Transcutaneous oximetry: variability in normal values for the upper and lower limb

Blake, Denise F., Young, Derelle A., and Brown, Lawrence H. (2018) Transcutaneous oximetry: variability in normal values for the upper and lower limb. Diving and Hyperbaric Medicine, 48 (1). pp. 2-9.

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Abstract

Introduction: Published normal transcutaneous oxygen partial pressures (PtcO2) for the chest and lower limb have defined tissue hypoxia as a value of < 40 mmHg (< 30 mmHg in some patients, < 50 mmHg in others).

Aim: To determine 'normal' PtcO2 for the upper and lower limb in healthy, non-smoking adults using the Radiometer® TCM400 with tc Sensor E5250.

Method: Thirty-two volunteers had transcutaneous oxygen measurements (TCOM) performed on the chest, upper and lower limbs breathing air, with leg then arm elevated and whilst breathing 100% oxygen.

Results: Room-air PtcO2 (mmHg, mean (95% confidence interval)) were: chest: 53.6 (48.7–58.5); upper arm: 60.0 (56.1−64.0);forearm: 52.3 (44.8–55.8); dorsum of hand: 50.2 (46.1–54.3); thenar eminence: 70.8 (67.7–73.8); hypothenar eminence:77.9 (75.1–80.7); lateral leg: 50.2 (46.2–54.2); lateral malleolus: 50.5 (46.6–54.3); medial malleolus: 48.9 (45.6–52.1);dorsum, between first and second toe: 53.1 (49.2–57.0); dorsum, proximal to fifth toe: 58.5 (55.0 – -62.0); plantar, 1st MTP:73.7 (70.3–77.1). Nineteen subjects had at least one room-air PtcO2 below 40 mmHg (nine upper limb, 13 lower limb, four chest). Approximately 10% lower limb PtcO2 were < 100 mmHg on normobaric oxygen. Only one subject at one site had an upper limb PtcO2 < 100 mmHg breathing oxygen.

Conclusion: The broad dispersion in PtcO2 in our healthy cohort reflects the inherent biologic variability in dermal perfusion and oxygen delivery, making it difficult to define narrow, rigid 'normal' values. Thus, we cannot recommend a single PtcO2 value as 'normal' for the upper or lower limb. A thorough patient assessment is essential to establish appropriateness for hyperbaric oxygen therapy, with TCOM used as an aid to guide this decision and not as an absolute.

Item ID: 52941
Item Type: Article (Research - C1)
ISSN: 1833-3516
Keywords: hyperbaric oxygen therapy; oxygen; patient monitoring; standards; wounds
Date Deposited: 13 Apr 2018 02:33
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110399 Clinical Sciences not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920117 Skin and Related Disorders @ 50%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 50%
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