Accuracy and Precision of Buccal Pulse Oximetry
Name: Marla DeJong
Rank: Lt Col
Performance Site: Wilford Hall Medical Center, Lackland AFB TX
Year Published: 2006
Abstract Status: Final
Hypoxemia is a life-threatening complication for combat casualties. Due to the nature of their injuries and the stressors of flight, casualties are at high risk for hypoxemia. Continuous pulse oximetry monitoring is the standard of care for monitoring critically injured casualties because it is more accurate and reliable than a visual assessment in detecting hypoxemia. Based on reports from deployed military Critical Care Air Transport Team (CCATT) clinicians, traditional oximetry monitoring using finger or ear lobe sites is not possible for combat casualties with severe burns, unilateral or bilateral amputations, profound vasoconstriction, hypothermia, or massive edema. Although buccal oximetry has been used in clinical practice, it is not known whether it is accurate and precise. Accordingly, the specific aims of the proposed study are to 1) describe the accuracy and precision of buccal pulse oximetry compared to arterial oxygen saturation (SaO2) at normoxemia (SpO2 > 95%) and under three hypoxemic (SpO2 = 90%, 80%, and 70%) conditions and 2) describe the bias and precision of oximetry measurements obtained from the buccal mucosa and finger of healthy participants during normoxemia (SpO2 > 95%) and under three hypoxemic (SpO2 = 90%, 80%, and 70%) conditions. Fifty adult healthy participants who are assigned to Wilford Hall Medical Center will be enrolled into this prospective study. Arterial oxygen saturation (co-oximetry), and buccal (SbpO2) and finger (SpO2) oximetry values will be recorded at normoxemia and at the three levels of hypoxemia. Hypoxemia will be induced using the Reduced Oxygen Breathing Device 2. The Bland-Altman approach will be used to assess agreement and the precision of measurements between the SbpO2 and SaO2 measures and between the SbpO2 and SpO2 measures. To assess the proportion of variance accounted for by persons and saturations levels, a G study will be conducted in which there variance components are estimated. A ┬▒ 4% variability will be the standard by which precision of the buccal measure will be judged for clinical acceptability or interchangeability. The proposed study will provide investigators and clinicians with valuable information regarding whether buccal oximetry monitoring is as feasible, accurate, and precise as oximetry data obtained from traditional pulse oximetry monitoring sites. The study results may yield vital information and propel future buccal oximetry research with acutely and critically ill patients. Ultimately, CCATT, critical care, and acute care clinicians may routinely use buccal oximetry monitoring in their practice and thus avoid gaps in monitoring that place casualties at greater risk for complications of undetected hypoxemia.
Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2013101283.xhtml