Oxygen

saturation/Plethysomography/Pulseoximetry/SpO2
1. How to measure/quantify the oxygenation of blood?

With Pulseoximetry. Based on the property of hemoglobin to change the color form
light red to dark red in dependence of the reversibly bound oxygen. (Definition: The
determination of oxygen hemoglobin saturation of blood either by withdrawing a
sample and passing it through a classical photoelectric oximeter or by electrodes
attached to some translucent part of the body like finger earlobe or skin fold. ->
non invasive)

2. For calculation of SpO2 (oxygen saturation by pulse oximetry) you

need to know which parameters/which variables?

SpO2=([HbO2])/([Hb]+[HbO2])

Hbcontent of deoxygenated hemoglobin, HbO 2.content of hemoglobin, Hb+

HbO2.total hemoglobin.

3. Describe the design/functional building blocks of a simple two-

wavelength pulse oximeter?

4. Assuming that the Lambert-Beer law holds true in calculation of the

oxygen saturation by pulseoximetry- which parameters/variables will
influence the exiting light intensity which is measured e.g.at the
digit?

Lambert Beer Law: I=I0 exp(-Ext*c*d)

Ext.Extinction coefficient, c.concentration of single light absorber, d. thickness

 5. Explain the oxygen dissociation relationship. How to interpret a left
shift of the dissociation relationship?

Oxygen dissociation curve (Definition: Relationship between oxygen saturation of

hemoglobin and partial pressure of oxygen). The Left shift is a result of decreased
body temperature, decreased partial pressure of CO 2, decrease in 2,3-
Diophosphoglycerat concentration and increase in pH.

6. Errors in SpO2 measurement?

Perturbances in signal by ambient light, poor perfusion and movement artefact.

Parturbances in light absorption by dyes (Cardiogreen methylene blue), Nail varnish
(artificial nails

7. Explain the term oxygen content?

Is the volume of oxygen carried in each 100ml blood. The Hfners number (1,34)
decribes the volume of oxygen which maximally can be bound be 1g Hb in vivo
which is under normal conditions 1,34ml

Blood pressure measurement/Druckmessung

8. Explain the underlying principles for the invasive measurement of
arterial blood pressure in humans?

A catheter is inserted into the radial or femoral artery and connected with the
transducer via a fluid filled line and externally placed manometer (catheter tip
manometer) is used. Besides an improved accuracy compared with the indirect
method also a continuous recording is provided.

9. Make a schematic drawing of the pressure relationship in the human

circulation?
 10.Explain the pressure transfer characteristics when using fluid filled
catheter manometer?

The original pressure signal must not be distorted when propagating along the
catheter. Therefore the pressure sensor must receive the fundamental frequency as
well as a maximal number of harmonics without a change in the phase relationship
nor in the amplitudes. For clinical monitoring the requirement is no distortion up to
the 10th harmonic.-> Satisfied by linear frequency response characteristic up to at
leas 25Hz. At the same time the damping factor should be higher than 0.3.

11.Explain the frequency damping relationship according to Gardner

(schematic drawing). Give the reason for the frequency range
required for correct measurement of invasive arterial blood
pressure?

12.What about the most important sources of error with the non-
invasive measurement of arterial pressure?

Inappropriate cuff/arm relation, Sthetoscope or transducer not over the brachial

artery, Observer error: Inadequate acuity or incorrect technique, Rapid cuff deflation

13.The diameter, the length and the compliance of the material of the
pressure line affect the resonant frequency and damping coefficient
of a catheter manometer system. Outline the relationship?
 14.Explain the influence of stagnation pressure on the reading of the
pressure measured by a fluid filled catheter manometer?

Circulation pulmonary artery catheter & dilution

methods
15.Provide detailed information on the Swan-Ganz pulmonary artery
catheter (PAC). Which parameters can be measured directly using a
state-of-the art pulmonary artery catheter, which parameters can
you derive from these measurements?

The catheter is introduced through a large vein. From this entry site it is threaded,
often with the aid of of fluoroscopy, through the right atrium of the heart, the right
ventricle and subsequently into the pulmonary artery. Measuring: Central Venous
Pressure, Right ventricular pressure, Pulmonary Artery Pressure (balloon deflated,
reflects RV function, pulmonary vascular resistance and LA filling pressure),
Pulmonary Capillary Wedge Pressure (balloon, deflated), Cardiac Output (calculated
using the thermodilution technique)

16.Name at least 5 risk factors which limit the use of the PAC?
17.Explain the differences between pulmonary and transpulmonary
determination of cardiac output using the bolus thermodilution
technique?

Bolus technique: A bolus of cold saline solution is injected in the right atrium and the
temp. in the pulmonary artery is monitored. The CO is calculated from this
temperature course.

18.Explain the double indicator dilution techniques and the differences

when using different indicators (indications, contraindications,
limitations in accuracy)?
19.Which factors influence the accuracy of cardiac output measurement
by pulmonary thermos-and dye-dilution?