Accuracy of a third (Dolphin Voyager) versus first generation pulse oximeter (Nellcor N- 180) in predicting arterial oxygen saturation and pulse rate in the anesthetized dog  Patrick M Burns, BVSc, MACVSc, Bernd Driessen, DVM, Dr Med Vet, DACVA, DECVPT, Ray Boston, MSc, PhD, Robert A Gunther, MA, PhD  Veterinary Anaesthesia and Analgesia  Volume 33, Issue 5, Pages 281-295 (September 2006) DOI: 10.1111/j.1467-2995.2005.00271.x Copyright © 2006 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia Terms and Conditions

Figure 1 The Dolphin Voyager pulse oximeter. The device consists of a compact flash card (a) that is attached to a finger clip probe and can be inserted into a Compaq iPAQ H3975 pocket PC (b) [Compaq Information Technologies Group, L.P., Houston, TX, USA] in order to display SpO2 and PR readings among other data (c). Data stored on the Compaq iPAQ H3975 pocket PC can later be uploaded to a desktop computer for further data analysis and display. Veterinary Anaesthesia and Analgesia 2006 33, 281-295DOI: (10.1111/j.1467-2995.2005.00271.x) Copyright © 2006 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia Terms and Conditions

Figure 2 Time course of the breathe-down protocol. After equilibration, dogs were ventilated with gas mixtures containing increasingly lower fractions of inspired oxygen (FiO2). By blending O2 with nitrogen (N2), the FiO2 was reduced in a stepwise but noncontinuous fashion from 1.00 to 0.09, returning to an FiO2 of 0.40 after each breathe-down step to achieve immediate re-saturation of arterial blood. Once each target FiO2 was reached, it was maintained for 3 minutes, at the end of which arterial blood samples and measurements were taken. Arrows indicate the time of each arterial blood sampling. Tick marks along the x-axis indicate the average time, at which each FiO2 plateau was reached during the experiment. The average inter-plateau interval was 3.7 ± 1.7 minutes. Veterinary Anaesthesia and Analgesia 2006 33, 281-295DOI: (10.1111/j.1467-2995.2005.00271.x) Copyright © 2006 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia Terms and Conditions

Figure 3 Comparison of arterial oxygen saturation as measured by pulse oximetry (SpO2) and co-oximetry (SaO2) in anesthetized dogs ventilated with gas mixtures with an inspired oxygen fraction (FiO2) ranging from 1.0 to 0.09. (a,b) Graphic representation of the SpO2versus SaO2 relationship for the Dolphin Voyager (a) and Nellcor N-180 (b) pulse oximeters as described by Bland and Altman (Bland & Altman 1986; Mantha et al. 2000), depicting for each data point (open circles) the SaO2 − SpO2 difference plotted against the arithmetic mean of the two measurements [i.e. (SpO2 − SaO2)/2]. Bold lines represent the bias or mean of the differences [i.e. (SpO2 − SaO2)/n] and dashed lines represent the 95% confidence interval for SpO2 (i.e. bias ± 2 SD). (c,d) Graphic representation of Lin's concordance correlation (Lin 1989, 2000) between SpO2 and SaO2 values for the Dolphin Voyager (c) and Nellcor N-180 (d) pulse oximeters. Solid lines represent the Lin's regression lines for all data points, while dashed lines are the lines of unity; data must overlay dashed lines for perfect concordance. All graphs include only 56 of the total 88 observations, thus excluding all observations recorded at repeated FiO2 plateaus of 0.4. Veterinary Anaesthesia and Analgesia 2006 33, 281-295DOI: (10.1111/j.1467-2995.2005.00271.x) Copyright © 2006 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia Terms and Conditions

Figure 5 Comparison of PR as measured by pulse oximetry (POx) and invasive blood pressure monitoring using PT in anesthetized dogs ventilated with gas mixtures with an inspired oxygen fraction (FiO2) ranging from 1.0 to 0.09. (a,b) Graphic representation of the PRPOxversus PRPT relationship for the Dolphin Voyager (a) and Nellcor N-180 (b) pulse oximeters as described by Bland and Altman (Bland & Altman 1986; Mantha et al. 2000), depicting for each data point (open circles) the PRPOx − PRPT difference plotted against the arithmetic mean of the two measurements [i.e. (PRPT − PRPOx)/2]. Bold lines represent the bias or mean of the differences [i.e. (PRPT − PRPox)/n] and dashed lines represent the 95% confidence interval for PRPOx (i.e. bias ± 2 SD). (c,d) Graphic representation of Lin's concordance correlation (Lin 1989, 2000) between PRPOx and PRPT values for the Dolphin Voyager (c) and Nellcor N-180 (d) pulse oximeters. Solid lines represent the Lin's regression lines for all data points, while dashed lines are the lines of unity; data must overlay dashed lines for perfect concordance. All graphs include only 56 of the total 88 observations, thus excluding all observations recorded at repeated FiO2 plateaus of 0.4. Veterinary Anaesthesia and Analgesia 2006 33, 281-295DOI: (10.1111/j.1467-2995.2005.00271.x) Copyright © 2006 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia Terms and Conditions

Figure 4 Comparison of arterial oxygen saturation as measured by pulse oximetry (SpO2) and co-oximetry (SaO2) in anesthetized dogs ventilated with gas mixtures with an inspired oxygen fraction (FiO2) ranging from 1.0 to 0.09: graphic representation of the SpO2versus SaO2 relationship for the Dolphin Voyager (a & c) and Nellcor N-180 (b & d) pulse oximeters as described by Lin's concordance (Lin 1989, 2000), depicting separate plots for data points (open circles) obtained at SaO2 ≥ 90% (n = 34; a,b) and <90% (n = 22; c,d). Solid lines represent the Lin's regression lines for all data points, while dashed lines are the lines of unity; data must overlay dashed lines for perfect concordance. Veterinary Anaesthesia and Analgesia 2006 33, 281-295DOI: (10.1111/j.1467-2995.2005.00271.x) Copyright © 2006 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia Terms and Conditions