Pulse-articles-c Cryptocurrencies And Poor Explanations

Pulse-articles-c cryptocurrencies and poor explanations

Pulse oximeters and poor perfusion

Pulse oximeters and poor perfusion Hanning, C.D.; Langton, J.A. 1991-10-01 00:00:00 1.

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KESSLER MR, EIDE HUMAYUN POPPERS Spurious pulse T, B, PJ. F , ~ROSEWARM , K’J.

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REYNoLDs 2. SCHELLER UNGER KELNER Effects of intravenously MS, RJ, MJ. injected dyes on pulse oximeter readings. Anesthesiology 1986; 6 5 550-2.

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3. RUBIN AS. Nail polish can affect pulse oximeter saturation. Anesthesiology 1988; 68:825. 4 COTECJ, GOLDSTEIN FUCHSMAN HOAGLIN The . EA, WH, DC.

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effect of nail polish on pulse oximetry. Anesthesia and Analgesia 1987; 67: 683-6. 5. SNEYD ‘Finger painting’ and the pulse oximeter. Anaesthesia JR. 1991; 46: 420-1. oximeter desaturation with Anesthesiology 1986; 6 5 435-6. methylene blue injection. Pulse oximeters and poor perfusion Professor Runciman and his colleagues (Anaesthesia 199 1; 46: 3) are to be congratulated on their detailed study of a large number of pulse oximeters.

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However, we are concerned that the publication of a ‘league table’, ranking different instruments in a particular order, may ,be misleading to potential purchasers. When peripheral perfusion is reduced the pulse wave amplitude diminishes and its shape resembles a sine wave rather than the characteristic rapid upstroke and exponential decay with a dichrotic notch.

Pulse oximeters generally make multiple measurements of transmitted red and infrared light every second and compare one with another in order to determine if any change is due to arterial pulsation or to artefact. Both the amplitude and the shape of the waveform are important in discriminating pulse from artefact.

Resulting measurements of Spo, are weighted, fed into an algorithm and the resulting average displayed on the front panel.

Pulse-articles-c cryptocurrencies and poor explanations

Different manufacturers use different strategems when the changes in light transmission as a result of arterial pulsation approaches those caused by artefact. Some calculate internal ‘confidence intervals’ and warn the user that the displayed value may not be reliable. Others stop displaying a value and search for a pulse wave while some hold the last value while searching for the pulse wave.

The former two methods are clinically acceptable as the user should not be given unreliable data provided that the manufacturer has set the level appropriately.

Pulse-articles-c cryptocurrencies and poor explanations

The dilemma for the manufacturer is that if he errs on the side of safety and indicates a problem with signal strength before his competitors, he runs the risk of being accused of inadequate performance under conditions of poor perfusion.

The converse situation, where an instrument continues to display a value when pulse amplitude is too small for reliable data collection, is dangerous clinically, but likely to win approval in poorly designed studies of poor perfusion where oxygenation is normal and unchanging.

The only acceptable method of checking proper pulse oximeter function is to examine the response to changes in oxygenation. Our own studies,’-’ which have examined a number of different aspects of pulse oximeter function, have been conducted in volunteers and have included intermittent exposure to hypoxic gas mixtures. Such studies test the most important purpose of pulse oximeters, namely their ability to detect the sudden onset of hypoxaemia.

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Our ‘league table’ of pulse oximeters would look very different to that of Professor Runciman. The most recent study from this Department’ has shown the ability of motion artefact to induce changes in the displayed Spo, and delayed detection of hypoxaemia.

Shivering is a common occurrence in the rewarming period folloviing cardiopulmonary bypass and we feel that it is possible that some of the changes seen by Professor Runciman’s group might have been due to motion artefact. The choice of a pulse oximeter is important and comparative studies are essential. Potential purchasers should be cautioned that accuracy and precision are not sufficient criteria for a decision and the ability to detect hypoxaemia reliably under adverse conditions should be considered.

Leicester Royal Infirmary, Leicester LEI 5 WW http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.pngAnaesthesiaWileyhttp://www.deepdyve.com/lp/wiley/pulse-oximeters-and-poor-perfusion-50I1FK0PY5

 

/lp/wiley/pulse-oximeters-and-poor-perfusion-50I1FK0PY5

Publisher
Wiley
Copyright
Copyright © 1991 Wiley Subscription Services, Inc., A Wiley Company
ISSN
0003-2409
eISSN
1365-2044
DOI
10.1111/j.1365-2044.1991.tb09614.x
Publisher site
See Article on Publisher Site

Abstract

1.

KESSLER MR, EIDE HUMAYUN POPPERS Spurious pulse T, B, PJ. F , ~ROSEWARM , K’J. REYNoLDs 2. SCHELLER UNGER KELNER Effects of intravenously MS, RJ, MJ.

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injected dyes on pulse oximeter readings. Anesthesiology 1986; 6 5 550-2. 3. RUBIN AS. Nail polish can affect pulse oximeter saturation.

Anesthesiology 1988; 68:825. 4 COTECJ, GOLDSTEIN FUCHSMAN HOAGLIN The . EA, WH, DC. effect of nail polish on pulse oximetry. Anesthesia and Analgesia 1987; 67: 683-6.

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5. SNEYD ‘Finger painting’ and the pulse oximeter. Anaesthesia JR. 1991; 46: 420-1. oximeter desaturation with Anesthesiology 1986; 6 5 435-6. methylene blue injection. Pulse oximeters and poor perfusion Professor Runciman and his colleagues (Anaesthesia 199 1; 46: 3) are to be congratulated on their detailed study of a large number of pulse oximeters.

However, we are concerned that the publication of a ‘league table’, ranking different instruments in a particular order, may ,be misleading to potential purchasers.

Pulse-articles-c cryptocurrencies and poor explanations

When peripheral perfusion is reduced the pulse wave amplitude diminishes and its shape resembles a sine wave rather than the characteristic rapid upstroke and exponential decay with a dichrotic notch. Pulse oximeters generally make multiple measurements of transmitted red and infrared light every second and compare one with another in order to determine if any change is due to arterial pulsation or to artefact.

Both the amplitude and the shape of the waveform are important in discriminating pulse from artefact. Resulting measurements of Spo, are weighted, fed into an algorithm and the resulting average displayed on the front panel.

Different manufacturers use different strategems when the changes in light transmission as a result of arterial pulsation approaches those caused by artefact.

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Some calculate internal ‘confidence intervals’ and warn the user that the displayed value may not be reliable. Others stop displaying a value and search for a pulse wave while some hold the last value while searching for the pulse wave. The former two methods are clinically acceptable as the user should not be given unreliable data provided that the manufacturer has set the level appropriately.

The dilemma for the manufacturer is that if he errs on the side of safety and indicates a problem with signal strength before his competitors, he runs the risk of being accused of inadequate performance under conditions of poor perfusion.

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The converse situation, where an instrument continues to display a value when pulse amplitude is too small for reliable data collection, is dangerous clinically, but likely to win approval in poorly designed studies of poor perfusion where oxygenation is normal and unchanging. The only acceptable method of checking proper pulse oximeter function is to examine the response to changes in oxygenation. Our own studies,’-’ which have examined a number of different aspects of pulse oximeter function, have been conducted in volunteers and have included intermittent exposure to hypoxic gas mixtures.

Such studies test the most important purpose of pulse oximeters, namely their ability to detect the sudden onset of hypoxaemia. Our ‘league table’ of pulse oximeters would look very different to that of Professor Runciman. The most recent study from this Department’ has shown the ability of motion artefact to induce changes in the displayed Spo, and delayed detection of hypoxaemia.

Shivering is a common occurrence in the rewarming period folloviing cardiopulmonary bypass and we feel that it is possible that some of the changes seen by Professor Runciman’s group might have been due to motion artefact. The choice of a pulse oximeter is important and comparative studies are essential.

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Potential purchasers should be cautioned that accuracy and precision are not sufficient criteria for a decision and the ability to detect hypoxaemia reliably under adverse conditions should be considered. Leicester Royal Infirmary, Leicester LEI 5 WW

Journal

Anaesthesia – Wiley

Published: Oct 1, 1991


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