Measuring arterial oxygen saturation from an intraosseous photoplethysmographic signal derived from the sternum

• Published in: Journal of clinical monitoring and computing Vol. 34; no. 1; pp. 55 - 62
• Main Authors: Näslund, Erik, Lindberg, Lars-Göran, Lund, Iréne, Näslund-Koch, Lui, Larsson, Agneta, Frithiof, Robert
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.02.2020; Springer Nature B.V
• Subjects: Anestesi och intensivvård; Anesthesiology; Biomedicinsk laboratorievetenskap/teknologi; Blood flow; Bone tissue; Critical Care Medicine; Ear; Fysiologi; Gas mixtures; Health Sciences; Hemoglobin; Human; Hypoxemia; Hypoxia; Intensive; Klinisk medicin; Medical electronics; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Medicinsk bioteknologi; Medicinska och farmaceutiska grundvetenskaper; Monitoring; Original Research; Oximetry; Oxygen; Oxygen content; Photoplethysmography (PPG); Respiration; Respiratory therapy; Rib cage; Statistics for Life Sciences; Sternum; Human; Hypoxia; Bone tissue; Respiration; Photoplethysmography (PPG); Monitoring
• ISSN: 1387-1307; 1573-2614; 1573-2614
• DOI: 10.1007/s10877-019-00289-w

Photoplethysmography performed on the peripheral extremities or the earlobes cannot always provide sufficiently rapid and accurate calculation of arterial oxygen saturation. The purpose of this study was to evaluate a novel photoplethysmography prototype to be fixed over the sternum. Our hypotheses were that arterial oxygen saturation can be determined from an intraosseous photoplethysmography signal from the sternum and that such monitoring detects hypoxemia faster than pulse oximetry at standard sites. Sixteen healthy male volunteers were subjected to incremental hypoxemia using different gas mixtures with decreasing oxygen content. The sternal probe was calibrated using arterial haemoglobin CO-oximetry (S a O 2 %). Sternal probe readings (S RH O 2 %) were then compared to S a O 2 % at various degrees of hypoxia. The time to detect hypoxemia was compared to measurements from standard finger and ear pulse oximeters. A significant association from individual regression between S RH O 2 % and S a O 2 % was found (r 2 0.97), Spearman R ranged between 0.71 and 0.92 for the different inhaled gas mixtures. Limits of agreement according to Bland–Altman plots had a increased interval with decreasing arterial oxygen saturation. The sternal probe detected hypoxemia 28.7 s faster than a finger probe (95% CI 20.0-37.4 s, p < 0.001) and 6.6 s faster than an ear probe (95% CI 5.3–8.7 s, p < 0.001). In an experimental setting, arterial oxygen saturation could be determined using the photoplethysmography signal obtained from sternal blood flow after calibration with CO-oximetry. This method detected hypoxemia significantly faster than pulse oximetry performed on the finger or the ear.