Y.; Jeon, Kye Jin; Park, Kun-Kook; Yeo, Hyung S.; Hwang, Hyun T.; Kim, Hong S.; Hwang, In-Duk

2002-09-01

Photo-plethysmography measures pulsatile blood flow in real-time and non-invasively. One of widely known applications of PPG is the measurement of saturated oxygen in arterial blood(SpO2). In our work, using several wavelengths more than those used in a pulse oximeter, an algorithm and instrument have been developed to measure hematocrit, saturated oxygen, pulse and respiratory rates simultaneously. To predict hematocrit, a dedicated algorithm is developed based on scattering of RBC and a protocol for detecting outlier signals is used to increase accuracy and reliability. Digital filtering techniques are used to extract respiratory rate signals. Utilization of wavelengths under 1000nm and a multi-wavelength LED array chip and digital-oriented electronics enable us to make a compact device. Our preliminary clinical trials show that the achieved percent errors are +/-8.2% for hematocrit when tested with 594 persons, R2 for SpO2 fitting is 0.99985 when tested with a Bi-Tek pulse oximeter simulator and the SpO2 error for in vivo test is +/-2.5% over the range of 75~100%. The error of pulse rates is less than +/-5%. We obtained a positive predictive value of 96% for respiratory rates in qualitative analysis.

Arterial input function of an optical tracer for dynamic contrast enhanced imaging can be determined from pulse oximetry oxygen saturation measurements.

PubMed

Elliott, Jonathan T; Wright, Eric A; Tichauer, Kenneth M; Diop, Mamadou; Morrison, Laura B; Pogue, Brian W; Lee, Ting-Yim; St Lawrence, Keith

2012-12-21

In many cases, kinetic modeling requires that the arterial input function (AIF)--the time-dependent arterial concentration of a tracer--be characterized. A straightforward method to measure the AIF of red and near-infrared optical dyes (e.g., indocyanine green) using a pulse oximeter is presented. The method is motivated by the ubiquity of pulse oximeters used in both preclinical and clinical applications, as well as the gap in currently available technologies to measure AIFs in small animals. The method is based on quantifying the interference that is observed in the derived arterial oxygen saturation (SaO₂) following a bolus injection of a light-absorbing dye. In other words, the change in SaO₂ can be converted into dye concentration knowing the chromophore-specific extinction coefficients, the true arterial oxygen saturation, and total hemoglobin concentration. A simple error analysis was performed to highlight potential limitations of the approach, and a validation of the method was conducted in rabbits by comparing the pulse oximetry method with the AIF acquired using a pulse dye densitometer. Considering that determining the AIF is required for performing quantitative tracer kinetics, this method provides a flexible tool for measuring the arterial dye concentration that could be used in a variety of applications.

[Effect of simulated microgravity on peripheral oxygen saturation in rats].

PubMed

Chen, Guangfei; Zhang, Yahui; Yuan, Ming; He, Shilin; Ying, Jun; Li, Chen

2018-02-01

To study the effect of microgravity on peripheral oxygen saturation (SpO 2 ) in rats, tail-suspended rats were applied to simulate microgravity environment. SpO 2 and arterial oxygen saturation (SaO 2 ) were measured by pulse oximeter and arterial blood gas analyzer (ABGA) respectively on the 14th day, 21st day and 28th day in tail-suspended group and control group. Paired t -test shows that SpO 2 was significantly lower than SaO 2 in tail-suspended group on the 14th day ( P < 0.05), the 21st day ( P < 0.05) and the 28th day ( P < 0.01). The ANOVA results shows that modeling time had significant effect on SpO 2 value but no effect on SaO 2 value in tail-suspended group. These results indicate that pulse oximeter may be not suitable for oxygen saturation test in microgravity environment.

Automatic Pre-Hospital Vital Signs Waveform and Trend Data Capture Fills Quality Management, Triage and Outcome Prediction Gaps

PubMed Central

Mackenzie, Colin F; Hu, Peter; Sen, Ayan; Dutton, Rick; Seebode, Steve; Floccare, Doug; Scalea, Tom

2008-01-01

Trauma Triage errors are frequent and costly. What happens in pre-hospital care remains anecdotal because of the dual responsibility of treatment (resuscitation and stabilization) and documentation in a time-critical environment. Continuous pre-hospital vital signs waveforms and numerical trends were automatically collected in our study. Abnormalities of pulse oximeter oxygen saturation (< 95%) and validated heart rate (> 100/min) showed better prediction of injury severity, need for immediate blood transfusion, intra-abdominal surgery, tracheal intubation and chest tube insertion than Trauma Registry data or Pre-hospital provider estimations. Automated means of data collection introduced the potential for more accurate and objective reporting of patient vital signs helping in evaluating quality of care and establishing performance indicators and benchmarks. Addition of novel and existing non-invasive monitors and waveform analyses could make the pulse oximeter the decision aid of choice to improve trauma patient triage. PMID:18999022

An efficient motion-resistant method for wearable pulse oximeter.

PubMed

Yan, Yong-Sheng; Zhang, Yuan-Ting

2008-05-01

Reduction of motion artifact and power saving are crucial in designing a wearable pulse oximeter for long-term telemedicine application. In this paper, a novel algorithm, minimum correlation discrete saturation transform (MCDST) has been developed for the estimation of arterial oxygen saturation (SaO2), based on an optical model derived from photon diffusion analysis. The simulation shows that the new algorithm MCDST is more robust under low SNRs than the clinically verified motion-resistant algorithm discrete saturation transform (DST). Further, the experiment with different severity of motions demonstrates that MCDST has a slightly better performance than DST algorithm. Moreover, MCDST is more computationally efficient than DST because the former uses linear algebra instead of the time-consuming adaptive filter used by latter, which indicates that MCDST can reduce the required power consumption and circuit complexity of the implementation. This is vital for wearable devices, where the physical size and long battery life are crucial.

Physiologic Waveform Analysis for Early Detection of Hemorrhage during Transport and Higher Echelon Medical Care of Combat Casualties

DTIC Science & Technology

2014-03-01

waveforms that are easier to measure than ABP (e.g., pulse oximeter waveforms); (3) a NIH SBIR Phase I proposal with Retia Medical to develop automated...the training dataset. Integrating the technique with non-invasive pulse transit time (PTT) was most effective. The integrated technique specifically...the peripheral ABP waveforms in the training dataset. These techniques included the rudimentary mean ABP technique, the classic pulse pressure times

Finger blood content, light transmission, and pulse oximetry errors.

PubMed

Craft, T M; Lawson, R A; Young, J D

1992-01-01

The changes in light emitting diode current necessary to maintain a constant level of light incident upon a photodetector were measured in 20 volunteers at the two wavelengths employed by pulse oximeters. Three states of finger blood content were assessed; exsanguinated, hyperaemic, and normal. The changes in light emitting diode current with changes in finger blood content were small and are not thought to represent a significant source of error in saturation as measured by pulse oximetry.

Evaluation of pulse oximeter derived photoplethysmographic signals for obstructive sleep apnea diagnosis.

PubMed

Li, Yan; Gao, He; Ma, Yan

2017-05-01

High prevalence of obstructive sleep apnea (OSA) has increased the demands for more convenient and accessible diagnostic devices other than standard in-lab polysomnography (PSG). Despite the increasing utility of photoplethysmograph (PPG), it remains understudied in underserved populations. This study aimed to evaluate the reliability of a standard pulse oximeter system with an automated analysis based on the PPG signal for the diagnosis of OSA, as compared with PSG derived measures.Consecutive out-patients with suspect OSA completed a PPG monitoring simultaneous with an overnight in-lab standard PSG. Forty-nine OSA patients (38 males, age 43.5 ± 16.9 years, BMI 26.9 ± 0.5 kg/m) were included in this study. Automated analyses were based on PPG and oximetry signals only. The PPG calculated measures were compared with PSG derived measures for agreement tests.Respiratory events index derived from PPG significantly correlated with PSG-derived apnea-hypopnea index (r = 0.935, P < .001). The calculation of total sleep time and oxygen desaturation index from PPG and PSG also significantly correlated (r = 0.418, P = .003; r = 0.933, P < .001, respectively). Bland-Altman plots showed good agreement between the PPG and the PSG measures. The overall sensitivity and specificity of PPG are good, especially in moderate and severe OSA groups.The tested PPG approach yielded acceptable results compared to the gold standard PSG among moderate to severe OSA patients. A pulse oximeter system with PPG recording can be used for the diagnosis or screening of OSA in high risk population.

Pulse oximeter saturation target limits for preterm infants: a survey among European neonatal intensive care units.

PubMed

Huizing, Maurice J; Villamor-Martínez, Eduardo; Vento, Máximo; Villamor, Eduardo

2017-01-01

The optimum range of pulse oximeter oxygen saturation (SpO 2 ) for preterm infants remains controversial. Between November 2015 and February 2016, we conducted a web-based survey aimed to investigate the current and former practices on SpO 2 targets in European neonatal intensive care units (NICUs). We obtained valid responses from 193 NICUs, treating 8590 newborns ≤28 weeks per year, across 27 countries. Forty different saturation ranges were reported, ranging from 82-93 to 94-99%. The most frequently utilized SpO 2 ranges were 90-95% (28%), 88-95% (12%), 90-94% (5%), and 91-95% (5%). A total of 156 NICUs (81%) changed their SpO 2 limits over the last 10 years. The most frequently reported former limits were 88-92% (18%), 85-95% (9%), 88-93 (7%), and 85-92% (6%). The NICUs that increased their SpO 2 ranges expected to obtain a reduction in mortality. A 54% of the NICUs found the scientific evidence supporting their SpO 2 targeting policy strong or very strong. We detected a high degree of heterogeneity in pulse oximeter SpO 2 target limits across European NICUs. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned. What is Known: • For preterm infants requiring supplemental oxygen, the optimum range of pulse oximeter oxygen saturation (SpO 2 ) to minimize organ damage, without causing hypoxic injury, remains controversial. What is New: • This survey highlights the lack of consensus regarding SpO 2 target limits for preterm infants among European neonatal intensive care units (NICUs). We detected 40 different SpO 2 ranges, and even the most frequently reported range (i.e., 90-95%) was used in only 28% of the 193 respondent NICUs. • A total of 156 NICUs (81%) changed their SpO 2 limits over the last 10 years. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned.

Effects of Simulated Pathophysiology on the Performance of a Decision Support Medical Monitoring System for Early Detection of Hemodynamic Decompensation in Humans

DTIC Science & Technology

2015-10-01

Arterial oxygen saturation was monitored 130 using a finger pulse oximeter and end-tidal CO2 (ETCO2) was collected from a nasal cannula 131 (Cardiocap/5...Johnson et al, J Appl Physiol 2014 PMID 24876357. 5 Keywords Trauma, coagulation, central venous pressure, stroke volume, pulse pressure...Johnson BD, Curry TB, Convertino VA, & Joyner MJ. The association between pulse pressure and stroke volume during lower body negative pressure and

Pulse Oximeter Plethysmograph Estimate of Pulsus Paradoxus as a Measure of Acute Asthma Exacerbation Severity and Response to Treatment.

PubMed

Arnold, Donald H; Wang, Li; Hartert, Tina V

2016-03-01

Pulsus paradoxus is one of the few objective bedside measures of acute asthma exacerbation severity but is difficult to measure in tachypneic and tachycardic patients and in noisy clinical environments. Our primary objective was to examine whether pulse oximeter plethysmograph estimate of pulsus paradoxus (PEP) is associated with physiologic and symptom measures of acute exacerbation severity (airway resistance by impulse oscillometry [%IOS] and the Acute Asthma Intensity Research Score [AAIRS]). Secondary objectives were to validate the previous association of PEP with percent predicted forced expiratory volume in 1 second (%FEV1 ) and to examine associations of change of PEP with change of these outcomes after 2 hours of treatment. This was a secondary analysis of data from a prospective observational study of patients aged 5-17 years with acute asthma exacerbations. The predictor variable, PEP, was measured using a dedicated pulse oximeter and waveform analysis program. Outcome measures included the AAIRS, %IOS, and %FEV1 at baseline and after 2 hours of treatment. We examined associations of PEP with %IOS and the AAIRS at baseline using multiple linear regression models adjusted for age, sex, and race. As secondary analyses we similarly examined the association of PEP with %FEV1 at baseline and change of PEP with change of %IOS, the AAIRS, and %FEV1 after 2 hours of treatment using multiple linear regression models adjusted for the baseline value of the outcome measure and the AAIRS. Among 684 participants (61% males; 61% African American) there were associations of baseline PEP with %IOS, the AAIRS, and %FEV1 (p < 0.001). Change of PEP after 2 hours of treatment was associated with change of %FEV1 (p < 0.001) and change of the AAIRS (p = 0.01) but not with change of %IOS (p = 0.60). PEP demonstrates criterion validity in predicting baseline %IOS, the AAIRS, and %FEV1 , and responsiveness to change of the AAIRS and %FEV1 . Data contained in the oximeter plethysmograph waveform might be utilized as a continuous, objective measure of acute asthma exacerbation severity and real-time response to treatment. © 2016 by the Society for Academic Emergency Medicine.

Multicenter Study Validating Accuracy of a Continuous Respiratory Rate Measurement Derived From Pulse Oximetry: A Comparison With Capnography.

PubMed

Bergese, Sergio D; Mestek, Michael L; Kelley, Scott D; McIntyre, Robert; Uribe, Alberto A; Sethi, Rakesh; Watson, James N; Addison, Paul S

2017-04-01

Intermittent measurement of respiratory rate via observation is routine in many patient care settings. This approach has several inherent limitations that diminish the clinical utility of these measurements because it is intermittent, susceptible to human error, and requires clinical resources. As an alternative, a software application that derives continuous respiratory rate measurement from a standard pulse oximeter has been developed. We sought to determine the performance characteristics of this new technology by comparison with clinician-reviewed capnography waveforms in both healthy subjects and hospitalized patients in a low-acuity care setting. Two independent observational studies were conducted to validate the performance of the Medtronic Nellcor Respiration Rate Software application. One study enrolled 26 healthy volunteer subjects in a clinical laboratory, and a second multicenter study enrolled 53 hospitalized patients. During a 30-minute study period taking place while participants were breathing spontaneously, pulse oximeter and nasal/oral capnography waveforms were collected. Pulse oximeter waveforms were processed to determine respiratory rate via the Medtronic Nellcor Respiration Rate Software. Capnography waveforms reviewed by a clinician were used to determine the reference respiratory rate. A total of 23,243 paired observations between the pulse oximeter-derived respiratory rate and the capnography reference method were collected and examined. The mean reference-based respiratory rate was 15.3 ± 4.3 breaths per minute with a range of 4 to 34 breaths per minute. The Pearson correlation coefficient between the Medtronic Nellcor Respiration Rate Software values and the capnography reference respiratory rate is reported as a linear correlation, R, as 0.92 ± 0.02 (P < .001), whereas Lin's concordance correlation coefficient indicates an overall agreement of 0.85 ± 0.04 (95% confidence interval [CI] +0.76; +0.93) (healthy volunteers: 0.94 ± 0.02 [95% CI +0.91; +0.97]; hospitalized patients: 0.80 ± 0.06 [95% CI +0.68; +0.92]). The mean bias of the Medtronic Nellcor Respiration Rate Software was 0.18 breaths per minute with a precision (SD) of 1.65 breaths per minute (healthy volunteers: 0.37 ± 0.78 [95% limits of agreement: -1.16; +1.90] breaths per minute; hospitalized patients: 0.07 ± 1.99 [95% limits of agreement: -3.84; +3.97] breaths per minute). The root mean square deviation was 1.35 breaths per minute (healthy volunteers: 0.81; hospitalized patients: 1.60). These data demonstrate the performance of the Medtronic Nellcor Respiration Rate Software in healthy subjects and patients hospitalized in a low-acuity care setting when compared with clinician-reviewed capnography. The observed performance of this technology suggests that it may be a useful adjunct to continuous pulse oximetry monitoring by providing continuous respiratory rate measurements. The potential patient safety benefit of using combined continuous pulse oximetry and respiratory rate monitoring warrants assessment.

Multicenter Study Validating Accuracy of a Continuous Respiratory Rate Measurement Derived From Pulse Oximetry: A Comparison With Capnography

PubMed Central

Bergese, Sergio D.; Kelley, Scott D.; McIntyre, Robert; Uribe, Alberto A.; Sethi, Rakesh; Watson, James N.; Addison, Paul S.

2017-01-01

BACKGROUND: Intermittent measurement of respiratory rate via observation is routine in many patient care settings. This approach has several inherent limitations that diminish the clinical utility of these measurements because it is intermittent, susceptible to human error, and requires clinical resources. As an alternative, a software application that derives continuous respiratory rate measurement from a standard pulse oximeter has been developed. We sought to determine the performance characteristics of this new technology by comparison with clinician-reviewed capnography waveforms in both healthy subjects and hospitalized patients in a low-acuity care setting. METHODS: Two independent observational studies were conducted to validate the performance of the Medtronic NellcorTM Respiration Rate Software application. One study enrolled 26 healthy volunteer subjects in a clinical laboratory, and a second multicenter study enrolled 53 hospitalized patients. During a 30-minute study period taking place while participants were breathing spontaneously, pulse oximeter and nasal/oral capnography waveforms were collected. Pulse oximeter waveforms were processed to determine respiratory rate via the Medtronic Nellcor Respiration Rate Software. Capnography waveforms reviewed by a clinician were used to determine the reference respiratory rate. RESULTS: A total of 23,243 paired observations between the pulse oximeter-derived respiratory rate and the capnography reference method were collected and examined. The mean reference-based respiratory rate was 15.3 ± 4.3 breaths per minute with a range of 4 to 34 breaths per minute. The Pearson correlation coefficient between the Medtronic Nellcor Respiration Rate Software values and the capnography reference respiratory rate is reported as a linear correlation, R, as 0.92 ± 0.02 (P < .001), whereas Lin’s concordance correlation coefficient indicates an overall agreement of 0.85 ± 0.04 (95% confidence interval [CI] +0.76; +0.93) (healthy volunteers: 0.94 ± 0.02 [95% CI +0.91; +0.97]; hospitalized patients: 0.80 ± 0.06 [95% CI +0.68; +0.92]). The mean bias of the Medtronic Nellcor Respiration Rate Software was 0.18 breaths per minute with a precision (SD) of 1.65 breaths per minute (healthy volunteers: 0.37 ± 0.78 [95% limits of agreement: –1.16; +1.90] breaths per minute; hospitalized patients: 0.07 ± 1.99 [95% limits of agreement: –3.84; +3.97] breaths per minute). The root mean square deviation was 1.35 breaths per minute (healthy volunteers: 0.81; hospitalized patients: 1.60). CONCLUSIONS: These data demonstrate the performance of the Medtronic Nellcor Respiration Rate Software in healthy subjects and patients hospitalized in a low-acuity care setting when compared with clinician-reviewed capnography. The observed performance of this technology suggests that it may be a useful adjunct to continuous pulse oximetry monitoring by providing continuous respiratory rate measurements. The potential patient safety benefit of using combined continuous pulse oximetry and respiratory rate monitoring warrants assessment. PMID:28099286

A confocal scanning laser ophthalmoscope for retinal vessel oximetry

NASA Astrophysics Data System (ADS)

Lompado, Arthur

Measurement of a person's blood oxygen saturation has long been recognized as a useful metric for the characterizing ailments ranging from chronic respiratory disorders to acute, potentially life threatening, traumas. The ubiquity of oxygen saturation monitors in the medical field, including portable pulse oximeters and laboratory based CO-oximeters, is a testament to the importance of this technique. The work presented here documents the design, fabrication and development of a unique type of oxygen saturation monitor, a confocal scanning retinal vessel oximeter, with the potential to expand the usefulness of the present devices. A large part of the knowledge base required to construct the instrument comes from the consideration of light scattering by red blood cells in a blood vessel. Therefore, a substantial portion of this work is devoted to the process of light scattering by whole human blood and its effects on the development of a more accurate oximeter. This light scattering effect has been both measured and modeled stochastically to determine its contribution to the measured oximeter signal. It is shown that, although well accepted in the published literature, the model only correlates marginally to the measurements due to inherent limitations imposed by the model assumptions. Nonetheless, enough material has been learned about the scattering to allow development of a mathematical model for the interaction of light with blood in a vessel, and this knowledge has been applied to the data reduction of the present oximeter. This data reduction technique has been tested in a controlled experiment employing a model eye with a blood filled mock retinal vessel. It will be shown that the presently developed technique exhibited strong correlation between the known blood oxygen saturation and that calculated by the new system.

Running wavelet archetype aids the determination of heart rate from the video photoplethysmogram during motion.

PubMed

Addison, Paul S; Foo, David M H; Jacquel, Dominique

2017-07-01

The extraction of heart rate from a video-based biosignal during motion using a novel wavelet-based ensemble averaging method is described. Running Wavelet Archetyping (RWA) allows for the enhanced extraction of pulse information from the time-frequency representation, from which a video-based heart rate (HRvid) can be derived. This compares favorably to a reference heart rate derived from a pulse oximeter.

Cerebral arterial oxygen saturation measurements using a fiber-optic pulse oximeter.

PubMed

Phillips, J P; Langford, R M; Chang, S H; Maney, K; Kyriacou, P A; Jones, D P

2010-10-01

A pilot investigation was undertaken to assess the performance of a novel fiber-optic cerebral pulse oximetry system. A fiber-optic probe designed to pass through the lumen of a cranial bolt of the type used to make intracranial pressure measurements was used to obtain optical reflectance signals directly from brain tissue. Short-duration measurements were made in six patients undergoing neurosurgery. These were followed by a longer duration measurement in a patient recovering from an intracerebral hematoma. Estimations of cerebral arterial oxygen saturation derived from a frequency domain-based algorithm are compared with simultaneous pulse oximetry (SpO2) and hemoximeter (SaO2) blood samples. The short-duration measurements showed that reliable photoplethysmographic signals could be obtained from the brain tissue. In the long-duration study, the mean (±SD) difference between cerebral oxygen saturation (ScaO2) and finger SpO2 (in saturation units) was -7.47(±3.4)%. The mean (±SD) difference between ScaO2 and blood SaO2 was -7.37(±2.8)%. This pilot study demonstrated that arterial oxygen saturation may be estimated from brain tissue via a fiber-optic pulse oximeter used in conjunction with a cranial bolt. Further studies are needed to confirm the clinical utility of the technique.

Quantitative clinical nonpulsatile and localized visible light oximeter: design of the T-Stat tissue oximeter

NASA Astrophysics Data System (ADS)

Benaron, David A.; Parachikov, Ilian H.; Cheong, Wai-Fung; Friedland, Shai; Duckworth, Joshua L.; Otten, David M.; Rubinsky, Boris E.; Horchner, Uwe B.; Kermit, Eben L.; Liu, Frank W.; Levinson, Carl J.; Murphy, Aileen L.; Price, John W.; Talmi, Yair; Weersing, James P.

2003-07-01

We report the development of a general, quantitative, and localized visible light clinical tissue oximeter, sensitive to both hypoxemia and ischemia. Monitor design and operation were optimized over four instrument generations. A range of clinical probes were developed, including non-contact wands, invasive catheters, and penetrating needles with injection ports. Real-time data were collected (a) from probes, standards, and reference solutions to optimize each component, (b) from ex vivo hemoglobin solutions co-analyzed for StO2% and pO2 during deoxygenation, and (c) from normoxic human subject skin and mucosal tissue surfaces. Results show that (a) differential spectroscopy allows extraction of features with minimization of the effects of scattering, (b) in vitro oximetry produces a hemoglobin saturation binding curve of expected sigmoid shape and values, and (c) that monitoring human tissues allows real-time tissue spectroscopic features to be monitored. Unlike with near-infrared (NIRS) or pulse oximetry (SpO2%) methods, we found non-pulsatile, diffusion-based tissue oximetry (StO2%) to work most reliably for non-contact reflectance monitoring and for invasive catheter- or needle-based monitoring, using blue to orange light (475-600 nm). Measured values were insensitive to motion artifact. Down time was non-existent. We conclude that the T-Stat oximeter design is suitable for the collection of spectroscopic data from human subjects, and that the oximeter may have application in the monitoring of regional hemoglobin oxygen saturation in the capillary tissue spaces of human subjects.

Processing of pulse oximeter signals using adaptive filtering and autocorrelation to isolate perfusion and oxygenation components

NASA Astrophysics Data System (ADS)

Ibey, Bennett; Subramanian, Hariharan; Ericson, Nance; Xu, Weijian; Wilson, Mark; Cote, Gerard L.

2005-03-01

A blood perfusion and oxygenation sensor has been developed for in situ monitoring of transplanted organs. In processing in situ data, motion artifacts due to increased perfusion can create invalid oxygenation saturation values. In order to remove the unwanted artifacts from the pulsatile signal, adaptive filtering was employed using a third wavelength source centered at 810nm as a reference signal. The 810 nm source resides approximately at the isosbestic point in the hemoglobin absorption curve where the absorbance of light is nearly equal for oxygenated and deoxygenated hemoglobin. Using an autocorrelation based algorithm oxygenation saturation values can be obtained without the need for large sampling data sets allowing for near real-time processing. This technique has been shown to be more reliable than traditional techniques and proven to adequately improve the measurement of oxygenation values in varying perfusion states.

Phantom with pulsatile arteries to investigate the influence of blood vessel depth on pulse oximeter signal strength.

PubMed

Stuban, Norbert; Niwayama, Masatsugu; Santha, Hunor

2012-01-01

This paper describes a three-layer head phantom with artificial pulsating arteries at five different depths (1.2 mm, 3.7 mm, 6.8 mm, 9.6 mm and 11.8 mm). The structure enables formation of spatially and temporally varying tissue properties similar to those of living tissues. In our experiment, pressure pulses were generated in the arteries by an electronically controlled pump. The physical and optical parameters of the layers and the liquid in the artificial arteries were similar to those of real tissues and blood. The amplitude of the pulsating component of the light returning from the phantom tissues was measured at each artery depth mentioned above. The build-up of the in-house-developed pulse oximeter used for performing the measurements and the physical layout of the measuring head are described. The radiant flux generated by the LED on the measuring head was measured to be 1.8 mW at 910 nm. The backscattered radiant flux was measured, and found to be 0.46 nW (0.26 ppm), 0.55 nW (0.31 ppm), and 0.18 nW (0.10 ppm) for the 1.2 mm, 3.7 mm and 6.8 mm arteries, respectively. In the case of the 9.6 mm and 11.8 mm arteries, useful measurement data were not obtained owing to weak signals. We simulated the phantom with the arteries at the above-mentioned five depths and at two additional ones (2.5 mm and 5.3 mm in depth) using the Monte Carlo method. The measurement results were verified by the simulation results. We concluded that in case of 11 mm source-detector separation the arteries at a depth of about 2.5 mm generate the strongest pulse oximeter signal level in a tissue system comprising three layers of thicknesses: 1.5 mm (skin), 5.0 mm (skull), and >50 mm (brain).

Phantom with Pulsatile Arteries to Investigate the Influence of Blood Vessel Depth on Pulse Oximeter Signal Strength

PubMed Central

Stuban, Norbert; Niwayama, Masatsugu; Santha, Hunor

2012-01-01

This paper describes a three-layer head phantom with artificial pulsating arteries at five different depths (1.2 mm, 3.7 mm, 6.8 mm, 9.6 mm and 11.8 mm). The structure enables formation of spatially and temporally varying tissue properties similar to those of living tissues. In our experiment, pressure pulses were generated in the arteries by an electronically controlled pump. The physical and optical parameters of the layers and the liquid in the artificial arteries were similar to those of real tissues and blood. The amplitude of the pulsating component of the light returning from the phantom tissues was measured at each artery depth mentioned above. The build-up of the in-house-developed pulse oximeter used for performing the measurements and the physical layout of the measuring head are described. The radiant flux generated by the LED on the measuring head was measured to be 1.8 mW at 910 nm. The backscattered radiant flux was measured, and found to be 0.46 nW (0.26 ppm), 0.55 nW (0.31 ppm), and 0.18 nW (0.10 ppm) for the 1.2 mm, 3.7 mm and 6.8 mm arteries, respectively. In the case of the 9.6 mm and 11.8 mm arteries, useful measurement data were not obtained owing to weak signals. We simulated the phantom with the arteries at the above-mentioned five depths and at two additional ones (2.5 mm and 5.3 mm in depth) using the Monte Carlo method. The measurement results were verified by the simulation results. We concluded that in case of 11 mm source-detector separation the arteries at a depth of about 2.5 mm generate the strongest pulse oximeter signal level in a tissue system comprising three layers of thicknesses: 1.5 mm (skin), 5.0 mm (skull), and >50 mm (brain). PMID:22368501

Detection of sleep disordered breathing and its central/obstructive character using nasal cannula and finger pulse oximeter.

PubMed

Sommermeyer, Dirk; Zou, Ding; Grote, Ludger; Hedner, Jan

2012-10-15

To assess the accuracy of novel algorithms using an oximeter-based finger plethysmographic signal in combination with a nasal cannula for the detection and differentiation of central and obstructive apneas. The validity of single pulse oximetry to detect respiratory disturbance events was also studied. Patients recruited from four sleep laboratories underwent an ambulatory overnight cardiorespiratory polygraphy recording. The nasal flow and photoplethysmographic signals of the recording were analyzed by automated algorithms. The apnea hypopnea index (AHI(auto)) was calculated using both signals, and a respiratory disturbance index (RDI(auto)) was calculated from photoplethysmography alone. Apnea events were classified into obstructive and central types using the oximeter derived pulse wave signal and compared with manual scoring. Sixty-six subjects (42 males, age 54 ± 14 yrs, body mass index 28.5 ± 5.9 kg/m(2)) were included in the analysis. AHI(manual) (19.4 ± 18.5 events/h) correlated highly significantly with AHI(auto) (19.9 ± 16.5 events/h) and RDI(auto) (20.4 ± 17.2 events/h); the correlation coefficients were r = 0.94 and 0.95, respectively (p < 0.001) with a mean difference of -0.5 ± 6.6 and -1.0 ± 6.1 events/h. The automatic analysis of AHI(auto) and RDI(auto) detected sleep apnea (cutoff AHI(manual) ≥ 15 events/h) with a sensitivity/specificity of 0.90/0.97 and 0.86/0.94, respectively. The automated obstructive/central apnea indices correlated closely with manually scoring (r = 0.87 and 0.95, p < 0.001) with mean difference of -4.3 ± 7.9 and 0.3 ± 1.5 events/h, respectively. Automatic analysis based on routine pulse oximetry alone may be used to detect sleep disordered breathing with accuracy. In addition, the combination of photoplethysmographic signals with a nasal flow signal provides an accurate distinction between obstructive and central apneic events during sleep.

Perfusion index derived from a pulse oximeter can detect changes in peripheral microcirculation during uretero-renal-scopy stone manipulation (URS-SM).

PubMed

Huang, Ho-Shiang; Chu, Chun-Lin; Tsai, Chia-Ti; Wu, Cho-Kai; Lai, Ling-Ping; Yeh, Huei-Ming

2014-01-01

The objective of this study was to test the effect of removal of a ureteral obstruction (renal calculus) from anesthetized patients on the perfusion index (PI), as measured by a pulse oximeter, and on the estimated glomerular filtration rate (eGFR). This prospective study enrolled 113 patients with unilateral ureteral obstructions (kidney stones) who were scheduled for ureteroscopy (URS) laser lithotripsy. One urologist graded patient hydronephrosis before surgery. A pulse oximeter was affixed to each patient's index finger ipsilateral to the intravenous catheter, and a non-invasive blood pressure cuff was placed on the contralateral side. Ipsilateral double J stents and Foley catheters were inserted and left indwelling for 24 h. PI and mean arterial pressure (MAP) were determined at baseline, 5 min after anesthesia, and 10 min after surgery; eGFR was determined at admission, 1 day after surgery, and 14 days after surgery. Patients with different grades of hydronephrosis had similar age, eGFR, PI, mean arterial pressure (MAP), and heart rate (HR). PI increased significantly in each hydronephrosis group after ureteral stone disintegration. None of the groups had significant post-URS changes in eGFR, although eGFR increased in the grade I hydronephrosis group after 14 days. The percent change of PI correlates significantly with the percent change of MAP, but not with that of eGFR. Our results demonstrate that release of a ureteral obstruction leads to a concurrent increase of PI during anesthesia. Measurement of PI may be a valuable tool to monitor the successful release of ureteral obstructions and changes of microcirculation during surgery. There were also increases in eGFR after 14 days, but not immediately after surgery.

Evaluation of pulse oximeter derived photoplethysmographic signals for obstructive sleep apnea diagnosis

PubMed Central

Li, Yan; Gao, He; Ma, Yan

2017-01-01

Abstract High prevalence of obstructive sleep apnea (OSA) has increased the demands for more convenient and accessible diagnostic devices other than standard in-lab polysomnography (PSG). Despite the increasing utility of photoplethysmograph (PPG), it remains understudied in underserved populations. This study aimed to evaluate the reliability of a standard pulse oximeter system with an automated analysis based on the PPG signal for the diagnosis of OSA, as compared with PSG derived measures. Consecutive out-patients with suspect OSA completed a PPG monitoring simultaneous with an overnight in-lab standard PSG. Forty-nine OSA patients (38 males, age 43.5 ± 16.9 years, BMI 26.9 ± 0.5 kg/m2) were included in this study. Automated analyses were based on PPG and oximetry signals only. The PPG calculated measures were compared with PSG derived measures for agreement tests. Respiratory events index derived from PPG significantly correlated with PSG-derived apnea–hypopnea index (r = 0.935, P < .001). The calculation of total sleep time and oxygen desaturation index from PPG and PSG also significantly correlated (r = 0.418, P = .003; r = 0.933, P < .001, respectively). Bland–Altman plots showed good agreement between the PPG and the PSG measures. The overall sensitivity and specificity of PPG are good, especially in moderate and severe OSA groups. The tested PPG approach yielded acceptable results compared to the gold standard PSG among moderate to severe OSA patients. A pulse oximeter system with PPG recording can be used for the diagnosis or screening of OSA in high risk population. PMID:28471970

Perfusion Index Derived from a Pulse Oximeter Can Detect Changes in Peripheral Microcirculation during Uretero-Renal-Scopy Stone Manipulation (URS-SM)

PubMed Central

Huang, Ho-Shiang; Chu, Chun-Lin; Tsai, Chia-Ti; Wu, Cho-Kai; Lai, Ling-Ping; Yeh, Huei-Ming

2014-01-01

Background The objective of this study was to test the effect of removal of a ureteral obstruction (renal calculus) from anesthetized patients on the perfusion index (PI), as measured by a pulse oximeter, and on the estimated glomerular filtration rate (eGFR). Patients and Methods This prospective study enrolled 113 patients with unilateral ureteral obstructions (kidney stones) who were scheduled for ureteroscopy (URS) laser lithotripsy. One urologist graded patient hydronephrosis before surgery. A pulse oximeter was affixed to each patient's index finger ipsilateral to the intravenous catheter, and a non-invasive blood pressure cuff was placed on the contralateral side. Ipsilateral double J stents and Foley catheters were inserted and left indwelling for 24 h. PI and mean arterial pressure (MAP) were determined at baseline, 5 min after anesthesia, and 10 min after surgery; eGFR was determined at admission, 1 day after surgery, and 14 days after surgery. Results Patients with different grades of hydronephrosis had similar age, eGFR, PI, mean arterial pressure (MAP), and heart rate (HR). PI increased significantly in each hydronephrosis group after ureteral stone disintegration. None of the groups had significant post-URS changes in eGFR, although eGFR increased in the grade I hydronephrosis group after 14 days. The percent change of PI correlates significantly with the percent change of MAP, but not with that of eGFR. Conclusion Our results demonstrate that release of a ureteral obstruction leads to a concurrent increase of PI during anesthesia. Measurement of PI may be a valuable tool to monitor the successful release of ureteral obstructions and changes of microcirculation during surgery. There were also increases in eGFR after 14 days, but not immediately after surgery. PMID:25542000

Effective standards and regulatory tools for respiratory gas monitors and pulse oximeters: the role of the engineer and clinician.

PubMed

Weininger, Sandy

2007-12-01

Developing safe and effective medical devices involves understanding the hazardous situations that can arise in clinical practice and implementing appropriate risk control measures. The hazardous situations may have their roots in the design or in the use of the device. Risk control measures may be engineering or clinically based. A multidisciplinary team of engineers and clinicians is needed to fully identify and assess the risks and implement and evaluate the effectiveness of the control measures. In this paper, I use three issues, calibration/accuracy, response time, and protective measures/alarms, to highlight the contributions of these groups. This important information is captured in standards and regulatory tools to control risk for respiratory gas monitors and pulse oximeters. This paper begins with a discussion of the framework of safety, explaining how voluntary standards and regulatory tools work. The discussion is followed by an examination of how engineering and clinical knowledge are used to support the assurance of safety.

Effects of altitude-related hypoxia on aircrews in aircraft with unpressurized cabins.

PubMed

Nishi, Shuji

2011-01-01

Generally, hypoxia at less than 10,000 ft (3,048 m) has no apparent effect on aircrews. Nevertheless, several hypoxic incidents have been reported in flights below 10,000 ft. A recently introduced pulse oximeter using finger probes allows accurate monitoring of oxygen saturation (SPO2) in the aeromedical environment. Using such a pulse oximeter, in-flight SPO2 levels were evaluated in aircrew in unpressurized aircraft. In addition, career in-flight hypoxic experiences were surveyed. In-flight SPO2 was measured in aircrews operating UH-60J helicopters at up to 13,000 ft, and 338 aircrew members operating unpressurized cabin aircraft were surveyed concerning possible in-flight hypoxic experiences. In aircrews operating UH-60J helicopters, SPO2 decreased significantly at altitudes over 5,000 ft, most markedly at 13,000 ft (vs. ground level). The survey identified three aircrew members with experiences suggesting hypoxemia at below 5,000 ft. Careful attention should be paid to the possibility of hypoxia in aircrews operating unpressurized cabin aircraft.

Use of plethysmographic variability index derived from the Massimo(®) pulse oximeter to predict fluid or preload responsiveness: a systematic review and meta-analysis.

PubMed

Yin, J Y; Ho, K M

2012-07-01

This systematic review and meta-analysis assessed the accuracy of plethysmographic variability index derived from the Massimo(®) pulse oximeter to predict preload responsiveness in peri-operative and critically ill patients. A total of 10 studies were retrieved from the literature, involving 328 patients who met the selection criteria. Overall, the diagnostic odds ratio (16.0; 95% CI 5-48) and area under the summary receiver operating characteristic curve (0.87; 95% CI 0.78-0.95) for plethysmographic variability index to predict fluid or preload responsiveness was very good, but significant heterogeneity existed. This could be explained by a lower accuracy of plethysmographic variability index in spontaneously breathing or paediatric patients and those studies that used pre-load challenges other than colloid fluid. The results indicate specific directions for future studies. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

Cyclic reconstruction of 4D retinal blood flow with pulse synchronization

NASA Astrophysics Data System (ADS)

Schmoll, Tilman; Lasser, Theo; Leitgeb, Rainer A.

2009-02-01

Doppler OCT systems allow nowadays to visualize quantitative and qualitative angiographic maps of retinal tissue. We equipped the instrument with a pulse oximeter and recorded the pulse synchronously with the resonant Doppler flow data. Recombination of tomograms according to the heart beat cycles yields full volumes for each cycle instant. We believe such multi-dimensional functional information and the ability to monitor dynamic processes over time to open exciting perspectives that ultimately contribute to a better understanding of retinal physiology and patho-physiology in-vivo.

Feasibility and accuracy of nasal alar pulse oximetry.

PubMed

Morey, T E; Rice, M J; Vasilopoulos, T; Dennis, D M; Melker, R J

2014-06-01

The nasal ala is an attractive site for pulse oximetry because of perfusion by branches of the external and internal carotid arteries. We evaluated the accuracy of a novel pulse oximetry sensor custom designed for the nasal ala. After IRB approval, healthy non-smoking subjects [n=12; aged 28 (23-41) yr; 6M/6F] breathed hypoxic mixtures of fresh gas by a facemask to achieve oxyhaemoglobin saturations of 70-100% measured by traditional co-oximetry from radial artery samples. Concurrent alar and finger pulse oximetry values were measured using probes designed for these sites. Data were analysed using the Bland-Altman method for multiple observations per subject. Bias, precision, and accuracy root mean square error (ARMS) over a range of 70-100% were significantly better for the alar probe compared with a standard finger probe. The mean bias for the alar and finger probes was 0.73% and 1.90% (P<0.001), respectively, with corresponding precision values of 1.65 and 1.83 (P=0.015) and ARMS values of 1.78% and 2.72% (P=0.047). The coefficients of determination were 0.96 and 0.96 for the alar and finger probes, respectively. The within/between-subject variation for the alar and finger probes were 1.14/1.57% and 1.87/1.47%, respectively. The limits of agreement were 3.96/-2.50% and 5.48/-1.68% for the alar and finger probes, respectively. Nasal alar pulse oximetry is feasible and demonstrates accurate pulse oximetry values over a range of 70-100%. The alar probe demonstrated greater accuracy compared with a conventional finger pulse oximeter. © The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Accuracy of non-invasive continuous total hemoglobin measurement by Pulse CO-Oximetry in severe traumatized and surgical bleeding patients.

PubMed

Baulig, Werner; Seifert, Burkhardt; Spahn, Donat R; Theusinger, Oliver M

2017-02-01

The Masimo Radical-7 Pulse CO-Oximeter (Masimo Corp., USA) non-invasively computes hemoglobin concentration (SpHb). SpHb was compared to Co-Oximeter readings (CoOxHb) of arterial samples in surgery patients of the emergency department. Forty-six patients were enrolled. The Masimo R1 25L (revision F and G) adult adhesive sensor was attached to the ring finger of the arterially cannulated hand. Before start, every 30 min during surgery and in the case of severe bleeding SpHb and CoOxHb values were documented. SpHb and post hoc adjusted SpHb (AdSpHb) values were analyzed. Linear regression analysis and Bland-Altman plot for agreement were performed. The detection failure rate of SpHb was 24.5 %. CoOxHb and SpHb showed a strong correlation (r = +0.81), but agreement was moderate [bias (LOA) of -0.6 (-3.0; +1.9)] g/dl. Positive and negative predicted value was 0.49 and 0.69. Exclusion of changes of CoOxHb values ≤1 g/dl resulted in a positive and negative predictive value of 0.66 and 1.00. Post hoc adjustment of the SpHb (AdSpHb) improved linear correlation of CoOxHb and AdSpHb [r = +0.90 (p < 0.001)] but less the agreement [bias (LOA) of CoOxHb and AdSpHb = -0.1 (-2.1/+1.9) g/dl]. SpHb agreed only moderately with CoOxHb values and predicted decreases of CoOxHb only if changes of SpHb ≤ 1.0 g/dl were excluded. The detection failure rate of SpHb was high. At present, additional refinements of the current technology are necessary to further improve performance of non-invasive hemoglobin measurement in the clinical setting.

Pulse perfusion value predicts eye opening after sevoflurane anaesthesia: an explorative study.

PubMed

Enekvist, Bruno; Johansson, Anders

2015-08-01

The variables measured in modern pulse oximetry apparatuses include a graphical pulse curve and a specified perfusion value (PV) that could be a sensitive marker for detecting differences in sympathetic activity. We hypothesized that there is a correlation between a reduction of PV and the time to eye opening after general anaesthesia. The objective was to investigate whether PV can predict eye opening after sevoflurane anaesthesia. Prospective, explorative clinical study included 20 patients, ASA physical status 1 or 2, at Skåne University Hospital, Lund, Sweden, from November 2012 to January 2013 scheduled for elective breast tumour surgery. A general anaesthesia was delivered with inhalation of oxygen, nitrous oxide and sevoflurane anaesthesia to a depth of 1.2 minimal alveolar concentration. Sevoflurane inspiratory and expiratory concentrations were measured. Bispectral index monitoring, PV as measured by pulse oximeter, heart rate and carbon dioxide were registered at before anaesthesia, 15 min after induction (at 1.2 minimal alveolar concentration), at end of surgery and at eye opening at the end of anaesthesia. PV values were lower before anaesthesia and at eye opening compared to at 15 min after induction and at end of surgery (P < 0.05). The reduction of PV between end of surgery and eye opening was 0.76. We conclude that the pulse oximeter PV could be a useful variable to assess the timing of recovery, in terms of eye opening after a general anaesthesia.

Warfighter Physiological and Environmental Monitoring: A Study for the U.S. Army Research Institute in Environmental Medicine and the Soldier Systems Center

DTIC Science & Technology

2004-11-01

peripheral devices , such as a heart- rate monitor, oximeter, etc., over a wireless link. Interfacing to peripheral sensors requires installation of... devices are powered from wall outlets. However, for networks comprising mobile devices , and in particular for a PAN comprising body-worn sensors ...SpO2) cost in excess of $25K per system 2. Size, weight, and power – Excluding the sensors , the mobile components (comm link and data archiving

Robust efficient estimation of heart rate pulse from video.

PubMed

Xu, Shuchang; Sun, Lingyun; Rohde, Gustavo Kunde

2014-04-01

We describe a simple but robust algorithm for estimating the heart rate pulse from video sequences containing human skin in real time. Based on a model of light interaction with human skin, we define the change of blood concentration due to arterial pulsation as a pixel quotient in log space, and successfully use the derived signal for computing the pulse heart rate. Various experiments with different cameras, different illumination condition, and different skin locations were conducted to demonstrate the effectiveness and robustness of the proposed algorithm. Examples computed with normal illumination show the algorithm is comparable with pulse oximeter devices both in accuracy and sensitivity.

Combined pulse-oximeter-NIRS system for biotissue diagnostics

NASA Astrophysics Data System (ADS)

Hovhannisyan, Vladimir A.

2005-08-01

Multi-wavelength (670, 805, 848 and 905 nm), multi-detector device for non-invasive measurement of biochemical components concentration in human or animal tissues, combining the methods of conventional pulse-oximetry and near infrared spectroscopy, is developed. The portable and clinically applicable system allows to measure heart pulse rate, oxygen saturation of arterial hemoglobin (pulse-oximetry method) and local absolute concentration of oxyhemoglobin, deoxyhemoglobin and oxidized cytochrome aa3 or other IR absorbed compounds (NIRS method). The system can be applied in monitoring of oxygen availability and utilization by the brain in neonatal and adults, neuro- traumatology, intensive care medicine, transplantation and plastic surgery, in sport, high-altitude and aviation medicine.

Robust efficient estimation of heart rate pulse from video

PubMed Central

Xu, Shuchang; Sun, Lingyun; Rohde, Gustavo Kunde

2014-01-01

We describe a simple but robust algorithm for estimating the heart rate pulse from video sequences containing human skin in real time. Based on a model of light interaction with human skin, we define the change of blood concentration due to arterial pulsation as a pixel quotient in log space, and successfully use the derived signal for computing the pulse heart rate. Various experiments with different cameras, different illumination condition, and different skin locations were conducted to demonstrate the effectiveness and robustness of the proposed algorithm. Examples computed with normal illumination show the algorithm is comparable with pulse oximeter devices both in accuracy and sensitivity. PMID:24761294

Oximetry: a reflective tool for the detection of physiological expression of emotions in a science education classroom

NASA Astrophysics Data System (ADS)

Calderón, Olga

2016-09-01

The pulse oximeter is a device that measures the oxygen concentration (or oxygen saturation—SpO2); heart rate, and heartbeat of a person at any given time. This instrument is commonly used in medical and aerospace fields to monitor physiological outputs of a patient according to health conditions or physiological yields of a flying pilot according to changes in altitude and oxygen availability in the atmosphere. Nonetheless, the uses for pulse oximetry may expand to other fields where there is human interaction and where physiological outputs reflect fluctuations mediated by arising emotions. A classroom, for instance is filled with a plethora of emotions, but very often participants in this space are unaware of others' or their own sentiments as these arise as a result of interactions and responses to class discussions. In this paper I describe part of a larger study-taking place at Brooklyn College of the City University of New York. The focus is on the exploration of emotions and mindfulness in the science classroom. The oximeter is used in this study as a reflexive tool to detect emotions emerging among participants of a graduate History and Philosophy of Science Education course offered in the spring of 2012. Important physiological information of class participants provided by the oximeter is used to analyze the role of emotions in the classroom as sensitive and controversial topics in science education are discussed every week.

Validation of noninvasive hemoglobin measurement by pulse co-oximeter in newborn infants.

PubMed

Nicholas, C; George, R; Sardesai, S; Durand, M; Ramanathan, R; Cayabyab, R

2015-08-01

To describe the accuracy of noninvasive hemoglobin (Hb) obtained with pulse co-oximeter (SpHb) compared with total Hb (tHb) from laboratory co-oximeter in neonates. Neonates with birth weight (BW) <3000 g admitted to LAC+USC Medical Center neonatal intensive care unit were included. SpHb was recorded using Masimo Radical-7 and compared with tHb. A total of three data sets were obtained for each patient. Regression analysis and Bland-Altman analysis were performed. Sixty-one patients (mean±s.d., BW 1177±610 g and gestational age 28.7±3.9 weeks) were enrolled. The mean tHb value was 13.9±2.0 g dl(-1) and the mean SpHb was 14.0±2.0 g dl(-1). There was a moderately positive correlation between SpHb and tHb (r=0.66, P<0.001) with a bias and precision of -0.09±1.67 g dl(-1). Data from a subgroup of infants with gestational age ⩽32 weeks (52/61 patients) were analyzed, and the correlation coefficient was moderately positive (r=0.69, P<0.001) with a bias and precision of -0.23±1.60 g dl(-1). Our results suggest that noninvasive SpHb may be considered as an adjunct to invasive tHb measurements in newborn infants <3000 g especially in preterm infants ⩽32 weeks of gestation.

Investigating Non-Invasive Hemodynamic Monitoring Devices Using Severe Dengue as a Surrogate for Trauma-Induced Shock

DTIC Science & Technology

2014-12-01

dengue hemorrhagic fever. In future work we will continue to evaluate the use of pulse wave forms to predict shock and will assess other...Index Three laboratory Phase I clinical trials have been completed to support a 510(k) application for FDA approval of the first prototype Pulse ... Oximeter with the CRI algorithm and capability for real-time continuous collection of photoplethymographic (PPG) analog signals. An FDA-cleared

Evaluation of Masimo signal extraction technology pulse oximetry in anaesthetized pregnant sheep.

PubMed

Quinn, Christopher T; Raisis, Anthea L; Musk, Gabrielle C

2013-03-01

Evaluation of the accuracy of Masimo signal extraction technology (SET) pulse oximetry in anaesthetized late gestational pregnant sheep. Prospective experimental study. Seventeen pregnant Merino ewes. Animals included in study were late gestation ewes undergoing general anaesthesia for Caesarean delivery or foetal surgery in a medical research laboratory. Masimo Radical-7 pulse oximetry (SpO(2) ) measurements were compared to co-oximetry (SaO(2) ) measurements from arterial blood gas analyses. The failure rate of the pulse oximeter was calculated. Accuracy was assessed by Bland & Altman's (2007) limits of agreement method. The effect of mean arterial blood pressure (MAP), perfusion index (PI) and haemoglobin (Hb) concentration on accuracy were assessed by regression analysis. Forty arterial blood samples paired with SpO(2) and blood pressure measurements were obtained. SpO(2) ranged from 42 to 99% and SaO(2) from 43.7 to 99.9%. MAP ranged from 24 to 82 mmHg, PI from 0.1 to 1.56 and Hb concentration from 71 to 114 g L(-1) . Masimo pulse oximetry measurements tended to underestimate oxyhaemoglobin saturation compared to co-oximetry with a bias (mean difference) of -2% and precision (standard deviation of the differences) of 6%. Accuracy appeared to decrease when SpO(2) was <75%, however numbers were too small for statistical comparisons. Hb concentration and PI had no significant effect on accuracy, whereas MAP was negatively correlated with SpO(2) bias. Masimo SET pulse oximetry can provide reliable and continuous monitoring of arterial oxyhaemoglobin saturation in anaesthetized pregnant sheep during clinically relevant levels of cardiopulmonary dysfunction. Further work is needed to assess pulse oximeter function during extreme hypotension and hypoxaemia. © 2012 The Authors. Veterinary Anaesthesia and Analgesia. © 2012 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.

Evaluation of the Human/Extreme Environment Interaction: Implications for Enhancing Operational Performance and Recovery

DTIC Science & Technology

2012-10-01

saturation was evaluated before and after exercise, and during recovery at 0:30, 2:30, 4:30, and 6:00 using a pulse oximeter (Nonin Onyx II 9550, Plymouth...Each collection was collected for 5 min, with the last 3 min averaged to represent the sample period. Pulse Oximetry. Blood oxygen ...would lead to more ATP per molecule of oxygen . The paradox with short-term and long-term metabolic adaptations is yet to be completely understood

Living for Six Days at 2200 M Improves Time-Trial Performance of Sea-Level Residents Exposed to 4300 M

DTIC Science & Technology

2008-02-01

breathing circuit by a rubber mouthpiece and nose clip, and to a finger pulse oximeter unit (Model 8600, Nonin Medical, Inc., Plymouth, MN) to...SaO2 via noninvasive finger pulse oximetry (Model 8600, Nonin Medical, Inc, Plymouth, MN) were monitored continuously, and ratings of perceived...respectively. Arterialization was achieved by warming the hand in 43ºC water for 5 min prior to obtaining a 150 µL fingertip blood sample for the

Pulsed near-infrared photoacoustic spectroscopy of blood

NASA Astrophysics Data System (ADS)

Laufer, Jan G.; Elwell, Clare E.; Delpy, Dave T.; Beard, Paul C.

2004-07-01

The aim of this study was to use pulsed near infrared photoacoustic spectroscopy to determine the oxygen saturation (SO2) of a saline suspension of red blood cells in vitro. The photoacoustic measurements were made in a cuvette which formed part of a larger circuit through which the red blood cell suspension was circulated. Oxygen saturation of the red blood cell suspension was altered between 2-3% to 100% in step increments using a membrane oxygenator and at each increment an independent measurement of oxygen saturation was made using a co-oximeter. An optical parametric oscillator laser system provided nanosecond excitation pulses at a number of wavelengths in the near-infrared spectrum (740-1040nm) which were incident on the cuvette. The resulting acoustic signals were detected using a broadband (15MHz) Fabry-Perot polymer film transducer. The optical transport coefficient and amplitude were determined from the acoustic signals as a function of wavelength. These data were then used to calculate the relative concentrations of oxy- and deoxyhaemoglobin, using their known specific absorption coefficients and an empirically determined wavelength dependence of optical scattering over the wavelength range investigated. From this, the oxygen saturation of the suspension was derived with an accuracy of +/-5% compared to the co-oximeter SO2 measurements.

Oxygen saturation profile in healthy preterm infants.

PubMed

Harigopal, S; Satish, H P; Taktak, A F G; Southern, K W; Shaw, N J

2011-09-01

To establish a reference range for oxygen saturation (SpO(2)) in well preterm infants to guide home oxygen therapy using a pulse oximeter and Pulse Oximetry Data Analysis Software (PODS). SpO(2) and heart-rate profiles of healthy preterm infants receiving mechanical ventilation for less than 6 h and supplemental oxygen for less than 48 h were monitored using a pulse oximeter. The stored data were downloaded from the monitor to a personal computer as individual files. Each infant's files of SpO(2) were subsequently displayed in graphic form, and a reference range was constructed using dedicated software, PODS. 43 infants were studied. The median value of all infants mean SpO(2) values was 95% (range 92-99%). The median duration of saturations less than 85% and between 85% and 90 % were 1% and 2% respectively. Using the study group median, 5th and 95th percentiles, a cumulative frequency curve of time against SpO(2) value was constructed (representing the reference range of SpO(2) profiles in healthy preterm infants). The SpO(2) reference range can be used as an easy and practical guide to compare SpO(2) profiles of infants on home oxygen therapy and guide their oxygen therapy.

Oxygen saturation targeting by pulse oximetry in the extremely low gestational age neonate: a quixotic quest.

PubMed

Cummings, James J; Lakshminrusimha, Satyan

2017-04-01

A collaboration of comparative effectiveness research trials of pulse oximeter saturation (SpO2) targeting in extremely low-gestational-age neonates have begun to report their aggregate results. We examine the results of those trials, collectively referred to as the Neonatal Oxygenation Prospective Meta-analysis or NeOProM. We also discuss the uncertainties that remain and the clinical challenges that lie ahead. The primary outcome from NeOProM was a composite of death or disability at 18-24 months corrected age. In 2016 the last of these reports was published. Although there were no differences in the primary outcome overall, analyses of secondary outcomes and data subsets following a pulse oximeter revision show significant treatment differences between targeting a lower compared with a higher SpO2. NeOProM represents the largest collaborative clinical research study of SpO2 targets in extremely low-gestational-age neonates. Although aggregate results give us some insight into the feasibility and efficacy of SpO2 targeting in this population, many questions remain. A patient-level analysis, tracking individual outcomes based on actual SpO2 experienced, may shed some light on these questions. However, finding a single optimal SpO2 range seems unlikely.

Accuracy of pulse oximetry in assessing heart rate of infants in the neonatal intensive care unit.

PubMed

Singh, Jasbir K S B; Kamlin, C Omar F; Morley, Colin J; O'Donnell, Colm P F; Donath, Susan M; Davis, Peter G

2008-05-01

To determine the accuracy of pulse oximetry measurement of heart rate in the neonatal intensive care unit. Stable preterm infants were monitored with a pulse oximeter and an ECG. The displays of both monitors were captured on video. Heart rate data from both monitors, including measures of signal quality, were extracted and analysed using Bland Altman plots. In 30 infants the mean (SD) difference between heart rate measured by pulse oximetry and electrocardiography was -0.4 (12) beats per minute. Accuracy was maintained when the signal quality or perfusion was low. Pulse oximetry may provide a useful measurement of heart rate in the neonatal intensive care unit. Studies of this technique in the delivery room are indicated.

Comparative Study of Pulp Vitality in Primary and Young Permanent Molars in Human Children with Pulse Oximeter and Electric Pulp Tester.

PubMed

Shahi, Prinka; Sood, P B; Sharma, Arun; Madan, Manish; Shahi, Nishat; Gandhi, Geetanjali

2015-01-01

The purpose of this study was to compare the pulp testing methods (pulse oximetry and electric pulp test) in primary and young permanent teeth of children. The study included a total of 155 children aged 4 to 15 years. Twenty children formed control group I. Study group included all healthy, 85 primary 2nd molars in group II and 85 permanent 1st molars in group III. Fifty children needing endodontics treatment formed test group IV. The readings were recorded as true positive (TP), false positive (FP), true negative (TN), false negative (FN). Based on this, the sensitivity, specificity, positive predictive value and negative predictive value were calculated for each method. The results were statistically analyzed using Chi-square test. On comparing pulse oximetry with electric pulp test 'p-value' was found to be 0.487 and 1.00 for groups 1 and 2 respectively and was statistically not significant. Whereas 'p-value' for groups 3 and 4 was < 0.0001 and 0.003 respectively and was statistically highly significant. The present study indicates that pulse oximetry can be used as a routine method for assessing the pulp vitality in primary, young permanent and mature permanent teeth. How to cite this article: Shahi P, Sood PB, Sharma A, Madan M, Shahi N, Gandhi G. Comparative Study of Pulp Vitality in Primary and Young Permanent Molars in Human Children with Pulse Oximeter and Electric Pulp Tester. Int J Clin Pediatr Dent 2015;8(2):94-98.

Utility of overnight pulse oximeter as a screening tool for sleep apnea to assess the 8-year risk of cardiovascular disease: Data from a large-scale bus driver cohort study.

PubMed

Wu, Wei-Te; Tsai, Su-Shan; Lin, Yu-Jen; Lin, Ming-Hsiu; Wu, Trong-Neng; Shih, Tung-Sheng; Liou, Saou-Hsing

2016-12-15

Professional drivers' work under conditions predisposes them for development of sleep-disordered breathing (SDB) and cardiovascular disease (CVD). However, the effect of SDB on CVD risk among professional drivers has never been investigated. A cohort study was used to evaluate the effectiveness of overnight pulse oximeter as a sleep apnea screening tool to assess the 8-year risk of CVD events. The Taiwan Bus Driver Cohort Study (TBDCS) recruited 1014 professional drivers in Taiwan since 2005. The subjects completed questionnaire interview and overnight pulse oximeter survey. This cohort was linked to the National Health Insurance Research Dataset (NHIRD). Researchers found 192 CVD cases from 2005 to 2012. Cox proportional hazards model was performed to estimate the hazard ratio for CVD. The statistical analysis was performed using SAS software in 2015. ODI4 and ODI3 levels increased the 8-year CVD risk, even adjusting for CVD risk factors (HR: 1.36, 95% CI: 1.05 to 1.78; p=0.022, and HR: 1.40, 95% CI: 1.03 to 1.90; p=0.033). ODI4 and ODI3 thresholds of 6.5 and 10events/h revealed differences of CVD risks (HR: 1.72, 95% CI: 1.00 to 2.95; p=0.048, and HR: 1.76, 95% CI: 1.03 to 3.03; p=0.041). Moreover, the ODI levels had an increased risk for hypertensive disease (not including essential hypertension). This study concludes that ODI for a sign of SDB is an independent predictor of elevated risk of CVD. Further research should be conducted regarding measures to prevent against SDB in order to reduce CVD risk in professional drivers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Childhood pneumonia diagnostics: community health workers' and national stakeholders' differing perspectives of new and existing aids.

PubMed

Spence, Hollie; Baker, Kevin; Wharton-Smith, Alexandra; Mucunguzi, Akasiima; Matata, Lena; Habte, Tedila; Nanyumba, Diana; Sebsibe, Anteneh; Thany, Thol; Källander, Karin

2017-01-01

Pneumonia heavily contributes to global under-five mortality. Many countries use community case management to detect and treat childhood pneumonia. Community health workers (CHWs) have limited tools to help them assess signs of pneumonia. New respiratory rate (RR) counting devices and pulse oximeters are being considered for this purpose. To explore perspectives of CHWs and national stakeholders regarding the potential usability and scalability of seven devices to aid community assessment of pneumonia signs. Pile sorting was conducted to rate the usability and scalability of 7 different RR counting aids and pulse oximeters amongst 16 groups of participants. Following each pile-sorting session, a focus group discussion (FGD) explored participants' sorting rationale. Purposive sampling was used to select CHWs and national stakeholders with experience in childhood pneumonia and integrated community case management (iCCM) in Cambodia, Ethiopia, Uganda and South Sudan. Pile-sorting data were aggregated for countries and participant groups. FGDs were audio recorded and transcribed verbatim. Translated FGDs transcripts were coded in NVivo 10 and analysed using thematic content analysis. Comparative analysis was performed between countries and groups to identify thematic patterns. CHWs and national stakeholders across the four countries perceived the acute respiratory infection (ARI) timer and fingertip pulse oximeter as highly scalable and easy for CHWs to use. National stakeholders were less receptive to new technologies. CHWs placed greater priority on device acceptability to caregivers and children. Both groups felt that heavy reliance on electricity reduced potential scalability and usability in rural areas. Device simplicity, affordability and sustainability were universally valued. CHWs and national stakeholders prioritise different device characteristics according to their specific focus of work. The views of all relevant stakeholders, including health workers, policy makers, children and parents, should be considered in future policy decisions, research and development regarding suitable pneumonia diagnostic aids for community use.

Design and preliminary validation of a mobile application-based expert system to facilitate repair of medical equipment in resource-limited health settings.

PubMed

Wong, Alison L; Lacob, Kelly M; Wilson, Madeline G; Zwolski, Stacie M; Acharya, Soumyadipta

2018-01-01

One of the greatest barriers to safe surgery is the availability of functional biomedical equipment. Biomedical technicians play a major role in ensuring that equipment is functional. Following in-field observations and an online survey, a mobile application was developed to aid technicians in troubleshooting biomedical equipment. It was hypothesized that this application could be used to aid technicians in equipment repair, as modeled by repair of a pulse oximeter. To identify specific barriers to equipment repair and maintenance for biomedical technicians, an online survey was conducted to determine current practices and challenges. These findings were used to guide the development of a mobile application system that guides technicians through maintenance and repair tasks. A convenience sample of technicians in Ethiopia tested the application using a broken pulse oximeter task and following this completed usability and content validity surveys. Fifty-three technicians from 13 countries responded to the initial survey. The results of the survey showed that technicians find equipment manuals most useful, but these are not easily accessible. Many do not know how to or are uncomfortable reaching out to human resources. Thirty-three technicians completed the broken pulse oximeter task using the application. All were able to appropriately identify and repair the equipment, and post-task surveys of usability and content validity demonstrated highly positive scores (Agree to Strongly Agree) on both scales. This research demonstrates the need for improved access to resources for technicians and shows that a mobile application can be used to address a gap in the access to knowledge and resources in low- and middle-income countries. Further research will include prospective studies to determine the impact of an application on the availability of functional equipment in a hospital and the effect on the provision and safety of surgical care.

Usefulness of overnight pulse oximeter as the sleep assessment tool to assess the 6-year risk of road traffic collision: evidence from the Taiwan Bus Driver Cohort Study.

PubMed

Wu, Wei-Te; Tsai, Su-Shan; Liao, Hui-Yi; Lin, Yu-Jen; Lin, Ming-Hsiu; Wu, Trong-Neng; Shih, Tung-Sheng; Liou, Saou-Hsing

2017-02-01

In order to support health service organizations in arranging a system for prevention of road traffic collisions (RTC), it is important to study the usefulness of sleep assessment tools. A cohort study was used to evaluate the effectiveness of subjective and objective sleep assessment tools to assess for the 6-year risk of both first RTC event only and recurrent RTC events. The Taiwan Bus Driver Cohort Study (TBDCS) recruited 1650 professional drivers from a large bus company in Taiwan in 2005. The subjects were interviewed in person, completed the sleep assessment questionnaires and had an overnight pulse oximeter survey. Moreover, this cohort of drivers was linked to the National Traffic Accident Database (NTAD) and researchers found 139 new RTC events from 2005 to 2010. Primary outcomes were traffic collisions from NTAD, nocturnal oxygen desaturation index (ODI) from pulse oximeter, Pittsburg sleeping quality score, Epworth daytime sleepiness score, Snore Outcomes Survey score and working patterns from questionnaires. A Cox proportional hazards model and an extended Cox regression model for repeated events were performed to estimate the hazard ratio for RTC. The RTC drivers had increased ODI4 levels (5.77 ± 4.72 vs 4.99 ± 6.68 events/h; P  = 0.008) and ODI3 levels (8.68 ± 6.79 vs 7.42 ± 7.94 events/h; P  = 0.007) in comparison with non-RTC drivers. These results were consistent regardless of whether ODI was evaluated as a continuous or a categorical variable. ODI4 and ODI3 levels increased the 6-year RTC risks among professional drivers even after adjusting for age, education, history of cardiovascular disease, caffeine intake, sleeping pills used, bus driving experience and shift modes. Moreover, there was an increased trend for ODI between the stratification of the number of RTCs in comparison with the non-RTC group. In the extended Cox regression models for repeated RTC events with the Anderson and Gill intensity model and Prentice-Williams-Petersen model, measurement of ODI increased hazards of the subsequent RTC events. This study showed that an increase in the 6-year risk of RTC was associated with objective measurement of ODI for a sign of sleep-disordered breathing (SDB), but was not associated with self-reported sleeping quality or daytime sleepiness. Therefore, the overnight pulse oximeter is an effective sleep assessment tool for assessing the risk of RTC. Further research should be conducted regarding measures to prevent against SDB among professional drivers. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

In Vivo Imaging of Branched Chain Amino Acid Metabolism in Prostate Cancer

DTIC Science & Technology

2012-08-01

system with heart rate and O2 saturation recorded using a pulse oximeter . Within a given scanning session, each mouse received one bolus injection... oxygen (~1.5 l/min), a tail vein catheter was inserted into each mouse, and the animal placed in a custom-build dual-tuned 13C/1H quadrature

Effect of glucose on the optical properties of arterial blood using Mie theory simulations

NASA Astrophysics Data System (ADS)

Clancy, Neil T.; Leahy, Martin J.

2005-08-01

The glucose concentration in arterial plasma has immediate effects on the optical properties of blood-bearing tissue due primarily to the alteration of refractive index mismatch between the scattering particles (red blood cells) and the medium (plasma). The influence of these effects on pulse oximetry is investigated using a numerical model based on Mie theory. The objective is to determine whether or not physiological fluctuations in blood glucose levels could sufficiently vary the optical properties to shift the calibration curve of a commercial pulse oximeter significantly.

Estimation of Individual-specific Progression to Impending Cardiovascular Instability using Arterial Waveforms

DTIC Science & Technology

2013-08-08

pressure; SpO2, oxygen saturation of arterial blood by pulse oximetry. -75-60-45-30-15Baseline 40 50 60 70 80 90 100 HT LT LBNP, mmHg S tr o ke V o...systolic arterial blood pressure (mmHg) generated from the Finometer. R-R intervals (ms) were used to calculate heart rate (beats/min). Oxygen saturation of...The CRI can be integrated into any standard monitor that generates an arterial waveform, including a finger pulse oximeter that is available in the

Oxygen Saturation Targeting by Pulse Oximetry (SpO2) in the Extremely Low Gestational Age Neonate (ELGAN): A Quixotic Quest

PubMed Central

Cummings, James J.; Lakshminrusimha, Satyan

2017-01-01

Purpose of review A collaboration of comparative effectiveness research trials of pulse oximeter saturation (SpO2) targeting in extremely low gestational age neonates (ELGANs) have begun to report their aggregate results. We will examine the results of those trials, collectively referred to as the Neonatal Oxygenation Prospective Meta-analysis, or NeOProM. We will also discuss the uncertainties that remain and the clinical challenges that lie ahead. Recent findings The primary outcome from NeOProM was a composite of death or disability at 18–24 months corrected age. Earlier this year, the last of these reports was published. Although there were no differences in the primary outcome overall, analyses of secondary outcomes and data subsets following a pulse oximeter revision show significant treatment differences between targeting a lower compared to a higher SpO2. Summary NeOProM represents the largest collaborative clinical research study of SpO2 targets in ELGANs. While aggregate results give us some insight into the feasibility and efficacy of SpO2 targeting in this population, many questions remain. A patient-level analysis, tracking individual outcomes based on actual SpO2 experienced, may shed some light on these questions. However, finding a single optimal SpO2 range seems unlikely. PMID:28085683

Novel Pulse Oximetry Sonifications for Neonatal Oxygen Saturation Monitoring: A Laboratory Study.

PubMed

Hinckfuss, Kelly; Sanderson, Penelope; Loeb, Robert G; Liley, Helen G; Liu, David

2016-03-01

We aimed to test whether the use of novel pulse oximetry sounds (sonifications) better informs listeners when a neonate's oxygen saturation (SpO2) deviates from the recommended range. Variable-pitch pulse oximeters do not accurately inform clinicians via sound alone when SpO2 is outside the target range of 90% to 95% for neonates on supplemental oxygen. Risk of blindness, organ damage, and death increase if SpO2 remains outside the target range. A more informative sonification may improve clinicians' ability to maintain the target range. In two desktop experiments, nonclinicians' ability to detect SpO2 range and direction of change was tested with novel versus conventional sonifications of simulated patient data. In Experiment 1, a "shoulder" sonification used larger pitch differences between adjacent saturation percentages for SpO2 values outside the target range. In Experiment 2, a "beacon" sonification used equal-appearing pitch differences, but when SpO2 was outside the target range, a fixed-pitch reference tone from the center of the target SpO2 range preceded every fourth pulse tone. The beacon sonification improved range identification accuracy over the control display (85% vs. 60%; p < .001), but the shoulder sonification did not (55% vs. 52%). The beacon provided a distinct auditory alert and reference that significantly improved nonclinical participants' ability to identify SpO2 range. Adding a beacon to the variable-pitch pulse oximeter sound may help clinicians identify when, and by how much, a neonate's SpO2 deviates from the target range, particularly during patient transport situations when auditory information becomes essential. © 2015, Human Factors and Ergonomics Society.

Multispectral imaging of organ viability during uterine transplantation surgery in rabbits and sheep

NASA Astrophysics Data System (ADS)

Clancy, Neil T.; Saso, Srdjan; Stoyanov, Danail; Sauvage, Vincent; Corless, David J.; Boyd, Michael; Noakes, David E.; Thum, Meen-Yau; Ghaem-Maghami, Sadaf; Smith, James Richard; Elson, Daniel S.

2016-10-01

Uterine transplantation surgery (UTx) has been proposed as a treatment for permanent absolute uterine factor infertility (AUFI) in the case of the congenital absence or surgical removal of the uterus. Successful surgical attachment of the organ and its associated vasculature is essential for the organ's reperfusion and long-term viability. Spectral imaging techniques have demonstrated the potential for the measurement of hemodynamics in medical applications. These involve the measurement of reflectance spectra by acquiring images of the tissue in different wavebands. Measures of tissue constituents at each pixel can then be extracted from these spectra through modeling of the light-tissue interaction. A multispectral imaging (MSI) laparoscope was used in sheep and rabbit UTx models to study short- and long-term changes in oxygen saturation following surgery. The whole organ was imaged in the donor and recipient animals in parallel with point measurements from a pulse oximeter. Imaging results confirmed the re-establishment of adequate perfusion in the transplanted organ after surgery. Cornual oxygenation trends measured with MSI are consistent with pulse oximeter readings, showing decreased StO2 immediately after anastomosis of the blood vessels. Long-term results show recovery of StO2 to preoperative levels.

Optical assessment of intravascular and intracellular parameters related to tissue viability

NASA Astrophysics Data System (ADS)

Mayevsky, Avraham; Sherman, Efrat; Cohen-Kashi, Meir; Dekel, Nava; Pewzner, Eliyahu

2007-02-01

Tissue viability represents the balance between O II supply and demand. In our previous paper (Mayevsky et al; Proc.SPIE 6083 : z1-z10, 2006) the HbO II was added to the multiparametric tissue spectroscope (Mayevsky et al J.Biomedical Optics 9:1028-1045,2004). This parameter provides relative values of microcirculatory blood oxygenation (MC-HbO II) evaluated by the 2 wavelength reflectometry principle. The advantage of this approach as compared to pulse oximetry is that the measurement is not dependent of the existence of the pulse of the heart. Also in the MC-HbO II the information is collected from small vessels providing O II to the mitochondria as compared to the pulse oximeter indicating blood oxygenation by the respiratory and cardiovascular systems. In the present study we compared the level of blood oxygenation measured by the pulse oximeter to that measured by the CritiView in the brain exposed to various systemic and localized perturbations of O II supply or demand. We exposed gerbils to anoxia, hypoxia, ischemia and terminal anoxia. In addition we measured mitochondrial NADH (surface fluorometry), tissue reflectance, tissue blood flow (laser Doppler flowmetry) from the same site of MC-HbO II measurement. A clear connection was found between the two blood oxygenation parameters only when systemic perturbations were used (anoxia, hypoxia and terminal anoxia). Under local events (ischemia) the MC-HbO II was responsive while the systemic oxygenation was unchanged. We concluded that MC-HbO II has a significant value in interpretation of tissue energy metabolism under pathophysiological conditions.

Oxygen Desaturation Index Estimation through Unconstrained Cardiac Sympathetic Activity Assessment Using Three Ballistocardiographic Systems.

PubMed

Jung, Da Woon; Hwang, Su Hwan; Lee, Yu Jin; Jeong, Do-Un; Park, Kwang Suk

2016-01-01

Nocturnal hypoxemia, characterized by abnormally low oxygen saturation levels in arterial blood during sleep, is a significant feature of various pathological conditions. The oxygen desaturation index, commonly used to evaluate the nocturnal hypoxemia severity, is acquired using nocturnal pulse oximetry that requires the overnight wear of a pulse oximeter probe. This study aimed to suggest a method for the unconstrained estimation of the oxygen desaturation index. We hypothesized that the severity of nocturnal hypoxemia would be positively associated with cardiac sympathetic activation during sleep. Unconstrained heart rate variability monitoring was conducted using three different ballistocardiographic systems to assess cardiac sympathetic activity. Overnight polysomnographic and ballistocardiographic recording pairs were collected from the 20 non-nocturnal hypoxemia (oxygen desaturation index <5 events/h) subjects and the 76 nocturnal hypoxemia patients. Among the 96 recording pairs, 48 were used as training data and the remaining 48 as test data. The regression analysis, performed using the low-frequency component of heart rate variability, exhibited a root mean square error of 3.33 events/h between the estimates and the reference values of the oxygen desaturation index. The nocturnal hypoxemia diagnostic performance produced by our method was presented with an average accuracy of 96.5% at oxygen desaturation index cutoffs of ≥5, 15, and 30 events/h. Our method has the potential to serve as a complementary measure against the accidental slip-out of a pulse oximeter probe during nocturnal pulse oximetry. The independent application of our method could facilitate home-based long-term oxygen desaturation index monitoring. © 2016 S. Karger AG, Basel.

Evaluation of treatment related fear using a newly developed fear scale for children: "Fear assessment picture scale" and its association with physiological response.

PubMed

Tiwari, Nishidha; Tiwari, Shilpi; Thakur, Ruchi; Agrawal, Nikita; Shashikiran, N D; Singla, Shilpy

2015-01-01

Dental treatment is usually a poignant phenomenon for children. Projective scales are preferred over psychometric scales to recognize it, and to obtain the self-report from children. The aims were to evaluate treatment related fear using a newly developed fear scale for children, fear assessment picture scale (FAPS), and anxiety with colored version of modified facial affective scale (MFAS) - three faces along with physiologic responses (pulse rate and oxygen saturation) obtained by pulse oximeter before and during pulpectomy procedure. Total, 60 children of age 6-8 years who were visiting the dental hospital for the first time and needed pulpectomy treatment were selected. Children selected were of sound physical, physiological, and mental condition. Two projective scales were used; one to assess fear - FAPS and to assess anxiety - colored version of MFAS - three faces. These were co-related with the physiological responses (oxygen saturation and pulse rate) of children obtained by pulse oximeter before and during the pulpectomy procedure. Shapiro-Wilk test, McNemar's test, Wilcoxon signed ranks test, Kruskal-Wallis test, Mann-Whitney test were applied in the study. The physiological responses showed association with FAPS and MFAS though not significant. However, oxygen saturation with MFAS showed a significant change between "no anxiety" and "some anxiety" as quantified by Kruskal-Wallis test value 6.287, P = 0.043 (<0.05) before pulpectomy procedure. The FAPS can prove to be a pragmatic tool in spotting the fear among young children. This test is easy and fast to apply on children and reduces the chair-side time.

Impact of study oximeter masking algorithm on titration of oxygen therapy in the Canadian oxygen trial.

PubMed

Schmidt, Barbara; Roberts, Robin S; Whyte, Robin K; Asztalos, Elizabeth V; Poets, Christian; Rabi, Yacov; Solimano, Alfonso; Nelson, Harvey

2014-10-01

To compare oxygen saturations as displayed to caregivers on offset pulse oximeters in the 2 groups of the Canadian Oxygen Trial. In 5 double-blind randomized trials of oxygen saturation targeting, displayed saturations between 88% and 92% were offset by 3% above or below the true values but returned to true values below 84% and above 96%. During the transition, displayed values remained static at 96% in the lower and at 84% in the higher target group during a 3% change in true saturations. In contrast, displayed values changed rapidly from 88% to 84% in the lower and from 92% to 96% in the higher target group during a 1% change in true saturations. We plotted the distributions of median displayed saturations on days with >12 hours of supplemental oxygen in 1075 Canadian Oxygen Trial participants to reconstruct what caregivers observed at the bedside. The oximeter masking algorithm was associated with an increase in both stability and instability of displayed saturations that occurred during the transition between offset and true displayed values at opposite ends of the 2 target ranges. Caregivers maintained saturations at lower displayed values in the higher than in the lower target group. This differential management reduced the separation between the median true saturations in the 2 groups by approximately 3.5%. The design of the oximeter masking algorithm may have contributed to the smaller-than-expected separation between true saturations in the 2 study groups of recent saturation targeting trials in extremely preterm infants. Copyright © 2014 Elsevier Inc. All rights reserved.

Oximetry: A Reflective Tool for the Detection of Physiological Expression of Emotions in a Science Education Classroom

ERIC Educational Resources Information Center

Calderón, Olga

2016-01-01

The pulse oximeter is a device that measures the oxygen concentration (or oxygen saturation--SpO[subscript 2]); heart rate, and heartbeat of a person at any given time. This instrument is commonly used in medical and aerospace fields to monitor physiological outputs of a patient according to health conditions or physiological yields of a flying…

Non-Invasive Tissue Oxygenation Measurement Systems. Phase 1.

DTIC Science & Technology

1995-10-01

vessels was shown ( in vivo hamster studies) to be a significant factor causing considerable variability in SaO2 in vessels ...shows that trends in blood oxygenation are tracked. The nearly universal applicability and turnkey type measurement capability of pulse oximeters are...approach early in Phase I that might be compatible with laser doppler blood flow measurements. Both methods depend on laser irradiation of the sample

Time Duration of Oxygen Adaptation Immediately after Birth; Monitoring by Pulse Oximeter in Perinatal Period of the Infants at Charoenkrung Pracharak Hospital.

PubMed

Suwattanaphim, Suparach; Yodavuhd, Sirisanpang; Puangsa-art, Supalarp

2015-07-01

Oxygen Saturation is one of the important data to determine patient status and worldwide applied in several situations. Evaluation about status of immediate perinatal period of the infant usually uses clinical assessment, Apgar scoring, which had been used for a long time without other scientific measurement. Pulse oximeter the non-invasive measurement of oxygen saturation, may play role for oxygen saturation evaluation in newborn that immediately change from intra to extra uterine environment. Monitoring the time duration that immediately born infants by normal labor or Cesarean section modes, used to archived target oxygen saturation (SpO) and looking for the other factors that influence oxygen saturation adaptation. The data of the 553 infants born in Charoenkrung Pracharak Hospital, Bangkok, Thailand between October 2012 and April 2013 were collected. The 204 healthy newborns that met all criteria were studied. All infants were recorded pulse oximeter from the second to the tenth minute after birth. They were grouped by several factors such as maternal gravidity, gestational age, mode of delivery, Apgar score, birth weight, and sex. Time interval to achieve target oxygen saturation (SpO2 ≥ 90%) was collected for analysis. The oxygen saturation of infants immediately after birth showed an increase. Median time interval was 6.5 (2-10) minutes for 90% saturation and 7 (2-10) minutes for 95% saturation, respectively. Only mode of delivery showed statistical significant time difference (p < 0.001). A Cox proportional hazards analysis of the Kaplan-Meier curves demonstrated that infants born by cesarean delivery took significantly longer time to reach a stable SpO2 ≥ 90% than infants born by vaginal delivery (95% CI = 1.28 to 2.74; p < 0.01). A newly born infant has to take 6.5 minutes (2-10) after birth to adjust their oxygen saturation to reach normal higher level of extra uterine life, median SpO2 of 90%. Furthermore, mode of delivery makes a significant difference of oxygen saturation status; the cesarean route takes significantly longer time than the vaginal route to achieve SpO2 ≥ 90%.

Effects of divided attention and operating room noise on perception of pulse oximeter pitch changes: a laboratory study.

PubMed

Stevenson, Ryan A; Schlesinger, Joseph J; Wallace, Mark T

2013-02-01

Anesthesiology requires performing visually oriented procedures while monitoring auditory information about a patient's vital signs. A concern in operating room environments is the amount of competing information and the effects that divided attention has on patient monitoring, such as detecting auditory changes in arterial oxygen saturation via pulse oximetry. The authors measured the impact of visual attentional load and auditory background noise on the ability of anesthesia residents to monitor the pulse oximeter auditory display in a laboratory setting. Accuracies and response times were recorded reflecting anesthesiologists' abilities to detect changes in oxygen saturation across three levels of visual attention in quiet and with noise. Results show that visual attentional load substantially affects the ability to detect changes in oxygen saturation concentrations conveyed by auditory cues signaling 99 and 98% saturation. These effects are compounded by auditory noise, up to a 17% decline in performance. These deficits are seen in the ability to accurately detect a change in oxygen saturation and in speed of response. Most anesthesia accidents are initiated by small errors that cascade into serious events. Lack of monitor vigilance and inattention are two of the more commonly cited factors. Reducing such errors is thus a priority for improving patient safety. Specifically, efforts to reduce distractors and decrease background noise should be considered during induction and emergence, periods of especially high risk, when anesthesiologists has to attend to many tasks and are thus susceptible to error.

Effects of Changes in Arterial Carbon Dioxide and Oxygen Partial Pressures on Cerebral Oximeter Performance.

PubMed

Schober, Andrew; Feiner, John R; Bickler, Philip E; Rollins, Mark D

2018-01-01

Cerebral oximetry (cerebral oxygen saturation; ScO2) is used to noninvasively monitor cerebral oxygenation. ScO2 readings are based on the fraction of reduced and oxidized hemoglobin as an indirect estimate of brain tissue oxygenation and assume a static ratio of arterial to venous intracranial blood. Conditions that alter cerebral blood flow, such as acute changes in PaCO2, may decrease accuracy. We assessed the performance of two commercial cerebral oximeters across a range of oxygen concentrations during normocapnia and hypocapnia. Casmed FORE-SIGHT Elite (CAS Medical Systems, Inc., USA) and Covidien INVOS 5100C (Covidien, USA) oximeter sensors were placed on 12 healthy volunteers. The fractional inspired oxygen tension was varied to achieve seven steady-state levels including hypoxic and hyperoxic PaO2 values. ScO2 and simultaneous arterial and jugular venous blood gas measurements were obtained with both normocapnia and hypocapnia. Oximeter bias was calculated as the difference between the ScO2 and reference saturation using manufacturer-specified weighting ratios from the arterial and venous samples. FORE-SIGHT Elite bias was greater during hypocapnia as compared with normocapnia (4 ± 9% vs. 0 ± 6%; P < 0.001). The INVOS 5100C bias was also lower during normocapnia (5 ± 15% vs. 3 ± 12%; P = 0.01). Hypocapnia resulted in a significant decrease in mixed venous oxygen saturation and mixed venous oxygen tension, as well as increased oxygen extraction across fractional inspired oxygen tension levels (P < 0.0001). Bias increased significantly with increasing oxygen extraction (P < 0.0001). Changes in PaCO2 affect cerebral oximeter accuracy, and increased bias occurs with hypocapnia. Decreased accuracy may represent an incorrect assumption of a static arterial-venous blood fraction. Understanding cerebral oximetry limitations is especially important in patients at risk for hypoxia-induced brain injury, where PaCO2 may be purposefully altered.

A validation method for near-infrared spectroscopy based tissue oximeters for cerebral and somatic tissue oxygen saturation measurements.

PubMed

Benni, Paul B; MacLeod, David; Ikeda, Keita; Lin, Hung-Mo

2018-04-01

We describe the validation methodology for the NIRS based FORE-SIGHT ELITE ® (CAS Medical Systems, Inc., Branford, CT, USA) tissue oximeter for cerebral and somatic tissue oxygen saturation (StO 2 ) measurements for adult subjects submitted to the United States Food and Drug Administration (FDA) to obtain clearance for clinical use. This validation methodology evolved from a history of NIRS validations in the literature and FDA recommended use of Deming regression and bootstrapping statistical validation methods. For cerebral validation, forehead cerebral StO 2 measurements were compared to a weighted 70:30 reference (REF CX B ) of co-oximeter internal jugular venous and arterial blood saturation of healthy adult subjects during a controlled hypoxia sequence, with a sensor placed on the forehead. For somatic validation, somatic StO 2 measurements were compared to a weighted 70:30 reference (REF CX S ) of co-oximetry central venous and arterial saturation values following a similar protocol, with sensors place on the flank, quadriceps muscle, and calf muscle. With informed consent, 25 subjects successfully completed the cerebral validation study. The bias and precision (1 SD) of cerebral StO 2 compared to REF CX B was -0.14 ± 3.07%. With informed consent, 24 subjects successfully completed the somatic validation study. The bias and precision of somatic StO 2 compared to REF CX S was 0.04 ± 4.22% from the average of flank, quadriceps, and calf StO 2 measurements to best represent the global whole body REF CX S . The NIRS validation methods presented potentially provide a reliable means to test NIRS monitors and qualify them for clinical use.

The accuracy of noninvasive hemoglobin monitoring using the radical-7 pulse CO-Oximeter in children undergoing neurosurgery.

PubMed

Park, Yong-Hee; Lee, Ji-Hyun; Song, Hyun-Gul; Byon, Hyo-Jin; Kim, Hee-Soo; Kim, Jin-Tae

2012-12-01

The most common method for determining the hemoglobin concentration is to draw blood from a patient. However, the Radical-7 Pulse CO-Oximeter (Masimo Corporation, Irvine, CA) can noninvasively provide continuous hemoglobin concentration (SpHb). In our study we compared noninvasive measurements of SpHb with simultaneous laboratory measurements of total hemoglobin in arterial blood samples taken from children (tHb). Arterial blood samples were analyzed using a laboratory CO-oximeter, and SpHb was simultaneously recorded in pediatric patients undergoing neurosurgery. When patients met the criteria for hypovolemia, 10 mL/kg of colloids or red blood cells were administered over 10 minutes. SpHb and tHb data were collected before and after intravascular volume resuscitation. The relationship between SpHb and tHb was assessed using a 4-quadrant plot, linear regression, mixed-effect model, and modified Bland-Altman analyses. One hundred nineteen paired samples were analyzed. The correlation coefficient between SpHb and tHb was 0.53 (P < 0.001), whereas that of change in SpHb versus change in tHb was 0.75 (P < 0.001). The average difference (bias) between tHb and SpHb was 0.90 g/dL (95% confidence interval [CI], 0.48-1.32 g/dL) and 1 standard deviation of the difference (sd) was 1.35 g/dL. The concordance rate (a measure of the number of data points that are in 1 of the 2 quadrants of agreement) determined using a 4-quadrant plot was 93%. The correlation coefficient between SpHb and tHb after intravascular volume resuscitation was 0.58 (P < 0.001), whereas that of changes in SpHb and tHb was 0.87 (P < 0.001). The bias immediately after volume resuscitation was 1.18 g/dL (95% CI, 0.81-1.55 g/dL), and sd was 1.28 g/dL with a concordance rate of 94.4%. The bias was -0.03 g/dL when tHb was ≥11 g/dL, which was significantly lower in comparison with biases when tHb <9 g/dL (1.24 g/dL) and tHb was 9-11 g/dL (1.17 g/dL) (P = 0.004). The Radical-7 Pulse CO-Oximeter can be useful as a trend monitor in children during surgery even immediately after intravascular volume expanders are administered. However, it is advisable to confirm the baseline hemoglobin level and to consider the influence of tHb level on the bias. In addition, one should be cautious with regard to using SpHb alone when making transfusion decisions.

Accuracy of pulse oximetry measurement of heart rate of newborn infants in the delivery room.

PubMed

Kamlin, C Omar F; Dawson, Jennifer A; O'Donnell, Colm P F; Morley, Colin J; Donath, Susan M; Sekhon, Jasbir; Davis, Peter G

2008-06-01

To determine the accuracy of heart rate obtained by pulse oximetry (HR(PO)) relative to HR obtained by 3-lead electrocardiography (HR(ECG)) in newborn infants in the delivery room. Immediately after birth, a preductal PO sensor and ECG leads were applied. PO and ECG monitor displays were recorded by a video camera. Two investigators reviewed the videos. Every two seconds, 1 of the investigators recorded HR(PO) and indicators of signal quality from the oximeter while masked to ECG, whereas the other recorded HR(ECG) and ECG signal quality while masked to PO. HR(PO) and HR(ECG) measurements were compared using Bland-Altman analysis. We attended 92 deliveries; 37 infants were excluded due to equipment malfunction. The 55 infants studied had a mean (+/-standard deviation [SD]) gestational age of 35 (+/-3.7) weeks, and birth weight 2399 (+/-869) g. In total, we analyzed 5877 data pairs. The mean difference (+/-2 SD) between HR(ECG) and HR(PO) was -2 (+/-26) beats per minute (bpm) overall and -0.5 (+/-16) bpm in those infants who received positive-pressure ventilation and/or cardiac massage. The sensitivity and specificity of PO for detecting HR(ECG) <100 bpm was 89% and 99%, respectively. PO provided an accurate display of newborn infants' HR in the delivery room, including those infants receiving advanced resuscitation.

Sensor fusion using a hybrid median filter for artifact removal in intraoperative heart rate monitoring.

PubMed

Yang, Ping; Dumont, Guy A; Ansermino, J Mark

2009-04-01

Intraoperative heart rate is routinely measured independently from the ECG monitor, pulse oximeter, and the invasive blood pressure monitor if available. The presence of artifacts, in one or more of theses signals, especially sustained artifacts, represents a critical challenge for physiological monitoring. When temporal filters are used to suppress sustained artifacts, unwanted delays or signal distortion are often introduced. The aim of this study was to remove artifacts and derive accurate estimates for the heart rate signal by using measurement redundancy. Heart rate measurements from multiple sensors and previous estimates that fall in a short moving window were treated as samples of the same heart rate. A hybrid median filter was used to align these samples into one ordinal series and to select the median as the fused estimate. This method can successfully remove artifacts that are sustained for shorter than half the length of the filter window, or artifacts that are sustained for a longer duration but presented in no more than half of the sensors. The method was tested on both simulated and clinical cases. The performance of the hybrid median filter in the simulated study was compared with that of a two-step estimation process, comprising a threshold-controlled artifact-removal module and a Kalman filter. The estimation accuracy of the hybrid median filter is better than that of the Kalman filter in the presence of artifacts. The hybrid median filter combines the structural and temporal information from two or more sensors and generates a robust estimate of heart rate without requiring strict assumptions about the signal's characteristics. This method is intuitive, computationally simple, and the performance can be easily adjusted. These considerable benefits make this method highly suitable for clinical use.

Occupational Survey Report. AFSC 4A2X1 Biomedical Equipment

DTIC Science & Technology

2004-05-01

Electrocardiograms 70 Hospital Beds, Electric 67 Surgical Lamps 67 Hospital Beds, Manual 66 Audiometers 64 Dental Curing Units 63 Dental Handpieces 63...Pumps 78 Pulse Oximeters 78 Dental Chairs 76 Blood Pressure Monitors, Automatic 74 Examination Lamps 72 Examination Tables 72 Blood Pressure Cuffs 71...Exercise Bicycles 63 Dental Amalgamators 62 Scales or Balances, other than Pediatric 62 Scales or Balances, Pediatric 61 First-Enlistment Personnel

Continuous pulse oximeter monitoring for inapparent hypoxemia after long bone fractures.

PubMed

Wong, Margaret Wan Nar; Tsui, Hon For; Yung, Shu Heng; Chan, Kai Ming; Cheng, Jack Chun Yiu

2004-02-01

Continuous pulse oximeter monitoring (CPOM) and daily intermittent arterial blood gas (ABG) were used to define the incidence, pattern, and severity of inapparent hypoxemia after long bone fractures. Twenty long bone fracture patients and 19 normal control patients were studied. CPOM, daily ABG, hypoxic symptoms, and features of fat embolism syndrome were monitored for 72 hours after fractures and after surgical interventions. CPOM trend curves showed that all fracture patients except one had recurrent desaturations below 90% Sao2 of varying duration and depth. The lowest Sao2 was down to 60% and the longest episode lasted for 1.47 hours. ABG analysis could not show the recurrent phenomena and never detected the corresponding desaturation episodes. Long bone fracture patients had more desaturation episodes, longer total desaturation duration, and larger total area under desaturation curves in both the postfracture and postoperative periods (p < 0.05). The mean Sao2 was significantly lower in the postfracture period. Although most patients remained asymptomatic and recovered spontaneously, two required transient oxygen therapy and one progressed to fat embolism syndrome. Inapparent hypoxia with profound desaturation is common after long bone fractures. CPOM of all patients admitted with long bone fractures is recommended for early detection. In patients who develop inapparent hypoxia, additional pulmonary insult should be avoided or undertaken with care and well timed.

Examiner's finger-mounted fetal tissue oximetry.

PubMed

Kanayama, Naohiro; Niwayama, Masatsugu

2014-06-01

The best way to assess fetal condition is to observe the oxygen status of the fetus (as well as to assess the condition of infants, children, and adults). Previously, several fetal oximeters have been developed; however, no instrument has been utilized in clinical practice because of the low-capturing rate of the fetal oxygen saturation. To overcome the problem, we developed a doctor's finger-mounted fetal tissue oximeter, whose sensor volume is one hundredth of the conventional one. Additionally, we prepared transparent gloves. The calculation algorithm of the hemoglobin concentration was derived from the light propagation analysis based on the transport theory. We measured neonatal and fetal oxygen saturation (StO₂) with the new tissue oximeter. Neonatal StO₂ was measured at any position of the head regardless of amount of hair. Neonatal StO₂ was found to be around 77%. Fetal StO₂ was detected in every position of the fetal head during labor regardless of the presence of labor pain. Fetal StO₂ without labor pain was around 70% in the first stage of labor and around 60% in the second stage of labor. We concluded that our new concept of fetal tissue oximetry would be useful for detecting fetal StO₂ in any condition of the fetus.

Examiner's finger-mounted fetal tissue oximetry

NASA Astrophysics Data System (ADS)

Kanayama, Naohiro; Niwayama, Masatsugu

2014-06-01

The best way to assess fetal condition is to observe the oxygen status of the fetus (as well as to assess the condition of infants, children, and adults). Previously, several fetal oximeters have been developed; however, no instrument has been utilized in clinical practice because of the low-capturing rate of the fetal oxygen saturation. To overcome the problem, we developed a doctor's finger-mounted fetal tissue oximeter, whose sensor volume is one hundredth of the conventional one. Additionally, we prepared transparent gloves. The calculation algorithm of the hemoglobin concentration was derived from the light propagation analysis based on the transport theory. We measured neonatal and fetal oxygen saturation (StO2) with the new tissue oximeter. Neonatal StO was measured at any position of the head regardless of amount of hair. Neonatal StO was found to be around 77%. Fetal StO was detected in every position of the fetal head during labor regardless of the presence of labor pain. Fetal StO without labor pain was around 70% in the first stage of labor and around 60% in the second stage of labor. We concluded that our new concept of fetal tissue oximetry would be useful for detecting fetal StO in any condition of the fetus.

Clinical application of pulse transit time and correlation with intrapartum fetal heart rate monitoring: a preliminary study of 18 full-term infants.

PubMed

Kawagoe, Yasuyuki; Sameshima, Hiroshi; Ikenoue, Tsuyomu

2008-07-01

The authors show that pulse transit time and blood pressure are reciprocal in fetal goat models. They applied this technique in clinical settings to correlate changes in pulse transit time with fetal heart rate monitoring patterns and acid-base status. In 18 uncomplicated pregnancies, pulse transit time was obtained from electrocardiograms to pulse oximeter waveform and averaged during each baseline period, defined by the interpretation of fetal heart rate monitoring. According to a > 10% change from the control value, chronological changes were categorized into shortened, unchanged, and prolonged. Pulse transit time was available in 82% +/- 11% of the recordings. In 15 fetuses, 2 (13%) showed prolonged, 7 (47%) showed shortened, and 6 (40%) showed unchanged conditions. Comparisons of the shortened and unchanged categories revealed that severe variable deceleration was significantly increased, and half or more fetuses showed hypoxemia in the shortened category. Shortening of pulse transit time, theoretically indicating a hypertensive condition, was more frequently associated with severe variable decelerations, suggesting that the pulse transit time may supplement the interpretation of fetal heart rate monitoring.

Dynamic tissue phantoms and their use in assessment of a noninvasive optical plethysmography imaging device

NASA Astrophysics Data System (ADS)

Thatcher, Jeffrey E.; Plant, Kevin D.; King, Darlene R.; Block, Kenneth L.; Fan, Wensheng; DiMaio, J. Michael

2014-05-01

Non-contact photoplethysmography (PPG) has been studied as a method to provide low-cost and non-invasive medical imaging for a variety of near-surface pathologies and two dimensional blood oxygenation measurements. Dynamic tissue phantoms were developed to evaluate this technology in a laboratory setting. The purpose of these phantoms was to generate a tissue model with tunable parameters including: blood vessel volume change; pulse wave frequency; and optical scattering and absorption parameters. A non-contact PPG imaging system was evaluated on this model and compared against laser Doppler imaging (LDI) and a traditional pulse oximeter. Results indicate non-contact PPG accurately identifies pulse frequency and appears to identify signals from optically dense phantoms with significantly higher detection thresholds than LDI.

Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement.

PubMed

Touger, Michael; Birnbaum, Adrienne; Wang, Jessica; Chou, Katherine; Pearson, Darion; Bijur, Polly

2010-10-01

We assess agreement between carboxyhemoglobin levels measured by the Rad-57 signal extraction pulse CO-oximeter (RAD), a Food and Drug Administration-approved device for noninvasive bedside measurement, and standard laboratory arterial or venous measurement in a sample of emergency department (ED) patients with suspected carbon monoxide poisoning. The study was a cross-sectional cohort design using a convenience sample of adult and pediatric ED patients in a Level I trauma, burn, and hyperbaric oxygen referral center. Measurement of RAD carboxyhemoglobin was performed simultaneously with blood sampling for laboratory determination of carboxyhemoglobin level. The difference between the measures for each patient was calculated as laboratory carboxyhemoglobin minus carboxyhemoglobin from the carbon monoxide oximeter. The limits of agreement from a Bland-Altman analysis are calculated as the mean of the differences between methods ±1.96 SDs above and below the mean. Median laboratory percentage carboxyhemoglobin level was 2.3% (interquartile range 1 to 8.5; range 0% to 38%). The mean difference between laboratory carboxyhemoglobin values and RAD values was 1.4% carboxyhemoglobin (95% confidence interval [CI] 0.2% to 2.6%). The limits of agreement of differences of measurement made with the 2 devices were -11.6% and 14.4% carboxyhemoglobin. This range exceeded the value of ±5% carboxyhemoglobin defined a priori as clinically acceptable. RAD correctly identified 11 of 23 patients with laboratory values greater than 15% carboxyhemoglobin (sensitivity 48%; 95% CI 27% to 69%). There was one case of a laboratory carboxyhemoglobin level less than 15%, in which the RAD device gave a result greater than 15% (specificity of RAD 96/97=99%; 95% CI 94% to 100%). In the range of carboxyhemoglobin values measured in this sample, the level of agreement observed suggests RAD measurement may not be used interchangeably with standard laboratory measurement. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Effectiveness of Preacclimatization Strategies for High-Altitude Exposure

DTIC Science & Technology

2013-01-01

pulse oximeter (Model 8600, Nonin Medical, Inc., Plymouth, MN). Ventilatory assessments were conducted repeatedly during all phases of each study...progressive rise in arterial oxygen saturation (Sa02, mean ± SE) for 37 men (21) and 22 women (20) while living on the summit of Pikes Peak (4300 m). Men...almost immediately with altitude exposure to compensate for the lower partial pressure of oxygen (P02 ). Nevertheless, the first few days of

Design of a visible-light spectroscopy clinical tissue oximeter.

PubMed

Benaron, David A; Parachikov, Ilian H; Cheong, Wai-Fung; Friedland, Shai; Rubinsky, Boris E; Otten, David M; Liu, Frank W H; Levinson, Carl J; Murphy, Aileen L; Price, John W; Talmi, Yair; Weersing, James P; Duckworth, Joshua L; Hörchner, Uwe B; Kermit, Eben L

2005-01-01

We develop a clinical visible-light spectroscopy (VLS) tissue oximeter. Unlike currently approved near-infrared spectroscopy (NIRS) or pulse oximetry (SpO2%), VLS relies on locally absorbed, shallow-penetrating visible light (475 to 625 nm) for the monitoring of microvascular hemoglobin oxygen saturation (StO2%), allowing incorporation into therapeutic catheters and probes. A range of probes is developed, including noncontact wands, invasive catheters, and penetrating needles with injection ports. Data are collected from: 1. probes, standards, and reference solutions to optimize each component; 2. ex vivo hemoglobin solutions analyzed for StO2% and pO2 during deoxygenation; and 3. human subject skin and mucosal tissue surfaces. Results show that differential VLS allows extraction of features and minimization of scattering effects, in vitro VLS oximetry reproduces the expected sigmoid hemoglobin binding curve, and in vivo VLS spectroscopy of human tissue allows for real-time monitoring (e.g., gastrointestinal mucosal saturation 69+/-4%, n=804; gastrointestinal tumor saturation 45+/-23%, n=14; and p<0.0001), with reproducible values and small standard deviations (SDs) in normal tissues. FDA approved VLS systems began shipping earlier this year. We conclude that VLS is suitable for the real-time collection of spectroscopic and oximetric data from human tissues, and that a VLS oximeter has application to the monitoring of localized subsurface hemoglobin oxygen saturation in the microvascular tissue spaces of human subjects.

Quantitative evaluation of ViOptix's tissue oximeter in an ex-vivo animal model

NASA Astrophysics Data System (ADS)

Mao, Jimmy J. M.; Xu, Ronald; Lash, Bob; Wright, Leigh

2008-02-01

We evaluate the performance of ODISsey TM Tissue Oximeter (ViOptix, Inc., Fremont, CA) against co-oximeter. Concurrent oxygen saturation measurements were made in three dog limbs surgically removed and perfused with an extracorporeal blood circulation system. Oxygen saturation was adjusted in steps ranging from 95% down to 5% as monitored by the co-oximeter. The co-oximeter was used to measure the oxygen saturation of the whole blood drawn from both the arterial and the venous ports of the limb. The tissue oxygenation measured by the ODISsey TM tissue oximeter was compared with the average of the arterial and the venous blood oxygenation measured by the co-oximeter. Linear correlation was observed between the average oxygenation given by the co-oximeter and the ODISseyTM readings, with a root-mean-square difference of 7.6% and the correlation coefficient of 0.941, calculated from N = 194 data points.

Pulse rate variability compared with Heart Rate Variability in children with and without sleep disordered breathing.

PubMed

Dehkordi, Parastoo; Garde, Ainara; Karlen, Walter; Wensley, David; Ansermino, J Mark; Dumont, Guy A

2013-01-01

Heart Rate Variability (HRV), the variation of time intervals between heartbeats, is one of the most promising and widely used quantitative markers of autonomic activity. Traditionally, HRV is measured as the series of instantaneous cycle intervals obtained from the electrocardiogram (ECG). In this study, we investigated the estimation of variation in heart rate from a photoplethysmography (PPG) signal, called pulse rate variability (PRV), and assessed its accuracy as an estimate of HRV in children with and without sleep disordered breathing (SDB). We recorded raw PPGs from 72 children using the Phone Oximeter, an oximeter connected to a mobile phone. Full polysomnography including ECG was simultaneously recorded for each subject. We used correlation and Bland-Altman analysis for comparing the parameters of HRV and PRV between two groups of children. Significant correlation (r > 0.90, p < 0.05) and close agreement were found between HRV and PRV for mean intervals, standard deviation of intervals (SDNN) and the root-mean square of the difference of successive intervals (RMSSD). However Bland-Altman analysis showed a large divergence for LF/HF ratio parameter. In addition, children with SDB had depressed SDNN and RMSSD and elevated LF/HF in comparison to children without SDB. In conclusion, PRV provides the accurate estimate of HRV in time domain analysis but does not reflect precise estimation for parameters in frequency domain.

Assessment of pulse oximeter perfusion index in pediatric caudal block under basal ketamine anesthesia.

PubMed

Xu, Zifeng; Zhang, Jianhai; Shen, Hao; Zheng, Jijian

2013-01-01

Whether pulse oximeter perfusion index (PI) may be applied to detect the onset of caudal block in pediatric patients under ketamine intravenous basal anesthesia is investigated. 40 ASA I, 2-8-year-old boys scheduled for elective circumcision surgery were randomized into two groups. Group I: 20 patients were anesthetized by 2 mg·kg(-1) ketamine intravenous injection (IV) followed by caudal block using 1 mL·kg(-1) lidocaine (1%); Group II: 20 patients were anesthetized by 2 mg·kg(-1) ketamine IV only. PI on the toe in Group II decreased by 33 ± 12%, 71 ± 9% and 65 ± 8% at 1 min, 15 min, and 30 min after ketamine injection. The maximum increase in MAP and HR after ketamine IV was 11 ± 6% at 3 min and 10 ± 6% at 2 min. Compared to the PI value before caudal injection of lidocaine, PI in Group I increased by 363 ± 318% and 778 ± 578% at 5 min and 20 min after caudal block, while no significant changes in MAP and HR were found compared to the baseline before caudal block. Thus, PI provides an earlier, more objective, and more sensitive indicator to assess the early onset of caudal block under basal ketamine anesthesia.

Comparison of oxygen saturation values obtained from fingers on physically restrained or unrestrained sides of the body.

PubMed

Korhan, Esra Akin; Yönt, Gülendam Hakverdioğlu; Khorshid, Leyla

2011-01-01

The aim of this study was to compare semiexperimentally the pulse oximetry values obtained from a finger on restrained or unrestrained sides of the body. The pulse oximeter provides a noninvasive measurement of the oxygen saturation of hemoglobin in arterial blood. One of the procedures most frequently applied to patients in intensive care units is the application of physical restraint. Circulation problems are the most important complication in patients who are physically restrained. Evaluation of oxygen saturation from body parts in which circulation is impeded or has deteriorated can cause false results. The research sample consisted of 30 hospitalized patients who participated in the study voluntarily and who were concordant with the inclusion criteria of the study. Patient information and patient follow-up forms were used for data collection. Pulse oximetry values were measured simultaneously using OxiMax Nellcor finger sensors from fingers on the restrained and unrestrained sides of the body. Numeric and percentile distributions were used in evaluating the sociodemographic properties of patients. A significant difference was found between the oxygen saturation values obtained from a finger of an arm that had been physically restrained and a finger of an arm that had not been physically restrained. The mean oxygen saturation value measured from a finger of an arm that had been physically restrained was found to be 93.40 (SD, 2.97), and the mean oxygen saturation value measured from a finger of an arm that had not been physically restrained was found to be 95.53 (SD, 2.38). The results of this study indicate that nurses should use a finger of an arm that is not physically restrained when evaluating oxygen saturation values to evaluate them correctly.

21 CFR 870.2700 - Oximeter.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Oximeter. 870.2700 Section 870.2700 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Monitoring Devices § 870.2700 Oximeter. (a) Identification. An oximeter is...

21 CFR 870.2700 - Oximeter.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oximeter. 870.2700 Section 870.2700 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Monitoring Devices § 870.2700 Oximeter. (a) Identification. An oximeter is...

Pleth variability index and respiratory system compliance to direct PEEP settings in mechanically ventilated patients, an exploratory study.

PubMed

Zhou, Jing; Han, Yi

2016-01-01

To analyze the ability of pleth variability index (PVI) and respiratory system compliance (RSC) on evaluating the hemodynamic and respiratory effects of positive end expiratory pressure (PEEP), then to direct PEEP settings in mechanically ventilated critical patients. We studied 22 mechanically ventilated critical patients in the intensive care unit. Patients were monitored with classical monitor and a pulse co-oximeter, with pulse sensors attached to patients' index fingers. Hemodynamic data [heart rate (HR), perfusion index (PI), PVI, central venous pressure (CVP), mean arterial pressure (MAP), peripheral blood oxygen saturation (SPO2), peripheral blood oxygen content (SPOC) and peripheral blood hemoglobin (SPHB)] as well as the respiratory data [respiratory rate (RR), tidal volume (VT), RSC and controlled airway pressure] were recorded for 15 min each at 3 different levels of PEEP (0, 5 and 10 cmH2O). Different levels of PEEP (0, 5 and 10 cmH2O) had no obvious effect on RR, HR, MAP, SPO2 and SPOC. However, 10 cmH2O PEEP induced significant hemodynamic disturbances, including decreases of PI, and increases of both PVI and CVP. Meanwhile, 5 cmH2O PEEP induced no significant changes on hemodynamics such as CVP, PI and PVI, but improved the RSC. RSC and PVI may be useful in detecting the hemodynamic and respiratory effects of PEEP, thus may help clinicians individualize PEEP settings in mechanically ventilated patients.

Video-based heart rate monitoring across a range of skin pigmentations during an acute hypoxic challenge.

PubMed

Addison, Paul S; Jacquel, Dominique; Foo, David M H; Borg, Ulf R

2017-11-09

The robust monitoring of heart rate from the video-photoplethysmogram (video-PPG) during challenging conditions requires new analysis techniques. The work reported here extends current research in this area by applying a motion tolerant algorithm to extract high quality video-PPGs from a cohort of subjects undergoing marked heart rate changes during a hypoxic challenge, and exhibiting a full range of skin pigmentation types. High uptimes in reported video-based heart rate (HR vid ) were targeted, while retaining high accuracy in the results. Ten healthy volunteers were studied during a double desaturation hypoxic challenge. Video-PPGs were generated from the acquired video image stream and processed to generate heart rate. HR vid was compared to the pulse rate posted by a reference pulse oximeter device (HR p ). Agreement between video-based heart rate and that provided by the pulse oximeter was as follows: Bias = - 0.21 bpm, RMSD = 2.15 bpm, least squares fit gradient = 1.00 (Pearson R = 0.99, p < 0.0001), with a 98.78% reporting uptime. The difference between the HR vid and HR p exceeded 5 and 10 bpm, for 3.59 and 0.35% of the reporting time respectively, and at no point did these differences exceed 25 bpm. Excellent agreement was found between the HR vid and HR p in a study covering the whole range of skin pigmentation types (Fitzpatrick scales I-VI), using standard room lighting and with moderate subject motion. Although promising, further work should include a larger cohort with multiple subjects per Fitzpatrick class combined with a more rigorous motion and lighting protocol.

Oxygen saturation in the dental pulp of permanent teeth: a critical review.

PubMed

Bruno, Kely Firmino; Barletta, Fernando Branco; Felippe, Wilson Tadeu; Silva, Júlio Almeida; Gonçalves de Alencar, Ana Helena; Estrela, Carlos

2014-08-01

Pulse oximetry is a noninvasive method for assessing vascular health based on oxygen saturation level. The method has recently also been used to assess dental pulp vitality, but a median oxygen saturation level suggestive of normal pulp physiology has not been determined. The objective of this study was to make a critical analysis of the published research to establish the median oxygen saturation for the diagnosis of normal dental pulps in maxillary anterior permanent teeth using pulse oximetry. Studies reporting on the use of pulse oximeters to determine oxygen saturation in dental pulps were retrieved using the MEDLINE, Scientific Electronic Library Online, and Cochrane Central Register of Controlled Trials databases plus a manual search of relevant references cited by selected articles. Different combinations of the terms "oximetry," "oximeter," "pulp," "dental," and "dentistry" were used in the search. Statistical analysis was performed for each group of teeth (central incisors, lateral incisors, and canines) using R statistical software (US EPA ORD NHEERL, Corvallis, OR) and a random effects model (P < .0001) with an I(2) of 99%. Of the 295 articles found, only 6 met the inclusion criteria (472 teeth). Of these, the number of articles included in each analysis (according to tooth group) was as follows: all 6 studies (288 teeth) for central incisors at a median oxygen saturation of 87.73%, 3 studies (90 teeth) for lateral incisors at a median oxygen saturation of 87.24%, and 4 studies (94 teeth) for canines at a median oxygen saturation of 87.26%. The median oxygen saturation in normal dental pulps of permanent central incisors, lateral incisors, and canines was higher than 87%. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The Impact of Averaging Window Length on the “Desaturation” Indexes Obtained Via Overnight Pulse Oximetry at High Altitude

PubMed Central

Cross, Troy J.; Keller-Ross, Manda; Issa, Amine; Wentz, Robert; Taylor, Bryan; Johnson, Bruce

2015-01-01

Study Objectives: To determine the impact of averaging window-length on the “desaturation” indexes (DIs) obtained via overnight pulse oximetry (SpO2) at high altitude. Design: Overnight SpO2 data were collected during a 10-day sojourn at high altitude. SpO2 was obtained using a commercial wrist-worn finger oximeter whose firmware was modified to store unaveraged beat-to-beat data. Simple moving averages of window lengths spanning 2 to 20 cardiac beats were retrospectively applied to beat-to-beat SpO2 datasets. After SpO2 artifacts were removed, the following DIs were then calculated for each of the averaged datasets: oxygen desaturation index (ODI); total sleep time with SpO2 < 80% (TST < 80), and the lowest SpO2 observed during sleep (SpO2 low). Setting: South Base Camp, Mt. Everest (5,364 m elevation). Participants: Five healthy, adult males (35 ± 5 y; 180 ± 1 cm; 85 ± 4 kg). Interventions: N/A. Measurements and Results: 49 datasets were obtained from the 5 participants, totalling 239 hours of data. For all window lengths ≥ 2 beats, ODI and TST < 80 were lower, and SpO2 low was higher than those values obtained from the beat-to-beat SpO2 time series data (P < 0.05). Conclusions: Our findings indicate that increasing oximeter averaging window length progressively underestimates the frequency and magnitude of sleep disordered breathing events at high altitude, as indirectly assessed via the desaturation indexes. Citation: Cross TJ, Keller-Ross M, Issa A, Wentz R, Taylor B, Johnson B. The impact of averaging window length on the “desaturation” indexes obtained via overnight pulse oximetry at high altitude. SLEEP 2015;38(8):1331–1334. PMID:25581919

Diagnosis of obstructive sleep apnea using pulse oximeter derived photoplethysmographic signals.

PubMed

Romem, Ayal; Romem, Anat; Koldobskiy, Dafna; Scharf, Steven M

2014-03-15

Increasing awareness of the high prevalence of obstructive sleep apnea (OSA) and its impact on health in conjunction with high cost, inconvenience, and short supply of in-lab polysomnography (PSG) has led to the development of more convenient, affordable, and accessible diagnostic devices. We evaluated the reliability and accuracy of a single-channel (finger pulse-oximetry) photoplethysmography (PPG)-based device for detection of OSA (Morpheus Ox). Among a cohort of 73 patients referred for in-laboratory evaluation of OSA, 65 were simultaneously monitored with the PPG based device while undergoing PSG. Among these, 19 had significant cardiopulmonary comorbidities. Using the PSG as the "gold standard," the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), as well as the positive likelihood ratio (+LR) for an apnea hypopnea index (AHI)PSG > 5/h and AHIPSG > 15/h were calculated for the PPG. Valid results were available for 65 subjects. Mean age: 52.1 ± 14.2, Male: 52%, and BMI: 36.3 ± 9.7 kg/m(2). Positive correlation was found between PPG-derived and PSG-derived AHI (r = 0.81, p < 0.001). For AHIPSG > 5/h, sensitivity was 80%, specificity 86%, PPV 93%, NPV 68%, and +LR was 5.9. For AHIPSG > 15/h, sensitivity was 70%, specificity 91%, PPV 80%, NPV 85%, and +LR was 7.83. The corresponding areas under the receiver operator curves were 0.91 and 0.9. PPG-derived data compare well with simultaneous in-lab PSG in the diagnosis of suspected OSA among patients with and without cardiopulmonary comorbidities. Romem A; Romem A; Koldobskiy D; Scharf SM. Diagnosis of obstructive sleep apnea using pulse oximeter derived photoplethysmographic signals.

Using a pulse oximeter to determine clinical depth of anesthesia-investigation of the utility of the perfusion index.

PubMed

Krishnamohan, Anirudh; Siriwardana, Viraj; Skowno, Justin J

2016-11-01

Peripheral vasodilation is a well-recognized side effect of general anesthesia, and induces changes in the amplitude of the pulse plethysmograph (PPG) waveform. This can be continuously quantitaed using the Perfusion Index (PI), a ratio of the pulsatile to nonpulsatile signal amplitude in the PPG waveform. We hypothesized that the perfusion index would rise with the induction of anesthesia in children, and fall with emergence, and performed a prospective, observational study to test this. Our primary aim was to test whether the different clinical stages of anesthesia were associated with changes in the perfusion index, and the secondary aim was to test the correlation between the normalized perfusion index and the MAC value. Twenty-one patients between the ages of 1 and 18 undergoing minor procedures with no anticipated painful stimuli were recruited. Patients with significant illnesses were excluded. Data collection commenced with a preinduction baseline, and data were collected continuously, with event marking, until completion of the anesthesia and removal of the pulse oximeter. Data collected included perfusion index, heart rate, and anesthetic gas concentration values. A normalized perfusion index was calculated by subtracting the initial baseline perfusion index value from all perfusion index values, allowing changes, from a standardized initial baseline value of zero, to be analyzed. During induction, the mean normalized perfusion index rose from 0.0 to 4.2, and then declined to 0.470 when the patients returned to consciousness. P < 0.001 using repeated measures anova test. The normalized perfusion index was correlated with MAC values (r 2 = 0.33, 95% CI 0.18-0.47, P < 0.01). The perfusion index changed significantly during different stages of anesthesia. There is a significant correlation between the perfusion index, measured by pulse oximetry, and the MAC value, in pediatric patients undergoing minor procedures. © 2016 John Wiley & Sons Ltd.

Discrepancies between arterial oxygen saturation and functional oxygen saturation measured with pulse oximetry in very preterm infants.

PubMed

Rosychuk, Rhonda J; Hudson-Mason, Ann; Eklund, Dianne; Lacaze-Masmonteil, Thierry

2012-01-01

Discrepancies between pulse oximetry saturation (SpO(2)) and arterial saturation (SaO(2)) at low blood oxygenation values have been previously reported with significant variations among instruments and studies. Whether pulse oximeters that attenuate motion artifact are less prone to such discrepancies is not well known. To prospectively assess the agreement of the Masimo V4 pulse oximeter within the critical 85-95% SpO(2) target range. For all consecutive babies with gestational age <33 weeks, postnatal age <7 days, and an umbilical arterial line, SpO(2) was measured continuously and SaO(2) analyzed on an as-needed basis. Bland-Altman techniques provided estimates of the difference (D = SaO(2) - SpO(2)), standard deviation (SD), and 95% limits of agreement (D ± 2*SD). There were 1,032 measurements (114 babies) with SpO(2) between 85 and 95%. The 95% limits of agreement were -2.0 ± 5.8, -2.4 ± 9.2, and -1.9 ± 5.3 in the SpO(2) categories 85-95, 85-89, and 91-95%, respectively. For the SpO(2) categories 85-89% and 91-95%, only 52% (53/101) and 59% (523/886) of SpO(2) values, respectively, corresponded to the analogous SaO(2) categories. In the 85-89% SpO(2) category, SaO(2) was lower than 85% in 39 of the 101 (39%) measurements. SaO(2) was lower on average than SpO(2) with an increased bias at lower saturation. The -2.4 ± 9.2 95% limits of agreement for SaO(2) - SpO(2) in the 85-89% SpO(2) category suggest that SpO(2) and SaO(2) are not interchangeable and intermittent SaO(2) assessments are warranted when the targeted SpO(2) is within this range. Copyright © 2011 S. Karger AG, Basel.

A two centre observational study of simultaneous pulse oximetry and arterial oxygen saturation recordings in intensive care unit patients.

PubMed

Ebmeier, S J; Barker, M; Bacon, M; Beasley, R C; Bellomo, R; Knee Chong, C; Eastwood, G M; Gilchrist, J; Kagaya, H; Pilcher, J; Reddy, S K; Ridgeon, E; Sarma, N; Sprogis, S; Tanaka, A; Tweedie, M; Weatherall, M; Young, P J

2018-05-01

The influence of variables that might affect the accuracy of pulse oximetry (SpO₂) recordings in critically ill patients is not well established. We sought to describe the relationship between paired SpO₂/SaO₂ (oxygen saturation via arterial blood gas analysis) in adult intensive care unit (ICU) patients and to describe the diagnostic performance of SpO₂ in detecting low SaO₂ and PaO₂. A paired SpO₂/SaO₂ measurement was obtained from 404 adults in ICU. Measurements were used to calculate bias, precision, and limits of agreement. Associations between bias and variables including vasopressor and inotrope use, capillary refill time, hand temperature, pulse pressure, body temperature, oximeter model, and skin colour were estimated. There was no overall statistically significant bias in paired SpO₂/SaO₂ measurements; observed limits of agreement were +/-4.4%. However, body temperature, oximeter model, and skin colour, were statistically significantly associated with the degree of bias. SpO₂ <89% had a sensitivity of 3/7 (42.9%; 95% confidence intervals, CI, 9.9% to 81.6%) and a specificity of 344/384 (89.6%; 95% CI 86.1% to 92.5%) for detecting SaO₂ <89%. The absence of statistically significant bias in paired SpO₂/SaO₂ in adult ICU patients provides support for the use of pulse oximetry to titrate oxygen therapy. However, SpO₂ recordings alone should be used cautiously when SaO₂ recordings of 4.4% higher or lower than the observed SpO₂ would be of concern. A range of variables relevant to the critically ill had little or no effect on bias.

Natural motion of the optic nerve head revealed by high speed phase-sensitive OCT

NASA Astrophysics Data System (ADS)

OHara, Keith; Schmoll, Tilman; Vass, Clemens; Leitgeb, Rainer A.

2013-03-01

We use phase-sensitive optical coherence tomography (OCT) to measure the deformation of the optic nerve head during the pulse cycle, motivated by the possibility that these deformations might be indicative of the progression of glaucoma. A spectral-domain OCT system acquired 100k A-scans per second, with measurements from a pulse-oximeter recorded simultaneously, correlating OCT data to the subject's pulse. Data acquisition lasted for 2 seconds, to cover at least two pulse cycles. A frame-rate of 200-400 B-scans per second results in a sufficient degree of correlated speckle between successive frames that the phase-differences between fames can be extracted. Bulk motion of the entire eye changes the phase by several full cycles between frames, but this does not severely hinder extracting the smaller phase-changes due to differential motion within a frame. The central cup moves about 5 μm/s relative to the retinal-pigment-epithelium edge, with tissue adjacent to blood vessels showing larger motion.

Full scattering profile for detecting physiological tissue properties

NASA Astrophysics Data System (ADS)

Duadi, Hamootal; Fixler, Dror

2017-02-01

Light reflectance and transmission from soft tissue has been utilized in noninvasive clinical measurement devices such as the photoplethysmograph (PPG) and reflectance pulse oximeter. Most methods of near infrared (NIR) spectroscopy focus on the volume reflectance from a semi-infinite sample, while very few measure transmission. We have previously shown that examining the full scattering profile (FSP), which is the angular distribution of exiting photons, provides more comprehensive information when measuring from a cylindrical tissue, such as earlobe, fingertip and pinched tissue. Our hypothesis is that the change in blood vessel diameter is more significant than the change in optical properties. The findings of this work demonstrate a realistic model for optical tissue measurements such as NIR spectroscopy, PPG and pulse oximetery.

Comparison of tissue oximeters on a liquid phantom with adjustable optical properties

PubMed Central

Kleiser, S.; Nasseri, N.; Andresen, B.; Greisen, G.; Wolf, M.

2016-01-01

The SafeBoosC trial showed that cerebral oximetry combined with a treatment guideline can reduce the the burden of hypoxia in neonates by 50% [Brit. Med. J. 350, g7635 (2015)25569128]. However, guidelines based on oximetry by one oximeter are not directly usable by other oximeters. We made a blood-lipid phantom simulating the neonatal head to determine the relation between oxygenation values obtained by different oximeters. We calculated coefficients for easy conversion from one oximeter to the other. We additionally determined the corresponding SafeBoosC intervention thresholds at which we measured an uncertainty of up to 9.2% when varying hemoglobin content from 25μM to 70μM. In conclusion, this paper makes the comparison of absolute values obtained by different oximeters possible. PMID:27570691

Clinical assessment of infant colour at delivery

PubMed Central

O'Donnell, Colm P F; Kamlin, C Omar F; Davis, Peter G; Carlin, John B; Morley, Colin J

2007-01-01

Objective Use of video recordings of newborn infants to determine: (1) if clinicians agreed whether infants were pink; and (2) the pulse oximeter oxygen saturation (Spo2) at which infants first looked pink. Methods Selected clips from video recordings of infants taken immediately after delivery were shown to medical and nursing staff. The infants received varying degrees of resuscitation (including none) and were monitored with pulse oximetry. The oximeter readings were obscured to observers but known to the investigators. A timer was visible and the sound was inaudible. The observers were asked to indicate whether each infant was pink at the beginning, became pink during the clip, or was never pink. If adjudged to turn pink during the clip, observers recorded the time this occurred and the corresponding Spo2 was determined. Results 27 clinicians assessed videos of 20 infants (mean (SD) gestation 31(4) weeks). One infant (5%) was perceived to be pink by all observers. The number of clinicians who thought each of the remaining 19 infants were never pink varied from 1 (4%) to 22 (81%). Observers determined the 10 infants with a maximum Spo2 ⩾95% never pink on 17% (46/270) of occasions. The Spo2 at which individual infants were perceived to turn pink varied from 10% to 100%. Conclusion Among clinicians observing the same videos there was disagreement about whether newborn infants looked pink with wide variation in the Spo2 when they were considered to become pink. PMID:17613535

Preliminary clinical investigations of a new noninvasive venous pulse oximeter

NASA Astrophysics Data System (ADS)

Chan, Daniel; Smith, Peter R.; Caine, Michael P.; Spyt, Tomasz; Boehm, Maria; Machin, David

2003-10-01

For decades, the monitoring of mixed venous oxygen saturation, SvO2 has been performed invasively using fibre-optic catheters. This procedure is not without risk as complications may arise from catheterisation. The group has devised a new non-invasive venous oximetry method which involves inducing regular modulations of the venous blood volume and associated measurement of those modulations using optical means. A clinical investigation was conducted in Glenfield Hospital, UK to evaluate the sensitivity of the new technique to haemodynamic changes such as Cardiac Output (CO) in intraoperative and postoperative cardiac patients. Preliminary trials on patients recovering from cardiac surgery yielded an average correlation of r = 0.72 between CO at different Intra Aortic Balloon Pump (IABP) augmentation levels and SvO2 measured by the new venous oximeter. In intraoperative patients undergoing off-pump cardiac surgery, SvO2 recorded by the new technique responded to unplanned events such as a cardiac arrest. CONCLUSION: The new venous oximetry technique is a promising technique which responds to haemodynamic changes such as CO and with further development might offer an alternative means of monitoring SvO2 non-invasively.

Clinical nurses' knowledge level on pulse oximetry: A descriptive multi-centre study.

PubMed

Milutinović, Dragana; Repić, Gordana; Aranđelović, Branimirka

2016-12-01

The aim of this study was to assess the level of knowledge on pulse oximetry among nurses. Understanding this is important because insufficient knowledge can lead to misinterpretation of pulse oximetry readings and consequently compromise patient safety. The study was cross-sectional and included a sample of 198 nurses. A modified questionnaire by Kiekkas et al. was used as the research tool. Intensive care units, anaesthesiology and emergency departments in two tertiary health care institutions in Serbia. Principles of pulse oximeter function and conditions that can affect accuracy and reliability of pulse oximetry readings. The lower percentage of correct responses about principles of pulse oximetry function was found in items related with the alarm reliability and understanding technical limitations. The factors that might affect pulse oximetry readings which were not identified by the nurses at a satisfactory level were the body position and specific kinds of ambient light. The mean scores of knowledge level were significantly different regarding departments (p=0.015). Since this study revealed a lower level of knowledge in some aspects of pulse oximetry, it can be concluded that the generally firm belief that "experience is everything" can be challenged. This fact is important for the quality of health care and the patient's safety. Copyright © 2016 Elsevier Ltd. All rights reserved.

Prognostic value of nocturnal pulse oximetry in patients with heart failure.

PubMed

Rivera-López, Ricardo; Jordán-Martínez, Laura; López-Fernández, Silvia; Rivera-Fernandez, Ricardo; Tercedor, Luis; Sáez-Roca, Germán

2018-05-23

To analyze the prognostic value of nocturnal hypoxemia measured with portable nocturnal pulse-oximetry in patients hospitalized due to heart failure and its relation to mortality and hospital readmission. We included 38 patients who were admitted consecutively to our unit with the diagnosis of decompensated heart failure. Pulse-oximetry was considered positive for hypoxemia when more than 10 desaturations per hour were recorded during sleep. Follow-up was performed for 30.3 (standard deviation [SD] 14.2) months, the main objective being a combined endpoint of all-cause mortality and hospital readmission due to heart failure. The average age was 70.7 (SD 10.7) years, 63.3% were males. Pulse-oximetry was considered positive for hypoxemia in 27 (71%) patients. Patients with positive pulse-oximetry had the most frequent endpoint (9.1% [1] vs. 61.5% [16], P = 0.003). After multivariate analysis, continuous nocturnal hypoxemia was related to the combined endpoint (HR = 8.37, 1.19-68.4, P = 0.03). Patients hospitalized for heart failure and nocturnal hypoxemia measured with portable pulse-oximeter have an increased risk of hospital readmission and death. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Near-Infrared Spectroscopy to Reduce Prophylactic Fasciotomies for and Missed Cases of Acute Compartment Syndrome in Soldiers Injured in OEF/OIF

DTIC Science & Technology

2014-10-01

validate the accuracy and reliability of a specific NIRS sensor (Equanox, Nonin , Inc, Plymouth, MN) in diagnosing acute compartment syndrome in...clinical studies (the Nonin EquanoxTM 7600 oximeter) is for monitoring regional tissue oxygenation. This device has been validated and is currently...between Nonin , Inc and J+M Shuler – Completed in Year 2 4b: Begin reduction to practice process – Completed in Period 4. The process of reducing to

Nuclear sensor signal processing circuit

DOEpatents

Kallenbach, Gene A [Bosque Farms, NM; Noda, Frank T [Albuquerque, NM; Mitchell, Dean J [Tijeras, NM; Etzkin, Joshua L [Albuquerque, NM

2007-02-20

An apparatus and method are disclosed for a compact and temperature-insensitive nuclear sensor that can be calibrated with a non-hazardous radioactive sample. The nuclear sensor includes a gamma ray sensor that generates tail pulses from radioactive samples. An analog conditioning circuit conditions the tail-pulse signals from the gamma ray sensor, and a tail-pulse simulator circuit generates a plurality of simulated tail-pulse signals. A computer system processes the tail pulses from the gamma ray sensor and the simulated tail pulses from the tail-pulse simulator circuit. The nuclear sensor is calibrated under the control of the computer. The offset is adjusted using the simulated tail pulses. Since the offset is set to zero or near zero, the sensor gain can be adjusted with a non-hazardous radioactive source such as, for example, naturally occurring radiation and potassium chloride.

Tracking Pulse Oximeter Findings Before, During and After Titration of Mandibular Advancement Devices (MAD) for Patients With Mild to Moderate Obstructive Sleep Apnea (OSA)

DTIC Science & Technology

2015-06-01

CP AP because of claustrophobia, noise, nose bleeds, dermatitis and nasal bridge sores. In many cases, these effects are due to incorrect pressure...checked for contact data in case a subject must be contacted due to scheduling problems, or some new information is learned that a subject needs to know...Subject initiated contacts via phone or email to the PI with respect to adverse events, side effects or questions will be recorded on an electronic log

The Use of Dexamethasone in Support of High-Altitude Ground Operations: Review of the Literature & Current Training of U.S. Special Operations Medical Members

DTIC Science & Technology

2013-03-14

Dexamethasone increased maximal aerobic capacity compared with placebo. For example, pulse oximeter oxygen saturation at rest was significantly lower...IHE for 6 to 7 days reduces AMS by an estimated 20% and increases oxygen saturation levels by 1% to 3%. Several IHE protocols exist, but none have... oxygen kinetics (pɘ.05) and reduced ventilator equivalent for CO2 (pɘ.01); no significant difference in peak O2 saturation between groups

Design and implementation of a sigma delta technology based pulse oximeter's acquisition stage

NASA Astrophysics Data System (ADS)

Rossi, E. E.; Peñalva, A.; Schaumburg, F.

2011-12-01

Pulse oximetry is a widely used tool in medical practice for estimating patient's fraction of hemoglobin bonded to oxygen. Conventional oximetry presents limitations when changes in the baseline, or low amplitude of signals involved occur. The aim of this paper is to simultaneously solve these constraints and to simplify the circuitry needed, by using ΣΔ technology. For this purpose, a board for the acquisition of the needed signals was developed, together with a PC managed software which controls it, and displays and processes in real time the information acquired. Also laboratory and field tests where designed and executed to verify the performance of this equipment in adverse situations. A simple, robust and economic instrument was achieved, capable of obtaining signals even in situations where conventional oximetry fails.

21 CFR 870.1230 - Fiberoptic oximeter catheter.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Fiberoptic oximeter catheter. 870.1230 Section 870.1230 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1230 Fiberoptic oximeter...

21 CFR 870.1230 - Fiberoptic oximeter catheter.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Fiberoptic oximeter catheter. 870.1230 Section 870.1230 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1230 Fiberoptic oximeter...

Development and Validation of a Smartphone Heart Rate Acquisition Application for Health Promotion and Wellness Telehealth Applications

PubMed Central

Gregoski, Mathew J.; Mueller, Martina; Vertegel, Alexey; Shaporev, Aleksey; Jackson, Brenda B.; Frenzel, Ronja M.; Sprehn, Sara M.; Treiber, Frank A.

2012-01-01

Objective. Current generation smartphones' video camera technologies enable photoplethysmographic (PPG) acquisition and heart rate (HR) measurement. The study objective was to develop an Android application and compare HRs derived from a Motorola Droid to electrocardiograph (ECG) and Nonin 9560BT pulse oximeter readings during various movement-free tasks. Materials and Methods. HRs were collected simultaneously from 14 subjects, ages 20 to 58, healthy or with clinical conditions, using the 3 devices during 5-minute periods while at rest, reading aloud under observation, and playing a video game. Correlation between the 3 devices was determined, and Bland-Altman plots for all possible pairs of devices across all conditions assessed agreement. Results. Across conditions, all device pairs showed high correlations. Bland-Altman plots further revealed the Droid as a valid measure for HR acquisition. Across all conditions, the Droid compared to ECG, 95% of the data points (differences between devices) fell within the limits of agreement. Conclusion. The Android application provides valid HRs at varying levels of movement free mental/perceptual motor exertion. Lack of electrode patches or wireless sensor telemetric straps make it advantageous for use in mobile-cell-phone-delivered health promotion and wellness programs. Further validation is needed to determine its applicability while engaging in physical movement-related activities. PMID:22272197

Development and validation of a smartphone heart rate acquisition application for health promotion and wellness telehealth applications.

PubMed

Gregoski, Mathew J; Mueller, Martina; Vertegel, Alexey; Shaporev, Aleksey; Jackson, Brenda B; Frenzel, Ronja M; Sprehn, Sara M; Treiber, Frank A

2012-01-01

Objective. Current generation smartphones' video camera technologies enable photoplethysmographic (PPG) acquisition and heart rate (HR) measurement. The study objective was to develop an Android application and compare HRs derived from a Motorola Droid to electrocardiograph (ECG) and Nonin 9560BT pulse oximeter readings during various movement-free tasks. Materials and Methods. HRs were collected simultaneously from 14 subjects, ages 20 to 58, healthy or with clinical conditions, using the 3 devices during 5-minute periods while at rest, reading aloud under observation, and playing a video game. Correlation between the 3 devices was determined, and Bland-Altman plots for all possible pairs of devices across all conditions assessed agreement. Results. Across conditions, all device pairs showed high correlations. Bland-Altman plots further revealed the Droid as a valid measure for HR acquisition. Across all conditions, the Droid compared to ECG, 95% of the data points (differences between devices) fell within the limits of agreement. Conclusion. The Android application provides valid HRs at varying levels of movement free mental/perceptual motor exertion. Lack of electrode patches or wireless sensor telemetric straps make it advantageous for use in mobile-cell-phone-delivered health promotion and wellness programs. Further validation is needed to determine its applicability while engaging in physical movement-related activities.

Saturation measurement accuracy in clinical near-infrared cerebral oximeters with a 3D-printed channel array phantom

NASA Astrophysics Data System (ADS)

Afshari, Ali; Ghassemi, Pejhman; Halprin, Molly; Lin, Jonathan; Weininger, Sandy; Gandjbakhche, Amir H.; Wang, Jianting; Pfefer, Joshua

2018-02-01

Clinical cerebral oximeters based on near-infrared spectroscopy (NIRS) are a commonly used, non-invasive tool for intraoperative monitoring of hemoglobin saturation. Research to verify performance of cerebral oximeters in human subject trials has shown differences between commercially available devices. Test methods based on tissue-simulating phantoms have been proposed to augment clinical findings. While prior studies have focused on liquid phantoms, this work is aimed at developing methods based on solid polymer phantoms that are stable. Specifically, we have designed and fabricated a neonatal/pediatric head mimicking layered phantoms based on a 3D-printed cerebral matrix incorporating an array of vessel-simulating linear channels. Superficial layers incorporating homogeneous molded polydimethylsiloxane (PDMS) slabs were fabricated to represent CSF, scalp and skull regions. The cerebral matrix was filled with bovine blood desaturated with sodium dithionite to achieve oxygenation levels across the 40-90% range. Measurements were performed with a commercially available cerebral oximeter using two probes with different illumination-collection geometries, as designed for neonatal and pediatric patients. Reference measurements of samples were performed with a CO-oximeter before injection and after extraction. Results from applied cerebral oximeters indicate a strong sensitivity to the thickness of the superficial layer of the phantom. Better correlation with the reference CO-oximeter results were obtained in the superficial layer thickness of 0.8-2.5 mm range. Channel array phantoms with modular superficial layers represent a promising approach for performance testing of NIRS-based cerebral oximeters.

The Accuracy of Noninvasive Peripheral Pulse Oximetry After Palliative Cardiac Surgery in Patients With Cyanotic Congenital Heart Disease.

PubMed

Scrimgeour, Gemma E; Griksaitis, Michael J; Pappachan, John V; Baldock, Andrew J

2017-01-01

Children with cyanotic congenital heart disease (CCHD) live with oxyhemoglobin saturations that are typically expressed as percentages in the range of 70s and 80s. Peripheral pulse oximetry (measurement of SpO 2 ) performs poorly in this range and yet is widely used to inform clinical decisions in these patients. The reference standard is co-oximetry of arterial samples (SaO 2 ). In this study, 515 paired measurements of SpO 2 and SaO 2 were taken from 19 children who had undergone palliative cardiac surgery. SpO 2 (Masimo SET LNCS Neo pulse oximeter) overestimated oxyhemoglobin saturation in 82% of measurements (mean 4.6% ± 6.6%). There was a strong negative correlation between mean bias and SaO 2 ( r = -.96, P = .002, 95% confidence interval: -0.99 to -0.68). The results raise a concern that critical hypoxemia may go undetected and untreated if pulse oximetry is relied upon as the primary means of assessing oxyhemoglobin saturation in children with CCHD. Strong preference must be given to co-oximetry of arterial samples.

Multispectral imaging of organ viability during uterine transplantation surgery

NASA Astrophysics Data System (ADS)

Clancy, Neil T.; Saso, Srdjan; Stoyanov, Danail; Sauvage, Vincent; Corless, David J.; Boyd, Michael; Noakes, David E.; Thum, Meen-Yau; Ghaem-Maghami, Sadaf; Smith, J. R.; Elson, Daniel S.

2014-02-01

Uterine transplantation surgery has been proposed as a treatment for permanent absolute uterine factor infertility (AUFI) in the case of loss of the uterus. Due to the complexity of the vasculature correct reanastomosis of the blood supply during transplantation surgery is a crucial step to ensure reperfusion and viability of the organ. While techniques such as fluorescent dye imaging have been proposed to visualise perfusion there is no gold standard for intraoperative visualisation of tissue oxygenation. In this paper results from a liquid crystal tuneable filter (LCTF)-based multispectral imaging (MSI) laparoscope are described. The system was used to monitor uterine oxygen saturation (SaO2) before and after transplantation. Results from surgeries on two animal models (rabbits and sheep) are presented. A feature-based registration algorithm was used to correct for misalignment induced by breathing or peristalsis in the tissues of interest prior to analysis. An absorption spectrum was calculated at each spatial pixel location using reflectance data from a reference standard, and the relative contributions from oxy- and deoxyhaemoglobin were calculated using a least squares regression algorithm with non-negativity constraints. Results acquired during animal surgeries show that cornual oxygenation changes are consistent with those observed in point measurements taken using a pulse oximeter, showing reduced SaO2 following reanastomosis. Values obtained using the MSI laparoscope were lower than those taken with the pulse oximeter, which may be due to the latter's use of the pulsatile arterial blood signal. Future work incorporating immunological test results will help to correlate SaO2 levels with surgical outcomes.

Comparison of smartphone application-based vital sign monitors without external hardware versus those used in clinical practice: a prospective trial.

PubMed

Alexander, John C; Minhajuddin, Abu; Joshi, Girish P

2017-08-01

Use of healthcare-related smartphone applications is common. However, there is concern that inaccurate information from these applications may lead patients to make erroneous healthcare decisions. The objective of this study is to study smartphone applications purporting to measure vital sign data using only onboard technology compared with monitors used routinely in clinical practice. This is a prospective trial comparing correlation between a clinically utilized vital sign monitor (Propaq CS, WelchAllyn, Skaneateles Falls, NY, USA) and four smartphone application-based monitors Instant Blood Pressure, Instant Blood Pressure Pro, Pulse Oximeter, and Pulse Oximeter Pro. We performed measurements of heart rate (HR), systolic blood pressures (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO 2 ) using standard monitor and four smartphone applications. Analysis of variance was used to compare measurements from the applications to the routine monitor. The study was completed on 100 healthy volunteers. Comparison of routine monitor with the smartphone applications shows significant differences in terms of HR, SpO 2 and DBP. The SBP values from the applications were not significantly different from those from the routine monitor, but had wide limits of agreement signifying a large degree of variation in the compared values. The degree of correlation between monitors routinely used in clinical practice and the smartphone-based applications studied is insufficient to recommend clinical utilization. This lack of correlation suggests that the applications evaluated do not provide clinically meaningful data. The inaccurate data provided by these applications can potentially contribute to patient harm.

The perfusion index derived from a pulse oximeter for predicting low superior vena cava flow in very low birth weight infants.

PubMed

Takahashi, S; Kakiuchi, S; Nanba, Y; Tsukamoto, K; Nakamura, T; Ito, Y

2010-04-01

Superior vena cava (SVC) flow is used as an index for evaluating systemic blood flow in neonates. Thus far, several reports have shown that low SVC flow is a risk factor for intraventricular hemorrhage (IVH) in the preterm infant. Therefore, it is likely to be a useful index in the management of the preterm infant. The perfusion index (PI) derived from a pulse oximeter is a marker that allows noninvasive and continuous monitoring of peripheral perfusion. The objective of this paper was to determine the accuracy of the PI for detecting low SVC flow in very low birth weight infants born before 32 weeks of gestation. We studied the correlation between PI and SVC flow 0 to 72 h after birth in very low birth weight infants born before 32 weeks of gestation. The best cut-off value for low SVC flow was calculated from the respective receiver-operating characteristic curves. A positive correlation was found between the PI and SVC flow (r=0.509, P<0.001). The best cut-off value for the PI to detect low SVC flow was 0.44 (sensitivity 87.5%, specificity 86.3%, positive predictive value 38.9%, negative predictive value 98.6%). This study found that the PI was associated with SVC flow, and it was a useful index for detecting low SVC flow in very low birth weight infants born before 32 weeks of gestation. Therefore, use of the PI should be evaluated in the cardiovascular management of the preterm infant.

21 CFR 870.2710 - Ear oximeter.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ear oximeter. 870.2710 Section 870.2710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Monitoring Devices § 870.2710 Ear oximeter. (a) Identification. An ear...

21 CFR 870.2710 - Ear oximeter.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ear oximeter. 870.2710 Section 870.2710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Monitoring Devices § 870.2710 Ear oximeter. (a) Identification. An ear...

mPneumonia, an Innovation for Diagnosing and Treating Childhood Pneumonia in Low-Resource Settings: A Feasibility, Usability and Acceptability Study in Ghana

PubMed Central

Ginsburg, Amy Sarah; Tawiah Agyemang, Charlotte; Ambler, Gwen; Delarosa, Jaclyn; Brunette, Waylon; Levari, Shahar; Larson, Clarice; Sundt, Mitch; Newton, Sam; Borriello, Gaetano; Anderson, Richard

2016-01-01

Pneumonia is the leading cause of infectious disease mortality in children. Currently, health care providers (HCPs) are trained to use World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and manually assess respiratory rate to diagnose pneumonia in low-resource settings (LRS). However, this approach of relying on clinical signs alone has proven problematic. Hypoxemia, a diagnostic indicator of pneumonia severity associated with an increased risk of death, is not assessed because pulse oximetry is often not available in LRS. To improve HCPs’ ability to diagnose, classify, and manage pneumonia and other childhood illnesses, “mPneumonia” was developed. mPneumonia is a mobile health application that integrates a digital version of the IMCI algorithm with a software-based breath counter and a pulse oximeter. A design-stage qualitative pilot study was conducted to assess feasibility, usability, and acceptability of mPneumonia in six health centers and five community-based health planning and services centers in Ghana. Nine health administrators, 30 HCPs, and 30 caregivers were interviewed. Transcribed interview audio recordings were coded and analyzed for common themes. Health administrators reported mPneumonia would be feasible to implement with approval and buy-in from national and regional decision makers. HCPs felt using the mPneumonia application would be feasible to integrate into their work with the potential to improve accurate patient care. They reported it was “easy to use” and provided confidence in diagnosis and treatment recommendations. HCPs and caregivers viewed the pulse oximeter and breath counter favorably. Challenges included electricity requirements for charging and the time needed to complete the application. Some caregivers saw mPneumonia as a sign of modernity, increasing their trust in the care received. Other caregivers were hesitant or confused about the new technology. Overall, this technology was valued by users and is a promising innovation for improving quality of care in frontline health facilities. PMID:27788179

High sensitive pulse oximeter-spectrophotometer for laser-optical dosimetry in biology and medicine

NASA Astrophysics Data System (ADS)

Asimov, M. M.; Asimov, R. M.; Rubinov, A. N.; Mamilov, S. A.; Plaksiy, Yu. S.

2006-03-01

High sensitive multi channel pulse oxymeter - spectrophotometer for control of the local tissue oxygen saturation is presented. Due to an original method of data storing and processing the accuracy of measurements 3-4 times are increased in compare with similar systems. This system is used for registration of the local changes of arterial blood saturation with oxygen under effect of low intensity laser radiation. It is shown that the photodissociation of oxyhemoglobin in cutaneous blood vessels play a dominant role in the mechanism of biostimulating and therapeutic effect of low intensity laser radiation. The results of experimental investigation in vivo the dependence of arterial oxygen blood saturation on temperature and the wavelength of laser radiation are presented. It is suggested that dosimetry for laser therapy could be base on regulation of local concentration of free oxygen in tissue.

Evaluation of peripheral perfusion in term newborns before and after Yintang (EX-HN 3) massage.

PubMed

Tugcu, Ali Ulas; Cabioglu, Tugrul; Abbasoglu, Aslihan; Ecevit, Ayse; Ince, Deniz Anuk; Tarcan, Aylin

2015-12-01

To identify how acupressure on the acupoint Yintang (EX-HN 3) impacts oxygen saturation, pulse rate, and peripheral perfusion in term-born infants without underlying disease. Infants born between weeks 37 and 42 of gestation were included in this study. The polyclinic's neonatology room was noise-controlled and made half-dark to prevent the perfusion index from being confounded. A pulse oximeter was linked to the baby's left lower extremity. Acupressure was applied on Yintang (EX-HN 3) for 30 s clockwise, held for 30 s, and then acupressure was applied for another 30 s counterclockwise. The baby's SaO2, pulse rate, and perfusion index were recorded for each minute before and after acupressure. When pre- and post-acupressure pulse rate values were compared, a significant decrease in pulse rate values after acupressure application was observed. When pre- and post-acupressure oxygen saturation values were compared, a significant increase in post-acupressure oxygen saturation was observed. In addition, peripheral perfusion increased significantly after acupressure. Acupressure application has been used in traditional medicine for many years. However, it is not yet widely used in modern medicine. This study shows the impact of acupressure on neonatal skin perfusion, oxygen saturation, and pulse rate.

Estimation of heart rate and heart rate variability from pulse oximeter recordings using localized model fitting.

PubMed

Wadehn, Federico; Carnal, David; Loeliger, Hans-Andrea

2015-08-01

Heart rate variability is one of the key parameters for assessing the health status of a subject's cardiovascular system. This paper presents a local model fitting algorithm used for finding single heart beats in photoplethysmogram recordings. The local fit of exponentially decaying cosines of frequencies within the physiological range is used to detect the presence of a heart beat. Using 42 subjects from the CapnoBase database, the average heart rate error was 0.16 BPM and the standard deviation of the absolute estimation error was 0.24 BPM.

RAPID COMMUNICATION: A novel time frequency-based 3D Lissajous figure method and its application to the determination of oxygen saturation from the photoplethysmogram

NASA Astrophysics Data System (ADS)

Addison, Paul S.; Watson, James N.

2004-11-01

We present a novel time-frequency method for the measurement of oxygen saturation using the photoplethysmogram (PPG) signals from a standard pulse oximeter machine. The method utilizes the time-frequency transformation of the red and infrared PPGs to derive a 3D Lissajous figure. By selecting the optimal Lissajous, the method provides an inherently robust basis for the determination of oxygen saturation as regions of the time-frequency plane where high- and low-frequency signal artefacts are to be found are automatically avoided.

Effects of a Taser: Conducted Energy Weapon on the Circulating Red-Blood-Cell Population and Other Factors in Sus scrofa

DTIC Science & Technology

2013-03-30

canvas sling. Heart rate, respiration rate, and oxygen saturation were monitored continuously using a pulse oximeter (VetOx G2 Digital, Heska Corporation...Pre Post 30 min Mean SD Median Range Mean SD Median Range Mean SD Median Range Oxygen saturation % 93.7 2.1 93.7 91–97 63.2* 17.4 66.5 36.7–91.3 92.2...as actin in human RBC membranes [29] and human neutrophils [34]. Discussion General findings Changes in heart rate, venous-blood oxygen saturation

CameraHRV: robust measurement of heart rate variability using a camera

NASA Astrophysics Data System (ADS)

Pai, Amruta; Veeraraghavan, Ashok; Sabharwal, Ashutosh

2018-02-01

The inter-beat-interval (time period of the cardiac cycle) changes slightly for every heartbeat; this variation is measured as Heart Rate Variability (HRV). HRV is presumed to occur due to interactions between the parasym- pathetic and sympathetic nervous system. Therefore, it is sometimes used as an indicator of the stress level of an individual. HRV also reveals some clinical information about cardiac health. Currently, HRV is accurately measured using contact devices such as a pulse oximeter. However, recent research in the field of non-contact imaging Photoplethysmography (iPPG) has made vital sign measurements using just the video recording of any exposed skin (such as a person's face) possible. The current signal processing methods for extracting HRV using peak detection perform well for contact-based systems but have poor performance for the iPPG signals. The main reason for this poor performance is the fact that current methods are sensitive to large noise sources which are often present in iPPG data. Further, current methods are not robust to motion artifacts that are common in iPPG systems. We developed a new algorithm, CameraHRV, for robustly extracting HRV even in low SNR such as is common with iPPG recordings. CameraHRV combined spatial combination and frequency demodulation to obtain HRV from the instantaneous frequency of the iPPG signal. CameraHRV outperforms other current methods of HRV estimation. Ground truth data was obtained from FDA-approved pulse oximeter for validation purposes. CameraHRV on iPPG data showed an error of 6 milliseconds for low motion and varying skin tone scenarios. The improvement in error was 14%. In case of high motion scenarios like reading, watching and talking, the error was 10 milliseconds.

Perfusion index derived from a pulse oximeter can predict the incidence of hypotension during spinal anaesthesia for Caesarean delivery.

PubMed

Toyama, S; Kakumoto, M; Morioka, M; Matsuoka, K; Omatsu, H; Tagaito, Y; Numai, T; Shimoyama, M

2013-08-01

Hypotension during spinal anaesthesia for Caesarean delivery is a result of decreased vascular resistance due to sympathetic blockade and decreased cardiac output due to blood pooling in blocked areas of the body. Change in baseline peripheral vascular tone due to pregnancy may affect the degree of such hypotension. The perfusion index (PI) derived from a pulse oximeter has been used for assessing peripheral perfusion dynamics due to changes in peripheral vascular tone. The aim of this study was to examine whether baseline PI could predict the incidence of spinal anaesthesia-induced hypotension during Caesarean delivery. Parturients undergoing elective Caesarean delivery under spinal anaesthesia with hyperbaric bupivacaine 10 mg and fentanyl 20 μg were enrolled in this prospective study. The correlation between baseline PI and the degree of hypotension during spinal anaesthesia and also the predictability of spinal anaesthesia-induced hypotension during Caesarean delivery by PI were investigated. Baseline PI correlated with the degree of decreases in systolic and mean arterial pressure (r=0.664, P<0.0001 and r=0.491, P=0.0029, respectively). The cut-off PI value of 3.5 identified parturients at risk for spinal anaesthesia-induced hypotension with a sensitivity of 81% and a specificity of 86% (P<0.001). The change of PI in parturients with baseline PI ≤ 3.5 was not significant during the observational period, while PI in parturients with baseline PI>3.5 demonstrated marked decreases after spinal injection. We demonstrated that higher baseline PI was associated with profound hypotension and that baseline PI could predict the incidence of spinal anaesthesia-induced hypotension during Caesarean delivery.

[Five years after the Spanish neonatal resuscitation survey. Are we improving?].

PubMed

Iriondo, M; Izquierdo, M; Salguero, E; Aguayo, J; Vento, M; Thió, M

2016-05-01

An analysis is presented of delivery room (DR) neonatal resuscitation practices in Spanish hospitals. A questionnaire was sent by e-mail to all hospitals attending deliveries in Spain. A total of 180 questionnaires were sent, of which 155 were fully completed (86%). Less than half (71, 46%) were level i or ii hospitals, while 84 were level iii hospital (54%). In almost three-quarters (74.2%) of the centres, parents and medical staff were involved in the decision on whether to start resuscitation or withdraw it. A qualified resuscitation team (at least two members) was available in 80% of the participant centres (63.9% level i-ii, and 94.0% level iii, P<.001). Neonatal resuscitation courses were held in 90.3% of the centres. The availability of gas blenders, pulse oximeters, manual ventilators, and plastic wraps was higher in level iii hospitals. Plastic wraps for pre-term hypothermia prevention were used in 63.9% of the centres (40.8% level i-iiand 83.3% level iii, P<.001). Term newborn resuscitation was started on room air in 89.7% of the centres. A manual ventilator (T-piece) was the device used in most cases when ventilation was required (42.3% level i-iiand 78.6% level iii, P<.001). Early CPAP in preterm infants was applied in 91.7% of the tertiary hospitals. In last 5 years some practices have improved, such neonatal resuscitation training, pulse oximeter use, or early CPAP support. There is an improvement in some practices of neonatal resuscitation. Significant differences have been found as regards the equipment or practices in the DR, when comparing hospitals of different levels of care. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Noninvasive Measurement of Hemoglobin Using Spectrophotometry: Is it Useful for the Critically Ill Child?

PubMed

Akyildiz, Basak

2018-01-01

This study compared the accuracy of noninvasively measuring hemoglobin using spectrophotometry (SpHb) with a pulse CO-oximeter and laboratory hemoglobin (Hb) measurements. A total of 345 critically ill children were included prospectively. Age, sex, and factors influencing the reliabilityof SpHb such as SpO2, heart rate, perfusion index (PI), and vasoactive inotropic score were recorded. SpHb measurements were recorded during the blood draw and compared with the Hb measurement. Thirteen patients (low PI in 9 patients and no available Hb in 4 patients) were excluded and 332 children were eligible for final analysis. The mean Hb was 8.71±1.49 g/dL (range, 5.9 to 12 g/dL) and the mean SpHb level was 9.55±1.53 g/dL (range, 6 to 14.2 g/dL). The SpHb bias was 0.84±0.86,with the limits of agreement ranging from -2.5 to 0.9 g/dL. The difference between Hb and SpHb was >1.5 g/dL for only 47 patients. Of these, 24 patients had laboratory Hb levels <7 g/dL. There was a weak positive correlation between differences and PI (r=0.349; P= 0.032). The pulse CO-oximeter is a promising tool for measuring SpHb and monitoring critically ill children. However, PI may affect these results. Additional studies investigating the reliability of the trend of continuous SpHb values compared with simultaneously measured laboratory Hb values in the same patient are warranted.

Frequent Oxygen Desaturation During Sleep on the Day of Bronchoscopy Evaluated by Continuous Pulse Oximeter Monitoring.

PubMed

Chojin, Yasuo; Ishimoto, Hiroshi; Noguchi, Shingo; Kawanami, Toshinori; Kato, Tatsuji; Mukae, Hiroshi; Yatera, Kazuhiro

To perform a bronchoscopy safely, it is very important to make a risk assessment before and after the procedure. There have been no reports of hypoxemia during sleep on the day after a bronchoscopic examination; therefore, we evaluated the oxygen saturation status during sleep on the days before and after bronchoscopy. Thirty patients that underwent bronchoscopy were studied. Continuous pulse oximetry monitoring was performed on the day before bronchoscopy and the day when the bronchoscopy was performed. The average oxygen saturation levels and the oxygen desaturation index (ODI) were evaluated. There was a significant increase (P < 0.05) in the ODI-3% during sleep on the day of the bronchoscopy compared to the day before the bronchoscopy. Clinicians should pay careful attention to hypoxia not only during bronchoscopy, but also during sleep on the night following the procedure.

Constrained independent component analysis approach to nonobtrusive pulse rate measurements

NASA Astrophysics Data System (ADS)

Tsouri, Gill R.; Kyal, Survi; Dianat, Sohail; Mestha, Lalit K.

2012-07-01

Nonobtrusive pulse rate measurement using a webcam is considered. We demonstrate how state-of-the-art algorithms based on independent component analysis suffer from a sorting problem which hinders their performance, and propose a novel algorithm based on constrained independent component analysis to improve performance. We present how the proposed algorithm extracts a photoplethysmography signal and resolves the sorting problem. In addition, we perform a comparative study between the proposed algorithm and state-of-the-art algorithms over 45 video streams using a finger probe oxymeter for reference measurements. The proposed algorithm provides improved accuracy: the root mean square error is decreased from 20.6 and 9.5 beats per minute (bpm) for existing algorithms to 3.5 bpm for the proposed algorithm. An error of 3.5 bpm is within the inaccuracy expected from the reference measurements. This implies that the proposed algorithm provided performance of equal accuracy to the finger probe oximeter.

Monitoring patients with continuous-flow ventricular assist devices outside of the intensive care unit: novel challenges to bedside nursing.

PubMed

O'Shea, Genevieve; Teuteberg, Jeffrey J; Severyn, Donald A

2013-03-01

Ventricular assist devices provide therapeutic options for patients with severe heart failure who have exhausted available medical therapies. With restoration of organ perfusion with ventricular assist devices, the heart failure resolves and quality of life and functional status improve. The current generation of continuous-flow devices present novel challenges to the clinical assessment of patients by substantially reducing or nearly eliminating any palpable pulse. Patients therefore generally have inadequate arterial pulsatility for most noninvasive monitoring devices such as pulse oximeters or automated blood pressure cuffs to work accurately. This article describes the function of continuous-flow devices and how this function affects common monitoring options, as well as how to clinically assess recipients of continuous-flow devices to promptly identify those whose condition may be deteriorating or who may be receiving inadequate perfusion.

Constrained independent component analysis approach to nonobtrusive pulse rate measurements.

PubMed

Tsouri, Gill R; Kyal, Survi; Dianat, Sohail; Mestha, Lalit K

2012-07-01

Nonobtrusive pulse rate measurement using a webcam is considered. We demonstrate how state-of-the-art algorithms based on independent component analysis suffer from a sorting problem which hinders their performance, and propose a novel algorithm based on constrained independent component analysis to improve performance. We present how the proposed algorithm extracts a photoplethysmography signal and resolves the sorting problem. In addition, we perform a comparative study between the proposed algorithm and state-of-the-art algorithms over 45 video streams using a finger probe oxymeter for reference measurements. The proposed algorithm provides improved accuracy: the root mean square error is decreased from 20.6 and 9.5 beats per minute (bpm) for existing algorithms to 3.5 bpm for the proposed algorithm. An error of 3.5 bpm is within the inaccuracy expected from the reference measurements. This implies that the proposed algorithm provided performance of equal accuracy to the finger probe oximeter.

Assessment of Pulp Oxygen Saturation Levels by Pulse Oximetry for Pulpal Diseases -A Diagnostic Study.

PubMed

Anusha, Bander; Madhusudhana, Koppolu; Chinni, Suneel Kumar; Paramesh, Yelloji

2017-09-01

Diagnosis of pulpal inflammation is a key to endodontics. Pulse oximetry is a true vitality testing device which relies on oxygen saturation levels of pulp and helps in diagnosis of different pulpal conditions. The aim of the study was to analyse oxygen saturation levels of different pulpally inflamed teeth by using pulse oximetry. Hundred patients were included in the study and categorized into five groups based on pulpal status of the test tooth by using heat test and cold test. Twenty patients were recruited in each of the experimental groups i.e., Reversible Pulpitis (RP), Irreversible Pulpitis (IP), Pulpal Necrosis (PN), Positive Control (PC, healthy teeth), and Negative Control (NC, endodontically treated teeth). Oxygen saturation levels of all the groups were measured along with each patient index finger oxygen saturation readings. Results were analysed by using ANOVA and Tukey HSD tests. The mean oxygen saturation levels of RP, IP, PN, PC and NC were 85.4%, 81.6%, 70.7%, 94.6% and 0 respectively. There was significant difference in the oxygen saturation levels between all the groups. Pulse oximeter is an effective tool in diagnosing different pulpal pathologies especially PN which was interpreted inaccurately by thermal tests.

A Wearable and Highly Sensitive Graphene Strain Sensor for Precise Home-Based Pulse Wave Monitoring.

PubMed

Yang, Tingting; Jiang, Xin; Zhong, Yujia; Zhao, Xuanliang; Lin, Shuyuan; Li, Jing; Li, Xinming; Xu, Jianlong; Li, Zhihong; Zhu, Hongwei

2017-07-28

Profuse medical information about cardiovascular properties can be gathered from pulse waveforms. Therefore, it is desirable to design a smart pulse monitoring device to achieve noninvasive and real-time acquisition of cardiovascular parameters. The majority of current pulse sensors are usually bulky or insufficient in sensitivity. In this work, a graphene-based skin-like sensor is explored for pulse wave sensing with features of easy use and wearing comfort. Moreover, the adjustment of the substrate stiffness and interfacial bonding accomplish the optimal balance between sensor linearity and signal sensitivity, as well as measurement of the beat-to-beat radial arterial pulse. Compared with the existing bulky and nonportable clinical instruments, this highly sensitive and soft sensing patch not only provides primary sensor interface to human skin, but also can objectively and accurately detect the subtle pulse signal variations in a real-time fashion, such as pulse waveforms with different ages, pre- and post-exercise, thus presenting a promising solution to home-based pulse monitoring.

Pulse oximetry in the evaluation of peripheral vascular disease.

PubMed

Jawahar, D; Rachamalla, H R; Rafalowski, A; Ilkhani, R; Bharathan, T; Anandarao, N

1997-08-01

The role of pulse oximetry in the evaluation of peripheral vascular disease (PVD) was investigated. In addition, the value of elevating the limb to improve the sensitivity of detection of PVD by the pulse oximeter was also determined. Pulse oximetry reading in the toes were obtained in 40 young, healthy volunteers and in 40 randomly selected patients referred to the vascular investigation laboratory over a period of two months. All 40 healthy volunteers had normal pulse oximetry readings. Normal pulse oximetry reading in the toes was defined as > 95% O2 Sat and +/-2 of finger pulse oximetry reading. In all 40 patients, pulse oximetry readings were either normal or not detected at all. Since there was no gradation in decrease in the pulse oximetry reading with severity of disease or with elevation of the patient's lower extremity, an absent or no reading was considered as an abnormal result from the test. The frequency of abnormal pulse oximetry readings increased significantly in groups with abnormal ankle-brachial pressure index (ABPI) and also varied significantly with elevation of the patients' lower limbs. In patients with no PVD detected by Doppler (ABPI > 0.9), pulse oximetry readings were normal in all. However, in patients with moderate PVD (ABPI, 0.5-0.9), 84% of the patients' lower limbs had normal pulse oximetry readings and 16% had an abnormal reading at baseline level (flat). An additional 12% of the lower limbs in this group had an abnormal reading on elevation of the limb to 12 inches. In patients with severe PVD (ABPI < 0.5), 54% of the patients' lower limbs had an abnormal reading at baseline and an additional 23% had an abnormal reading at elevation of the limb to 12 inches. In conclusion, pulse oximetry was not a sensitive test for detecting early PVD.

Smartphones and e-tablets in perioperative medicine.

PubMed

Michard, Frederic

2017-10-01

Smartphones and electronic tablets (e-tablets) have become ubiquitous devices. Their ease of use, smartness, accessibility, mobility and connectivity create unique opportunities to improve quality of surgical care from prehabilitation to rehabilitation. Before surgery, digital applications (Apps), serious games and text messaging may help for a better control of risk factors (hypertension, overweight), for smoking cessation, and for optimizing adherence to preoperative recommendations (e.g., regarding anticoagulation or antihypertensive treatments). During surgery, Apps may help to rationalize fluid management and estimate blood loss. After surgery, smartphones and/or connected sensors (pulse oximeter, adhesive path, electronic tattoo, bioimpedance necklace) can be used to monitor body temperature, heart rate, heart rate variability (detection of cardiac arrhythmia), respiratory rate, arterial oxygen saturation and thoracic fluid content. Therefore, these tools have potential for the early detection of infectious, cardiac and respiratory complications in the wards and from home. When connected to echo probes, smartphones and e-tablets can also be used as ultrasound devices during central venous catheter insertion, for peripheral nerve blocks, and to perform echocardiography in patients developing cardiac complications. Finally, electronic checklists now exist as Apps to enhance communication between patients and healthcare professionals, and to track and record step by step each element of the surgical journey. Studies are now urgently needed to investigate whether this digital revolution can translate into a better outcome, an earlier detection of postoperative complications, a decrease in hospital readmissions and in health care costs.

Retinopathy of prematurity and the oxygen conundrum: lessons learned from recent randomized trials.

PubMed

Fleck, Brian W; Stenson, Ben J

2013-06-01

Emerging data from randomised controlled trials of different pulse oximeter oxygen saturation (SpO(2)) target ranges shows that higher SpO(2) targets are associated with a higher risk of severe retinopathy of prematurity. However, the trials have also shown that higher SpO(2) targets are associated with improved survival. In the light of these results and pending the full results for long-term outcome, it is recommended that oxygen saturation targets for preterm infants of gestational age less than 28 weeks at birth should be maintained at or more than 90%. Copyright © 2013 Elsevier Inc. All rights reserved.

Methemoglobinemia with the use of benzocaine spray for awake fiberoptic intubation.

PubMed

Abdel-Aziz, Samer; Hashmi, Nazish; Khan, Sabina; Ismaeil, Mohamed

2013-10-01

We report a case in which the use of benzocaine spray to facilitate awake fiber optic intubation (FOI) in a patient with a difficult airway caused methemoglobinemia intraoperatively. Local benzocaine was sprayed to numb the patient's airway for a total time of one second, fifteen minutes later SpO2 decreased to 85% on the pulse oximeter. Arterial blood gas (ABG) showed a MetHb of 24.6% of total Hemoglobin. The patient was successfully treated with methylene blue intravenously and recovered uneventfully. Small amounts of local benzocaine sprayed to numb the airway can cause significant methemoglobinemia that requires immediate recognition and appropriate management.

In Vivo Monitoring of Hemodynamic Changes during Clogging and Unclogging of Blood Supply for the Application of Clinical Shock Detection

NASA Astrophysics Data System (ADS)

Kanawade, Rajesh; Stelzle, Florian; Schmidt, Michael

This paper presents a novel methodology in early detection of clinical shock by monitoring hemodynamic changes using diffuse reflectance measurement technique. Detailed prototype of the reflectance measurement system and data analysis technique of hemodynamic monitoring was carried out in our laboratory. The real time in-vivo measurements were done from the index finger. This study demonstrates preliminary results of real time monitoring of reduced/- oxyhemoglobin changes during clogging and unclogging of blood flow in the finger tip. The obtained results were verified with pulse-oximeter values, connected to the tip of the same index finger.

Non-contact measurement of oxygen saturation with an RGB camera

PubMed Central

Guazzi, Alessandro R.; Villarroel, Mauricio; Jorge, João; Daly, Jonathan; Frise, Matthew C.; Robbins, Peter A.; Tarassenko, Lionel

2015-01-01

A novel method (Sophia) is presented to track oxygen saturation changes in a controlled environment using an RGB camera placed approximately 1.5 m away from the subject. The method is evaluated on five healthy volunteers (Fitzpatrick skin phenotypes II, III, and IV) whose oxygen saturations were varied between 80% and 100% in a purpose-built chamber over 40 minutes each. The method carefully selects regions of interest (ROI) in the camera image by calculating signal-to-noise ratios for each ROI. This allows it to track changes in oxygen saturation accurately with respect to a conventional pulse oximeter (median coefficient of determination, 0.85). PMID:26417504

Legitimate data in remote monitoring.

PubMed

Schilling, J D

2009-01-01

An approach for ensuring legitimate data transfers of an individual within a remote healthcare solution. Biometric traits and networking are discussed for clarification of the approach. In this approach, a biometric solution is identified as a fingerprint scanner for use in a personal area network of the patient's home. Secure data exchange is acknowledged as a potential weakness in the transferring of patient data within this network. Some options are discussed to ensure security of data for the review by the caregiver. Example approaches regarding legitimacy are identified using a pulse oximeter [1], a blood pressure meter, and a weight scale as the remote patient devices in the remote healthcare solution.

Comparative Efficacy of 2 Topical Anesthetics for the Placement of Orthodontic Temporary Anchorage Devices

PubMed Central

Reznik, Derek S; Jeske, Arthur H; Chen, Jung-Wei; English, Jeryl

2009-01-01

This study compared the effectiveness of topical benzocaine 20% versus a combination of lidocaine, tetracaine, and phenylephrine in providing sufficient analgesia for the placement of orthodontic temporary anchorage devices (TADs). The 2 topical anesthetics were tested against each other bilaterally using a randomized, double-blind, crossover design. The agents were left in place for the amount of time prescribed by the manufacturer. The TAD was then placed, and each subject rated the degree of pain on a Heft-Parker visual analogue scale. A pulse oximeter was used to record the preoperative and postoperative pulse rates. Statistically significant differences in perceived pain (P < .05) and success rate (P < .01) between drugs were seen, but no significant difference in pulse rate change between the topical anesthetics was observed (P > .05). It was concluded that when the efficacy of topical benzocaine and of a combination product was compared as the sole anesthetic to facilitate acceptable pain control for placement of orthodontic temporary anchorage devices, the combination product was considerably more efficacious. PMID:19769421

Algorithmic processing of intrinsic signals in affixed transmission speckle analysis (ATSA) (Conference Presentation)

NASA Astrophysics Data System (ADS)

Ghijsen, Michael T.; Tromberg, Bruce J.

2017-03-01

Affixed Transmission Speckle Analysis (ATSA) is a method recently developed to measure blood flow that is based on laser speckle imaging miniaturized into a clip-on form factor the size of a pulse-oximeter. Measuring at a rate of 250 Hz, ATSA is capable or obtaining the cardiac waveform in blood flow data, referred to as the Speckle-Plethysmogram (SPG). ATSA is also capable of simultaneously measuring the Photoplethysmogram (PPG), a more conventional signal related to light intensity. In this work we present several novel algorithms for extracting physiologically relevant information from the combined SPG-PPG waveform data. First we show that there is a slight time-delay between the SPG and PPG that can be extracted computationally. Second, we present a set of frequency domain algorithms that measure harmonic content on pulse-by-pulse basis for both the SPG and PPG. Finally, we apply these algorithms to data obtained from a set of subjects including healthy controls and individuals with heightened cardiovascular risk. We hypothesize that the time-delay and frequency content are correlated with cardiovascular health; specifically with vascular stiffening.

Photoplethysmography: beyond the calculation of arterial oxygen saturation and heart rate.

PubMed

Shelley, Kirk H

2007-12-01

In this article, I examine the source of the photoplethysmograph (PPG), as well as methods of investigation, with an emphasize on amplitude, rhythm, and pulse analysis. The PPG waveform was first described in the 1930s. Although considered an interesting ancillary monitor, the "pulse waveform" never underwent intensive investigation. Its importance in clinical medicine was greatly increased with the introduction of the pulse oximeter into routine clinical care in the 1980s. Its waveform is now commonly displayed in the clinical setting. Active research efforts are beginning to demonstrate a utility beyond oxygen saturation and heart rate determination. Future trends are being heavily influenced by modern digital signal processing, which is allowing a re-examination of this ubiquitous waveform. Key to unlocking the potential of this waveform is an unfettered access to the raw signal, combined with standardization of its presentation, and methods of analysis. In the long run, we need to learn how to consistently quantify the characteristics of the PPG in such a way as to allow the results from research efforts be translated into clinically useful devices.

Type III home sleep testing versus pulse oximetry: is the respiratory disturbance index better than the oxygen desaturation index to predict the apnoea-hypopnoea index measured during laboratory polysomnography?

PubMed

Dawson, Arthur; Loving, Richard T; Gordon, Robert M; Abel, Susan L; Loewy, Derek; Kripke, Daniel F; Kline, Lawrence E

2015-06-30

In its guidelines on the use of portable monitors to diagnose obstructive sleep apnoea, the American Academy of Sleep Medicine endorses home polygraphy with type III devices recording at a minimum airflow the respiratory effort and pulse oximetry, but advises against simple pulse oximetry. However, oximetry is widely available and simple to use in the home. This study was designed to compare the ability of the oxygen desaturation index (ODI) based on oximetry alone with a stand-alone pulse oximeter (SPO) and from the oximetry channel of the ApneaLink Plus (ALP), with the respiratory disturbance index (RDI) based on four channels from the ALP to predict the apnoea-hypopnoea index (AHI) from laboratory polysomnography. Cross-sectional diagnostic accuracy study. Sleep medicine practice of a multispecialty clinic. Patients referred for laboratory polysomnography with suspected sleep apnoea. We enrolled 135 participants with 123 attempting the home sleep testing and 73 having at least 4 hours of satisfactory data from SPO and ALP. Participants had home testing performed simultaneously with both a SPO and an ALP. The 2 oximeter probes were worn on different fingers of the same hand. The ODI for the SPO was calculated using Profox software (ODI(SOX)). For the ALP, RDI and ODI were calculated using both technician scoring (RDI(MAN) and ODI(MAN)) and the ALP computer scoring (RDI(RAW) and ODI(RAW)). The receiver-operator characteristic areas under the curve for AHI ≥ 5 were RDI(MAN) 0.88 (95% confidence limits 0.81-0.96), RDI(RAW) 0.86 (0.76-0.94), ODI(MAN) 0.86 (0.77-0.95), ODI(RAW) 0.84 (0.75-0.93) and ODI(SOX) 0.83 (0.73-0.93). We conclude that the RDI and the ODI, measured at home on the same night, give similar predictions of the laboratory AHI, measured on a different night. The differences between the two methods are small compared with the reported night-to-night variation of the AHI. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Ventilation-Induced Modulation of Pulse Oximeter Waveforms: A Method for the Assessment of Early Changes in Intravascular Volume During Spinal Fusion Surgery in Pediatric Patients.

PubMed

Alian, Aymen A; Atteya, Gourg; Gaal, Dorothy; Golembeski, Thomas; Smith, Brian G; Dai, Feng; Silverman, David G; Shelley, Kirk

2016-08-01

Scoliosis surgery is often associated with substantial blood loss, requiring fluid resuscitation and blood transfusions. In adults, dynamic preload indices have been shown to be more reliable for guiding fluid resuscitation, but these indices have not been useful in children undergoing surgery. The aim of this study was to introduce frequency-analyzed photoplethysmogram (PPG) and arterial pressure waveform variables and to study the ability of these parameters to detect early bleeding in children during surgery. We studied 20 children undergoing spinal fusion. Electrocardiogram, arterial pressure, finger pulse oximetry (finger PPG), and airway pressure waveforms were analyzed using time domain and frequency domain methods of analysis. Frequency domain analysis consisted of calculating the amplitude density of PPG and arterial pressure waveforms at the respiratory and cardiac frequencies using Fourier analysis. This generated 2 measurements: The first is related to slow mean arterial pressure modulation induced by ventilation (also known as DC modulation when referring to the PPG), and the second corresponds to pulse pressure modulation (AC modulation or changes in the amplitude of pulse oximeter plethysmograph when referring to the PPG). Both PPG and arterial pressure measurements were divided by their respective cardiac pulse amplitude to generate DC% and AC% (normalized values). Standard hemodynamic data were also recorded. Data at baseline and after bleeding (estimated blood loss about 9% of blood volume) were presented as median and interquartile range and compared using Wilcoxon signed-rank tests; a Bonferroni-corrected P value <0.05 was considered statistically significant. There were significant increases in PPG DC% (median [interquartile range] = 359% [210 to 541], P = 0.002), PPG AC% (160% [87 to 251], P = 0.003), and arterial DC% (44% [19 to 84], P = 0.012) modulations, respectively, whereas arterial AC% modulations showed nonsignificant increase (41% [1 to 85], P = 0.12). The change in PPG DC% was significantly higher than that in PPG AC%, arterial DC%, arterial AC%, and systolic blood pressure with P values of 0.008, 0.002, 0.003, and 0.002, respectively. Only systolic blood pressure showed significant changes (11% [4 to 21], P = 0.003) between bleeding phase and baseline. Finger PPG and arterial waveform parameters (using frequency analysis) can track changes in blood volume during the bleeding phase, suggesting the potential for a noninvasive monitor for tracking changes in blood volume in pediatric patients. PPG waveform baseline modulation (PPG DC%) was more sensitive to changes in venous blood volume when compared with respiration-induced modulation seen in the arterial pressure waveform.

Accuracy of Smartphone-Based Pulse Oximetry Compared with Hospital-Grade Pulse Oximetry in Healthy Children.

PubMed

Tomlinson, Sarah; Behrmann, Sydney; Cranford, James; Louie, Marisa; Hashikawa, Andrew

2017-12-07

Pulse oximetry, a ubiquitous, noninvasive method to monitor oxygen saturation (SpO 2 ), requires larger, nonportable equipment. Smartphone pulse oximeter applications (apps) provide a portable, cost-effective option, but are untested in children. We hypothesize that smartphone pulse oximetry will not be inferior to standard pulse oximetry measured in healthy children. Two main types of pulse oximetry apps, a camera-based app (CBA) that uses a phone camera flash and lens and a probe-based app (PBA) that uses an external plug-in probe, were compared with standard pulse oximetry measured in children ages 2-13 years without a respiratory complaint and a triage SpO 2 ≥97% seen in a pediatric Emergency Department. Two investigators obtained heart rate and SpO 2 using each app. Inter-rater reliability was tested using interclass correlations (ICCs), and Bland-Altman method was used to compare app values to triage measurements. Eighty-one patients were enrolled. ICC for SpO 2 for PBA and CBA were 0.73 and -0.24, respectively. The 95% limits of agreement between the PBA SpO 2 and triage SpO 2 were -2.8 to +2.5 compared with -4.1 to +3.5 for the CBA SpO 2 and triage SpO 2 . Mean differences between triage SpO 2 and the PBA SpO 2 (-0.17%) and triage SpO 2 and CBA SpO 2 (-0.33%) were not statistically significant. Smartphone-based pulse oximetry is not inferior to standard pulse oximetry in pediatric patients without hypoxia. Reliability was superior for PBA compared with CBA, with more precise agreement for the PBA compared with the CBA. Future studies should test pulse oximetry apps in a hypoxic pediatric population.

Range gated strip proximity sensor

DOEpatents

McEwan, T.E.

1996-12-03

A range gated strip proximity sensor uses one set of sensor electronics and a distributed antenna or strip which extends along the perimeter to be sensed. A micro-power RF transmitter is coupled to the first end of the strip and transmits a sequence of RF pulses on the strip to produce a sensor field along the strip. A receiver is coupled to the second end of the strip, and generates a field reference signal in response to the sequence of pulse on the line combined with received electromagnetic energy from reflections in the field. The sensor signals comprise pulses of radio frequency signals having a duration of less than 10 nanoseconds, and a pulse repetition rate on the order of 1 to 10 MegaHertz or less. The duration of the radio frequency pulses is adjusted to control the range of the sensor. An RF detector feeds a filter capacitor in response to received pulses on the strip line to produce a field reference signal representing the average amplitude of the received pulses. When a received pulse is mixed with a received echo, the mixing causes a fluctuation in the amplitude of the field reference signal, providing a range-limited Doppler type signature of a field disturbance. 6 figs.

Range gated strip proximity sensor

DOEpatents

McEwan, Thomas E.

1996-01-01

A range gated strip proximity sensor uses one set of sensor electronics and a distributed antenna or strip which extends along the perimeter to be sensed. A micro-power RF transmitter is coupled to the first end of the strip and transmits a sequence of RF pulses on the strip to produce a sensor field along the strip. A receiver is coupled to the second end of the strip, and generates a field reference signal in response to the sequence of pulse on the line combined with received electromagnetic energy from reflections in the field. The sensor signals comprise pulses of radio frequency signals having a duration of less than 10 nanoseconds, and a pulse repetition rate on the order of 1 to 10 MegaHertz or less. The duration of the radio frequency pulses is adjusted to control the range of the sensor. An RF detector feeds a filter capacitor in response to received pulses on the strip line to produce a field reference signal representing the average amplitude of the received pulses. When a received pulse is mixed with a received echo, the mixing causes a fluctuation in the amplitude of the field reference signal, providing a range-limited Doppler type signature of a field disturbance.

Self-Powered Real-Time Arterial Pulse Monitoring Using Ultrathin Epidermal Piezoelectric Sensors.

PubMed

Park, Dae Yong; Joe, Daniel J; Kim, Dong Hyun; Park, Hyewon; Han, Jae Hyun; Jeong, Chang Kyu; Park, Hyelim; Park, Jung Gyu; Joung, Boyoung; Lee, Keon Jae

2017-10-01

Continuous monitoring of an arterial pulse using a pressure sensor attached on the epidermis is an important technology for detecting the early onset of cardiovascular disease and assessing personal health status. Conventional pulse sensors have the capability of detecting human biosignals, but have significant drawbacks of power consumption issues that limit sustainable operation of wearable medical devices. Here, a self-powered piezoelectric pulse sensor is demonstrated to enable in vivo measurement of radial/carotid pulse signals in near-surface arteries. The inorganic piezoelectric sensor on an ultrathin plastic achieves conformal contact with the complex texture of the rugged skin, which allows to respond to the tiny pulse changes arising on the surface of epidermis. Experimental studies provide characteristics of the sensor with a sensitivity (≈0.018 kPa -1 ), response time (≈60 ms), and good mechanical stability. Wireless transmission of detected arterial pressure signals to a smart phone demonstrates the possibility of self-powered and real-time pulse monitoring system. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Accuracy of pulse oximeter readings from probe placement on newborn wrist and ankle.

PubMed

Phattraprayoon, N; Sardesai, S; Durand, M; Ramanathan, R

2012-04-01

To compare the accuracy of pulse oximetry oxygen saturation (SpO(2)) measured on the wrist compared with the ipsilateral palm, and SpO(2) measured on the ankle compared with the ipsilateral sole. In this prospective observational study, neonates admitted to the neonatal intensive care unit were enrolled. We recorded SpO(2) (Masimo Radical-7 pulse oximeter) detected at the palm and ipsilateral wrist initially, then at 30 s, and at 1 min, and we repeated the same procedure over the sole and ipsilateral ankle. We recorded the time to obtain the SpO(2) readings from all these sites. Regression analysis was performed to determine the relationship between paired SpO(2) measurements. The mean difference (bias) and standard deviation of the paired SpO(2) differences (precision) were calculated (Bland-Altman plots). A total of 150 patients (birth weight 2381±1020 g, gestational age 34.3±4.3 weeks, median postnatal age 3.5 days (25th-75th percentile 1-16 days)) were enrolled. There was a good correlation between SpO(2) measured at the palm versus the wrist (r=0.95, P<0.001 (right); r=0.97, P< 0.001 (left)) and between SpO(2) measured at the sole versus the ankle (r=0.92, P<0.001 (right); r=0.91, P<0.001 (left)). There was also a good agreement between paired SpO(2) measurements from these sites. The bias and precision for SpO(2) at the right palm and right wrist was 0.08±0.94% and for the left palm and left wrist 0.22±0.87%. Similarly, the bias and precision for SpO(2) at the right sole and right ankle was -0.03±0.93% and for the left sole and left ankle was -0.01±0.93%. Our results show that the wrist and ankle can be used as alternative sites to measure SpO(2) in newborn infants in place of the routinely used palm or sole.

False positive rate of carbon monoxide saturation by pulse oximetry of emergency department patients.

PubMed

Weaver, Lindell K; Churchill, Susan K; Deru, Kayla; Cooney, Darryl

2013-02-01

Symptoms of carbon monoxide (CO) poisoning are non-specific. Diagnosis requires suspicion of exposure, confirmed by measuring ambient CO levels or carboxyhemoglobin (COHb). An FDA-approved pulse oximeter (Rad-57) can measure CO saturation (S(pCO)). The device accuracy has implications for clinical decision-making. From April 1 to August 15, 2008, study personnel measured S(pCO) and documented demographic factors at time of clinical blood draw, in a convenience sample of 1,363 subjects presenting to the emergency department at Intermountain Medical Center, Murray, Utah. The technician then assayed COHb. COHb and S(pCO) values were compared by subject; false positive or negative values were defined as S(pCO) at least 3 percentage points greater or less than COHb level, reported by the manufacturer to be ± 1 SD in performance. In 1,363 subjects, 613 (45%) were male, 1,141 (84%) were light-skinned, 14 in shock, 4 with CO poisoning, and 122 (9%) met the criteria for a false positive value (range 3-19 percentage points), while 247 (18%) met the criteria for a false negative value (-13 to -3 percentage points). Risks for a false positive S(pCO) reading included being female and having a lower perfusion index. Methemoglobin, body temperature, and blood pressure also appear to influence the S(pCO) accuracy. There was variability among monitors, possibly related to technician technique, as rotation of monitors among technicians was not enforced. While the Rad-57 pulse oximeter functioned within the manufacturer's specifications, clinicians using the Rad-57 should expect some S(pCO) readings to be significantly higher or lower than COHb measurements, and should not use S(pCO) to direct triage or patient management. An elevated S(pCO) could broaden the diagnosis of CO poisoning in patients with non-specific symptoms. However, a negative S(pCO) level in patients suspected of having CO poisoning should never rule out CO poisoning, and should always be confirmed by COHb. © 2013 Daedalus Enterprises.

An approach to improving the signal-to-optical-noise ratio of pulsed magnetic field photonic sensors

NASA Astrophysics Data System (ADS)

Wang, Jiang-ping; Li, Yu-quan

2008-12-01

During last years, interest in pulsed magnetic field sensors has widely increased. In fact, magnetic field measurement has a critical part in various scientific and technical areas. In order to research on pulsed magnetic field characteristic and corresponding measuring and defending means, a sensor with high immunity to electrical noise, high sensitivity, high accuracy and wide dynamic range is needed. The conventional magnetic field measurement system currently use active metallic probes which can disturb the measuring magnetic field and make sensor very sensitive to electromagnetic noise. Photonic magnetic field sensor exhibit great advantages with respect to the electronic ones: a very good galvanic insulation, high sensitivity and very wide bandwidth. Photonic sensing technology is fit for demand of a measure pulsed magnetic field. A type of pulsed magnetic field photonic sensor has been designed, analyzed, and tested. The cross polarization angle in photonic sensor effect on the signal-to-optical-noise ratio is theoretically analyzed in this paper. A novel approach for improving the signal-to-optical-noise ratio of pulsed magnetic field sensors was proposed. The experiments have proved that this approach is practical. The theoretical analysis and simulation results show that the signal-to-optical-noise ratio can potentially be considerably improved by setup suitable for the cross polarization angle.

Video monitoring of oxygen saturation during controlled episodes of acute hypoxia.

PubMed

Addison, Paul S; Foo, David M H; Jacquel, Dominique; Borg, Ulf

2016-08-01

A method for extracting video photoplethysmographic information from an RGB video stream is tested on data acquired during a porcine model of acute hypoxia. Cardiac pulsatile information was extracted from the acquired signals and processed to determine a continuously reported oxygen saturation (SvidO2). A high degree of correlation was found to exist between the video and a reference from a pulse oximeter. The calculated mean bias and accuracy across all eight desaturation episodes were -0.03% (range: -0.21% to 0.24%) and accuracy 4.90% (range: 3.80% to 6.19%) respectively. The results support the hypothesis that oxygen saturation trending can be evaluated accurately from a video system during acute hypoxia.

Automation of Physiologic Data Presentation and Alarms in the Post Anesthesia Care Unit

PubMed Central

Aukburg, S.J.; Ketikidis, P.H.; Kitz, D.S.; Mavrides, T.G.; Matschinsky, B.B.

1989-01-01

The routine use of pulse oximeters, non-invasive blood pressure monitors and electrocardiogram monitors have considerably improved patient care in the post anesthesia period. Using an automated data collection system, we investigated the occurrence of several adverse events frequently revealed by these monitors. We found that the incidence of hypoxia was 35%, hypertension 12%, hypotension 8%, tachycardia 25% and bradycardia 1%. Discriminant analysis was able to correctly predict classification of about 90% of patients into normal vs. hypotensive or hypotensive groups. The system software minimizes artifact, validates data for epidemiologic studies, and is able to identify variables that predict adverse events through application of appropriate statistical and artificial intelligence techniques.

Accuracy of pulse oximetry in children.

PubMed

Ross, Patrick A; Newth, Christopher J L; Khemani, Robinder G

2014-01-01

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.

Wearable sensor glove based on conducting fabric using electrodermal activity and pulse-wave sensors for e-health application.

PubMed

Lee, Youngbum; Lee, Byungwoo; Lee, Myoungho

2010-03-01

Improvement of the quality and efficiency of health in medicine, both at home and the hospital, calls for improved sensors that might be included in a common carrier such as a wearable sensor device to measure various biosignals and provide healthcare services that use e-health technology. Designed to be user-friendly, smart clothes and gloves respond well to the end users for health monitoring. This study describes a wearable sensor glove that is equipped with an electrodermal activity (EDA) sensor, pulse-wave sensor, conducting fabric, and an embedded system. The EDA sensor utilizes the relationship between drowsiness and the EDA signal. The EDA sensors were made using a conducting fabric instead of silver chloride electrodes, as a more practical and practically wearable device. The pulse-wave sensor measurement system, which is widely applied in oriental medicinal practices, is also a strong element in e-health monitoring systems. The EDA and pulse-wave signal acquisition module was constructed by connecting the sensor to the glove via a conductive fabric. The signal acquisition module is then connected to a personal computer that displays the results of the EDA and pulse-wave signal processing analysis and gives accurate feedback to the user. This system is designed for a number of applications for the e-health services, including drowsiness detection and oriental medicine.

Eight-channel time-resolved tissue oximeter for functional muscle studies

NASA Astrophysics Data System (ADS)

Cubeddu, Rinaldo; Biscotti, Giovanni; Pifferi, Antonio; Taroni, Paola; Torricelli, Alessandro; Ferrari, Marco; Quaresima, Valentina

2003-07-01

A portable instrument for tissue oximetry based on time-resolved reflectance spectroscopy was developed. The output pulses of 2 laser diodes (683 and 785 nm, 80 MHz pulse repetition rate, 1 mW average power, 100 ps FWHM) are delayed and coupled into a multimode graded-index fiber (50/125 μm and injected into the tissue. The reflectance photons are collected by 8 independent 1 mm fibers and detected by a 16-anode photomultiplier. A time-correlated single photon counting PC board is used for the parallel acquisition of the curves. Simultaneous estimate of the transport scattering and absorption coefficients is achieved by best fitting of time-resolved reflectance curves with a standard model of Diffusion Theory. The performances of the system were tested on phantoms in terms of stability, reproducibility among channels, and accuracy in the determination of the optical properties. Preliminary in vivo measurements were performed on healthy volunteers to monitor spatial changes in calf (medical and lateral gastrocnemius) oxygen hemoglobin saturation and blood volume during dynamic plantar flexion exercise.

Carboxyhemoglobin: a primer for clinicians.

PubMed

Hampson, Neil B

2018-01-01

One of carbon monoxide's several mechanisms of toxicity is binding with circulating hemoglobin to form carboxyhemoglobin, resulting in a functional anemia. While patients with carbon monoxide poisoning are often said to be "cherry-red," such discoloration is rarely seen. Carboxyhemoglobin levels cannot be measured with conventional pulse oximetry, can be approximated with pulse CO-oximetry, and are most accurately measured with a laboratory CO-oximeter. Carboxyhemoglobin levels are quite stable and can be accurately measured on a transported blood sample. For clinical purposes, arterial and venous carboxyhemoglobin levels can be considered to be equivalent. Carboxyhemoglobin levels are typically lower than 2% in non-smokers and lower than 5% in smokers. A level over 9% is almost always due to exogenous carbon monoxide exposure, even among smokers. Conversely, a low level does not exclude significant exposure under certain circumstances. As carboxyhemoglobin levels of poisoned patients do not correlate with symptoms or outcome, their greatest utility is a marker of exposure. Copyright© Undersea and Hyperbaric Medical Society.

A Fiber Bragg Grating Sensor for Radial Artery Pulse Waveform Measurement.

PubMed

Jia, Dagong; Chao, Jing; Li, Shuai; Zhang, Hongxia; Yan, Yingzhan; Liu, Tiegen; Sun, Ye

2018-04-01

In this paper, we report the design and experimental validation of a novel optical sensor for radial artery pulse measurement based on fiber Bragg grating (FBG) and lever amplification mechanism. Pulse waveform analysis is a diagnostic tool for clinical examination and disease diagnosis. High fidelity radial artery pulse waveform has been investigated in clinical studies for estimating central aortic pressure, which is proved to be predictors of cardiovascular diseases. As a three-dimensional cylinder, the radial artery needs to be examined from different locations to achieve optimal pulse waveform for estimation and diagnosis. The proposed optical sensing system is featured as high sensitivity and immunity to electromagnetic interference for multilocation radial artery pulse waveform measurement. The FBG sensor can achieve the sensitivity of 8.236 nm/N, which is comparable to a commonly used electrical sensor. This FBG-based system can provide high accurate measurement, and the key characteristic parameters can be then extracted from the raw signals for clinical applications. The detecting performance is validated through experiments guided by physicians. In the experimental validation, we applied this sensor to measure the pulse waveforms at various positions and depths of the radial artery in the wrist according to the diagnostic requirements. The results demonstrate the high feasibility of using optical systems for physiological measurement and using this FBG sensor for radial artery pulse waveform in clinical applications.

Accuracy of detection of carboxyhemoglobin and methemoglobin in human and bovine blood with an inexpensive, pocket-size infrared scanner.

PubMed

Bickler, Margot P; Rhodes, Laura J

2018-01-01

Detecting life-threatening common dyshemoglobins such as carboxyhemoglobin (COHb, resulting from carbon monoxide poisoning) or methemoglobin (MetHb, caused by exposure to nitrates) typically requires a laboratory CO-oximeter. Because of cost, these spectrophotometer-based instrument are often inaccessible in resource-poor settings. The aim of this study was to determine if an inexpensive pocket infrared spectrometer and smartphone (SCiO®Pocket Molecular Sensor, Consumer Physics Ltd., Israel) accurately detects COHb and MetHb in single drops of blood. COHb was created by adding carbon monoxide gas to syringes of heparinized blood human or cow blood. In separate syringes, MetHb was produced by addition of sodium nitrite solution. After incubation and mixing, fractional concentrations of COHb or MetHb were measured using a Radiometer ABL-90 Flex® CO-oximeter. Fifty microliters of the sample were then placed on a microscope slide, a cover slip applied and scanned with the SCiO spectrometer. The spectrograms were used to create simple linear models predicting [COHb] or [MetHb] based on spectrogram maxima, minima and isobestic wavelengths. Our model predicted clinically significant carbon monoxide poisoning (COHb ≥15%) with a sensitivity of 93% and specificity of 88% (regression r2 = 0.63, slope P<0.0001), with a mean bias of 0.11% and an RMS error of 21%. Methemoglobinemia severe enough to cause symptoms (>20% MetHb) was detected with a sensitivity of 100% and specificity of 71% (regression r2 = 0.92, slope P<0.001) mean bias 2.7% and RMS error 21%. Although not as precise as a laboratory CO-oximeter, an inexpensive pocket-sized infrared scanner/smartphone detects >15% COHb or >20% MetHb on a single drop of blood with enough accuracy to be useful as an initial clinical screening. The SCiO and similar relatively low cost spectrometers could be developed as inexpensive diagnostic tools for developing countries.

High-resolution ultrasound imaging and noninvasive optoacoustic monitoring of blood variables in peripheral blood vessels

NASA Astrophysics Data System (ADS)

Petrov, Irene Y.; Petrov, Yuriy; Prough, Donald S.; Esenaliev, Rinat O.

2011-03-01

Ultrasound imaging is being widely used in clinics to obtain diagnostic information non-invasively and in real time. A high-resolution ultrasound imaging platform, Vevo (VisualSonics, Inc.) provides in vivo, real-time images with exceptional resolution (up to 30 microns) using high-frequency transducers (up to 80 MHz). Recently, we built optoacoustic systems for probing radial artery and peripheral veins that can be used for noninvasive monitoring of total hemoglobin concentration, oxyhemoglobin saturation, and concentration of important endogenous and exogenous chromophores (such as ICG). In this work we used the high-resolution ultrasound imaging system Vevo 770 for visualization of the radial artery and peripheral veins and acquired corresponding optoacoustic signals from them using the optoacoustic systems. Analysis of the optoacoustic data with a specially developed algorithm allowed for measurement of blood oxygenation in the blood vessels as well as for continuous, real-time monitoring of arterial and venous blood oxygenation. Our results indicate that: 1) the optoacoustic technique (unlike pure optical approaches and other noninvasive techniques) is capable of accurate peripheral venous oxygenation measurement; and 2) peripheral venous oxygenation is dependent on skin temperature and local hemodynamics. Moreover, we performed for the first time (to the best of our knowledge) a comparative study of optoacoustic arterial oximetry and a standard pulse oximeter in humans and demonstrated superior performance of the optoacoustic arterial oximeter, in particular at low blood flow.

A Hybrid Wavelet-Based Method for the Peak Detection of Photoplethysmography Signals.

PubMed

Li, Suyi; Jiang, Shanqing; Jiang, Shan; Wu, Jiang; Xiong, Wenji; Diao, Shu

2017-01-01

The noninvasive peripheral oxygen saturation (SpO 2 ) and the pulse rate can be extracted from photoplethysmography (PPG) signals. However, the accuracy of the extraction is directly affected by the quality of the signal obtained and the peak of the signal identified; therefore, a hybrid wavelet-based method is proposed in this study. Firstly, we suppressed the partial motion artifacts and corrected the baseline drift by using a wavelet method based on the principle of wavelet multiresolution. And then, we designed a quadratic spline wavelet modulus maximum algorithm to identify the PPG peaks automatically. To evaluate this hybrid method, a reflective pulse oximeter was used to acquire ten subjects' PPG signals under sitting, raising hand, and gently walking postures, and the peak recognition results on the raw signal and on the corrected signal were compared, respectively. The results showed that the hybrid method not only corrected the morphologies of the signal well but also optimized the peaks identification quality, subsequently elevating the measurement accuracy of SpO 2 and the pulse rate. As a result, our hybrid wavelet-based method profoundly optimized the evaluation of respiratory function and heart rate variability analysis.

A Hybrid Wavelet-Based Method for the Peak Detection of Photoplethysmography Signals

PubMed Central

Jiang, Shanqing; Jiang, Shan; Wu, Jiang; Xiong, Wenji

2017-01-01

The noninvasive peripheral oxygen saturation (SpO2) and the pulse rate can be extracted from photoplethysmography (PPG) signals. However, the accuracy of the extraction is directly affected by the quality of the signal obtained and the peak of the signal identified; therefore, a hybrid wavelet-based method is proposed in this study. Firstly, we suppressed the partial motion artifacts and corrected the baseline drift by using a wavelet method based on the principle of wavelet multiresolution. And then, we designed a quadratic spline wavelet modulus maximum algorithm to identify the PPG peaks automatically. To evaluate this hybrid method, a reflective pulse oximeter was used to acquire ten subjects' PPG signals under sitting, raising hand, and gently walking postures, and the peak recognition results on the raw signal and on the corrected signal were compared, respectively. The results showed that the hybrid method not only corrected the morphologies of the signal well but also optimized the peaks identification quality, subsequently elevating the measurement accuracy of SpO2 and the pulse rate. As a result, our hybrid wavelet-based method profoundly optimized the evaluation of respiratory function and heart rate variability analysis. PMID:29250135

Characterization of an electrochemical mercury sensor using alternating current, cyclic, square wave and differential pulse voltammetry.

PubMed

Guerreiro, Gabriela V; Zaitouna, Anita J; Lai, Rebecca Y

2014-01-31

Here we report the characterization of an electrochemical mercury (Hg(2+)) sensor constructed with a methylene blue (MB)-modified and thymine-containing linear DNA probe. Similar to the linear probe electrochemical DNA sensor, the resultant sensor behaved as a "signal-off" sensor in alternating current voltammetry and cyclic voltammetry. However, depending on the applied frequency or pulse width, the sensor can behave as either a "signal-off" or "signal-on" sensor in square wave voltammetry (SWV) and differential pulse voltammetry (DPV). In SWV, the sensor showed "signal-on" behavior at low frequencies and "signal-off" behavior at high frequencies. In DPV, the sensor showed "signal-off" behavior at short pulse widths and "signal-on" behavior at long pulse widths. Independent of the sensor interrogation technique, the limit of detection was found to be 10nM, with a linear dynamic range between 10nM and 500nM. In addition, the sensor responded to Hg(2+) rather rapidly; majority of the signal change occurred in <20min. Overall, the sensor retains all the characteristics of this class of sensors; it is reagentless, reusable, sensitive, specific and selective. This study also highlights the feasibility of using a MB-modified probe for real-time sensing of Hg(2+), which has not been previously reported. More importantly, the observed "switching" behavior in SWV and DPV is potentially generalizable and should be applicable to most sensors in this class of dynamics-based electrochemical biosensors. Copyright © 2013 Elsevier B.V. All rights reserved.

Electrocardiogram provides a continuous heart rate faster than oximetry during neonatal resuscitation.

PubMed

Katheria, Anup; Rich, Wade; Finer, Neil

2012-11-01

To compare the time required to obtain a continuous audible heart rate signal from an electrocardiogram (ECG) monitor and pulse oximeter (PO) in infants requiring resuscitation. Infants who had both ECG and PO placed during resuscitation were analyzed using video and analog recordings. The median times from arrival until the ECG electrodes and PO sensor were placed, and the time to achieve audible tones from the devices, were compared. Forty-six infants had ECG and PO data. Thirty infants were very low birth weight (23-30 weeks). There was a difference in the median total time to place either device (26 vs 38 seconds; P = .04), and a difference (P < .001) in the time to achieve an audible heart rate signal after ECG lead (2 seconds) versus PO probe (24 seconds) placement. In infants weighing >1500 g (n = 16), the median time (interquartile range) to place the ECG was 20 seconds (14-43) whereas the time to place the PO was 36 seconds (28-56) (P = .74). The median times (interquartile range) to acquire a signal from the ECG and PO were 4 seconds (1-6) and 32 seconds (15-40, P = .001), respectively. During the first minutes of resuscitation, 93% of infants had an ECG heart rate compared with only 56% for PO. Early application of ECG electrodes during infant resuscitation can provide the resuscitation team with a continuous audible heart rate, and its use may improve the timeliness of appropriate critical interventions.

Smartphones and e-tablets in perioperative medicine

PubMed Central

2017-01-01

Smartphones and electronic tablets (e-tablets) have become ubiquitous devices. Their ease of use, smartness, accessibility, mobility and connectivity create unique opportunities to improve quality of surgical care from prehabilitation to rehabilitation. Before surgery, digital applications (Apps), serious games and text messaging may help for a better control of risk factors (hypertension, overweight), for smoking cessation, and for optimizing adherence to preoperative recommendations (e.g., regarding anticoagulation or antihypertensive treatments). During surgery, Apps may help to rationalize fluid management and estimate blood loss. After surgery, smartphones and/or connected sensors (pulse oximeter, adhesive path, electronic tattoo, bioimpedance necklace) can be used to monitor body temperature, heart rate, heart rate variability (detection of cardiac arrhythmia), respiratory rate, arterial oxygen saturation and thoracic fluid content. Therefore, these tools have potential for the early detection of infectious, cardiac and respiratory complications in the wards and from home. When connected to echo probes, smartphones and e-tablets can also be used as ultrasound devices during central venous catheter insertion, for peripheral nerve blocks, and to perform echocardiography in patients developing cardiac complications. Finally, electronic checklists now exist as Apps to enhance communication between patients and healthcare professionals, and to track and record step by step each element of the surgical journey. Studies are now urgently needed to investigate whether this digital revolution can translate into a better outcome, an earlier detection of postoperative complications, a decrease in hospital readmissions and in health care costs. PMID:29046768

Integrative Gaming: A Framework for Sustainable Game-Based Diabetes Management

PubMed Central

Kahol, Kanav

2011-01-01

Obesity and diabetes have reached epidemic proportions in both developing and developed nations. While doctors and caregivers stress the importance of physical exercise in maintaining a healthy lifestyle, many people have difficulty subscribing to a healthy lifestyle. Virtual reality games offer a potentially exciting aid in accelerating and sustaining behavior change. However, care needs to be taken to develop sustainable models of employing games for the management of diabetes and obesity. In this article, we propose an integrative gaming paradigm designed to combine multiple activities involving physical exercises and cognitive skills through a game-based storyline. The persuasive story acts as a motivational binder that enables a user to perform multiple activities such as running, cycling, and problem solving. These activities guide a virtual character through different stages of the game. While performing the activities in the games, users wear sensors that can measure movement (accelerometers, gyrometers, magnetometers) and sense physiological measures (heart rate, pulse oximeter oxygen saturation). These measures drive the game and are stored and analyzed on a cloud computing platform. A prototype integrative gaming system is described and design considerations are discussed. The system is highly configurable and allows researchers to build games for the system with ease and drive the games with different types of activities. The capabilities of the system allow for engaging and motivating the user in the long term. Clinicians can employ the system to collect clinically relevant data in a seamless manner. PMID:21527096

Microshell-tipped optical fibers as sensors of high-pressure pulses in adverse environments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benjamin, R.F.; Mayer, F.J.; Maynard, R.L.

1984-01-01

An optical-fiber sensor for detecting the arrival of strong pressure pulses was developed. The sensor consists of an optical fiber, tipped with a gas-filled microballoon. They have been used successfully in adverse environments including explosives, ballistics and electromagnetic pulses (EMP). The sensor produces a bright optical pulse caused by the rapid shock-heating of a gas, typically argon or xenon, which is confined in the spherical glass or plastic microballoon. The light pulse is transmitted via the optical fiber to a photo detector, usually a streak camera or photomultiplier tube. The microballoon optical sensor (called an optical pin by analogy tomore » standard electrical pins), was originally developed for diagnosing an explosive, pulsed-power generator. Optical pins are required due to the EMP. The optical pins are economical arrival-time indicators because many channels can be recorded by one streak camera. The generator tests and related experiments, involving projectile velocities and detonation velocities of several kilometers per sec have demonstrated the usefulness of the sensors in explosives and ballistics applications. The technical and cost advantages of this optical pin make it potentially useful for many electromagnetic, explosive, and ballistics applications.« less

Detecting obstructive sleep apnea in children by self-affine visualization of oximetry.

PubMed

Garde, Ainara; Dekhordi, Parastoo; Petersen, Christian L; Ansermino, J Mark; Dumont, Guy A

2017-07-01

Obstructive sleep apnea (OSA), characterized by cessations of breathing during sleep due to upper airway collapse, can affect the healthy growth and development of children. The gold standard for OSA diagnosis, polysomnography(PSG), is expensive and resource intensive, resulting in long waiting lists to perform a PSG. Previously, we investigated the time-frequency analysis of blood oxygen saturation (SpO 2 ) to screen for OSA. We used overnight pulse oximetry from 146 children, collected using a smartphone-based pulse oximeter (Phone Oximeter), simultaneously with standard PSG. Sleep technicians manually scored PSG and provided the average of apnea/hypoapnea events per hour (AHI). In this study, we proposed an alternative method for analyzing SpO 2 , in which a set of contracting transformations form a self-affine set with a 2D attractor, previously developed for qualitative visualization of the photoplethysmogram and electroencephalogram. We applied this technique to the overnight SpO 2 signal from individual patients and extracted features based on the distribution of points (radius and angle) in the visualization. The cloud of points in children without OSA (NonOSA) was more confined than in children with OSA, which was reflected by more empty pixels (radius and angles). The maximum value, skewness and standard deviation of the distribution of points located at different radius and angles were significantly (Bonferroni corrected) higher in NonOSA compared to OSA children. To detect OSA defined at different levels (AHI≥5, AHI≥10 and AHI≥15), three multivariate logistic regression models were implemented using a stepwise feature selection and internally validated through bootstrapping. The models (AHI≥5, AHI≥10, AHI≥15), consisting of 3, 4 and 1 features respectively, provided a bootstrap-corrected AUC of 73%, 81%, 73%. Thus, applying this visualization to nocturnal SpO 2 could yield both visual and quantitative information that might be useful for screening children for OSA.

Total intravenous anaesthesia by boluses or by continuous rate infusion of propofol in mute swans (Cygnus olor).

PubMed

Müller, Kerstin; Holzapfel, Judith; Brunnberg, Leo

2011-07-01

To investigate intravenous (IV) propofol given by intermittent boluses or by continuous rate infusion (CRI) for anaesthesia in swans. Prospective randomized clinical study. Twenty mute swans (Cygnus olor) (eight immature and 12 adults) of unknown sex undergoing painless diagnostic or therapeutic procedures. Induction of anaesthesia was with 8 mg kg(-1) propofol IV. To maintain anaesthesia, ten birds (group BOLI) received propofol as boluses, whilst 10 (group CRI) received propofol as a CRI. Some physiological parameters were measured. Anaesthetic duration was 35 minutes. Groups were compared using Mann-Whitney U-test. Results are median (range). Anaesthetic induction was smooth and tracheal intubation was achieved easily in all birds. Bolus dose in group BOLI was 2.9 (1.3-4.3) mg kg(-1); interval between and number of boluses required were 4 (1-8) minutes and 6 (4-11) boluses respectively. Total dose of propofol was 19 (12.3-37.1) mg kg(-1). Awakening between boluses was very abrupt. In group CRI, propofol infusion rate was 0.85 (0.8-0.9) mg kg(-1) minute(-1), and anaesthesia was stable. Body temperature, heart and respiratory rates, oxygen saturation (by pulse oximeter) and reflexes did not differ between groups. Oxygen saturations (from pulse oximeter readings) were low in some birds. Following anaesthesia, all birds recovered within 40 minutes. In 55% of all, transient signs of central nervous system excitement occurred during recovery. 8 mg kg(-1) propofol appears an adequate induction dose for mute swans. For maintenance, a CRI of 0.85 mg kg(-1) minute(-1) produced stable anaesthesia suitable for painless clinical procedures. In contrast bolus administration, was unsatisfactory as birds awoke very suddenly, and the short intervals between bolus requirements hampered clinical procedures. Administration of additional oxygen throughout anaesthesia might reduce the incidence of low arterial haemoglobin saturation. © 2011 The Authors. Veterinary Anaesthesia and Analgesia. © 2011 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.

Microshell-tipped optical fibers as sensors of high-pressure pulses in adverse environments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benjamin, R.F.; Mayer, F.J.; Maynard, R.L.

1984-01-01

We have developed and used an optical-fiber sensor for detecting the arrival of strong pressure pulses. The sensor consists of an optical fiber, tipped with a gas-filled microballoon. They have been used successfully in adverse environments including explosives, ballistics and electromagnetic pulses (EMP). The sensor produces a bright optical pulse caused by the rapid shock-heating of a gas, typically argon or xenon, which is confined in the spherical glass or plastic microballoon. The light pulse is transmitted via the optical fiber to a photo detector, usually a streak camera or photomultiplier tube. The microballoon optical sensor (called an optical pinmore » by analogy to standard electrical pins), was originally developed for diagnosing an explosive, pulsed-power generator. Optical pins are required due to the EMP. The optical pins are economical arrival-time indicators because many channels can be recorded by one streak camera. The generator tests and related experiments, involving projectile velocities and detonation velocities of several kilometers per/sec have demonstrated the usefulness of the sensors in explosives and ballistics applications. We have also measured the sensitivity of the optical pins to slowly-moving projectiles and found that a 200 m/sec projectile impacting the microballoon sensor produces a flash having a risetime less than 100 ns and a pulse duration (FWHM) of less than 300 ns. The technical and cost advantages of this optical pin make it potentially useful for many electromagnetic, explosive, and ballistics applications.« less

Singing Greeting Card Beeper as a Finger Pulse Sensor

ERIC Educational Resources Information Center

Belusic, Gregor; Zupancic, Gregor

2010-01-01

We constructed a robust and low-priced finger pulse sensor from a singing greeting card beeper. The beeper outputs the plethysmographic signal, which is indistinguishable from that of commercial grade sensors. The sensor can be used in school for a number of experiments in human cardiovascular physiology.

Study of extracerebral contamination for three cerebral oximeters by Monte Carlo simulation using CT data

NASA Astrophysics Data System (ADS)

Tarasov, A. P.; Egorov, A. I.; Rogatkin, D. A.

2017-07-01

Using multidetector computed tomography, thicknesses of bone squame and soft tissues of human head were assessed. MC simulation revealed impropriety of source-detector separation distances for 3 oximeters, which can cause extracerebral contamination.

Unconstrained pulse pressure monitoring for health management using hetero-core fiber optic sensor.

PubMed

Nishiyama, Michiko; Sonobe, Masako; Watanabe, Kazuhiro

2016-09-01

In this paper, we present a pulse pressure waveform sensor that does not constrain a wearer's daily activity; the sensor uses hetero-core fiber optics. Hetero-core fiber sensors have been found to be sensitive to moderate bending. To detect minute pulse pressure changes from the radial artery at the wrist, we devised a fiber sensor arrangement using three-point bending supports. We analyzed and evaluated the measurement validity using wavelet transformation, which is well-suited for biological signal processing. It was confirmed that the detected pulse waveform had a fundamental mode frequency of around 1.25 Hz over the time-varying waveform. A band-pass filter with a range of frequencies from 0.85 to 1.7 Hz was used to pick up the fundamental mode. In addition, a high-pass filter with 0.85 Hz frequency eliminated arm motion artifacts; consequently, we achieved high signal-to-noise ratio. For unrestricted daily health management, it is desirable that pulse pressure monitoring can be achieved by simply placing a device on the hand without the sensor being noticed. Two types of arrangements were developed and demonstrated in which the pulse sensors were either embedded in a base, such as an armrest, or in a wearable device. A wearable device without cuff pressure using a sensitivity-enhanced fiber sensor was successfully achieved with a sensitivity of 0.07-0.3 dB with a noise floor lower than 0.01 dB for multiple subjects.

Contact-free heart rate measurement using multiple video data

NASA Astrophysics Data System (ADS)

Hung, Pang-Chan; Lee, Kual-Zheng; Tsai, Luo-Wei

2013-10-01

In this paper, we propose a contact-free heart rate measurement method by analyzing sequential images of multiple video data. In the proposed method, skin-like pixels are firstly detected from multiple video data for extracting the color features. These color features are synchronized and analyzed by independent component analysis. A representative component is finally selected among these independent component candidates to measure the HR, which achieves under 2% deviation on average compared with a pulse oximeter in the controllable environment. The advantages of the proposed method include: 1) it uses low cost and high accessibility camera device; 2) it eases users' discomfort by utilizing contact-free measurement; and 3) it achieves the low error rate and the high stability by integrating multiple video data.

Using optical fibers with different modes to improve the signal-to-noise ratio of diffuse correlation spectroscopy flow-oximeter measurements

PubMed Central

He, Lian; Lin, Yu; Shang, Yu; Shelton, Brent J.

2013-01-01

Abstract. The dual-wavelength diffuse correlation spectroscopy (DCS) flow-oximeter is an emerging technique enabling simultaneous measurements of blood flow and blood oxygenation changes in deep tissues. High signal-to-noise ratio (SNR) is crucial when applying DCS technologies in the study of human tissues where the detected signals are usually very weak. In this study, single-mode, few-mode, and multimode fibers are compared to explore the possibility of improving the SNR of DCS flow-oximeter measurements. Experiments on liquid phantom solutions and in vivo muscle tissues show only slight improvements in flow measurements when using the few-mode fiber compared with using the single-mode fiber. However, light intensities detected by the few-mode and multimode fibers are increased, leading to significant SNR improvements in detections of phantom optical property and tissue blood oxygenation. The outcomes from this study provide useful guidance for the selection of optical fibers to improve DCS flow-oximeter measurements. PMID:23455963

Design of an Oximeter Based on LED-LED Configuration and FPGA Technology

PubMed Central

Stojanovic, Radovan; Karadaglic, Dejan

2013-01-01

A fully digital photoplethysmographic (PPG) sensor and actuator has been developed. The sensing circuit uses one Light Emitting Diode (LED) for emitting light into human tissue and one LED for detecting the reflectance light from human tissue. A Field Programmable Gate Array (FPGA) is used to control the LEDs and determine the PPG and Blood Oxygen Saturation (SpO2). The configurations with two LEDs and four LEDs are developed for measuring PPG signal and Blood Oxygen Saturation (SpO2). N-LEDs configuration is proposed for multichannel SpO2 measurements. The approach resulted in better spectral sensitivity, increased and adjustable resolution, reduced noise, small size, low cost and low power consumption. PMID:23291575

A visible light imaging device for cardiac rate detection with reduced effect of body movement

NASA Astrophysics Data System (ADS)

Jiang, Xiaotian; Liu, Ming; Zhao, Yuejin

2014-09-01

A visible light imaging system to detect human cardiac rate is proposed in this paper. A color camera and several LEDs, acting as lighting source, were used to avoid the interference of ambient light. From people's forehead, the cardiac rate could be acquired based on photoplethysmography (PPG) theory. The template matching method was used after the capture of video. The video signal was discomposed into three signal channels (RGB) and the region of interest was chosen to take the average gray value. The green channel signal could provide an excellent waveform of pulse wave on the account of green lights' absorptive characteristics of blood. Through the fast Fourier transform, the cardiac rate was exactly achieved. But the research goal was not just to achieve the cardiac rate accurately. With the template matching method, the effects of body movement are reduced to a large extent, therefore the pulse wave can be detected even while people are in the moving state and the waveform is largely optimized. Several experiments are conducted on volunteers, and the results are compared with the ones gained by a finger clamped pulse oximeter. The contrast results between these two ways are exactly agreeable. This method to detect the cardiac rate and the pulse wave largely reduces the effects of body movement and can probably be widely used in the future.

Prevention of retinopathy of prematurity in preterm infants through changes in clinical practice and SpO₂technology.

PubMed

Castillo, Armando; Deulofeut, Richard; Critz, Ann; Sola, Augusto

2011-02-01

To identify whether pulse oximetry technology is associated with decreased retinopathy of prematurity (ROP) and laser treatment. Inborn infants <1250 g who had eye exams were compared at two centres in three periods. In Period 1, SpO₂ target was ≥93% and pulse oximetry technology was the same in both Centres. In Period 2, guidelines for SpO₂ 88-93% were implemented at both centres and Centre B changed to oximeters with signal extraction technology (SET(®)) while Centre A did not, but did so in Period 3. One ophthalmology department performed eye exams using international criteria. In 571 newborns <1250 g, birth weight and gestational age were similar in the different periods and centres. At Centre A, severe ROP and need for laser remained the same in Periods 1 and 2, decreasing in Period 3-6% and 3%, respectively. At Centre B, severe ROP decreased from 12% (Period 1) to 5% (Period 2) and need for laser decreased from 5% to 3%, remaining low in Period 3. In a large group of inborn infants <1250 g, a change in clinical practice in combination with pulse oximetry with Masimo SET, but not without it, led to significant reduction in severe ROP and need for laser therapy. Pulse oximetry selection is important in managing critically ill infants. © 2010 The Author(s)/Acta Paediatrica © 2010 Foundation Acta Paediatrica.

ACCURACY OF NONINVASIVE ANESTHETIC MONITORING IN THE ANESTHETIZED GIRAFFE (GIRAFFA CAMELOPARDALIS).

PubMed

Bertelsen, Mads F; Grøndahl, Carsten; Stegmann, George F; Sauer, Cathrine; Secher, Niels H; Hasenkam, J Michael; Damkjær, Mads; Aalkjær, Christian; Wang, Tobias

2017-09-01

This study evaluated the accuracy of pulse oximetry, capnography, and oscillometric blood pressure during general anesthesia in giraffes (Giraffa camelopardalis). Thirty-two giraffes anesthetized for physiologic experiments were instrumented with a pulse oximeter transmittance probe positioned on the tongue and a capnograph sampling line placed at the oral end of the endotracheal tube. A human size 10 blood pressure cuff was placed around the base of the tail, and an indwelling arterial catheter in the auricular artery continuously measured blood pressure. Giraffes were intermittently ventilated using a Hudson demand valve throughout the procedures. Arterial blood for blood gas analysis was collected at multiple time points. Relationships between oxygen saturation as determined by pulse oximetry and arterial oxygen saturation, between arterial carbon dioxide partial pressure and end-tidal carbon dioxide, and between oscillometric pressure and invasive arterial blood pressure were assessed, and the accuracy of pulse oximetry, capnography, and oscillometric blood pressure monitoring evaluated using Bland-Altman analysis. All three noninvasive methods provided relatively poor estimates of the reference values. Receiver operating characteristic curve fitting was used to determine cut-off values for hypoxia, hypocapnia, hypercapnia, and hypotension for dichotomous decision-making. Applying these cut-off values, there was reasonable sensitivity for detection of hypocapnia, hypercapnia, and hypotension, but not for hypoxemia. Noninvasive anesthetic monitoring should be interpreted with caution in giraffes and, ideally, invasive monitoring should be employed.

Monitoring cerebral oxygen saturation during cardiopulmonary bypass using near-infrared spectroscopy: the relationships with body temperature and perfusion rate.

PubMed

Teng, Yichao; Ding, Haishu; Gong, Qingcheng; Jia, Zaishen; Huang, Lan

2006-01-01

During cardiopulmonary bypass (CPB) because of weak arterial pulsation, near-IR spectroscopy (NIRS) is almost the only available method to monitor cerebral oxygenation noninvasively. Our group develops a NIRS oximeter to monitor regional cerebral oxygenation especially its oxygen saturation (rScO2). To achieve optimal coupling between the sensor and human brain, the distances between the light source and the detectors on it are properly chosen. The oximeter is calibrated by blood gas analysis, and the results indicate that its algorithm is little influenced by either background absorption or overlying tissue. We used it to measure the rScO2 of 15 patients during CPB. It is shown that rScO2 is negatively correlated with body temperature and positively with perfusion rate. There are two critical stages during CPB when rScO2 might be relatively low: one is the low-perfusion-rate stage, the other is the early rewarming stage. During cooling, the changes of total hemoglobin concentration (C(tHb)) compared with its original value is also monitored. It is shown that C(tHb) decreases to a small extent, which may mainly reflect cerebral vasoconstriction induced by cooling. All these results indicate that NIRS can be used to monitor cerebral oxygenation to protect cerebral tissue during CPB.

Validation of a Second-Generation Near-Infrared Spectroscopy Monitor in Children With Congenital Heart Disease.

PubMed

Nasr, Viviane G; Bergersen, Lisa T; Lin, Hung-Mo; Benni, Paul B; Bernier, Rachel S; Anderson, Michelle E; Kussman, Barry D

2018-01-09

Cerebral oximetry using near-infrared spectroscopy is a noninvasive optical technology to detect cerebral hypoxia-ischemia and develop interventions to prevent and ameliorate hypoxic brain injury. Cerebral oximeters are calibrated and validated by comparison of the near-infrared spectroscopy-measured cerebral O2 saturation (SctO2) to a "field" or reference O2 saturation (REF CX) calculated as a weighted average from arterial and jugular bulb oxygen saturations. In this study, we calibrated and validated the second-generation, 5 wavelength, FORE-SIGHT Elite with the medium sensor (source-detector separation 12 and 40 mm) for measurement of SctO2 in children with congenital heart disease. After institutional review board approval and written informed consent, 63 children older than 1 month and ≥2.5 kg scheduled for cardiac catheterization were enrolled. Self-adhesive FORE-SIGHT Elite medium sensors were placed on the right and left sides of the forehead. Blood samples for calculation of REF CX were drawn simultaneously from the aorta or femoral artery and the jugular bulb before (T1) and shortly after (T2) baseline hemodynamic measurements. FORE-SIGHT Elite SctO2 measurements were compared to the REF CX (REF CX = [0.3 SaO2] + [0.7 SjbO2]) using Deming regression, least squares linear regression, and Bland-Altman analysis. Sixty-one subjects (4.5 [standard deviation 4.4] years of age; 17 [standard deviation 13] kg, male 56%) completed the study protocol. Arterial oxygen saturation ranged from 64.7% to 99.1% (median 96.0%), jugular bulb venous oxygen saturation from 34.1% to 88.1% (median 68.2%), the REF CX from 43.8% to 91.4% (median 76.9%), and the SctO2 from 47.8% to 90.8% (median 76.3%). There was a high degree of correlation in SctO2 between the right and left sensors at a given time point (within subject between sensor correlation r = 0.91 and 95% confidence interval [CI], 0.85-0.94) or between T1 and T2 for the right and left sensors (replicates, within subject between time point correlation r = 0.95 and 95% CI, 0.92-0.96). By Deming regression, the estimated slope was 0.966 (95% CI, 0.786-1.147; P = .706 for testing against null hypothesis of slope = 1) with a y intercept of 2.776 (95% CI, -11.102 to 16.654; P = .689). The concordance correlation coefficient was 0.873 (95% CI, 0.798-0.922). Bland-Altman analysis for agreement between SctO2 and REF CX that accounted for repeated measures (both in times and sensors) found a bias of -0.30% (95% limits of agreement: -10.56% to 9.95%). This study calibrated and validated the FORE-SIGHT Elite tissue oximeter to accurately measure SctO2 in pediatric patients with the medium sensor.

Three-dimensional spatiotemporal pulse characterization with an acousto-optic pulse shaper and a Hartmann-Shack wavefront sensor.

PubMed

Cousin, Seth L; Bueno, Juan M; Forget, Nicolas; Austin, Dane R; Biegert, J

2012-08-01

We demonstrate a simplified arrangement for spatiotemporal ultrashort pulse characterization called Hartmann-Shack assisted, multidimensional, shaper-based technique for electric-field reconstruction. It employs an acousto-optic pulse shaper in combination with a second-order nonlinear crystal and a Hartmann-Shack wavefront sensor. The shaper is used as a tunable bandpass filter, and the wavefronts and intensities of quasimonochromatic spectral slices of the pulse are obtained using the Hartmann-Shack wavefront sensor. The wavefronts and intensities of the spectral slices are related to one another using shaper-assisted frequency-resolved optical gating measurements, performed at particular points in the beam. This enables a three-dimensional reconstruction of the amplitude and phase of the pulse. We present some example pulse measurements and discuss the operating parameters of the device.

Pulse oximeter oxygen saturation in prediction of arterial oxygen saturation in liver transplant candidates.

PubMed

Ghayumi, Seiyed Mohammad Ali; Khalafi-Nezhad, Abolfazl; Jowkar, Zahra

2014-04-01

Liver transplant is the only definitive treatment for many patients with end stage liver disease. Presence and severity of preoperative pulmonary disease directly affect the rate of postoperative complications of the liver transplantation. Arterial blood gas (ABG) measurement, performed in many transplant centers, is considered as a traditional method to diagnose hypoxemia. Because ABG measurement is invasive and painful, pulse oximetry, a bedside, noninvasive and inexpensive technique, has been recommended as an alternative source for the ABG measurement. The aim of this study was to evaluate the efficacy of pulse oximetry as a screening tool in hypoxemia detection in liver transplant candidates and to compare the results with ABGs. Three hundred and ninety transplant candidates (237 males and 153 females) participated in this study. Arterial blood gas oxyhemoglobin saturation (SaO2) was recorded and compared with pulse oximetry oxyhemoglobin saturation (SpO2) results for each participants. The area under the curve (AUC) of receiver operating characteristic (ROC) curves was calculated by means of nonparametric methods to evaluate the efficacy of pulse oximetry to detect hypoxemia. Roc-derived SpO2 threshold of ≤ 94% can predict hypoxemia (PaO2 < 60 mmHg) with a sensitivity of 100% and a specificity of 95%. Furthermore, there are associations between the ROC-derived SpO2 threshold of ≤ 97% and detection of hypoxemia (PaO2 < 70 mmHg) with a sensitivity of 100% and a specificity of 46%. The accuracy of pulse oximetry was not affected by the severity of liver disease in detection of hypoxemia. Provided that SpO2 is equal to or greater than 94%, attained from pulse oximetry can be used as a reliable and accurate substitute for the ABG measurements to evaluate hypoxemia in patients with end stage liver disease.

Characterization of silicon micro-strip sensors with a pulsed infra-red laser system for the CBM experiment at FAIR

NASA Astrophysics Data System (ADS)

Ghosh, P.

2015-03-01

The Compressed Baryonic Matter (CBM) experiment at FAIR is composed of 8 tracking stations consisting of 1292 double sided silicon micro-strip sensors. For the quality assurance of produced prototype sensors a laser test system (LTS) has been developed. The aim of the LTS is to scan sensors with a pulsed infra-red laser driven by step motor to determine the charge sharing in-between strips and to measure qualitative uniformity of the sensor response over the whole active area. The prototype sensors which are tested with the LTS so far have 256 strips with a pitch of 50 μm on each side. They are read-out using a self-triggering prototype read-out electronic ASIC called n-XYTER. The LTS is designed to measure sensor response in an automatized procedure at several thousand positions across the sensor with focused infra-red laser light (spot size ≈ 12 μm , wavelength = 1060 nm). The pulse with duration (≈ 10 ns) and power (≈ 5 mW) of the laser pulses is selected such, that the absorption of the laser light in the 300 μm thick silicon sensors produces a number of about 24000 electrons, which is similar to the charge created by minimum ionizing particles (MIP) in these sensors. Laser scans different prototype sensors is reported.

High-speed multi-frame dynamic transmission electron microscope image acquisition system with arbitrary timing

DOEpatents

Reed, Bryan W.; DeHope, William J.; Huete, Glenn; LaGrange, Thomas B.; Shuttlesworth, Richard M.

2016-02-23

An electron microscope is disclosed which has a laser-driven photocathode and an arbitrary waveform generator (AWG) laser system ("laser"). The laser produces a train of temporally-shaped laser pulses each being of a programmable pulse duration, and directs the laser pulses to the laser-driven photocathode to produce a train of electron pulses. An image sensor is used along with a deflector subsystem. The deflector subsystem is arranged downstream of the target but upstream of the image sensor, and has a plurality of plates. A control system having a digital sequencer controls the laser and a plurality of switching components, synchronized with the laser, to independently control excitation of each one of the deflector plates. This allows each electron pulse to be directed to a different portion of the image sensor, as well as to enable programmable pulse durations and programmable inter-pulse spacings.

Second-hand smoking and carboxyhemoglobin levels in children: a prospective observational study.

PubMed

Yee, Branden E; Ahmed, Mohammed I; Brugge, Doug; Farrell, Maureen; Lozada, Gustavo; Idupaganthi, Raghu; Schumann, Roman

2010-01-01

To establish baseline noninvasive carboxyhemoglobin (COHb) levels in children and determine the influence of exposure to environmental sources of carbon monoxide (CO), especially environmental tobacco smoke, on such levels. Second-hand smoking may be a risk factor for adverse outcomes following anesthesia and surgery in children (1) and may potentially be preventable. Parents and their children between the ages of 1-12 were enrolled on the day of elective surgery. The preoperative COHb levels of the children were assessed noninvasively using a CO-Oximeter (Radical-7 Rainbow SET Pulse CO-Oximeter; Masimo, Irvine, CA, USA). The parents were asked to complete an environmental air-quality questionnaire. The COHb levels were tabulated and correlated with responses to the survey in aggregate analysis. Statistical analyses were performed using the nonparametric Mann-Whitney and Kruskal-Wallis tests. P < 0.05 was statistically significant. Two hundred children with their parents were enrolled. Children exposed to parental smoking had higher COHb levels than the children of nonsmoking controls. Higher COHb values were seen in the youngest children, ages 1-2, exposed to parental cigarette smoke. However, these trends did not reach statistical significance, and confidence intervals were wide. This study revealed interesting trends of COHb levels in children presenting for anesthesia and surgery. However, the COHb levels measured in our patients were close to the error margin of the device used in our study. An expected improvement in measurement technology may allow screening children for potential pulmonary perioperative risk factors in the future.

Impact of pulse thermal processing on the properties of inkjet printed metal and flexible sensors

DOE PAGES

Joshi, Pooran C.; Kuruganti, Teja; Killough, Stephen M.

2015-03-11

In this paper, we report on the low temperature processing of environmental sensors employing pulse thermal processing (PTP) technique to define a path toward flexible sensor technology on plastic, paper, and fabric substrates. Inkjet printing and pulse thermal processing technique were used to realize mask-less, additive integration of low-cost sensors on polymeric substrates with specific focus on temperature, humidity, and strain sensors. The printed metal line performance was evaluated in terms of the electrical conductivity characteristics as a function of post-deposition thermal processing conditions. The PTP processed Ag metal lines exhibited high conductivity with metal sheet resistance values below 100more » mΩ/{whitesquare} using a pulse width as short as 250 μs. The flexible temperature and relative humidity sensors were defined on flexible polyimide substrates by direct printing of Ag metal structures. The printed resistive temperature sensor and capacitive humidity sensor were characterized for their sensitivity with focus on future smart-building applications. Strain gauges were printed on polyimide substrate to determine the mechanical properties of the silver nanoparticle films. Finally, the observed electrical properties of the printed metal lines and the sensitivity of the flexible sensors show promise for the realization of a high performance print-on-demand technology exploiting low thermal-budget PTP technique.« less

Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial.

PubMed

Cunningham, Steve; Rodriguez, Aryelly; Adams, Tim; Boyd, Kathleen A; Butcher, Isabella; Enderby, Beth; MacLean, Morag; McCormick, Jonathan; Paton, James Y; Wee, Fiona; Thomas, Huw; Riding, Kay; Turner, Steve W; Williams, Chris; McIntosh, Emma; Lewis, Steff C

2015-09-12

The American Academy of Pediatrics recommends a permissive hypoxaemic target for an oxygen saturation of 90% for children with bronchiolitis, which is consistent with the WHO recommendations for targets in children with lower respiratory tract infections. No evidence exists to support this threshold. We aimed to assess whether the 90% or higher target for management of oxygen supplementation was equivalent to a normoxic 94% or higher target for infants admitted to hospital with viral bronchiolitis. We did a parallel-group, randomised, controlled, equivalence trial of infants aged 6 weeks to 12 months of age with physician-diagnosed bronchiolitis newly admitted into eight paediatric hospital units in the UK (the Bronchiolitis of Infancy Discharge Study [BIDS]). A central computer randomly allocated (1:1) infants, in varying length blocks of four and six and without stratification, to be clipped to standard oximeters (patients treated with oxygen if pulse oxygen saturation [SpO2] <94%) or modified oximeters (displayed a measured value of 90% as 94%, therefore oxygen not given until SpO2 <90%). All parents, clinical staff, and outcome assessors were masked to allocation. The primary outcome was time to resolution of cough (prespecified equivalence limits of plus or minus 2 days) in the intention-to-treat population. This trial is registered with ISRCTN, number ISRCTN28405428. Between Oct 3, and March 30, 2012, and Oct 1, and March 29, 2013, we randomly assigned 308 infants to standard oximeters and 307 infants to modified oximeters. Cough resolved by 15·0 days (median) in both groups (95% CI for difference -1 to 2) and so oxygen thresholds were equivalent. We recorded 35 serious adverse events in 32 infants in the standard care group and 25 serious adverse events in 24 infants in the modified care group. In the standard care group, eight infants transferred to a high-dependency unit, 23 were readmitted, and one had a prolonged hospital stay. In the modified care group, 12 infants were transferred to a high-dependency unit and 12 were readmitted to hospital. Recorded adverse events did not differ significantly. Management of infants with bronchiolitis to an oxygen saturation target of 90% or higher is as safe and clinically effective as one of 94% or higher. Future research should assess the benefits and risks of different oxygen saturation targets in acute respiratory infection in older children, particularly in developing nations where resources are scarce. National Institute for Health Research, Health Technology Assessment programme. Copyright © 2015 Cunningham et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by Elsevier Ltd.. All rights reserved.

On better estimating and normalizing the relationship between clinical parameters: comparing respiratory modulations in the photoplethysmogram and blood pressure signal (DPOP versus PPV).

PubMed

Addison, Paul S; Wang, Rui; Uribe, Alberto A; Bergese, Sergio D

2015-01-01

DPOP (ΔPOP or Delta-POP) is a noninvasive parameter which measures the strength of respiratory modulations present in the pulse oximeter waveform. It has been proposed as a noninvasive alternative to pulse pressure variation (PPV) used in the prediction of the response to volume expansion in hypovolemic patients. We considered a number of simple techniques for better determining the underlying relationship between the two parameters. It was shown numerically that baseline-induced signal errors were asymmetric in nature, which corresponded to observation, and we proposed a method which combines a least-median-of-squares estimator with the requirement that the relationship passes through the origin (the LMSO method). We further developed a method of normalization of the parameters through rescaling DPOP using the inverse gradient of the linear fitted relationship. We propose that this normalization method (LMSO-N) is applicable to the matching of a wide range of clinical parameters. It is also generally applicable to the self-normalizing of parameters whose behaviour may change slightly due to algorithmic improvements.

On Better Estimating and Normalizing the Relationship between Clinical Parameters: Comparing Respiratory Modulations in the Photoplethysmogram and Blood Pressure Signal (DPOP versus PPV)

PubMed Central

Addison, Paul S.; Wang, Rui; Uribe, Alberto A.; Bergese, Sergio D.

2015-01-01

DPOP (ΔPOP or Delta-POP) is a noninvasive parameter which measures the strength of respiratory modulations present in the pulse oximeter waveform. It has been proposed as a noninvasive alternative to pulse pressure variation (PPV) used in the prediction of the response to volume expansion in hypovolemic patients. We considered a number of simple techniques for better determining the underlying relationship between the two parameters. It was shown numerically that baseline-induced signal errors were asymmetric in nature, which corresponded to observation, and we proposed a method which combines a least-median-of-squares estimator with the requirement that the relationship passes through the origin (the LMSO method). We further developed a method of normalization of the parameters through rescaling DPOP using the inverse gradient of the linear fitted relationship. We propose that this normalization method (LMSO-N) is applicable to the matching of a wide range of clinical parameters. It is also generally applicable to the self-normalizing of parameters whose behaviour may change slightly due to algorithmic improvements. PMID:25691912

Applications of the Petri net to simulate, test, and validate the performance and safety of complex, heterogeneous, multi-modality patient monitoring alarm systems.

PubMed

Sloane, E B; Gelhot, V

2004-01-01

This research is motivated by the rapid pace of medical device and information system integration. Although the ability to interconnect many medical devices and information systems may help improve patient care, there is no way to detect if incompatibilities between one or more devices might cause critical events such as patient alarms to go unnoticed or cause one or more of the devices to become stuck in a disabled state. Petri net tools allow automated testing of all possible states and transitions between devices and/or systems to detect potential failure modes in advance. This paper describes an early research project to use Petri nets to simulate and validate a multi-modality central patient monitoring system. A free Petri net tool, HPSim, is used to simulate two wireless patient monitoring networks: one with 44 heart monitors and a central monitoring system and a second version that includes an additional 44 wireless pulse oximeters. In the latter Petri net simulation, a potentially dangerous heart arrhythmia and pulse oximetry alarms were detected.

Pulsed Polarization-Based NOx Sensors of YSZ Films Produced by the Aerosol Deposition Method and by Screen-Printing

PubMed Central

Exner, Jörg; Albrecht, Gaby; Schönauer-Kamin, Daniela; Kita, Jaroslaw; Moos, Ralf

2017-01-01

The pulsed polarization technique on solid electrolytes is based on alternating potential pulses interrupted by self-discharge pauses. Since even small concentrations of nitrogen oxides (NOx) in the ppm range significantly change the polarization and discharge behavior, pulsed polarization sensors are well suited to measure low amounts of NOx. In contrast to all previous investigations, planar pulsed polarization sensors were built using an electrolyte thick film and platinum interdigital electrodes on alumina substrates. Two different sensor layouts were investigated, the first with buried Pt electrodes under the electrolyte and the second one with conventional overlying Pt electrodes. Electrolyte thick films were either formed by aerosol deposition or by screen-printing, therefore exhibiting a dense or porous microstructure, respectively. For screen-printed electrolytes, the influence of the electrolyte resistance on the NOx sensing ability was investigated as well. Sensors with buried electrodes showed little to no response even at higher NOx concentrations, in good agreement with the intended sensor mechanism. Electrolyte films with overlying electrodes, however, allowed the quantitative detection of NOx. In particular, aerosol deposited electrolytes exhibited high sensitivities with a sensor output signal ΔU of 50 mV and 75 mV for 3 ppm of NO and NO2, respectively. For screen-printed electrolytes, a clear trend indicated a decrease in sensitivity with increased electrolyte resistance. PMID:28933736

Pulsed Polarization-Based NOx Sensors of YSZ Films Produced by the Aerosol Deposition Method and by Screen-Printing.

PubMed

Exner, Jörg; Albrecht, Gaby; Schönauer-Kamin, Daniela; Kita, Jaroslaw; Moos, Ralf

2017-07-26

The pulsed polarization technique on solid electrolytes is based on alternating potential pulses interrupted by self-discharge pauses. Since even small concentrations of nitrogen oxides (NO x ) in the ppm range significantly change the polarization and discharge behavior, pulsed polarization sensors are well suited to measure low amounts of NO x . In contrast to all previous investigations, planar pulsed polarization sensors were built using an electrolyte thick film and platinum interdigital electrodes on alumina substrates. Two different sensor layouts were investigated, the first with buried Pt electrodes under the electrolyte and the second one with conventional overlying Pt electrodes. Electrolyte thick films were either formed by aerosol deposition or by screen-printing, therefore exhibiting a dense or porous microstructure, respectively. For screen-printed electrolytes, the influence of the electrolyte resistance on the NO x sensing ability was investigated as well. Sensors with buried electrodes showed little to no response even at higher NO x concentrations, in good agreement with the intended sensor mechanism. Electrolyte films with overlying electrodes, however, allowed the quantitative detection of NO x . In particular, aerosol deposited electrolytes exhibited high sensitivities with a sensor output signal Δ U of 50 mV and 75 mV for 3 ppm of NO and NO₂, respectively. For screen-printed electrolytes, a clear trend indicated a decrease in sensitivity with increased electrolyte resistance.

Vital sign monitoring for elderly at home: development of a compound sensor for pulse rate and motion.

PubMed

Sum, K W; Zheng, Y P; Mak, A F T

2005-01-01

This paper describes the development of a miniaturized wearable vital sign monitor which is aimed for use by elderly at home. The development of a compound sensor for pulse rate, motion, and skin temperature is reported. A pair of infrared sensor working in reflection mode was used to detect the pulse rate from various sites over the body including the wrist and finger. Meanwhile, a motion sensor was used to detect the motion of the body. In addition, the temperature on the skin surface was sensed by a semiconductor temperature sensor. A prototype has been built into a box with a dimension of 2 x 2.5 x 4 cm3. The device includes the sensors, microprocessor, circuits, battery, and a wireless transceiver for communicating data with a data terminal.

Pulse oximetry in the pulmonary tissue for the non-invasive measurement of mixed venous oxygen saturation.

PubMed

Nitzan, Meir; Nitzan, Itamar

2013-08-01

The oxygen saturation of the systemic arterial blood is associated with the adequacy of respiration, and can be measured non-invasively by pulse oximetry in the systemic tissue. The oxygen saturation of the blood in the pulmonary artery, the mixed venous blood, reflects the balance between oxygen supply to the systemic tissues and their oxygen demand. The mixed venous oxygen saturation has also clinical significance because it is used in Fick equation for the quantitative measurement of cardiac output. At present the measurement of the mixed venous oxygen saturation is invasive and requires insertion of a Swan-Ganz catheter into the pulmonary artery. We suggest a noninvasive method for the measurement of the mixed venous oxygen saturation in infants, pulmonary pulse oximetry. The method is similar to the systemic pulse oximetry, which is based on the different light absorption curves of oxygenated and deoxygenated hemoglobin and on the analysis of photoplethysmographic curves in two wavelengths. The proposed pulmonary pulse oximeter includes light-sources of two wavelengths in the infrared, which illuminate the pulmonary tissue through the thoracic wall. Part of the light which is scattered back from the pulmonary tissue and passes through the thoracic wall is detected, and for each wavelength a pulmonary photoplethysmographic curve is obtained. The pulmonary photoplethysmographic curves reflect blood volume increase during systole in the pulmonary arteries in the lung tissue, which contain mixed venous blood. The ratio R of the amplitude-to-baseline ratio for the two wavelengths is related to the mixed venous oxygen saturation through equations derived for the systemic pulse oximetry. The method requires the use of extinction coefficients values for oxygenated and deoxygenated hemoglobin, which can be found in the literature. Copyright © 2013 Elsevier Ltd. All rights reserved.

Global operating theatre distribution and pulse oximetry supply: an estimation from reported data.

PubMed

Funk, Luke M; Weiser, Thomas G; Berry, William R; Lipsitz, Stuart R; Merry, Alan F; Enright, Angela C; Wilson, Iain H; Dziekan, Gerald; Gawande, Atul A

2010-09-25

Surgery is an essential part of health care, but resources to ensure the availability of surgical services are often inadequate. We estimated the global distribution of operating theatres and quantified the availability of pulse oximetry, which is an essential monitoring device during surgery and a potential measure of operating theatre resources. We calculated ratios of the number of operating theatres to hospital beds in seven geographical regions worldwide on the basis of profiles from 769 hospitals in 92 countries that participated in WHO's safe surgery saves lives initiative. We used hospital bed figures from 190 WHO member states to estimate the number of operating theatres per 100,000 people in 21 subregions throughout the world. To estimate availability of pulse oximetry, we sent surveys to anaesthesia providers in 72 countries selected to ensure a geographically and demographically diverse sample. A predictive regression model was used to estimate the pulse oximetry need for countries that did not provide data. The estimated number of operating theatres ranged from 1·0 (95% CI 0·9-1·2) per 100,000 people in west sub-Saharan Africa to 25·1 (20·9-30·1) per 100,000 in eastern Europe. High-income subregions all averaged more than 14 per 100,000 people, whereas all low-income subregions, representing 2·2 billion people, had fewer than two theatres per 100,000. Pulse oximetry data from 54 countries suggested that around 77,700 (63,195-95,533) theatres worldwide (19·2% [15·2-23·9]) were not equipped with pulse oximeters. Improvements in public-health strategies and monitoring are needed to reduce disparities for more than 2 billion people without adequate access to surgical care. WHO. Copyright © 2010 Elsevier Ltd. All rights reserved.

Are Currently Available Wearable Devices for Activity Tracking and Heart Rate Monitoring Accurate, Precise, and Medically Beneficial?

PubMed Central

El-Amrawy, Fatema

2015-01-01

Objectives The new wave of wireless technologies, fitness trackers, and body sensor devices can have great impact on healthcare systems and the quality of life. However, there have not been enough studies to prove the accuracy and precision of these trackers. The objective of this study was to evaluate the accuracy, precision, and overall performance of seventeen wearable devices currently available compared with direct observation of step counts and heart rate monitoring. Methods Each participant in this study used three accelerometers at a time, running the three corresponding applications of each tracker on an Android or iOS device simultaneously. Each participant was instructed to walk 200, 500, and 1,000 steps. Each set was repeated 40 times. Data was recorded after each trial, and the mean step count, standard deviation, accuracy, and precision were estimated for each tracker. Heart rate was measured by all trackers (if applicable), which support heart rate monitoring, and compared to a positive control, the Onyx Vantage 9590 professional clinical pulse oximeter. Results The accuracy of the tested products ranged between 79.8% and 99.1%, while the coefficient of variation (precision) ranged between 4% and 17.5%. MisFit Shine showed the highest accuracy and precision (along with Qualcomm Toq), while Samsung Gear 2 showed the lowest accuracy, and Jawbone UP showed the lowest precision. However, Xiaomi Mi band showed the best package compared to its price. Conclusions The accuracy and precision of the selected fitness trackers are reasonable and can indicate the average level of activity and thus average energy expenditure. PMID:26618039

Are Currently Available Wearable Devices for Activity Tracking and Heart Rate Monitoring Accurate, Precise, and Medically Beneficial?

PubMed

El-Amrawy, Fatema; Nounou, Mohamed Ismail

2015-10-01

The new wave of wireless technologies, fitness trackers, and body sensor devices can have great impact on healthcare systems and the quality of life. However, there have not been enough studies to prove the accuracy and precision of these trackers. The objective of this study was to evaluate the accuracy, precision, and overall performance of seventeen wearable devices currently available compared with direct observation of step counts and heart rate monitoring. Each participant in this study used three accelerometers at a time, running the three corresponding applications of each tracker on an Android or iOS device simultaneously. Each participant was instructed to walk 200, 500, and 1,000 steps. Each set was repeated 40 times. Data was recorded after each trial, and the mean step count, standard deviation, accuracy, and precision were estimated for each tracker. Heart rate was measured by all trackers (if applicable), which support heart rate monitoring, and compared to a positive control, the Onyx Vantage 9590 professional clinical pulse oximeter. The accuracy of the tested products ranged between 79.8% and 99.1%, while the coefficient of variation (precision) ranged between 4% and 17.5%. MisFit Shine showed the highest accuracy and precision (along with Qualcomm Toq), while Samsung Gear 2 showed the lowest accuracy, and Jawbone UP showed the lowest precision. However, Xiaomi Mi band showed the best package compared to its price. The accuracy and precision of the selected fitness trackers are reasonable and can indicate the average level of activity and thus average energy expenditure.

Optic fiber pulse-diagnosis sensor of traditional Chinese medicine

NASA Astrophysics Data System (ADS)

Ni, J. S.; Jin, W.; Zhao, B. N.; Zhang, X. L.; Wang, C.; Li, S. J.; Zhang, F. X.; Peng, G. D.

2013-09-01

The wrist-pulse is a kind of signals, from which a lot of physiological and pathological status of patients are deduced according to traditional Chinese medicine theories. This paper designs a new optic fiber wrist-pulse sensor that based on a group of FBGs. Sensitivity of the optic fiber wrist-pulse measurement system reaches 0.05% FS and the range reaches 50kPa. Frequency response is from 0 Hz to 5 kHz. A group of typical pulse signal is given out in the paper to compare different status of patient. It will improve quantification of pulse diagnosis greatly.

Reconfigurable wavefront sensor for ultrashort pulses.

PubMed

Bock, Martin; Das, Susanta Kumar; Fischer, Carsten; Diehl, Michael; Börner, Peter; Grunwald, Ruediger

2012-04-01

A highly flexible Shack-Hartmann wavefront sensor for ultrashort pulse diagnostics is presented. The temporal system performance is studied in detail. Reflective operation is enabled by programming tilt-tolerant microaxicons into a liquid-crystal-on-silicon spatial light modulator. Nearly undistorted pulse transfer is obtained by generating nondiffracting needle beams as subbeams. Reproducible wavefront analysis and spatially resolved second-order autocorrelation are demonstrated at incident angles up to 50° and pulse durations down to 6 fs.

High-speed multiframe dynamic transmission electron microscope image acquisition system with arbitrary timing

DOEpatents

Reed, Bryan W.; DeHope, William J.; Huete, Glenn; LaGrange, Thomas B.; Shuttlesworth, Richard M.

2015-10-20

An electron microscope is disclosed which has a laser-driven photocathode and an arbitrary waveform generator (AWG) laser system ("laser"). The laser produces a train of temporally-shaped laser pulses of a predefined pulse duration and waveform, and directs the laser pulses to the laser-driven photocathode to produce a train of electron pulses. An image sensor is used along with a deflector subsystem. The deflector subsystem is arranged downstream of the target but upstream of the image sensor, and has two pairs of plates arranged perpendicular to one another. A control system controls the laser and a plurality of switching components synchronized with the laser, to independently control excitation of each one of the deflector plates. This allows each electron pulse to be directed to a different portion of the image sensor, as well as to be provided with an independently set duration and independently set inter-pulse spacings.

High-speed multiframe dynamic transmission electron microscope image acquisition system with arbitrary timing

DOEpatents

Reed, Bryan W.; Dehope, William J; Huete, Glenn; LaGrange, Thomas B.; Shuttlesworth, Richard M

2016-06-21

An electron microscope is disclosed which has a laser-driven photocathode and an arbitrary waveform generator (AWG) laser system ("laser"). The laser produces a train of temporally-shaped laser pulses of a predefined pulse duration and waveform, and directs the laser pulses to the laser-driven photocathode to produce a train of electron pulses. An image sensor is used along with a deflector subsystem. The deflector subsystem is arranged downstream of the target but upstream of the image sensor, and has two pairs of plates arranged perpendicular to one another. A control system controls the laser and a plurality of switching components synchronized with the laser, to independently control excitation of each one of the deflector plates. This allows each electron pulse to be directed to a different portion of the image sensor, as well as to be provided with an independently set duration and independently set inter-pulse spacings.

Incorporating oximeter analyses to investigate synchronies in heart rate while teaching and learning about race

NASA Astrophysics Data System (ADS)

Amat, Arnau; Zapata, Corinna; Alexakos, Konstantinos; Pride, Leah D.; Paylor-Smith, Christian; Hernandez, Matthew

2016-09-01

In this paper, we look closely at two events selected through event-oriented inquiry that were part of a classroom presentation on race. The first event was a provocative discussion about Mark Twain's ( Pudd'nhead Wilson, Harper, New York, 1899) and passing for being White. The other was a discussion on the use of the N-word. Grounded in authentic inquiry, we use ethnographic narrative, cogenerative dialogues, and video and oximeter data analyses as part of a multi-ontological approach for studying emotions. Statistical analysis of oximeter data shows statistically significant heart rate synchrony among two of the coteachers during their presentations, providing evidence of emotional synchrony, resonance, and social and emotional contagion.

Smartphone-based Continuous Blood Pressure Measurement Using Pulse Transit Time.

PubMed

Gholamhosseini, Hamid; Meintjes, Andries; Baig, Mirza; Linden, Maria

2016-01-01

The increasing availability of low cost and easy to use personalized medical monitoring devices has opened the door for new and innovative methods of health monitoring to emerge. Cuff-less and continuous methods of measuring blood pressure are particularly attractive as blood pressure is one of the most important measurements of long term cardiovascular health. Current methods of noninvasive blood pressure measurement are based on inflation and deflation of a cuff with some effects on arteries where blood pressure is being measured. This inflation can also cause patient discomfort and alter the measurement results. In this work, a mobile application was developed to collate the PhotoPlethysmoGramm (PPG) waveform provided by a pulse oximeter and the electrocardiogram (ECG) for calculating the pulse transit time. This information is then indirectly related to the user's systolic blood pressure. The developed application successfully connects to the PPG and ECG monitoring devices using Bluetooth wireless connection and stores the data onto an online server. The pulse transit time is estimated in real time and the user's systolic blood pressure can be estimated after the system has been calibrated. The synchronization between the two devices was found to pose a challenge to this method of continuous blood pressure monitoring. However, the implemented continuous blood pressure monitoring system effectively serves as a proof of concept. This combined with the massive benefits that an accurate and robust continuous blood pressure monitoring system would provide indicates that it is certainly worthwhile to further develop this system.

Noncontact simultaneous dual wavelength photoplethysmography: A further step toward noncontact pulse oximetry

NASA Astrophysics Data System (ADS)

Humphreys, Kenneth; Ward, Tomas; Markham, Charles

2007-04-01

We present a camera-based device capable of capturing two photoplethysmographic (PPG) signals at two different wavelengths simultaneously, in a remote noncontact manner. The system comprises a complementary metal-oxide semiconductor camera and dual wavelength array of light emitting diodes (760 and 880nm). By alternately illuminating a region of tissue with each wavelength of light, and detecting the backscattered photons with the camera at a rate of 16frames/wavelengths, two multiplexed PPG wave forms are simultaneously captured. This process is the basis of pulse oximetry, and we describe how, with the inclusion of a calibration procedure, this system could be used as a noncontact pulse oximeter to measure arterial oxygen saturation (SpO2) remotely. Results from an experiment on ten subjects, exhibiting normal SpO2 readings, that demonstrate the instrument's ability to capture signals from a range of subjects under realistic lighting and environmental conditions are presented. We compare the signals captured by the noncontact system to a conventional PPG signal captured concurrently from a finger, and show by means of a J. Bland and D. Altman [Lancet 327, 307 (1986); Statistician 32, 307 (1983)] test, the noncontact device to be comparable to a contact device as a monitor of heart rate. We highlight some considerations that should be made when using camera-based "integrative" sampling methods and demonstrate through simulation, the suitability of the captured PPG signals for application of existing pulse oximetry calibration procedures.

Rapid Two-Millisecond Interrogation of Electrochemical, Aptamer-Based Sensor Response Using Intermittent Pulse Amperometry.

PubMed

Santos-Cancel, Mirelis; Lazenby, Robert A; White, Ryan J

2018-06-22

In this manuscript, we employ the technique intermittent pulse amperometry (IPA) to interrogate equilibrium and kinetic target binding to the surface of electrochemical, aptamer-based (E-AB) sensors, achieving as fast as 2 ms time resolution. E-AB sensors comprise an electrode surface modified with a flexible nucleic acid aptamer tethered at the 3'-terminus with a redox-active molecule. The introduction of a target changes the conformation and flexibility of the nucleic acid, which alters the charge transfer rate of the appended redox molecule. Typically, changes in charge transfer rate within this class of sensor are monitored via voltammetric methods. Here, we demonstrate that the use of IPA enables the detection of changes in charge transfer rates (i.e., current) at times <100 μs after the application of a potential pulse. Changes in sensor current are quantitatively related to target analyte concentration and can be used to create binding isotherms. Furthermore, the application of IPA enables rapid probing of the electrochemical surface with a time resolution equivalent to as low as twice the applied potential pulse width, not previously demonstrated with traditional voltammetric techniques employed with E-AB sensors (alternating current, square wave, cyclic). To visualize binding, we developed false-color plots analogous to those used in the field of fast-scan cyclic voltammetry. The use of IPA is universal, as demonstrated with two representative small molecule E-AB sensors directed against the aminoglycoside antibiotic tobramycin and adenosine triphosphate (ATP). Intermittent pulse amperometry exhibits an unprecedented sub-microsecond temporal response and is a general method for measuring rapid sensor performance.

Ultra-wideband radar motion sensor

DOEpatents

McEwan, Thomas E.

1994-01-01

A motion sensor is based on ultra-wideband (UWB) radar. UWB radar range is determined by a pulse-echo interval. For motion detection, the sensors operate by staring at a fixed range and then sensing any change in the averaged radar reflectivity at that range. A sampling gate is opened at a fixed delay after the emission of a transmit pulse. The resultant sampling gate output is averaged over repeated pulses. Changes in the averaged sampling gate output represent changes in the radar reflectivity at a particular range, and thus motion.

Ultra-wideband radar motion sensor

DOEpatents

McEwan, T.E.

1994-11-01

A motion sensor is based on ultra-wideband (UWB) radar. UWB radar range is determined by a pulse-echo interval. For motion detection, the sensors operate by staring at a fixed range and then sensing any change in the averaged radar reflectivity at that range. A sampling gate is opened at a fixed delay after the emission of a transmit pulse. The resultant sampling gate output is averaged over repeated pulses. Changes in the averaged sampling gate output represent changes in the radar reflectivity at a particular range, and thus motion. 15 figs.

Capacitively-coupled inductive sensors for measurements of pulsed currents and pulsed magnetic fields

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ekdahl, C.A.

In experiments involving pulsed high magnetic fields the appearance of the full induced voltage at the output terminals of large-area inductive sensors such as diamagnetic loops and Rogowski belts imposes severe requirements on the insulation near the output. Capacitive detection of the inductive-sensor output voltage provides an ideal geometry for high-voltage insulation, and also accomplishes the necessary voltage division. An inductive-shunt current monitor was designed to utilize the capacitive-detection principle. The contruction of this device and its performance are described in this paper.

Benefits of Oxygen Saturation Targeting Trials: Oximeter Calibration Software Revision and Infant Saturations.

PubMed

Whyte, Robin K; Nelson, Harvey; Roberts, Robin S; Schmidt, Barbara

2017-03-01

It has been reported in the 3 Benefits of Oxygen Saturation Targeting (BOOST-II) trials that changes in oximeter calibration software resulted in clearer separation between the oxygen saturations in the two trial target groups. A revised analysis of the published BOOST-II data does not support this conclusion. Copyright © 2016 Elsevier Inc. All rights reserved.

Digital health system for personalised COPD long-term management.

PubMed

Velardo, Carmelo; Shah, Syed Ahmar; Gibson, Oliver; Clifford, Gari; Heneghan, Carl; Rutter, Heather; Farmer, Andrew; Tarassenko, Lionel

2017-02-20

Recent telehealth studies have demonstrated minor impact on patients affected by long-term conditions. The use of technology does not guarantee the compliance required for sustained collection of high-quality symptom and physiological data. Remote monitoring alone is not sufficient for successful disease management. A patient-centred design approach is needed in order to allow the personalisation of interventions and encourage the completion of daily self-management tasks. A digital health system was designed to support patients suffering from chronic obstructive pulmonary disease in self-managing their condition. The system includes a mobile application running on a consumer tablet personal computer and a secure backend server accessible to the health professionals in charge of patient management. The patient daily routine included the completion of an adaptive, electronic symptom diary on the tablet, and the measurement of oxygen saturation via a wireless pulse oximeter. The design of the system was based on a patient-centred design approach, informed by patient workshops. One hundred and ten patients in the intervention arm of a randomised controlled trial were subsequently given the tablet computer and pulse oximeter for a 12-month period. Patients were encouraged, but not mandated, to use the digital health system daily. The average used was 6.0 times a week by all those who participated in the full trial. Three months after enrolment, patients were able to complete their symptom diary and oxygen saturation measurement in less than 1 m 40s (96% of symptom diaries). Custom algorithms, based on the self-monitoring data collected during the first 50 days of use, were developed to personalise alert thresholds. Strategies and tools aimed at refining a digital health intervention require iterative use to enable convergence on an optimal, usable design. 'Continuous improvement' allowed feedback from users to have an immediate impact on the design of the system (e.g., collection of quality data), resulting in high compliance with self-monitoring over a prolonged period of time (12-month). Health professionals were prompted by prioritisation algorithms to review patient data, which led to their regular use of the remote monitoring website throughout the trial. Trial registration: ISRCTN40367841 . Registered 17/10/2012.

Flexible PZT Thin Film Tactile Sensor for Biomedical Monitoring

PubMed Central

Tseng, Hong-Jie; Tian, Wei-Cheng; Wu, Wen-Jong

2013-01-01

This paper presents the development of tactile sensors using the sol-gel process to deposit a PZT thin-film from 250 nm to 1 μm on a flexible stainless steel substrate. The PZT thin-film tactile sensor can be used to measure human pulses from several areas, including carotid, brachial, finger, ankle, radial artery, and the apical region. Flexible PZT tactile sensors can overcome the diverse topology of various human regions and sense the corresponding signals from human bodies. The measured arterial pulse waveform can be used to diagnose hypertension and cardiac failure in patients. The proposed sensors have several advantages, such as flexibility, reliability, high strain, low cost, simple fabrication, and low temperature processing. The PZT thin-film deposition process includes a pyrolysis process at 150 °C/500 °C for 10/5 min, followed by an annealing process at 650 °C for 10 min. Finally, the consistent pulse wave velocity (PWV) was demonstrated based on human pulse measurements from apical to radial, brachial to radial, and radial to ankle. It is characterized that the sensitivity of our PZT-based tactile sensor was approximately 0.798 mV/g. PMID:23698262

Flexible PZT thin film tactile sensor for biomedical monitoring.

PubMed

Tseng, Hong-Jie; Tian, Wei-Cheng; Wu, Wen-Jong

2013-04-25

This paper presents the development of tactile sensors using the sol-gel process to deposit a PZT thin-film from 250 nm to 1 μm on a flexible stainless steel substrate. The PZT thin-film tactile sensor can be used to measure human pulses from several areas, including carotid, brachial, finger, ankle, radial artery, and the apical region. Flexible PZT tactile sensors can overcome the diverse topology of various human regions and sense the corresponding signals from human bodies. The measured arterial pulse waveform can be used to diagnose hypertension and cardiac failure in patients. The proposed sensors have several advantages, such as flexibility, reliability, high strain, low cost, simple fabrication, and low temperature processing. The PZT thin-film deposition process includes a pyrolysis process at 150 °C/500 °C for 10/5 min, followed by an annealing process at 650 °C for 10 min. Finally, the consistent pulse wave velocity (PWV) was demonstrated based on human pulse measurements from apical to radial, brachial to radial, and radial to ankle. It is characterized that the sensitivity of our PZT-based tactile sensor was approximately 0.798 mV/g.

Handheld CZT radiation detector

DOEpatents

Murray, William S.; Butterfield, Kenneth B.; Baird, William

2004-08-24

A handheld CZT radiation detector having a CZT gamma-ray sensor, a multichannel analyzer, a fuzzy-logic component, and a display component is disclosed. The CZT gamma-ray sensor may be a coplanar grid CZT gamma-ray sensor, which provides high-quality gamma-ray analysis at a wide range of operating temperatures. The multichannel analyzer categorizes pulses produce by the CZT gamma-ray sensor into channels (discrete energy levels), resulting in pulse height data. The fuzzy-logic component analyzes the pulse height data and produces a ranked listing of radioisotopes. The fuzzy-logic component is flexible and well-suited to in-field analysis of radioisotopes. The display component may be a personal data assistant, which provides a user-friendly method of interacting with the detector. In addition, the radiation detector may be equipped with a neutron sensor to provide an enhanced mechanism of sensing radioactive materials.

Development of electronic tattoo for pulse rate monitoring: Materials perspective

NASA Astrophysics Data System (ADS)

Shinde, Shilpa Vikas; Sonavane, S. S.

2018-05-01

In India, there is a growing concern of the heart diseases and deaths due to heart failure. The severity of the problem can be minimised by efficient heart rate monitoring which can be used to provide before time caution to cater heart attack. Wearable sensor can be designed to sense the pulse. The sensor can be either placed near to heart or on the wrist to sense pulses and send pulse signals to the doctors. Such sensor should adhere to the skin for sufficiently long period without causing etching to the patient. It should also be bendable and stretchable like skin. This paper is a part of the research work carried out to develop patch type sensor, which is termed as Electronic Tattoo (ET). In pursuit for development of ET, we came across various designs and candidate materials which can be used for the ET. Thus, in this paper, we describe the process of selecting best suited method and material for the ET. It may also be noted that the sensor development is governed by the prevailing IEEE 802.15.6 standard.

Time-Resolved Measurements in Optoelectronic Microbioanalysis

NASA Technical Reports Server (NTRS)

Bearman, Gregory; Kossakovski, Dmitri

2003-01-01

A report presents discussion of time-resolved measurements in optoelectronic microbioanalysis. Proposed microbioanalytical laboratory-on-a-chip devices for detection of microbes and toxic chemicals would include optoelectronic sensors and associated electronic circuits that would look for fluorescence or phosphorescence signatures of multiple hazardous biomolecules in order to detect which ones were present in a given situation. The emphasis in the instant report is on gating an active-pixel sensor in the time domain, instead of filtering light in the wavelength domain, to prevent the sensor from responding to a laser pulse used to excite fluorescence or phosphorescence while enabling the sensor to respond to the decaying fluorescence or phosphorescence signal that follows the laser pulse. The active-pixel sensor would be turned on after the laser pulse and would be used to either integrate the fluorescence or phosphorescence signal over several lifetimes and many excitation pulses or else take time-resolved measurements of the fluorescence or phosphorescence. The report also discusses issues of multiplexing and of using time-resolved measurements of fluorophores with known different fluorescence lifetimes to distinguish among them.

Development of a wavefront sensor for terahertz pulses.

PubMed

Abraham, Emmanuel; Cahyadi, Harsono; Brossard, Mathilde; Degert, Jérôme; Freysz, Eric; Yasui, Takeshi

2016-03-07

Wavefront characterization of terahertz pulses is essential to optimize far-field intensity distribution of time-domain (imaging) spectrometers or increase the peak power of intense terahertz sources. In this paper, we report on the wavefront measurement of terahertz pulses using a Hartmann sensor associated with a 2D electro-optic imaging system composed of a ZnTe crystal and a CMOS camera. We quantitatively determined the deformations of planar and converging spherical wavefronts using the modal Zernike reconstruction least-squares method. Associated with deformable mirrors, the sensor will also open the route to terahertz adaptive optics.

Power pulsing of the CMOS sensor Mimosa 26

NASA Astrophysics Data System (ADS)

Kuprash, Oleg

2013-12-01

Mimosa 26 is a monolithic active pixel sensor developed by IPHC (Strasbourg) & IRFU (Saclay) as a prototype for the ILC vertex detector studies. The resolution requirements for the ILC tracking detector are very extreme, demanding very low material in the detector, thus only air cooling can be considered. Power consumption has to be reduced as far as possible. The beam structure of the ILC allows the possibility of power pulsing: only for about the 1 ms long bunch train full power is required, and during the 199 ms long pauses between the bunch trains the power can be reduced to a minimum. Not being adapted for the power pulsing, the sensor shows in laboratory tests a good performance under power pulsing. The power pulsing allows to significantly reduce the heating of the chip and divides power consumption approximately by a factor of 6. In this report a summary of power pulsing studies using the digital readout of Mimosa 26 is given.

Preliminary Optical And Electric Field Pulse Statistics From Storm Overflights During The Altus Cumulus Electrification Study

NASA Technical Reports Server (NTRS)

Mach, D. A.; Blakeslee, R. J.; Bailey, J. C.; Farrell, W. M.; Goldberg, R. A.; Desch, M. D.; Houser, J. G.

2003-01-01

The Altus Cumulus Electrification Study (ACES) was conducted during the month of August, 2002 in an area near Key West, Florida. One of the goals of this uninhabited aerial vehicle (UAV) study was to collect high resolution optical pulse and electric field data from thunderstorms. During the month long campaign, we acquired 5294 lightning generated optical pulses with associated electric field changes. Most of these observations were made while close to the top of the storms. We found filtered mean and median 10-10% optical pulse widths of 875 and 830 microns respectively while the 50-50% mean and median optical pulse widths are 422 and 365 microns respectively. These values are similar to previous results as are the 10-90% mean and median rise times of 327 and 265 microns. The peak electrical to optical pulse delay mean and median were 209 and 145 microns which is longer than one would expect from theoretical results. The results of the pulse analysis will contribute to further validation of the Optical Transient Detector (OTD) and the Lightning Imaging Sensor (LIS) satellites. Pre-launch estimates of the flash detection efficiency were based on a small sample of optical pulse measurements associated with less than 350 lightning discharges collected by NASA U-2 aircraft in the early 1980s. Preliminary analyses of the ACES measurements show that we have greatly increased the number of optical pulses available for validation of the LIS and other orbital lightning optical sensors. Since the Altus was often close to the cloud tops, many of the optical pulses are from low-energy pulses. From these low-energy pulses, we can determine the fraction of optical lightning pulses below the thresholds of LIS, OTD, and any future satellite-based optical sensors such as the geostationary Lightning Mapping Sensor.

Generic Sensor Modeling Using Pulse Method

NASA Technical Reports Server (NTRS)

Helder, Dennis L.; Choi, Taeyoung

2005-01-01

Recent development of high spatial resolution satellites such as IKONOS, Quickbird and Orbview enable observation of the Earth's surface with sub-meter resolution. Compared to the 30 meter resolution of Landsat 5 TM, the amount of information in the output image was dramatically increased. In this era of high spatial resolution, the estimation of spatial quality of images is gaining attention. Historically, the Modulation Transfer Function (MTF) concept has been used to estimate an imaging system's spatial quality. Sometimes classified by target shapes, various methods were developed in laboratory environment utilizing sinusoidal inputs, periodic bar patterns and narrow slits. On-orbit sensor MTF estimation was performed on 30-meter GSD Landsat4 Thematic Mapper (TM) data from the bridge pulse target as a pulse input . Because of a high resolution sensor s small Ground Sampling Distance (GSD), reasonably sized man-made edge, pulse, and impulse targets can be deployed on a uniform grassy area with accurate control of ground targets using tarps and convex mirrors. All the previous work cited calculated MTF without testing the MTF estimator's performance. In previous report, a numerical generic sensor model had been developed to simulate and improve the performance of on-orbit MTF estimating techniques. Results from the previous sensor modeling report that have been incorporated into standard MTF estimation work include Fermi edge detection and the newly developed 4th order modified Savitzky-Golay (MSG) interpolation technique. Noise sensitivity had been studied by performing simulations on known noise sources and a sensor model. Extensive investigation was done to characterize multi-resolution ground noise. Finally, angle simulation was tested by using synthetic pulse targets with angles from 2 to 15 degrees, several brightness levels, and different noise levels from both ground targets and imaging system. As a continuing research activity using the developed sensor model, this report was dedicated to MTF estimation via pulse input method characterization using the Fermi edge detection and 4th order MSG interpolation method. The relationship between pulse width and MTF value at Nyquist was studied including error detection and correction schemes. Pulse target angle sensitivity was studied by using synthetic targets angled from 2 to 12 degrees. In this report, from the ground and system noise simulation, a minimum SNR value was suggested for a stable MTF value at Nyquist for the pulse method. Target width error detection and adjustment technique based on a smooth transition of MTF profile is presented, which is specifically applicable only to the pulse method with 3 pixel wide targets.

Influence of Individual Differences on the Calculation Method for FBG-Type Blood Pressure Sensors

PubMed Central

Koyama, Shouhei; Ishizawa, Hiroaki; Fujimoto, Keisaku; Chino, Shun; Kobayashi, Yuka

2016-01-01

In this paper, we propose a blood pressure calculation and associated measurement method that by using a fiber Bragg grating (FBG) sensor. There are several points at which the pulse can be measured on the surface of the human body, and when a FBG sensor located at any of these points, the pulse wave signal can be measured. The measured waveform is similar to the acceleration pulse wave. The pulse wave signal changes depending on several factors, including whether or not the individual is healthy and/or elderly. The measured pulse wave signal can be used to calculate the blood pressure using a calibration curve, which is constructed by a partial least squares (PLS) regression analysis using a reference blood pressure and the pulse wave signal. In this paper, we focus on the influence of individual differences from calculated blood pressure based on each calibration curve. In our study, the calculated blood pressure from both the individual and overall calibration curves were compared, and our results show that the calculated blood pressure based on the overall calibration curve had a lower measurement accuracy than that based on an individual calibration curve. We also found that the influence of the individual differences on the calculated blood pressure when using the FBG sensor method were very low. Therefore, the FBG sensor method that we developed for measuring the blood pressure was found to be suitable for use by many people. PMID:28036015

Influence of Individual Differences on the Calculation Method for FBG-Type Blood Pressure Sensors.

PubMed

Koyama, Shouhei; Ishizawa, Hiroaki; Fujimoto, Keisaku; Chino, Shun; Kobayashi, Yuka

2016-12-28

In this paper, we propose a blood pressure calculation and associated measurement method that by using a fiber Bragg grating (FBG) sensor. There are several points at which the pulse can be measured on the surface of the human body, and when a FBG sensor located at any of these points, the pulse wave signal can be measured. The measured waveform is similar to the acceleration pulse wave. The pulse wave signal changes depending on several factors, including whether or not the individual is healthy and/or elderly. The measured pulse wave signal can be used to calculate the blood pressure using a calibration curve, which is constructed by a partial least squares (PLS) regression analysis using a reference blood pressure and the pulse wave signal. In this paper, we focus on the influence of individual differences from calculated blood pressure based on each calibration curve. In our study, the calculated blood pressure from both the individual and overall calibration curves were compared, and our results show that the calculated blood pressure based on the overall calibration curve had a lower measurement accuracy than that based on an individual calibration curve. We also found that the influence of the individual differences on the calculated blood pressure when using the FBG sensor method were very low. Therefore, the FBG sensor method that we developed for measuring the blood pressure was found to be suitable for use by many people.

A FBG pulse wave demodulation method based on PCF modal interference filter

NASA Astrophysics Data System (ADS)

Zhang, Cheng; Xu, Shan; Shen, Ziqi; Zhao, Junfa; Miao, Changyun; Bai, Hua

2016-10-01

Fiber optic sensor embedded in textiles has been a new direction of researching smart wearable technology. Pulse signal which is generated by heart beat contains vast amounts of physio-pathological information about the cardiovascular system. Therefore, the research for textile-based fiber optic sensor which can detect pulse wave has far-reaching effects on early discovery and timely treatment of cardiovascular diseases. A novel wavelength demodulation method based on photonic crystal fiber (PCF) modal interference filter is proposed for the purpose of developing FBG pulse wave sensing system embedded in smart clothing. The mechanism of the PCF modal interference and the principle of wavelength demodulation based on In-line Mach-Zehnder interferometer (In-line MZI) are analyzed in theory. The fabricated PCF modal interferometer has the advantages of good repeatability and low temperature sensitivity of 3.5pm/°C from 25°C to 60°C. The designed demodulation system can achieve linear demodulation in the range of 2nm, with the wavelength resolution of 2.2pm and the wavelength sensitivity of 0.055nm-1. The actual experiments' result indicates that the pulse wave can be well detected by this demodulation method, which is in accordance with the commercial demodulation instrument (SM130) and more sensitive than the traditional piezoelectric pulse sensor. This demodulation method provides important references for the research of smart clothing based on fiber grating sensor embedded in textiles and accelerates the developments of wearable fiber optic sensors technology.

Identifying individual sleep apnea/hypoapnea epochs using smartphone-based pulse oximetry.

PubMed

Garde, Ainara; Dekhordi, Parastoo; Ansermino, J Mark; Dumont, Guy A

2016-08-01

Sleep apnea, characterized by frequent pauses in breathing during sleep, poses a serious threat to the healthy growth and development of children. Polysomnography (PSG), the gold standard for sleep apnea diagnosis, is resource intensive and confined to sleep laboratories, thus reducing its accessibility. Pulse oximetry alone, providing blood oxygen saturation (SpO2) and blood volume changes in tissue (PPG), has the potential to identify children with sleep apnea. Thus, we aim to develop a tool for at-home sleep apnea screening that provides a detailed and automated 30 sec epoch-by-epoch sleep apnea analysis. We propose to extract features characterizing pulse oximetry (SpO2 and pulse rate variability [PRV], a surrogate measure of heart rate variability) to create a multivariate logistic regression model that identifies epochs containing apnea/hypoapnea events. Overnight pulse oximetry was collected using a smartphone-based pulse oximeter, simultaneously with standard PSG from 160 children at the British Columbia Children's hospital. The sleep technician manually scored all apnea/hypoapnea events during the PSG study. Based on these scores we labeled each epoch as containing or not containing apnea/hypoapnea. We randomly divided the subjects into training data (40%), used to develop the model applying the LASSO method, and testing data (60%), used to validate the model. The developed model was assessed epoch-by-epoch for each subject. The test dataset had a median area under the receiver operating characteristic (ROC) curve of 81%; the model provided a median accuracy of 74% sensitivity of 75%, and specificity of 73% when using a risk threshold similar to the percentage of apnea/hypopnea epochs. Thus, providing a detailed epoch-by-epoch analysis with at-home pulse oximetry alone is feasible with accuracy, sensitivity and specificity values above 73% However, the performance might decrease when analyzing subjects with a low number of apnea/hypoapnea events.

Full scattering profile of tissues with elliptical cross sections

NASA Astrophysics Data System (ADS)

Duadi, H.; Feder, I.; Fixler, D.

2018-02-01

Light reflectance and transmission from soft tissue has been utilized in noninvasive clinical measurement devices such as the photoplethysmograph (PPG) and reflectance pulse oximeter. Most methods of near infrared (NIR) spectroscopy focus on the volume reflectance from a semi-infinite sample, while very few measure transmission. However, since PPG and pulse oximetry are usually measured on tissue such as earlobe, fingertip, lip and pinched tissue, we propose examining the full scattering profile (FSP), which is the angular distribution of exiting photons. The FSP provides more comprehensive information when measuring from a cylindrical tissue. In our work we discovered a unique point, that we named the iso-pathlength (IPL) point, which is not dependent on changes in the reduced scattering coefficient (µs'). This IPL point was observed both in Monte Carlo (MC) simulation and in experimental tissue mimicking phantoms. The angle corresponding to this IPL point depends only on the tissue geometry. In the case of cylindrical tissues this point linearly depends on the tissue diameter. Since the target tissues for clinically physiological measuring are not a perfect cylinder, in this work we will examine how the change in the tissue cross section geometry influences the FSP and the IPL point. We used a MC simulation to compare a circular to an elliptic tissue cross section. The IPL point can serve as a self-calibration point for optical tissue measurements such as NIR spectroscopy, PPG and pulse oximetery.

Assessment of oxygen saturation in dental pulp of permanent teeth with periodontal disease.

PubMed

Giovanella, Larissa Bergesch; Barletta, Fernando Branco; Felippe, Wilson Tadeu; Bruno, Kely Firmino; de Alencar, Ana Helena Gonçalves; Estrela, Carlos

2014-12-01

In individuals with periodontal disease, dental pulp status should be determined before a treatment plan is made. Pulse oximeters are promising diagnostic tools to evaluate pulp vascularization. This study used pulse oximetry to determine the level of oxygen saturation in dental pulp of intact permanent teeth with periodontal attachment loss (PAL) and gingival recession (GR) and to evaluate the correlation between periodontal disease and level of oxygen saturation in the pulp. This study included 67 anterior teeth of 35 patients; all teeth showed intact crowns, PAL, a periodontal pocket (PP), and GR. The teeth underwent periodontal examination, cold and electric pulp testing, and pulse oximetry measurements. The Pearson correlation coefficient and a linear regression coefficient were calculated to evaluate the degree of correlation between periodontal disease markers (PAL, PP, and GR) and the level of oxygen saturation in dental pulp. These tests also evaluated possible associations between oxygen saturation and cold and electric pulp testing. PAL, PP, and GR had negative correlations with oxygen saturation in dental pulp. Conversely, no statistically significant association was found between oxygen saturation in dental pulp and the response to electric sensibility testing. Oxygen saturation was lower in the pulp of permanent teeth with PAL, PP, and GR, indicating that periodontal disease correlates with the level of oxygen saturation in the pulp. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Pulse oximetry recorded from the Phone Oximeter for detection of obstructive sleep apnea events with and without oxygen desaturation in children.

PubMed

Garde, Ainara; Dehkordi, Parastoo; Wensley, David; Ansermino, J Mark; Dumont, Guy A

2015-01-01

Obstructive sleep apnea (OSA) disrupts normal ventilation during sleep and can lead to serious health problems in children if left untreated. Polysomnography, the gold standard for OSA diagnosis, is resource intensive and requires a specialized laboratory. Thus, we proposed to use the Phone Oximeter™, a portable device integrating pulse oximetry with a smartphone, to detect OSA events. As a proportion of OSA events occur without oxygen desaturation (defined as SpO2 decreases ≥ 3%), we suggest combining SpO2 and pulse rate variability (PRV) analysis to identify all OSA events and provide a more detailed sleep analysis. We recruited 160 children and recorded pulse oximetry consisting of SpO2 and plethysmography (PPG) using the Phone Oximeter™, alongside standard polysomnography. A sleep technician visually scored all OSA events with and without oxygen desaturation from polysomnography. We divided pulse oximetry signals into 1-min signal segments and extracted several features from SpO2 and PPG analysis in the time and frequency domain. Segments with OSA, especially the ones with oxygen desaturation, presented greater SpO2 variability and modulation reflected in the spectral domain than segments without OSA. Segments with OSA also showed higher heart rate and sympathetic activity through the PRV analysis relative to segments without OSA. PRV analysis was more sensitive than SpO2 analysis for identification of OSA events without oxygen desaturation. Combining SpO2 and PRV analysis enhanced OSA event detection through a multiple logistic regression model. The area under the ROC curve increased from 81% to 87%. Thus, the Phone Oximeter™ might be useful to monitor sleep and identify OSA events with and without oxygen desaturation at home.

Open carbon nanopipettes as resistive-pulse sensors, rectification sensors, and electrochemical nanoprobes.

PubMed

Hu, Keke; Wang, Yixian; Cai, Huijing; Mirkin, Michael V; Gao, Yang; Friedman, Gary; Gogotsi, Yury

2014-09-16

Nanometer-sized glass and quartz pipettes have been widely used as a core of chemical sensors, patch clamps, and scanning probe microscope tips. Many of those applications require the control of the surface charge and chemical state of the inner pipette wall. Both objectives can be attained by coating the inner wall of a quartz pipette with a nanometer-thick layer of carbon. In this letter, we demonstrate the possibility of using open carbon nanopipettes (CNP) produced by chemical vapor deposition as resistive-pulse sensors, rectification sensors, and electrochemical nanoprobes. By applying a potential to the carbon layer, one can change the surface charge and electrical double-layer at the pipette wall, which, in turn, affect the ion current rectification and adsorption/desorption processes essential for resistive-pulse sensors. CNPs can also be used as versatile electrochemical probes such as asymmetric bipolar nanoelectrodes and dual electrodes based on simultaneous recording of the ion current through the pipette and the current produced by oxidation/reduction of molecules at the carbon nanoring.

Quantifying the effect of adipose tissue in muscle oximetry by near infrared spectroscopy

PubMed Central

Nasseri, Nassim; Kleiser, Stefan; Ostojic, Daniel; Karen, Tanja; Wolf, Martin

2016-01-01

Change of muscle tissue oxygen saturation (StO2), due to exercise, measured by near infrared spectroscopy (NIRS) is known to be lower for subjects with higher adipose tissue thickness. This is most likely not physiological but caused by the superficial fat and adipose tissue. In this paper we assessed, in vitro, the influence of adipose tissue thickness on muscle StO2, measured by NIRS oximeters. We measured StO2 of a liquid phantom by 3 continuous wave (CW) oximeters (Sensmart Model X-100 Universal Oximetry System, INVOS 5100C, and OxyPrem v1.3), as well as a frequency-domain oximeter, OxiplexTS, through superficial layers with 4 different thicknesses. Later, we employed the results to calibrate OxyPrem v1.3 for adipose tissue thickness in-vivo. PMID:27895999

Wide-Range Temperature Sensors with High-Level Pulse Train Output

NASA Technical Reports Server (NTRS)

Hammoud, Ahmad; Patterson, Richard L.

2009-01-01

Two types of temperature sensors have been developed for wide-range temperature applications. The two sensors measure temperature in the range of -190 to +200 C and utilize a thin-film platinum RTD (resistance temperature detector) as the temperature-sensing element. Other parts used in the fabrication of these sensors include NPO (negative-positive- zero) type ceramic capacitors for timing, thermally-stable film or wirewound resistors, and high-temperature circuit boards and solder. The first type of temperature sensor is a relaxation oscillator circuit using an SOI (silicon-on-insulator) operational amplifier as a comparator. The output is a pulse train with a period that is roughly proportional to the temperature being measured. The voltage level of the pulse train is high-level, for example 10 V. The high-level output makes the sensor less sensitive to noise or electromagnetic interference. The output can be read by a frequency or period meter and then converted into a temperature reading. The second type of temperature sensor is made up of various types of multivibrator circuits using an SOI type 555 timer and the passive components mentioned above. Three configurations have been developed that were based on the technique of charging and discharging a capacitor through a resistive element to create a train of pulses governed by the capacitor-resistor time constant. Both types of sensors, which operated successfully over the wide temperature range, have potential use in extreme temperature environments including jet engines and space exploration missions.

Bias-field equalizer for bubble memories

NASA Technical Reports Server (NTRS)

Keefe, G. E.

1977-01-01

Magnetoresistive Perm-alloy sensor monitors bias field required to maintain bubble memory. Sensor provides error signal that, in turn, corrects magnitude of bias field. Error signal from sensor can be used to control magnitude of bias field in either auxiliary set of bias-field coils around permanent magnet field, or current in small coils used to remagnetize permanent magnet by infrequent, short, high-current pulse or short sequence of pulses.

Pulse-driven micro gas sensor fitted with clustered Pd/SnO2 nanoparticles.

PubMed

Suematsu, Koichi; Shin, Yuka; Ma, Nan; Oyama, Tokiharu; Sasaki, Miyuki; Yuasa, Masayoshi; Kida, Tetsuya; Shimanoe, Kengo

2015-08-18

Real-time monitoring of specific gas concentrations with a compact and portable gas sensing device is required to sense potential health risk and danger from toxic gases. For such purposes, we developed an ultrasmall gas sensor device, where a micro sensing film was deposited on a micro heater integrated with electrodes fabricated by the microelectromechanical system (MEMS) technology. The developed device was operated in a pulse-heating mode to significantly reduce the heater power consumption and make the device battery-driven and portable. Using clustered Pd/SnO2 nanoparticles, we succeeded in introducing mesopores ranging from 10 to 30 nm in the micro gas sensing film (area: ϕ 150 μm) to detect large volatile organic compounds (VOCs). The micro sensor showed quick, stable, and high sensor responses to toluene at ppm (parts per million) concentrations at 300 °C even by operating the micro heater in a pulse-heating mode where switch-on and -off cycles were repeated at one-second intervals. The high performance of the micro sensor should result from the creation of efficient diffusion paths decorated with Pd sensitizers by using the clustered Pd/SnO2 nanoparticles. Hence we demonstrate that our pulse-driven micro sensor using nanostructured oxide materials holds promise as a battery-operable, portable gas sensing device.

Smart wheelchair: integration of multiple sensors

NASA Astrophysics Data System (ADS)

Gassara, H. E.; Almuhamed, S.; Moukadem, A.; Schacher, L.; Dieterlen, A.; Adolphe, D.

2017-10-01

The aim of the present work is to develop a smart wheelchair by integrating multiple sensors for measuring user’s physiological signals and subsequently transmitting and monitoring the treated signals to the user, a designated person or institution. Among other sensors, force, accelerometer, and temperature sensors are successfully integrated within both the backrest and the seat cushions of the wheelchair; while a pulse sensor is integrated within the armrest. The pulse sensor is connected to an amplification circuit board that is, in turn, placed within the armrest. The force and temperature sensors are integrated into a textile cover of the cushions by means of embroidery and sewing techniques. The signal from accelerometer is transmitted through Wi-Fi connection. The electrical connections needed for power supplying of sensors are made by embroidered conductive threads.

Ballistocardiogaphic studies with acceleration and electromechanical film sensors.

PubMed

Alametsä, J; Värri, A; Viik, J; Hyttinen, J; Palomäki, A

2009-11-01

The purpose of this research is to demonstrate and compare the utilization of electromechanical film (EMFi) and two acceleration sensors, ADXL202 and MXA2500U, for ballistocardiographic (BCG) and pulse transit time (PTT) studies. We have constructed a mobile physiological measurement station including amplifiers and a data collection system to record the previously mentioned signals and an electrocardiogram signal. Various versions of the measuring systems used in BCG studies in the past are also presented and evaluated. We have showed the ability of the EMFi sensor to define the elastic properties of the cardiovascular system and to ensure the functionality of the proposed instrumentation in different physiological loading conditions, before and after exercise and sauna bath. The EMFi sensor provided a BCG signal of good quality in the study of the human heart and function of the cardiovascular system with different measurement configurations. EMFi BCG measurements provided accurate and repeatable results for the different components of the heart cycle. In multiple-channel EMFi measurements, the carotid and limb pulse signals acquired were detailed and distinctive, allowing accurate PTT measurements. Changes in blood pressure were clearly observed and easily determined with EMFi sensor strips in pulse wave velocity (PWV) measurements. In conclusion, the configuration of the constructed device provided reliable measurements of the electrocardiogram, BCG, heart sound, and carotid and ankle pulse wave signals. Attached EMFi sensor strips on the neck and limbs yield completely new applications of the EMFi sensors aside from the conventional seat and supine recordings. Higher sensitivity, ease of utilization, and minimum discomfort of the EMFi sensor compared with acceleration sensors strengthen the status of the EMFi sensor for accurate and reliable BCG and PWV measurements, providing novel evaluation of the elastic properties of the cardiovascular system.

Arrhythmia during extracorporeal shock wave lithotripsy.

PubMed

Zeng, Z R; Lindstedt, E; Roijer, A; Olsson, S B

1993-01-01

A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12-lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right-sided and left-sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s. It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo-analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oximeter to be perfectly reliable for raising the alarm when depression of respiration and vaso-vagal reactions occur.

Heart Rate Effects of Intraosseous Injections Using Slow and Fast Rates of Anesthetic Solution Deposition

PubMed Central

Susi, Louis; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel; Drum, Melissa

2008-01-01

The authors, using a crossover design, randomly administered, in a single-blind manner, 3 primary intraosseous injections to 61 subjects using: the Wand local anesthetic system at a deposition rate of 45 seconds (fast injection); the Wand local anesthetic system at a deposition rate of 4 minutes and 45 seconds (slow injection); a conventional syringe injection at a deposition rate of 4 minutes and 45 seconds (slow injection), in 3 separate appointments spaced at least 3 weeks apart. A pulse oximeter measured heart rate (pulse). The results demonstrated the mean maximum heart rate was statistically higher with the fast intraosseous injection (average 21 to 28 beats/min increase) than either of the 2 slow intraosseous injections (average 10 to 12 beats/min increase). There was no statistically significant difference between the 2 slow injections. We concluded that an intraosseous injection of 1.4 mL of 2% lidocaine with 1 : 100,000 epinephrine with the Wand at a 45-second rate of anesthetic deposition resulted in a significantly higher heart rate when compared with a 4-minute and 45-second anesthetic solution deposition using either the Wand or traditional syringe. PMID:18327970

Heart rate effects of intraosseous injections using slow and fast rates of anesthetic solution deposition.

PubMed

Susi, Louis; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel; Drum, Melissa

2008-01-01

The authors, using a crossover design, randomly administered, in a single-blind manner, 3 primary intraosseous injections to 61 subjects using: the Wand local anesthetic system at a deposition rate of 45 seconds (fast injection); the Wand local anesthetic system at a deposition rate of 4 minutes and 45 seconds (slow injection); a conventional syringe injection at a deposition rate of 4 minutes and 45 seconds (slow injection), in 3 separate appointments spaced at least 3 weeks apart. A pulse oximeter measured heart rate (pulse). The results demonstrated the mean maximum heart rate was statistically higher with the fast intraosseous injection (average 21 to 28 beats/min increase) than either of the 2 slow intraosseous injections (average 10 to 12 beats/min increase). There was no statistically significant difference between the 2 slow injections. We concluded that an intraosseous injection of 1.4 mL of 2% lidocaine with 1 : 100,000 epinephrine with the Wand at a 45-second rate of anesthetic deposition resulted in a significantly higher heart rate when compared with a 4-minute and 45-second anesthetic solution deposition using either the Wand or traditional syringe.

Improving Video Based Heart Rate Monitoring.

PubMed

Lin, Jian; Rozado, David; Duenser, Andreas

2015-01-01

Non-contact measurements of cardiac pulse can provide robust measurement of heart rate (HR) without the annoyance of attaching electrodes to the body. In this paper we explore a novel and reliable method to carry out video-based HR estimation and propose various performance improvement over existing approaches. The investigated method uses Independent Component Analysis (ICA) to detect the underlying HR signal from a mixed source signal present in the RGB channels of the image. The original ICA algorithm was implemented and several modifications were explored in order to determine which one could be optimal for accurate HR estimation. Using statistical analysis, we compared the cardiac pulse rate estimation from the different methods under comparison on the extracted videos to a commercially available oximeter. We found that some of these methods are quite effective and efficient in terms of improving accuracy and latency of the system. We have made the code of our algorithms openly available to the scientific community so that other researchers can explore how to integrate video-based HR monitoring in novel health technology applications. We conclude by noting that recent advances in video-based HR monitoring permit computers to be aware of a user's psychophysiological status in real time.

Heart rate measurement based on a time-lapse image.

PubMed

Takano, Chihiro; Ohta, Yuji

2007-10-01

Using a time-lapse image acquired from a CCD camera, we developed a non-contact and non-invasive device, which could measure both the respiratory and pulse rate simultaneously. The time-lapse image of a part of the subject's skin was consecutively captured, and the changes in the average image brightness of the region of interest (ROI) were measured for 30s. The brightness data were processed by a series of operations of interpolation as follows a first-order derivative, a low pass filter of 2 Hz, and a sixth-order auto-regressive (AR) spectral analysis. Fourteen sound and healthy female subjects (22-27 years of age) participated in the experiments. Each subject was told to keep a relaxed seating posture with no physical restriction. At the same time, heart rate was measured by a pulse oximeter and respiratory rate was measured by a thermistor placed at the external naris. Using AR spectral analysis, two clear peaks could be detected at approximately 0.3 and 1.2 Hz. The peaks were thought to correspond to the respiratory rate and the heart rate. Correlation coefficients of 0.90 and 0.93 were obtained for the measurement of heart rate and respiratory rate, respectively.

Step climbing capacity in patients with pulmonary hypertension.

PubMed

Fox, Benjamin Daniel; Langleben, David; Hirsch, Andrew; Boutet, Kim; Shimony, Avi

2013-01-01

Patients with pulmonary hypertension (PH) typically have exercise intolerance and limitation in climbing steps. To explore the exercise physiology of step climbing in PH patients, on a laboratory-based step test. We built a step oximetry system from an 'aerobics' step equipped with pressure sensors and pulse oximeter linked to a computer. Subjects mounted and dismounted from the step until their maximal exercise capacity or 200 steps was achieved. Step-count, SpO(2) and heart rate were monitored throughout exercise and recovery. We derived indices of exercise performance, desaturation and heart rate. A 6-min walk test and serum NT-proBrain Natriuretic Peptide (BNP) level were measured. Lung function tests and hemodynamic parameters were extracted from the medical record. Eighty-six subjects [52 pulmonary arterial hypertension (PAH), 14 chronic thromboembolic PH (CTEPH), 20 controls] were recruited. Exercise performance (climbing time, height gained, velocity, energy expenditure, work-rate and climbing index) on the step test was significantly worse with PH and/or worsening WHO functional class (ANOVA, p < 0.001). There was a good correlation between exercise performance on the step and 6-min walking distance-climb index (r = -0.77, p < 0.0001). The saturation deviation (mean of SpO(2) values <95 %) on the step test correlated with diffusion capacity of the lung (ρ = -0.49, p = 0.001). No correlations were found between the step test indices and other lung function tests, hemodynamic parameters or NT-proBNP levels. Patients with PAH/CTEPH have significant limitation in step climbing ability that correlates with functional class and 6-min walking distance. This is a significant impediment to their daily activities.

Continuous non-contact vital sign monitoring in neonatal intensive care unit

PubMed Central

Guazzi, Alessandro; Jorge, João; Davis, Sara; Watkinson, Peter; Green, Gabrielle; Shenvi, Asha; McCormick, Kenny; Tarassenko, Lionel

2014-01-01

Current technologies to allow continuous monitoring of vital signs in pre-term infants in the hospital require adhesive electrodes or sensors to be in direct contact with the patient. These can cause stress, pain, and also damage the fragile skin of the infants. It has been established previously that the colour and volume changes in superficial blood vessels during the cardiac cycle can be measured using a digital video camera and ambient light, making it possible to obtain estimates of heart rate or breathing rate. Most of the papers in the literature on non-contact vital sign monitoring report results on adult healthy human volunteers in controlled environments for short periods of time. The authors' current clinical study involves the continuous monitoring of pre-term infants, for at least four consecutive days each, in the high-dependency care area of the Neonatal Intensive Care Unit (NICU) at the John Radcliffe Hospital in Oxford. The authors have further developed their video-based, non-contact monitoring methods to obtain continuous estimates of heart rate, respiratory rate and oxygen saturation for infants nursed in incubators. In this Letter, it is shown that continuous estimates of these three parameters can be computed with an accuracy which is clinically useful. During stable sections with minimal infant motion, the mean absolute error between the camera-derived estimates of heart rate and the reference value derived from the ECG is similar to the mean absolute error between the ECG-derived value and the heart rate value from a pulse oximeter. Continuous non-contact vital sign monitoring in the NICU using ambient light is feasible, and the authors have shown that clinically important events such as a bradycardia accompanied by a major desaturation can be identified with their algorithms for processing the video signal. PMID:26609384

Reference ranges for regional cerebral tissue oxygen saturation and fractional oxygen extraction in neonates during immediate transition after birth.

PubMed

Pichler, Gerhard; Binder, Corinna; Avian, Alexander; Beckenbach, Elisabeth; Schmölzer, Georg M; Urlesberger, Berndt

2013-12-01

To define reference ranges for regional cerebral tissue oxygen saturation (crSO2) and regional cerebral fractional tissue oxygen extraction (cFTOE) during the first 15 minutes after birth in neonates requiring no medical support. The crSO2 was measured using near infrared spectroscopy (Invos 5100 cerebral/somatic oximeter monitor; Somanetics Corp, Troy, Michigan) during the first 15 minutes after birth for term and preterm neonates. The near infrared spectroscopy sensor was placed on the left forehead. Peripheral oxygen saturation and heart rate were continuously measured by pulse oximetry, and cFTOE was calculated. Neonates were excluded if they required any medical support. A total of 381 neonates were included: 82 term neonates after vaginal delivery, 272 term neonates after cesarean delivery, and 27 preterm neonates after cesarean delivery. In all neonates, median (10th-90th percentiles) crSO2 was 41% (23-64) at 2 minutes, 68% (45-85) at 5 minutes, 79% (65-90) at 10 minutes, and 77% (63-89) at 15 minutes of age. In all neonates, median (10th-90th percentiles) cFTOE was 33% (11-70) at 2 minutes, 21% (6-45) at 5 minutes, 15% (5-31) at 10 minutes, and 18% (7-34) at 15 minutes of age. We report reference ranges of crSO2 and cFTOE in neonates requiring no medical support during transition immediately after birth. The use of cerebral oxygenation monitoring and use of these reference ranges in neonates during transition may help to guide oxygen delivery and avoid cerebral hypo-oxygenation and hyperoxygenation. Copyright © 2013 Mosby, Inc. All rights reserved.