Accuracy and precision of buccal pulse oximetry

• Published in: Heart & lung 2011-01, Vol.40 (1), p.31-40
• Main Authors: De Jong, Marla J., PhD, RN, CCNS, Schmelz, Joseph, PhD, RN, CIP, FAAN, Evers, Karen, MS, RN, Bradshaw, Patricia, MS, CCNS, CCRN, CEN, McKnight, Kathleen, PhD, Bridges, Elizabeth, PhD, RN, CCNS, FCCM, FAAN
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Cardiovascular; Cardiovascular disease; Comparative analysis; Confidence Intervals; Critical Care; Female; Fingers - blood supply; Humans; Male; Medical equipment; Oximetry - methods; Oximetry - nursing; Oximetry - statistics & numerical data; Oxygen; Oxygen Consumption; Precision; Prospective Studies; Pulmonary/Respiratory; Pulse oximetry; Respiratory diseases; Statistics as Topic
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2009.12.002

Abstract Objective We sought to describe the accuracy and precision of buccal pulse oximetry (SbpO2 ) compared with arterial oxygen saturation (SaO2 ) and pulse oximetry (SpO2 ) in healthy adults at normoxemia and under 3 induced hypoxemic conditions. Methods In this prospective, correlational study, SbpO2 , SaO2 , and SpO2 values were recorded at normoxemia and at three hypoxemic conditions (SpO2 = 90%, 80%, and 70%) for 53 healthy, nonsmoking adults who were without cardiac or pulmonary disease, baseline hypoxemia, peripheral edema, dyshemoglobinemia, and fever. Bland-Altman analyses were used to assess agreement and precision between SbpO2 and SaO2 measures and between SbpO2 and SpO2 measures. Data were adjusted to account for a lag time between buccal and finger sites. Results When comparing SbpO2 and SaO2 values, mean differences of –1.8%, .3%, 2.4%, and 2.6% were evident at the normoxemia, 90%, 80%, and 70% levels, respectively. When comparing SbpO2 and SpO2 values, the mean differences were –1.4%, .1%, 3.3%, and 4.7% at the normoxemia, 90%, 80%, and 70% levels, respectively. The SbpO2 and SaO2 values met a priori precision criteria (1.6%; 95% confidence limit, –4.9% to 1.3%) at normoxemia. The SbpO2 and SpO2 values met precision criteria at normoxemia (1.5%; 95% confidence limit, –4.4% to 1.5%) and 90% (1.9%; 95% confidence limit, –3.6% to 3.8%) conditions, but exceeded precision criteria at the other tested conditions. On average, SpO2 lagged 21 seconds behind SbpO2. Conclusion Buccal oximetry is an inaccurate and imprecise method of assessing SpO2 when oxygen saturation is