Proof of concept non-invasive estimation of peripheral venous oxygen saturation

Background: Pulse oximeters continuously monitor arterial oxygen saturation. Continuous monitoring of venous oxygen saturation (SvO(2)) would enable real-time assessment of tissue oxygen extraction (O2E) and perfusion changes leading to improved diagnosis of clinical conditions, such as sepsis. Methods: This study presents the proof of concept of a novel pulse oximeter method that utilises the compliance difference between arteries and veins to induce artificial respiration-like modulations to the peripheral vasculature. These modulations make the venous blood pulsatile, which are then detected by a pulse oximeter sensor. The resulting photoplethysmograph (PPG) signals from the pulse oximeter are processed and analysed to develop a calibration model to estimate regional venous oxygen saturation (SpvO(2)), in parallel to arterial oxygen saturation estimation (SpaO(2)). A clinical study with healthy adult volunteers (n = 8) was conducted to assess peripheral SvO(2) using this pulse oximeter method. A range of physiologically realistic SvO(2) values were induced using arm lift and vascular occlusion tests. Gold standard, arterial and venous blood gas measurements were used as reference measurements. Modulation ratios related to arterial and venous systems were determined using a frequency domain analysis of the PPG signals. Results: A strong, linear correlation (r(2) = 0.95) was found between estimated venous modulation ratio (R-Ven) and measured SvO(2), providing a calibration curve relating measured R-Ven to venous oxygen saturation. There is a significant difference in gradient between the SpvO(2) estimation model (SpvO(2) = 111 -40.6*R) and the empirical SpaO(2) estimation model (SpaO(2) = 110 -25*R), which yields the expected arterial-venous differences. Median venous and arterial oxygen saturation accuracies of paired measurements between pulse oximeter estimated and gold standard measurements were 0.29 and 0.65%, respectively, showing good accuracy of the pulse oximeter system. Conclusions: The main outcome of this study is the proof of concept validation of a novel pulse oximeter sensor and calibration model to assess peripheral SvO(2), and thus O2E, using the method used in this study. Further validation, improvement, and application of this model can aid in clinical diagnosis of microcirculation failures due to alterations in oxygen extraction.