Comparison of oxygenation measurements in pediatric patients during sickle cell crises,☆☆,,★★

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Abstract

Measurements of the saturation of arterial blood with oxygen (Sao2) were compared in 24 children during sickle cell crises. Simultaneous pulse oximetry (Nellcor N-100 pulse oximeter) and arterial blood analysis showed that Sao2 measured by pulse oximetry overestimated cooximeter-measured Sao2 (mean bias, 6.9%; p < 0.001). The blood gas machine–calculated Sao2 also overestimated cooximeter-measured Sao2 (p < 0.001). The bias increased with increasing age (p = 0.002) and carboxyhemoglobin level (p = 0.005) but was not related to methemoglobin, total hemoglobin, percentage of hemoglobin S, or percentage of hemoglobin F. (J PEDIATR 1994;124:93-5)

Section snippets

METHODS

Twenty-four children with documented sickle cell hemoglobinopathy and clinical symptoms of hypoxemia were studied. Their ages ranged from 1.4 to 16 years (mean age, 7.3 years). Their diagnoses included acute chest syndrome with pneumonia (10 children), pain crisis (6), sepsis (1), and reactive airways disease (1).

We analyzed simultaneous Spo2 (Nellcor N-100 pulse oximeter) and arterial blood gas values (Corning 178 analyzer; Corning Medical and Scientific, Medford, Mass.) for pH, arterial

RESULTS

Oxygen saturation measurements in our study population ranged from 71% to 98% (median 95%) as measured by cooximetry. Hemoglobin characteristics of this population were as follows: mean total hemoglobin level 78.6 gm/L (range, 57 to 123 gm/L), mean HbS 81% (range, 28% to 100%), mean HbF 5.5% (range, 0% to 29.9%), mean MetHb 2.2% (range, 0.1% to 6.4%), and mean COHb 5.4% (range, 3.2% to 7.6%). There was a linear relationship between cooximeter-measured Sao2 and pulse oximeter- measured Spo2 (r =

DISCUSSION

Our data show that in pediatric patients with sickle cell disease and suspected hypoxemia, Spo2 measurements significantly overestimate cooximeter-measured Sao2. The mean bias of 6.9% is more than three times the accepted 2% accuracy error of the pulse oximeter, and is clinically significant. Blood gas analyzer–calculated Sao2 also significantly overestimates cooximeter-measured Sao2. These biases were not related to %MetHb, %HbS,%HbF, or total hemoglobin; the overestimation bias of pulse

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From the Department of Pediatrics, Medical Center of Delaware, Newark, and Children's National Medical Center, George Washington University Medical Center, Washington, D.C.

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Supported by a Research Grant from the Brandywine Professional Association.

Reprint requests: Vinay Nadkarni, MD, Department of Pediatrics, Medical Center of Delaware, 4755 Stanton-Ogletown Rd., PO Box 6001, Newark, DE 19718.

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