Reliability, clinical performance and trending ability of a pulse oximeter and pulse co-oximeter, in monitoring blood oxygenation, at two measurement sites, in immobilised white rhinoceros (Ceratotherium simum).

BACKGROUND: Monitoring blood oxygenation is essential in immobilised rhinoceros, which are susceptible to opioid-induced hypoxaemia. This study assessed the reliability, clinical performance and trending ability of the Nonin PalmSAT 2500 A pulse oximeter's and the Masimo Radical-7 pulse co-oximeter's dual-wavelength technology, with their probes placed at two measurement sites, the inner surface of the third-eyelid and the scarified ear pinna of immobilised white rhinoceroses. Eight white rhinoceros were immobilised with etorphine-based drug combinations and given butorphanol after 12 min, and oxygen after 40 min, of recumbency. The Nonin and Masimo devices, with dual-wavelength probes attached to the third-eyelid and ear recorded arterial peripheral oxygen-haemoglobin saturation (SpO2) at pre-determined time points, concurrently with measurements of arterial oxygen-haemoglobin saturation (SaO2), from drawn blood samples, by a benchtop AVOXimeter 4000 co-oximeter (reference method). Reliability of the Nonin and Masimo devices was evaluated using the Bland-Altman and the area root mean squares (ARMS) methods. Clinical performance of the devices was evaluated for their ability to accurately detect clinical hypoxemia using receiver operating characteristic (ROC) curves and measures of sensitivity, specificity, and positive and negative predictive values. Trending ability of the devices was assessed by calculating concordance rates from four-quadrant plots. RESULTS: Only the Nonin device with transflectance probe attached to the third-eyelid provided reliable SpO2 measurements across the 70 to 100% saturation range (bias - 1%, precision 4%, ARMS 4%). Nonin and Masimo devices with transflectance probes attached to the third-eyelid both had high clinical performance at detecting clinical hypoxaemia [area under the ROC curves (AUC): 0.93 and 0.90, respectively]. However, the Nonin and Masimo devices with transmission probes attached to the ear were unreliable and provided only moderate clinical performance. Both Nonin and Masimo devices, at both measurement sites, had concordance rates lower than the recommended threshold of ≥ 90%, indicating poor trending ability. CONCLUSIONS: The overall assessment of reliability, clinical performance and trending ability indicate that the Nonin device with transflectance probe attached to the third-eyelid is best suited for monitoring of blood oxygenation in immobilised rhinoceros. The immobilisation procedure may have affected cardiovascular function to an extent that it limited the devices' performance.

Reliability of the Enterprise Point-of-Care (EPOC) blood analyzer's calculated arterial oxygen-hemoglobin saturation in immobilized white rhinoceroses (Ceratotherium simum).

BACKGROUND: Enterprise Point-of-Care (EPOC) blood analysis is used routinely in wildlife veterinary practice to monitor blood oxygenation, but the reliability of the EPOC calculated arterial oxygen-hemoglobin saturation (cSaO2 ) has never been validated in the white rhinoceros (Ceratotherium simum), despite their susceptibility to hypoxemia during chemical immobilization. OBJECTIVES: We aimed to evaluate the reliability of the EPOC cSaO2 by comparing it against arterial oxygen-hemoglobin saturation (SaO2 ) measured by a co-oximeter reference method in immobilized white rhinoceroses. METHODS: Male white rhinoceroses in two studies (both n = 8) were immobilized by darting with different etorphine-based drug combinations, followed by butorphanol or saline (administered intravenously). Animals in both studies received oxygen via intranasal insufflation after 60 min. Blood samples were drawn, at predetermined time points, from a catheter inserted into the auricular artery and analyzed using the EPOC and a co-oximeter. Bland-Altman (to estimate bias and precision) and area root mean squares (ARMS) plots were used to determine the reliability of the EPOC cSaO2 compared with simultaneous co-oximeter SaO2 readings. RESULTS: The rhinoceros were acidotic (pH of 7.3 ± 0.1 [mean ± standard deviation]), hypercapnic (PaCO2 of 73.7 ± 10.5 mmHg), and normothermic (body temperature of 37.4 ± 1.8°C). In total, 389 paired cSaO2 -SaO2 measurements were recorded (the cSaO2 ranged between 13.2% and 99.0%, and the SaO2 ranged between 11.8% and 99.9%). The EPOC cSaO2 readings were unreliable (inaccurate, imprecise, and poor ARMS) across the entire saturation range (bias -6%, precision 5%, and ARMS 8%). CONCLUSIONS: The EPOC cSaO2 is unreliable and should not be used to monitor blood oxygenation in immobilized white rhinoceroses.

Reliability of pulse oximetry at four different attachment sites in immobilized white rhinoceros (Ceratotherium simum).

OBJECTIVES: To determine the reliability of peripheral oxygen haemoglobin saturation (SpO2), measured by a Nonin PalmSAT 2500A pulse oximeter with 2000T transflectance probes at four attachment sites (third eyelid, cheek, rectum and tail), by comparing these measurements to arterial oxygen haemoglobin saturation (SaO2), measured by an AVOXimeter 4000 co-oximeter reference method in immobilized white rhinoceros (Ceratotherium simum). STUDY DESIGN: Randomized crossover study. ANIMALS: A convenience sample of eight wild-caught male white rhinoceros. METHODS: White rhinoceros were immobilized with etorphine (0.0026 ± 0.0002 mg kg-1, mean ± standard deviation) intramuscularly, after which the pinna was aseptically prepared for arterial blood sample collection, and four pulse oximeters with transflectance probes were fixed securely to their attachment sites (third eyelid, cheek, rectum and tail). At 30 minutes following recumbency resulting from etorphine administration, the animals were given either butorphanol (0.026 ± 0.0001 mg kg-1) or an equivalent volume of saline intravenously. At 60 minutes following recumbency, insufflated oxygen (15 L minute-1 flow rate) was provided intranasally. In total, the SpO2 paired measurements from the third eyelid (n = 80), cheek (n = 67), rectum (n = 59) and tail (n = 76) were compared with near-simultaneous SaO2 measurements using Bland-Altman to assess bias (accuracy), precision, and the area root mean squares (ARMS) method. RESULTS: Compared with SaO2, SpO2 measurements from the third eyelid were reliable (i.e., accurate and precise) above an SaO2 range of 70% (bias = 1, precision = 3, ARMS = 3). However, SpO2 measurements from the cheek, rectum and tail were unreliable (i.e., inaccurate or imprecise). CONCLUSIONS AND CLINICAL RELEVANCE: A Nonin PalmSAT pulse oximeter with a transflectance probe inserted into the space between the third eyelid and the sclera provided reliable SpO2 measurements when SaO2 was > 70%, in immobilized white rhinoceros.

Evaluation of the reliability of pulse oximetry, at different attachment sites, to detect hypoxaemia in immobilized impala (Aepyceros melampus).

OBJECTIVE: Evaluation of the reliability of pulse oximetry at four different attachment sites compared to haemoglobin oxygen saturation measured by a co-oximeter and calculated by a blood gas analyser in immobilized impala. STUDY DESIGN: Randomized crossover study. ANIMALS: A total of 16 female impala. METHODS: Impala were immobilized with etorphine or thiafentanil alone, or etorphine in combination with a novel drug. Once immobilized, arterial blood samples were collected at 5 minute intervals for 30 minutes. Then oxygen was insufflated (5 L minute-1) intranasally at 40 minutes and additional samples were collected. A blood gas analyser was used to measure the arterial partial pressure of oxygen and calculate the oxygen haemoglobin saturation (cSaO2); a co-oximeter was used to measure the oxygen haemoglobin saturation (SaO2) in arterial blood. Pulse oximeter probes were attached: under the tail, to the pinna (ear) and buccal mucosa (cheek) and inside the rectum. Pulse oximeter readings [peripheral oxygen haemoglobin saturation (SpO2) and pulse quality] were recorded at each site and compared with SaO2 and cSaO2 using Bland-Altman and accuracy of the area root mean squares (Arms) methods to determine the efficacy. P value < 0.05 was considered significant. RESULTS: Pulse quality was 'good' at each attachment site. SpO2 measured under the tail was accurate and precise but only when SaO2 values were above 90% (bias = 3, precision = 3, Arms = 4). The ear, cheek and rectal probes failed to give accurate or precise readings (ear: bias = -4, precision = 14, Arms = 15; cheek: bias = 12, precision = 11, Arms = 16; and rectum: bias = 5, precision = 12, Arms = 13). CONCLUSIONS AND CLINICAL RELEVANCE: In order to obtain accurate and precise pulse oximetry readings in immobilized impala, probes must be placed under the tail and SaO2 must be above 90%. Since SaO2 values are usually low in immobilized impala, pulse oximeter readings should be interpreted with caution.