A prototype device for standardized calibration of pulse oximeters

Approaches for calibration and validation of near-infrared optical methods for oxygenation monitoring

Pulse oximetry for arterial oxygenation monitoring and tissue oximetry for monitoring of cerebral oxygenation or muscle oxygenation are based on quantitative in vivo diffuse optical spectroscopy. However, in both cases the information on absolute or relative concentration of human tissue constituents and especially on hemoglobin oxygenation can often not be retrieved by model-based analysis. An in vivo calibration against an accepted reference measurement can be a practical alternative. Pulse oximeters and most of commercial cerebral tissue oximeters rely on empirical calibration based on invasive controlled human desaturation studies. As invasive in vivo tests on healthy subjects are ethically disputable and should be limited to exceptional cases this calibration practice is unsatisfactory. We present the current status and problems of calibration and validation in pulse oximetry and cerebral tissue oximetry including the pros and cons of in vivo as well as in vitro methods. We emphasize various digital and physical phantom approaches and discuss the prospects of their application and possible further developments.

Automated frequency domain analysis of oxygen saturation as a screening tool for SAHS

Sleep apnea-hypopnea syndrome (SAHS) is significantly underdiagnosed and new screening systems are needed. The analysis of oxygen desaturation has been proposed as a screening method. However, when oxygen saturation (SpO(2)) is used as a standalone single channel device, algorithms working in time domain achieve either a high sensitivity or a high specificity, but not usually both. This limitation arises from the dependence of time-domain analysis on absolute SpO(2) values and the lack of standardized thresholds defined as pathological. The aim of this study is to assess the degree of concordance between SAHS screening using offline frequency domain processing of SpO(2) signals and the apnea-hypopnea index (AHI), and the diagnostic performance of such a new method. SpO(2) signals from 115 subjects were analyzed. Data were divided in a training data set (37) and a test set (78). Power spectral density was calculated and related to the desaturation index scored by physicians. A frequency desaturation index (FDI) was then estimated and its accuracy compared to the classical desaturation index and to the apnea-hypopnea index. The findings point to a high diagnostic agreement: the best sensitivity and specificity values obtained were 83.33% and 80.44%, respectively. Moreover, the proposed method does not rely on absolute SpO(2) values and is highly robust to artifacts.

A prototype device for standardized calibration of pulse oximeters II

OBJECTIVE

There is no commonly accepted in vivo calibration method for pulse oximeters available up to now. On the basis of a prototype device for the calibration of pulse oximeters which was introduced recently, a second approach based on the same concept was tackled in order to design a reliable method for standardized calibration of pulse oximeters.

METHODS

An extensive clinical database of time-resolved optical transmission spectra of patient fingers is used to simulate the behavior of patients. A device which is capable of playing back these spectroscopic data to pulse oximeters, and a database where the oxygen status measured with the reference method (Co-Oximetry) is stored, are the main parts of the concept. The playback device has an artificial finger as interface to the pulse oximeters and serves to collect light from the pulse oximeter for analysis and to playback simulated light to the pulse oximeter. The light intensity emitted by two LEDs which illuminates the pulse oximeter detector is controlled via a computer in such a way that it is the same as if the pulse oximeter light had passed the finger. The pulse oximeter display during the data playback can thus be compared to the true SaO2 of the patient. The device is tested with 4 pulse oximeters based on 100 patient spectra.

RESULTS

For the four pulse oximeters used in this investigation, an Agilent Technologies CMS monitor (formerly Hewlett-Packard), an Ivy 2000 with Masimo Set technology and Nellcor N-3000 and N-395, there is good correlation between SPO2 and SaO2, and mean and standard deviation of in vivo SpO2-SaO2 and playback SpO2-SaO2 are in good agreement. For two instruments, Nellcor N3000 and Agilent CMS Monitor, a quantitative comparison between the in vivo and in vitro SpO, results was derived. A mean of the deviation playback vs. in vivo SpO2 is less than 0.5% SpO2. The error limits are comparable with the calibration error of the conventional calibration routine. The device is also capable of data playback even in situations with rapid desaturation changes, as displayed in Figure 2. For the other tested pulse oximeters the results are comparable.

CONCLUSIONS

Compared to the first prototype the current version is simpler and less expensive in production. Many of previously existing problems are solved and the applicability to a large variety of pulse oximeters and sensors is given. The novel concept for the calibration of pulse oximeters is a tool for assessing the performance of pulse oximeters.