From the Department of Anesthesia (Dr Asahina), St. Luke’s International Hospital; and Perianesthesia Nursing (Dr Miyasaka), St. Luke’s International University.
CORRESPONDENCE TO: Katsuyuki Miyasaka, MD, PhD, Perianesthesia Nursing, St. Luke’s International University, 10-1, Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; e-mail: firstname.lastname@example.org
CONFLICT OF INTEREST: None declared.
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We read with great interest the article by Aldrich et al1 in this issue of CHEST (see page 1484). In 2003, we reported our trial of measuring noninvasive arterial saturation during a pulseless situation (cardiopulmonary bypass [CPB]) by inducing a simulated pulse.2 We were interested in finding a way to obtain pulse oximeter function during CPB at the time because we had experienced a mortally instructive cardiac case in which the routine anesthesia practice of turning off the pulse oximeter during CPB resulted in severe hypoxic brain damage.
Aldrich et al1 did not describe their method in detail, so we are not sure whether the method they used was the same as ours. We applied a BP cuff at the forearm or finger, which was intermittently (0.5-1 Hz) inflated by a makeshift air pump to produce simulated pulses. A conventional pulse oximeter and its probe were attached to an ipsilateral finger.
Our system worked under most conditions, and the method was patented, but we could not pursue further development because, ironically, the algorithms used and the features integrated into conventional pulse oximeters to eliminate undesirable clinical noise prevented us from achieving steady and reliable measurements. The current assumption that only arterial blood is pulsating may not be valid because our method of inducing pulsation definitely produced venous and tissue pulsations. This concept may necessitate the development of a totally different measuring algorithm.3
Aldrich et al1 should be commended on their approach to developing a designated oximeter for this purpose as our approach of using a conventional pulse oximeter has serious limitations. We needed industry to cooperate with us, but unfortunately this proved difficult because of a perception of small clinical need. Conditions have changed over the past decade regarding concern for patient safety and for continuous oxygenation monitoring of pulseless conditions. In addition to its use in CPB, patients on extracorporeal membrane oxygenation and those with an artificial heart have now been added to the wish list.
The current common practice of depending solely on intermittent arterial blood gases from the CPB circuit alone is critically flawed.2 All pulseless conditions should be monitored for arterial oxygenation.
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