Transcutaneous oxygen saturation accuracy in critically ill children

Abstract

AIMS & OBJECTIVES: Few studies have evaluated accuracy and precision of SpO2 in children, although sensor manufacturers claim high sensitivity, specificity and accuracy. This study aims to evaluate the performance of pulse oximetry in critically ill paediatric patients, quantify the bias between SpO2 and SaO2, determine the sensitivity and specificity to detect true hypoxaemia. METHODS: This observational study paired SpO2 readings obtained with a Masimo and a Nellcor sensor and prospectively matched and validated them to the arterial haemoglobin oxygen saturation (SaO2). Bias between SpO2 and SaO2 (SpO2-SaO2), accuracy root mean square (Arms), sensitivity, specificity and kappa agreement were calculated for sensors. Multivariable regression analysis was conducted to determine the relationship between clinical variables and bias in paired sensor readings. This study was conducted in a 36-bed mixed medical/surgical paediatric intensive care unit. All children <16 years old with an arterial line were eligible. RESULTS: There were 929 participants with 16,839 readings (9,382 simultaneous Masimo and Nellcor). Nineteen percent of paired values had SaO2<88%. Bias increased with decreasing SaO2. Both sensors failed to achieve FDA's Arms requirement in all ranges. Of the 15.5% patients with 'true hypoxaemia' (SaO2<88%), 28.6% (n=1165) were not correctly identified by pulse oximetry. Variables associated with higher odds of bias included sepsis, respiratory distress and post-cardiac arrest; increasing lactate; vasoconstrictor use; lower SaO2and low admission weight. CONCLUSIONS: Both tested sensors, with current algorithms, are not precise enough for a PICU setting. Sensor readings in patients with respiratory disease, sepsis and cardiac arrest should be used with caution.L6347728052021-04-21 <br />