Pulse - Oximetery

Dr Prashant S Agarwal
Dr Ashok Jadon
Deptt. Of Anaesthesia
 Why ?
• Cyanosis - poor guide to the detection of
arterial hypoxemia
• Comroe JH, Botelho S. The unreliability of
cyanosis in the recognition of arterial anoxemia.
Am J Med Sci 1947;214:1–6.
• 5 g reduced hemoglobin per 100 ml
capillary blood must be present to produce
visible cyanosis
• Lundsgaard C, Van Slyke DD. Cyanosis. Medicine
1923;2:1.
Necessity is the mother of invention
• “Oxygen lack not only stops the machine
but wrecks the machinery”
• JS Haldane;1921
• Anoxia - how long :- damage to
cerebral cortex - 1 min
heart - 5 min
liver and kidney -10 minutes
skeletal muscle - 2 hours.
 HISTORY

• Glenn Millikan (1942) -

– First oximeter
– For pilots of World War II
– halogen incandescent lamp

• Hewlett-Packard ear oximeter

– fibreoptic light guide, eight wavelengths
– considered to be the “gold standard” for first pulse oximeters
calibration
– No separation of the absorption due to arterial blood from the
veins
– large and cumbersome
– frequent calibration
 Current Pulse Oximetry

• Continuous non-
invasive method for
measuring
– Arterial oxygen
saturation
– Pulse rate
 Optical principles
Beer–Lambert law -
A = log (Io/I) = εlc
Principle of operation
• Use of 2 different wavelengths (Oxyhemoglobin
absorbs more infrared light Reduced hemoglobin absorbs
more red light)
Comparison’s are made between peak
and trough of the cardiac cycle
Difference in absorptions is read by the
computer and displayed on the screen
Plethysmogram
What to look for ?
• Signal Strength
• Wave form
• PR
• SpO2
• Tone ( Pitch changes
with decrease in
saturation - Nellcor Pulse
Oximeter 1983 )
• Rhythm (with expertise)
 Indications
• Oxygen lack
• Acute hypoxia
• Chronic hypoxia
• Respiratory failure
• Asthma
• Chronic obstructive pulmonary disease
• Adult respiratory distress syndrome
• Pulse oximetry for screening
 Uses
• Operation Theater
• Recovery Room
• Intensive Care Unit
• Emergency Room
• High-dependency units
• Prehospital care
• Transportation
 Applications
• Avoidance of Hypoxemia
• Monitoring Oxygenation
• Controlling Oxygen Administration
• Monitoring Circulation
• Determining Systolic Blood Pressure
• Locating Vessels
• Monitoring Vascular Volume
• Monitoring of Peripheral Blood Flow
 Sites
• Finger
• Ear lobule
• Nose
• Tongue
• Lips
• Forehead
• Scalp
• Foot
• Miscellaneous
 Conditions Affecting Accuracy
• Ambient light
• Electronic interferences
• Patient conditions
– Carboxyhemoglobin
– Methmoglobinemia
– Hypovolemia/Hypotension
– Hypothermia
– Nail Polish (blue, black and
green affects accuracy)
– Patient movement
– Peripheral shut down
– Saturation < 75%
 Anemia

• The lower limit of hemoglobin in vivo at which the

pulse oximeter becomes totally unreliable has
not yet been determined
• Jay et al., have shown good performance at
Hemoglobin as low as 2.3 g/dL
 Advantages
• Accuracy
• Dependability
• Convenience
• Fast Response Time
• Non-Invasiveness
• Continuous Monitoring
• User Friendly
• Economical
• Ecological
 Limitations

• neither indicates functional nor fractional

saturation.
• indicates a value, SpO2, which is best defined as
oxygen saturation as measured by a pulse oximeter
• only measures oxygenation not ventilation
• no indication of PaO2, pH or PaCO2 levels
 Cautions

• Hypoventilation (hypercarbia) may

precede decrease in saturations by many
minutes.
• Supplemental oxygen may mask
hypoventilation and CO2 retention.
 Complications

• Ocular Injury
• Pressure & Ischemic
Injuries
• Burns
• Electric Shock
 Review Literature
• The 88%-SAT may be more effective than spirometry for
identifying reactive airways disease
• Wagner et al.
• Pulse oximetry is a sensitive indicator of perfusion in
patients suffering peripheral vascular disease.
• Joyce WP, Walsh K, Gough JB et al. Br J Surg 1990; 77:115–7.
• Pulse oximetry as a means of assessing bowel viability
at surgery.
• DeNobile J, Guzzetta P, J Surg Res 1990;48:21–3.
• Tollefson DF, Wright DJ, Reddy DJ, Ann Vasc Surg 1995;9:357–60.
• Plastic surgery - Viability of skin flaps which have been
“swung” around, and also of “free” flaps.
Newer advances

• Fetal pulse oximetery

• Reflection pulse oximetry
– Can be placed on more proximal sites
– Viability of visceras can be detected

• For MRI -
• has all of its electronic components in the main unit and the light
energy is transmitted to and from the patient by optical fibers.
• must be kept at least 3 m away from the bore of the MRI magnet
Reflectance Pl-Ox
 Take Home Message
• Pulse oximetry is NOT intended to
replace any part of the patient
assessment!
• Treat carboxyhemoglobinemia with
high flow oxygen regardless of the
pulse oximetry reading!
• Always administer oxygen to
patients with poor perfusion!
 Finally……….

Assess and treat the

PATIENT not the
oximeter!
THANK YOU