ABSTRACT
OBJECTIVE: To examine the effect of abnormal cardiac index on the accuracy of measurement of oxygen saturation by pulse oximetry. METHODS: Forty-six patients (mean age, 49 years) in a 9-bed medical ICU were studied. Measurements of oxygen saturation obtained with pulse oximeters and with a functional cooximeter were collected at baseline and 4, 8, 16, 24, 32, 40, and 48 hours later. Hemodynamic and cardiopulmonary parameters were recorded. RESULTS: The Bland-Altman technique yielded upper and lower limits of agreement of 2.53% and -7.11%. Most (95.7%) of the differences between the measurements of oxygen saturation obtained with the 2 methods were within these limits, although some of these differences may be clinically unacceptable. The bias was -2.29%, and the precision was 2.41%. The clinical conditions associated with inaccurate tracking of saturation by pulse oximetry across the range of actual arterial oxygen saturation values were abnormal cardiac index, partial pressure of carbon dioxide, heart rate, and pulmonary capillary wedge pressure. CONCLUSIONS: In patients with abnormal cardiac index, the pulse oximeter measurements exceeded the actual oxygen saturation by up to 7%. Pending prospective studies, clinicians should be aware that when certain cardiopulmonary parameters are abnormal, the margin of error in measurements of oxygen saturation obtained with a pulse oximeter may be greater than when those parameters are normal.
Subject(s)
Cardiac Output , Multiple Organ Failure/metabolism , Multiple Organ Failure/physiopathology , Oximetry/standards , Oxygen/blood , Sepsis/metabolism , Sepsis/physiopathology , Adult , Aged , Bias , Blood Gas Analysis/standards , Critical Illness , Female , Humans , Male , Middle Aged , Monitoring, Physiologic/methods , Reproducibility of ResultsABSTRACT
One of the possible combinations when merging specialty units is combining a pediatric intensive care unit with an adult intensive care unit. The response related to the merging of these specialty units solicits very intense, diverse opinions. The authors address this controversial issue in a debate forum to present both sides of the issue.
Subject(s)
Hospital Restructuring , Intensive Care Units, Pediatric/organization & administration , Intensive Care Units/organization & administration , Interdepartmental Relations , Adult , Child , HumansABSTRACT
Unit mergers offer an opportunity for nurses to acquire additional skills. A model for unit mergers is presented. The authors describe how didactic and clinical competencies serve as a foundation upon which the nurse develops proficiency and expertise in a new subspecialty.
