Rotes Licht auf zyanotischer Haut

Die Pulsoxymetrie zur kontinuierlichen Überwachung der arteriellen Sauerstoffsättigung und ggf. Steuerung der Sauerstoffzufuhr ist auf neonatologischen Stationen nicht mehr wegzudenken. Wie bei jeder Medizintechnik gibt es jedoch technische Voraussetzungen für die korrekte Anwendung, und man benötigt Hintergrundwissen für die korrekte Interpretation der Messergebnisse.

Schlüsselwörter

Pulsoxymetrie - Frühgeborene - Pulsoximetrie - SpO2

• Literatur

• 1 Hoppe PF. Ueber das Verhalten des Blutfarbstoffes im Spectrum des Sonnenlichtes. Virchows Archiv 1862; 23: 446-449
• 2 Matthes K. Untersuchungen über die Sauerstoffsättigung des menschlichen Arterienblutes. Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie 1935; 179: 698-711
• 3 Kramer K. Ein Verfahren zur fortlaufenden Messung des Sauerstoffgehaltes im strömenden Blute an uneröffneten Gefäßen. Zeitschr Biol 1935; 96: 61-75
• 4 Aoyagi T, Horikawa M, Asahina M. et al. Improvement of the dye dilution curve measurement. Proceedings of the 12th Conference of the Japanese Society of Medical Electronics and Biological Engeneering (in Japanese). Japanese Journal of Medical Electronics and Biomedical Engineering 1973; 11: s85-86
• 5 Barker SJ, Shah NK. The effects of motion on the performance of pulse oximeters in volunteers (revised publication). Anesthesiology 1997; 86: 101-108
• 6 Masimo International. Brochure - RD SET Sensors. Accessed January 10, 2025 at: https://professional.masimo.com/siteassets/us/documents/pdf/plm-10041f-brochure-rd-set-sensors-us.pdf
• 7 Poets CF. Noninvasive monitoring and assessment of oxygenation in infants. Clin Perinatol 2019; 46: 417-433
• 8 Maiwald CA, Schwarz CE, Böckmann K. et al. Randomised crossover study on pulse oximeter readings from different sensors in very preterm infants. Arch Dis Child Fetal Neonatal Ed 2024; 109: 391-396
• 9 Al-Halawani R, Charlton PH, Qassem M. et al. A review of the effect of skin pigmentation on pulse oximeter accuracy. Physiol Meas 2023; 44
• 10 Lakshminrusimha S, Manja V, Mathew B. et al. Oxygen targeting in preterm infants: a physiological interpretation. J Perinatol 2015; 35: 8-15
• 11 Poets CF, Southall DP. Noninvasive monitoring of oxygenation in infants and children: practical considerations and areas of concern. Pediatrics 1994; 93: 737-746
• 12 Hummler HD, Engelmann A, Pohlandt F. et al. Decreased accuracy of pulse oximetry measurements during low perfusion caused by sepsis: is the perfusion index of any value?. Intensive Care Med 2006; 32: 1428-1431
• 13 Hummler HD, Pohlandt F, Franz AR. Pulse oximetry during low perfusion caused by emerging pneumonia and sepsis in rabbits. Crit Care Med 2002; 30: 2501-2508
• 14 Hummler HD, Engelmann A, Pohlandt F. et al. Accuracy of pulse oximetry readings in an animal model of low perfusion caused by emerging pneumonia and sepsis. Intensive Care Med 2004; 30: 709-713
• 15 Vesoulis Z, Tims A, Lodhi H. et al. Racial discrepancy in pulse oximeter accuracy in preterm infants. J Perinatol 2022; 42: 79-85
• 16 Foglia EE, Whyte RK, Chaudhary A. et al. The effect of skin pigmentation on the accuracy of pulse oximetry in infants with hypoxemia. J Pediatr 2017; 182: 375-377e372
• 17 Iglesias B, Rodrí Guez MAJ, Aleo E. et al. 3-lead electrocardiogram is more reliable than pulse oximetry to detect bradycardia during stabilisation at birth of very preterm infants. Arch Dis Child Fetal Neonatal Ed 2018; 103: F233-f237
• 18 Langanky LO, Kreutzer KB, Poets CF. et al. Pulse oximetry signal loss during hypoxic episodes in preterm infants receiving automated oxygen control. Eur J Pediatr 2024; 183: 2865-2869
• 19 Nellcor. Product information - Nellcor Oxiband OXI-A/N OxiMax Sensor. Accessed January 10, 2025 at: https://www.c2med.de
• 20 Nellcor. Product information - Nellcor Oxiband OXI-P/I OxiMax Sensor. Accessed January 10, 2025 at: https://www.c2med.de
• 21 Medtronic. Product brochure - Nellcor OxySoft Neonatal-Adult SpO2 Sensor. Accessed January 10, 2025 at: https://www.medtronic.com/content/dam/emanuals/mitg/PT00158321A00_IFU_OxySoftN
• 22 Bachman TE, Newth CJL, Iyer NP. et al. Hypoxemic and hyperoxemic likelihood in pulse oximetry ranges: NICU observational study. Arch. Dis. Child. Fetal Neonatal Ed 2019; 104: F274-F279
• 23 Wackernagel D, Blennow M, Hellström A. Accuracy of pulse oximetry in preterm and term infants is insufficient to determine arterial oxygen saturation and tension. Acta Paediatr 2020; 109: 2251-2257
• 24 Nitzan I, Hammerman C, Mimouni FB. et al. Packed red blood cells transfusion in neonates: effect on FiO(2) and PaO(2)/SaO(2) ratio, and implications for neonatal saturation targeting. J Perinatol 2018; 38: 693-695
• 25 Hagadorn JI, Furey AM, Nghiem TH. et al. Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: the AVIOx study. Pediatrics 2006; 118: 1574-1582
• 26 Watanabe Y, Osawa K, Sato I. et al. Foetal haemoglobin concentration at postmenstrual age is unaffected by gestational age at birth. Ann Clin Biochem 2018; 55: 400-403
• 27 Carlo WA, Higgins RD. Optimum oxygen therapy to prevent retinopathy of prematurity. Expert Rev Ophthalmol 2010; 5: 583-585
• 28 Stenson BJ. Oxygen targets for preterm infants. Neonatology 2013; 103: 341-345
• 29 Saugstad OD, Aune D. Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation target studies. Neonatology 2014; 105: 55-63
• 30 Schmidt B, Whyte RK, Asztalos EV. et al. Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial. Jama 2013; 309: 2111-2120
• 31 Askie LM, Darlow BA, Davis PG. et al. Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants. Cochrane Database Syst Rev 2017; 4: Cd011190
• 32 Saugstad OD. Oxygenation of the immature infant: a commentary and recommendations for oxygen saturation targets and alarm limits. Neonatology 2018; 114: 69-75
• 33 Sweet DG, Carnielli V, Greisen G. et al. European Consensus Guidelines on the management of respiratory distress syndrome - 2019 update. Neonatology 2019; 115: 432-450
• 34 Stenson BJ, Donoghoe M, Brocklehurst P. et al. Pulse Oximeter Saturation Targeting and Oximeter Changes in the Benefits of Oxygen Saturation Targeting (BOOST)-II Australia and BOOST-II UK Oxygen Trials. J Pediatr 2019; 204: 301-304 e302
• 35 Masimo International. Product information - newborn sensors. Accessed January 10, 2025 at: https://professional.masimo.com/siteassets/us/documents/pdf/plm-10199b-product-information-newborn-sensors-us.pdf
• 36 Maiwald CA, Schwarz CE, Böckmann K. et al. Response to “Randomised crossover study on pulse oximeter readings from different sensors in very preterm infants” by Sharma et al. Arch Dis Child Fetal Neonatal Ed 2024; 110: 110-111
• 37 Johnson KR, Hagadorn JI, Sink DW. Alarm safety and alarm fatigue. Clin Perinatol 2017; 44: 713-728
• 38 Klevebro S, Hammar U, Holmström G. et al. Adherence to oxygen saturation targets increased in preterm infants when a higher target range and tighter alarm limits were introduced. Acta Paediatr 2019; 108: 1584-1589
• 39 Vagedes J, Poets CF, Dietz K. Averaging time, desaturation level, duration and extent. Arch Dis Child Fetal Neonatal Ed 2013; 98: F265-266
• 40 McClure C, Jang SY, Fairchild K. Alarms, oxygen saturations, and SpO2 averaging time in the NICU. J Neonatal Perinatal Med 2016; 9: 357-362
• 41 Armbruster J, Schmidt B, Poets CF. et al. Nurses' compliance with alarm limits for pulse oximetry: qualitative study. J Perinatol 2010; 30: 531-534