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(Chest. 1999;115:1316-1320.)
© 1999 American College of Chest Physicians

Determination of Hemoglobin Saturation in Patients With Acute Sickle Chest Syndrome*

A Comparison of Arterial Blood Gases and Pulse Oximetry

John P. Kress, MD; Anne S. Pohlman, RN, MSN and Jesse B. Hall, MD

* From the Department of Medicine, University of Chicago, Chicago, IL.

Correspondence to: Jesse B. Hall, MD, Section of Pulmonary and Critical Care Medicine, MC 6026, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637; e-mail: jhall{at}medicine.bsd.uchicago.edu

Study objectives: To evaluate three different methods of measuring oxygen saturation in patients suffering from acute sickle chest syndrome.

Design: A prospective, descriptive study of 9 months' duration.

Setting: A tertiary care university hospital.

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

Interventions: None.

Measurements: 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.

Key Words: arterial blood gas • co-oximetry • exchange transfusion • oxygen dissociation curve • pulse oximetry • sickle cell anemia




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