Buccal pulse oximetry: Accuracy and precision
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Dr. Patricia Nicole Meza, RN, PhD, MS, CEN, CCNS, TCRN
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- Delta Alpha at-Large
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Abstract
Clinicians assess multiple biomarkers and patient signs/symptoms in clinical settings such as intensive care units, operating rooms, emergency departments, and patient transport. Pulse oximetry monitoring remains a standard. There are instances in which traditional pulse oximetry monitoring sites, such as the fingers, toes or earlobes, fail or access is infeasible. In these instances, clinicians seek alternative monitoring sites, such as the buccal area. Unstable patients may also challenge ability to acquire a pulse oximetry signal, possibly preventing reliable pulse oximetry values. Compared to fingers or toes, the buccal area is not as susceptible to local vasoconstriction effects. Therefore, the buccal area may enable measurement of pulse oximetry even in low flow states. Only a few studies have investigated accuracy and/or precision of buccal pulse oximetry relative to arterial blood oxygenation.
The purpose of this study was to establish limits of agreement between buccal pulse oximetry and arterial blood oxygenation and to compare the limits of agreement for buccal pulse oximetry and finger pulse oximetry relative to arterial blood oxygenation. The present study also examined the degree to which fraction of inspired oxygen, partial pressure of oxygen dissolved in arterial blood, minute ventilation, heart rate, mean arterial pressure, pulse oximetry waveform amplitude, presence of vasoactive medication intravenous infusions, body temperature, and skin phototype (pigment) influenced buccal and finger pulse oximetry - arterial blood oxygenation bias.
A prospective clinical investigation approach was used and 136 participants were initially recruited in a large Level 1 trauma center. The final sample size was 98. Study inclusion criteria were: age 18 or greater, presence of an endotracheal or tracheostomy tube, and presence of mechanical ventilation. Buccal and finger pulse oximetry measurements were compared to the gold standard SaO2. Data were analyzed using Bland-Altman analyses, Pearson Correlation, and independent-samples t-test.
Results: The present study revealed limits of agreement between buccal pulse oximetry and arterial blood oxygenation were -13.73 to 9.87. Limits of agreement between buccal pulse oximetry and arterial blood oxygenation were dispersed more widely when compared to finger pulse oximetry and arterial blood oxygenation (-4.11 to 4.3), especially at arterial blood oxygenation values less than 90 percent. The present study also revealed that decreased mean arterial pressure and presence of vasopressor infusions independently were associated with more negative finger pulse oximetry- arterial blood oxygen saturation bias. Lastly, participants with brown skin phototype had more positive finger pulse oximetry- arterial blood oxygen saturation bias.
Implications: As buccal pulse oximetry may vary by greater than 4 percent of arterial blood oxygenation, the present study indicated that buccal pulse oximetry is an imprecise measure of arterial blood oxygenation in mechanically-ventilated adults. Clinicians should be aware that decreased mean arterial pressure or presence of vasopressor infusions may result in finger pulse oximetry values that underestimate arterial blood oxygen saturation. Finally, clinicians should be aware that brown skin phototype may be associated with finger pulse oximetry values that overestimate arterial blood oxygen saturation.
Description
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 10270683; ProQuest document ID: 1910119877. The author still retains copyright.
Repository Posting Date
2020-04-08T15:04:13Z
Notes
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
Type Information
Type | Dissertation |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Category Information
Evidence Level | Cohort |
Research Approach | Quantitative Research |
Keywords | Taking Vital Signs; Measurement Accuracy; Patient Care |
CINAHL Subject(s) | Pulse Oximetry; Mouth Mucosa; Oxygen Saturation; Blood Gas Analysis; Pulse Oximetry--Methods |
Degree Information
Grantor | The University of Texas Health Science Center at San Antonio |
Advisor | Berndt, Andrea E. |
Level | PhD |
Year | 2017 |
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