• Marco Fernandez, Kathy Burns, Beverly Calhoun, Saramma George, Beverly Martin, and Chris Weaver.
• Saint Thomas Health Services, Nashville, TN 37202, USA. mfernand@stthomas.org
• Am. J. Crit. Care. 2007 Mar 1;16(2):146-52.

BackgroundA new forehead noninvasive oxygen saturation sensor may improve signal quality in patients with low cardiac index.ObjectivesTo examine agreement between oxygen saturation values obtained by using digit-based and forehead pulse oximeters with arterial oxygen saturation in patients with low cardiac index.MethodsA method-comparison study was used to examine the agreement between 2 different pulse oximeters and arterial oxygen saturation in patients with low cardiac index. Readings were obtained from a finger and a forehead sensor and by analysis of a blood sample. Bias, precision, and root mean square differences were calculated for the digit and forehead sensors. Differences in bias and precision between the 2 noninvasive devices were evaluated with a t test (level of significance P<.05).ResultsNineteen patients with low cardiac index (calculated as cardiac output in liters per minute divided by body surface area in square meters; mean 1.98, SD 0.34) were studied for a total of 54 sampling periods. Mean (SD) oxygen saturations were 97% (2.4) for blood samples, 96% (3.2) for the finger sensor, and 97% (2.8) for the forehead sensor. By Bland Altman analysis, bias +/- precision was -1.16 +/- 1.62% for the digit sensor and -0.36 +/- 1.74% for the forehead sensor; root mean square differences were 1.93% and 1.70%, respectively. Bias and precision differed significantly between the 2 devices; the forehead sensor differed less from the blood sample.ConclusionsIn patients with low cardiac index, the forehead sensor was better than the digit sensor for pulse oximetry.

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