Heart & Lung: The Journal of Acute and Critical Care
Volume 37, Issue 1 , Page 76, January 2008

Forehead oximetry: Another (little) brick in the wall

Emergency Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy

Article Outline

 

To the Editor:

In regard to the article by Schallom and colleagues1 recently published in Heart and Lung, we would like to contribute to the international discussion about the measurement of pulse oximetry with the use of forehead sensors in patients with potential tissue hypoperfusion by reporting briefly the results of our study published only in Italian.

During August and November of 2005, in the clinical setting of the emergency department of Azienda Ospedaliera Universitaria Careggi, a 1700-bed university urban hospital in Florence, Italy, we performed a prospective study to compare the reliability of the measurements obtained from a Max-fast Nellcor forehead sensor (Nellcor; Pleasanton, CA) connected to the N-595 pulse oximeter with the measurements obtained from a DS100 A Nellcor finger sensor connected to the multiparametric monitor Siemens SC 7000 (Siemens AG Medical Solution; Munich, Federal Republic of Germany).2

The inclusion criteria were as follows:

•Age ≥18 years

•A red code (emergency) assigned by the triage nurse

•Absence of carbon monoxide intoxication, jaundice, and wounds or burns on the forehead and at least one of these conditions: Glasgow Coma Scale ≤14; systolic blood pressure ≤90 mm Hg; tympanic temperature ≤35.5°C; burn of 2 degrees ≥25% of body surface area; burn of 3 degrees ≥10% of body surface area.

Thirteen patients with medical, surgical, or traumatic emergency were studied. The measurement of Spo2 with forehead sensor, finger sensor, and Sao2 arterial blood gas values were scheduled at 0, 30, and 60 minutes. We obtained 22 forehead Spo2 recordings and 20 finger Spo2 recordings compared with Sao2 values.

The mean bias was .35 for forehead oximetry (standard deviation ± 3.27; 95% confidence interval: −1.1/+1.8) compared with 2.03 (standard deviation ± 6.44; 95% confidence interval: −.98/+5.04) for finger oxymetry, indicating a better accuracy for forehead oximetry.

The standardized mean difference of 1.68 (95% confidence interval: −1.46/+4.82; P = .29) showed a lack of statistical significance (probably because of the small number of patients) to be able to state that the forehead sensor is more reliable than the finger sensor.

Two interesting points about the forehead sensor emerged from the research: 1) fewer dislocations than the finger sensor and 2) the radiotransparency of the forehead sensor tested by computed tomography scanning before the beginning of our study.

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References 

  1. Schallom L, Sona C, McSweeney M, Mazuski J. Comparison of forehead and digit oximetry in surgical/trauma patients at risk for decreased peripheral perfusion. Heart Lung. 2007;36:188–194
  2. Orlandi I, Bambi S, Lumini E, Becattini G. Studio sulla rilevazione periferica dell’ossigeno (SpO2) mediante utilizzo dell’elettrodo frontale rispetto all’elettrodo al dito nei pazienti critici. Giornale Italiano di Scienze Infermieristiche. 2006;4:28–35

PII: S0147-9563(07)00192-6

doi:10.1016/j.hrtlng.2007.10.004

Refers to article:

  • Comparison of forehead and digit oximetry in surgical/trauma patients at risk for decreased peripheral perfusion

    Lynn Schallom, Carrie Sona, Maryellen McSweeney, John Mazuski
    Heart & Lung: The Journal of Acute and Critical Care May 2007 (Vol. 36, Issue 3, Pages 188-194)

Heart & Lung: The Journal of Acute and Critical Care
Volume 37, Issue 1 , Page 76, January 2008

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