Pulse oximetry is at present the standard of care for the continuous monitoring of arterial oxygen saturation (SpO2). Pulse oximeters provide instantaneous in-vivo measurements of arterial oxygenation, and thereby provide early warning of arterial hypoxemia, for example.
A pulse oximeter comprises a computerized measuring unit and a probe attached to the patient, typically to his or her finger or ear lobe. The probe includes a light source for sending an optical signal through the tissue and a photo detector for receiving the signal after transmission through the tissue. On the basis of the transmitted and received signals, light absorption by the tissue can be determined. During each cardiac cycle, light absorption by the tissue varies cyclically. During the diastolic phase, absorption is caused by venous blood, tissue, bone, and pigments, whereas during the systolic phase there is an increase in absorption, which is caused by the influx of arterial blood into the tissue. Pulse oximeters focus the measurement on this arterial blood portion by determining the difference between the peak absorption during the systolic phase and the constant absorption during the diastolic phase. Pulse oximetry is thus based on the assumption that the pulsatile component of the absorption is due to arterial blood only.
Light transmission through an ideal absorbing sample is determined by the known Lambert-Beer equation as follows:Iout=Iine−εDC,  (1)where Iin is the light intensity entering the sample, Iout is the light intensity received from the sample, D is the path length through the sample, ε is the extinction coefficient of the analyte in the sample at a specific wavelength, and C is the concentration of the analyte. When Iin, D, and ε are known, and Iout is measured, the concentration C can be calculated.
In pulse oximetry, in order to distinguish between the two species of hemoglobin, oxyhemoglobin (HbO2), and deoxyhemoglobin (RHb), absorption must be measured at two different wavelengths, i.e. the probe includes two different light emitting diodes (LEDs). The wavelength values widely used are 660 nm (red) and 940 nm (infrared), since the said two species of hemoglobin have substantially different absorption values at these wavelengths. Each LED is illuminated in turn at a frequency which is typically several hundred Hz.
The accuracy of a pulse oximeter is affected by several factors. This is discussed briefly in the following.
Firstly, the dyshemoglobins which do not participate in oxygen transport, i.e. methemoglobin (MetHb) and carboxyhemoglobin (CoHb), absorb light at the wavelengths used in the measurement. Pulse oximeters are set up to measure oxygen saturation on the assumption that the patient's blood composition is the same as that of a healthy, non-smoking individual. Therefore, if these species of hemoglobin are present in higher concentrations than normal, a pulse oximeter may display erroneous data.
Secondly, intravenous dyes used for diagnostic purposes may cause considerable deviation in pulse oximeter readings. However, the effect of these dyes is short-lived since the liver purifies blood efficiently.
Thirdly, coatings such as nail polish may in practice impair the accuracy of a pulse oximeter, even though the absorption caused by them is constant, not pulsatile, and thus in theory it should not have an effect on the accuracy.
Fourthly, the optical signal may be degraded by both noise and motion artifacts. One source of noise is the ambient light received by the photodetector. Many solutions have been devised with the aim of minimizing or eliminating the effect of the movement of the patient on the signal, and the ability of a pulse oximeter to function correctly in the presence of patient motion depends on the design of the pulse oximeter. One way of canceling out the motion artefact is to use an extra wavelength for this purpose.
A further factor affecting the accuracy of a pulse oximeter is the direct electrical crosstalk between the circuitry driving the LEDs and the circuitry receiving the signal from the photodetector. Due to crosstalk of this type, non-optical signal components may superimpose on the signal received and thus cause erroneous oxygen saturation readings. This problem does not exist with conventional pulse oximeters using wide pulses, but has surfaced with the current trend towards lower power consumption, which is essential for battery operated oximeters, for example. Lower power consumption calls for narrower pulses for driving the LEDs, the narrower pulses being more vulnerable to this type of crosstalk. The problem is further aggravated if the tissue of the patient is thicker than normal, whereby the signal received from the photodetector is weaker than normal.
It is an objective of the invention to bring about a solution by means of which it is possible to decide whether this type of crosstalk is present and whether it will cause erroneous results in the oxygen saturation measurements. A further objective of the present invention is to bring about a solution by means of which the measurement can be performed so that the crosstalk, even if strong, will not cause erroneous readings.