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Original Research: Pulmonary Procedures |

Pulseless OximetryPulseless Oximetry: A Preliminary Evaluation

Thomas K. Aldrich, MD; Pragya Gupta, MD; Sean P. Stoy, MD; Anthony Carlese, DO; Daniel J. Goldstein, MD
Author and Funding Information

From the Pulmonary Medicine Division (Drs Aldrich, Gupta, and Stoy), the Critical Care Medicine Division (Dr Carlese), and the Department of Cardiothoracic Surgery (Dr Goldstein), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.

CORRESPONDENCE TO: Thomas K. Aldrich, MD, Pulmonary Medicine Division, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; e-mail: taldrich@montefiore.org


Part of this article was presented at CHEST 2014, October 25-30, 2014, Austin, TX.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(6):1484-1488. doi:10.1378/chest.15-0435
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BACKGROUND:  Pulse oximetry fails when pulsations are weak or absent, common in patients with continuous flow left ventricular assist devices (LVADs). We developed a method to measure arterial oxygenation (Sao2) noninvasively in pulseless patients with LVADs.

METHODS:  The technique involves 5- to 10-s occlusions of radial and ulnar arteries on one hand. A fingertip is transilluminated alternately with light-emitting diodes emitting 660 nm (red) and 905 nm (infrared). During the approximately 1 s after release of occlusion, changing attenuance of each wavelength is measured and their red/infrared arterial blood attenuance ratio (R/IR) calculated. We studied five normal subjects breathing hyperoxic, normoxic, or hypoxic gas mixtures to establish a calibration curve, using standard pulse oximetry as the gold standard. We also studied seven pulseless patients with LVADs (two studied twice) at clinically determined oxygenation.

RESULTS:  Normal subject data showed close correlation of oxygen saturation by pulse oximetry (Spo2) with R/IR, (Spo2 = 111 − [26.7 × R/IR]; R2 = 0.975). For patients with LVADs, predicted Sao2 (from the calibration curve) tended to underestimate measured Sao2 (from arterial blood) by a clinically insignificant 1.1 ± 1.6 percentage points (mean ± SD), maximum 3.4 percentage points.

CONCLUSIONS:  Preliminary results in a small number of patients demonstrate that pulseless oximetry can be used to estimate arterial saturation with acceptable accuracy. A noninvasive oximeter that does not rely on pulsatile flow would be a valuable advance in assessing oxygenation in patients with LVADs, for whom the only current option is arterial puncture, which is painful, risks arterial injury, and only provides a snapshot evaluation of oxygenation.

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