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Arterial Oxygen Saturation, Pulse Oximetry, and Cerebral and Tissue Oximetry in Hypobaric Hypoxia

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INTRODUCTION: Clinical accuracy of pulse oximeters (giving Spo2) is routinely tested down to an Sao2 of 70%, but lower oxygen saturations are often experienced during hypobaric hypoxia. Cerebral (Sco2) and peripheral tissue (Sto2) oxygen saturations can be measured using near infra-red spectroscopy. In a project simulating oxygen system failure during high altitude-high opening parachuting (HAHO), Sao2, Spo2, Sco2, and forearm Sto2 were measured. The aim of the present analysis was to explore the agreement between Sao2 and the three noninvasive measurements of hypoxemia (Spo2, Sco2, and Sto2).

METHODS: Healthy volunteers from the Norwegian Special Operations Commando were studied in a hypobaric chamber as supplemental oxygen was removed at 301 hPa ambient pressure (30,000 ft) and recompressed at 25 hPa · min-1 (1000 ft · min-1) to ground level simulating a HAHO parachute flight. Sao2 was compared with Spo2, Sco2, and Sto2 in scatterplots and Bland-Altman plots, calculating bias and limits of agreement (LOA).

RESULTS: The bias ± LOA were: Sao2 vs. Spo2: −5.8% ± 16, Sao2 vs. Sco2: −3.4% ± 11, and Sao2 vs. Sto2: 17% ± 30. The bias for Sao2 vs. Spo2 was dependent on the range of values, and correcting for this with a sloped bias line reduced the LOA to ± 8.2%.

DISCUSSION: There were wide limits of agreement between Sao2 and Spo2. Sao2 and Sco2 agreed better, whereas Sao2 and forearm Sto2 had wide LOA. The agreement between Sao2 and Spo2 improved when correcting for the underestimation of Spo2 at low values. There is a poor agreement between Spo2 and the gold standard Sao2 during extreme hypobaric hypoxemia.

Ottestad W, Kåsin JI, Høiseth LØ. Arterial oxygen saturation, pulse oximetery, and cerebral and tissue oximetry in hypobaric hypoxia. Aerospace Med Hum Perform. 2018; 89(12):1045–1049.
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Keywords: atmospheric pressure; blood gas analysis; hypoxia; oximetry

Document Type: Research Article

Publication date: 01 December 2018

More about this publication?
  • This journal (formerly Aviation, Space, and Environmental Medicine), representing the members of the Aerospace Medical Association, is published monthly for those interested in aerospace medicine and human performance. It is devoted to serving and supporting all who explore, travel, work, or live in hazardous environments ranging from beneath the sea to the outermost reaches of space. The original scientific articles in this journal provide the latest available information on investigations into such areas as changes in ambient pressure, motion sickness, increased or decreased gravitational forces, thermal stresses, vision, fatigue, circadian rhythms, psychological stress, artificial environments, predictors of success, health maintenance, human factors engineering, clinical care, and others. This journal also publishes notes on scientific news and technical items of interest to the general reader, and provides teaching material and reviews for health care professionals.

    To access volumes 74 through 85, please click here.
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