Evaluation of oesophageal reflectance pulse oximetry in major burns patients

Abstract

Pulse oximetry is being used in everyday clinical practice in anaesthesia utilising a peripheral probe. However, it may be unreliable in certain clinical situations such as hypothermia, hypovolemia, vasoconstriction and decreased cardiac output. Similar situations occur in burns patients and, more importantly, burns to extremities which limit the sites available for measurement of peripheral oxygen saturation (SpO(2)). To overcome these limitations, the oesophagus has been investigated as an alternative measurement site, as perfusion may be preferentially preserved centrally. A miniaturised reflectance oesophageal saturation (SpO(2)) probe has been constructed utilising infrared and red photodiodes and a photodetector. Our study was aimed at evaluating the reliability of oesophageal pulse oximetry in major burns patients. Seven adult patients (five males, two females) were studied. They were sedated and ventilated as part of their routine care. Measurable photoplethysmographic (PPG) traces and SpO(2) values were obtained in the oesophagus of all patients at a mean depth of 15.6+/-1.8 cm (measured from the lips). It was found that the oesophageal pulse oximeter results were in good agreement with oxygen saturation measurements obtained by a CO-oximeter. The mean (+/-S.D.) of the differences between the oesophageal oxygen saturation results and those from CO-oximetry was 0.50+/-0.69%. A Bland and Altman analysis showed that the bias and the limits of agreement between the oesophageal and commercial toe pulse oximeters were 0.4% and -3.6% to 4.6%, respectively. This study suggests that the oesophagus can be used as an alternative site for monitoring arterial blood oxygen saturation by pulse oximetry in burned patients.