Determination of hemoglobin saturation in patients with acute sickle chest syndrome: a comparison of arterial blood gases and pulse oximetry.
OBJECTIVE
To evaluate three different methods of measuring oxygen saturation in patients suffering from acute sickle chest syndrome.


METHODS
A prospective, descriptive study of 9 months' duration.


METHODS
A tertiary care university hospital.


METHODS
Adult patients with acute sickle chest syndrome scheduled to undergo RBC exchange transfusion.


METHODS
None.


METHODS
Baseline hemoglobin oxygen saturation was determined simultaneously by (1) calculation based on PaO2 and an oxyhemoglobin dissociation curve algorithm, (2) co-oximetry, and (3) pulse oximetry. These same measures were repeated after exchange transfusion. Baseline and postexchange hemoglobin electrophoresis was performed in all patients.


RESULTS
Baseline calculated saturation overestimated true saturation (determined by co-oximetry) with a baseline mean bias (co-oximetry minus calculated saturation) of -6.78 +/- 2.63% (95% confidence interval for bias: -8.37% to -5.19%). Pulse oximetry was not different than co-oximetry at baseline with a baseline bias of +1.86 +/- 3.25% (95% confidence interval: -0.1% to 3.82%). After exchange transfusion, there was no bias between either co-oximetry and calculated saturation (mean difference: -0.17 +/- 1.31% [95% confidence interval: -0.95% to 0.61%]), or co-oximetry and pulse oximetry (mean difference: +0.3 +/- 1.53% [95% confidence interval: -0.62% to 1.22%]).


CONCLUSIONS
Calculated saturation overestimates true saturation during acute sickle chest syndrome. This discrepancy abates after exchange transfusion. Pulse oximetry more closely follows co-oximetry than does calculated saturation during acute sickle chest syndrome.
Kress
J P
JP
Department of Medicine, University of Chicago, IL 60637, USA.
Pohlman
A S
AS
Hall
J B
JB
D000208:Acute Disease; D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood* / Q000150:complications / Q000628:therapy; D005069:Evaluation Studies as Topic; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006451:Hemoglobin, Sickle / Q000032:analysis; D006801:Humans; D008297:Male; D010092:Oximetry / Q000295:instrumentation / Q000379:methods; D010100:Oxygen / Q000097:blood; D010108:Oxyhemoglobins / Q000032:analysis*; D011446:Prospective Studies; D013577:Syndrome; D013896:Thoracic Diseases / Q000097:blood / Q000209:etiology*
D006451:Hemoglobin, Sickle; D010108:Oxyhemoglobins; D010100:Oxygen