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• W2912559278 abstract "To the Editor: Chows et al conclude their recent report1Ghows MB Josen MJ Chuang MT Sacks HS Tierstin AS Transcutaneous oxygen monitoring during fiberoptic bronchoscopy.Chest. 1986; 89: 543-544Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar by saying that a transcutaneous oxygen electrode can reliably monitor oxygenation in patients undergoing bronchoscopy. Their data do not support this contention. With normal arterial oxygen levels (PaO2) of 85 to 95 mm Hg, transcutaneous oxygen levels (tcPo2) ranged from 45 to 90 mm Hg, while with a tcPo2 near 40 mm Hg, PaO2 ranged from 50 to near 80 mm Hg—not a very helpful guide to normoxia or hypoxial Consider the internist who read that a transcutaneous oxygen sensor (type not named) “correctly detected all instances when PaO2 was less than 65 mm Hg. The sensor was noninvasive and caused no adverse effects.” It would seem reasonable for him to assume that such a device would reliably distinguish between normoxia and hypoxia in his patients undergoing bronchoscopy, and avoid the expense and hazards of arterial blood gas analysis. Wrong! Their results may have been affected by 1) ignoring the response time of the electrode, 2) local pressure on the electrode reducing capillary perfusion, or 3) taking pre-bronchoscopy readings before tcPo2 was stable. In vivo 90 percent response time (90 percent of the time taken to reach a new steady state after a step change in oxygenation) of most transcutaneous electrodes is on the order of minutes, so tcPo2 might not detect rapid oscillations in PaO2 at all! Ghows et al fail to mention this problem in the design of their study. It should be appreciated that upon applying an electrode to the skin, tcPo2 values will rise, reaching a plateau at 10 to 20 min; this value will depend on PaO2, the electrode operating temperature, the position of the electrode, skin perfusion, local tissue oxygen consumption, skin thickness, and response time of the electrode, not to mention interference from anaesthetic agents.2Rithalia SV Booth S Factors influencing transcutaneous oxygen tension.Intens Care World. 1985; 2: 126-131Google Scholar Nothing is said of the monitor's characteristics in the report. The authors state that “measurements of tcPo2 correlated well with PaO2.” They did not. The correlation coefficient of 0.69 proves this point, as it indicates that less than 50 percent of the variability in tcPo2 was accounted for by changes in PaO2 values (variance r2 = 0.476).3Godfrey K Simple linear regression in medical research.N Engl J Med. 1985; 313: 1629-1636Crossref PubMed Scopus (87) Google Scholar They further quote a significance value of p<0.001, indicating that the two methods are related; however, it would be amazing if two methods (blood gas analyzer and transcutaneous electrode) designed to measure the same quantity were not related. Although measurements of tcPo2 were statistically significantly correlated with PaO2, the degree of correlation reported tells us little about the accuracy of the transcutaneous monitor. A plot of the differences between tcPo2 and PaO2 against the mean of the two estimates of arterial oxygen would be a more helpful guide, and would allow the calculation of the mean difference and 90 percent confidence intervals for the difference between tcPo2 and PaO2.4Bland JM Altman DG Statistical methods for assessing agreement between two methods of clinical measurement.Lancet. 1986; 1: 307-310Abstract PubMed Scopus (39786) Google Scholar The implication in the authors’ concluding sentence is neither safe nor cautious, as it suggests that a cutaneous oxygen sensor “affords a safe and reliable means of monitoring oxygenation in hemodynamically stable adults”—without reference to arterial blood gas measurement. Yet well-conducted studies of transcutaneous monitoring in adults always warn of the necessity to check tcPo2 values against PaO2 values, even if excellent correlation between the two is present." @default.
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• W2912559278 date "1987-06-01" @default.
• W2912559278 modified "2023-09-26" @default.
• W2912559278 title "Monitoring Oxygenation" @default.
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• W2912559278 doi "https://doi.org/10.1378/chest.91.6.932a" @default.
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