title: Accuracy of a third (Dolphin Voyager) versus first generation pulse oximeter (Nellcor N-180) in predicting arterial oxygen saturation and pulse rate in the anesthetized dog.
abstract: OBJECTIVE
  To compare the accuracy of a 3rd (Dolphin Voyager) versus 1st generation pulse oximeter (Nellcor N-180).
  
  
  METHODS
  Prospective laboratory investigation.
  
  
  METHODS
  Eight adult dogs.
  
  
  METHODS
  In anesthetized dogs, arterial oxygen saturation (SpO(2)) was recorded simultaneously with each pulse oximeter. The oxygen fraction in inspired gas (FiO(2)) was successively reduced from 1.00 to 0.09, with re-saturation (FiO(2) 0.40) after each breathe-down step. After each 3-minute FiO(2) plateau, SpO(2) and pulse rate (PR) were compared with the fractional arterial saturation (SaO(2)) and PR determined by co-oximetry and invasive blood pressure monitoring, respectively. Data analysis included Bland-Altman (B-A) plots, Lin's concordance correlation factor (rho(c)), and linear regression models.
  
  
  RESULTS
  Over a SaO(2) range of 33-99%, the overall bias (mean SpO(2) - SaO(2)), precision (SD of bias), and accuracy (A(rms)) for the Dolphin Voyager and Nellcor N-180 were 4.3%, 4.4%, and 6.1%, and 3.2%, 3.0%, and 4.3%, respectively. Bias increased at SaO(2) < 90%, more so with the Dolphin Voyager (from 1.6% to 8.6%) than Nellcor N-180 (from 3.2% to 4.5%). The SpO(2) readings correlated significantly with SaO(2) for both the Dolphin Voyager (rho(c) = 0.94) and Nellcor N-180 (rho(c) = 0.97) (p < 0.001). Regarding PR, bias, precision, and accuracy (A(rms)) for the Dolphin Voyager and Nellcor N-180 were -0.5, 4.6, and 4.6 and 1.38, 4.3, and 4.5 beats minute(-1), respectively. Significant correlation existed between pulse oximeter and directly measured PR (Dolphin Voyager: rho(c) = 0.98; Nellcor N-180: rho(c) = 0.99) (p < 0.001).
  
  
  CONCLUSIONS
  In anesthetized dogs with adequate hemodynamic function, both instruments record SaO(2) relatively accurately over a wide range of normal saturation values. However, there is an increasing overestimation at SaO(2) < 90%, particularly with the Dolphin Voyager, indicating that 3rd generation pulse oximeters may not perform better than older instruments. The 5.4-fold increase in bias with the Dolphin Voyager at SaO(2) < 90% stresses the importance of a 93-94% SpO(2) threshold to ensure an arterial saturation of >or=90%. In contrast, PR monitoring with both devices is very reliable.
authors.affiliation: Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, PA, USA. driessen@vet.upenn.edu
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Burns
authors.forename: Bernd
authors.initials: B
authors.lastname: Driessen
authors.forename: Ray
authors.initials: R
authors.lastname: Boston
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gunther
mesh_terms: D000758:Anesthesia; D000769:Anesthesia, Inhalation / Q000662:veterinary; D000818:Animals; D004285:Dogs / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D008297:Male; D010092:Oximetry / Q000295:instrumentation* / Q000662:veterinary*; D010100:Oxygen / Q000097:blood*; D012680:Sensitivity and Specificity
chemical_list: D010100:Oxygen