Citation

Sebbane M, Claret PG, Mercier G, Lefebvre S, Théry R, Dumont R, Maillé M, Richard JP, Eledjam JJ, de La Coussaye JE. Respir. Care 2013; 58(10): 1614-1620.

Affiliation

Département des urgences, département d'information médicale, Centre Hospitalier Régional Universitaire Lapeyronie - 371, avenue du doyen Gaston Giraud - 34295 - MONTPELLIER Cedex 5.

Copyright

(Copyright © 2013, American Association for Respiratory Therapy, Publisher Daedalus Enterprises)

DOI

10.4187/respcare.02313

PMID

23513247

Abstract

Study objective:The RAD-57 pulse CO-oximeter is a lightweight device allowing non-invasive measurement of blood carboxyhemoglobin (SpCO).We assessed the diagnostic value of pulse CO-oximetry, comparing SpCO to standard laboratory blood measurement (COHb) in emergency department (ED) patients with suspected carbon monoxide (CO) poisoning.Methods:This was a prospective, diagnostic accuracy study according to STARD criteria (Standards for the Reporting of Diagnostic accuracy studies) in consecutive adult ED patients with suspected CO poisoning. Transcutaneous SpCO was obtained using the RAD-57 simultaneously with blood sampling for laboratory blood gas analysis, with no change to standard management of CO poisoning. Correlation between SpCO and COHb was assessed using Bland and Altman's method. Diagnostic performances of SpCO for the screening of CO poisoning were determined using ROC curve analysis. Blood COHb levels >5% and 10% for non-smokers and smokers respectively were applied as the reference standard.Results:93 patients were included (56 smokers, 37 non-smokers). CO poisoning was diagnosed in 26 patients (28%). SpCO values ranged from 1% to 30%, with a median of 4% (IQR: 2.7 - 7.3). COHb values ranged from 0% to 34%, median: 5% (IQR: 2 - 9). Mean differences between COHb and SpCO values was -0.2% ± 3.3%, with 95% limits of agreement (LOA) [-6.7%, +6.3%] COHb (-0.7%, LOA [-7.7, +6.2] for non-smokers ; +0.6%, LOA [-5.0, +6.2] for smokers). 6% and 9% SpCO provided optimal thresholds for detecting CO poisoning, in smokers and non-smokers respectively.Conclusion:SpCO measurement using the RAD-57 pulse-oximeter cannot be used as a substitute for standard blood COHb measurement. However, non invasive pulse CO-oximetry could be useful as a first-line screening test, enabling rapid detection and management of CO-poisoned patients in the ED.

Language: en