masimo corporation 40 parker irvine ca 92618 www.masimo.com Measurement duringverylowperfusion Peripheral SpO technology havebeenshowntobecapable ofmonitoringSpO pulsation andSpO Since thatreport,Masimohascontinuedefforts focusingonmaximizingsensitivityfordetecting reading plusthepercentoftimedevicewasgreaterthan3%fromcontrol. greater than32%. Total errorwasdefinedas percentoftimethedevicewasunabletogivea the total errorfortheMasimowaslessthan2%whilebestofothercompetitors to 5pulseoximeters:Nellcor(withandwithoutC-Lock),Novametrix,Criticare,Ohmeda.Infact prototypedevicehadthelowesttotal errorcompared clamping. They foundthataMasimoSET Masimo toseveralthencurrentpulseoximetersduringlowperfusioncausedbybrachialartery during resuscitation inneonatal patients. perfusion andinfacthavebeenreportedtocorrectlymonitoradequacyofchestcompression D clearancetoclaimtheaccuratemeasuringofSpO FDA poster presentedatthe1995Societyfor Technology in . The earliestreportofMasimo'senhancedabilitytoreadinlowperfusionwasanabstractand the leaderinread-through-motionandlowperfusiontechnology. than theconventionalpulseoximetersthatwereonmarket. Today, Masimocontinuestobe result wasasystemthatabletomonitoratlowperfusionlevelsapproximately10foldlower in pickingupthepulsationsmidstofartifacts causedbymotionand otherartifacts. The the actualSpO which canbecomesolowastobedifficult todistinguishfromthebackgroundnoise.Detecting of monitoringSpO It isimportant tounderstand theconceptof"signaltonoiseratio"whenconsideringproblem and continuouslyreadSpO clearancefortheabilitytoaccurately Masimo Corporationwasthefirstcompany toreceiveFDA perfusion. providesjustthat;accurateandreliablepulseoximetry duringconditionsoflow Masimo SET oximetry needstofunctionaccuratelywheneverpresented withconditionsoflowperfusion. be abletoreliablypredictwhenpatients maydevelopthiscondition. Therefore, reliablepulse Critically illpatients are atriskofdevelopinglowperipheralperfusion.Cliniciansmaynotalways perfusion. technology isclearlysuperiortoallotherpulseoximeters duringconditionsofmotionandlow periods oflowperfusionandmotion.Numerousstudies haveshowntheMasimo'sSET isintheabilitytoaccurately measureSpO of MasimoSET pulsations toacquireaccuratereadingsofSpO designed tolowernoise,Masimoengineerswereableobtain thesignal duringveryweak sensors (LNOP),cablesdesignedtominimizeelectricalinterference,andcircuitboards algorithm, hardwareandsensordesign. Through theuseofspeciallydesignedlownoise pulseoximeter. Masimowasabletoaccomplishthisfeatthroughits proprietary Masimo SET Pulmonary Bypass andresuscitation. environments andsituationswhereverylowperfusioncanoccursuchas:ICU, Trauma, Cardio- oximeterprovidesvaluableinformation(whenotheroximeterscannot)incritical local perfusionlevels. An important clinicaladvantage ofincreasedsensitivityisthattheMasimo difficult todistinguishthesmallamplitudeSpO motion. Ineffect, themotionraisesbackgroundnoiseleveltherebymakingitevenmore 2,3,5,6,9,14,15,16 2 signal duringlowperfusionsituationsismademoredifficult duringperiodsof 2 2 during lowperfusion.Lowperfusionresults inaverysmallamplitudesignal, values inpatients suffering fromextremelylowcardiacoutputand/or 2 During ConditionsInvolvingLow 2 values throughmotion.Itwasalsothefirstcompany toreceive 3-17 The improvedlowperfusioncapabilities ofMasimoSET 17 2 2 signal duringlowperfusion. The clearadvantage n us ae aioSTalgorithmsassist and pulserate.MasimoSET 2 during lowperipheralperfusionwithits 2 during theworstofallsituations, 2 and PRduringextremelylow 1 Researchers compared whitepaper 1 masimo corporation 40 parker irvine ca 92618 www.masimo.com Measurement duringverylowperfusion References 7 GoldsteinMR,FurmanGI,Lawas-AlejoP, OchikuboCG,17. PerniaML,SindelBD, Yang LL,MartinGI. The UseofPulseOximetryto pulse ShahN,Hoang TD ClackSL, Anderson CT.16. The impact ofmotionandlowperfusionontheperformanceMasimoSET 5 ShahN,ClackSL,Hoang TD. Isthereadifference intherecoverytimeforaccuratedisplayofoxygensaturation(SpO2) 15. POduring comparison offourmajorbrandspulseoximeters(PO)withMasimo SET ClackSL,ShahN,Hoang TD, Gupta B. A 14. Comparison Kawagishi ofthePerformancePulseOximetersduringBloodPressureCuff-T, KanayaN,NakayamaM,Namiki 13. A. A DurbinCG, RostowSK.Morereliableoximetryreducesthefrequencyofarterialbloodgasanalysisandhastensoxygenweaning 12. Comparison Kawagishi ofthePerformancePulseOximetersduringBloodPressureCuff-T, KanayaN,NakayamaM,Namiki 11. A. A GoldsteinMR.Left hearthypoplasia:alifesavedwiththeuseofnewpulseoximetertechnology. Neonatal IntensiveCare 10. Witucki PJ,BellSJ.Comparison ofthreenewtechnologypulseoximetersduringrecoveryfromextremeexerciseinadultmales. 9. Irita K,Kai Y, Akiyoshi K, Tanaka Y, Takahashi S.PerformanceEvaluationofaNewPulseoximeterDuringMildHypothermic 8. LichtenthalP, BarkerS. An EvaluationofPulseOximetry-Pre,during,andPost-CardiopulmonaryBypass. Anesthesiology 2002; 7. Torres A, SkenderK,Wohrley J, Aldag J,Raff G, GeissD. Assessment of2NewGenerationPulseoximetersDuringLowPerfusion 6. DurbinCG, RostowSK. Advantages ofNew Technology PulseOximetrywith Adults inExtremis. Anesthesia and Analgesia 2002; 5. Gangitano ES, Taschuk RD,LibermanRL.NearcontinuouspulseoximetryduringnewbornECLS ASAIO Journal1999;45(2):125 4. GoldsteinMR,LibermanRL, Taschuk RD, Thomas A, Vogt JF. Pulseoximetryintransportofpoorlyperfusedbabies.Pediatrics 3. BarkerSJ,NovakS,MorganS. The performanceofthreepulseoximetersduringlowperfusioninvolunteers. Anesthesiology 2. Weber W, ElfadelIM,Barker, SJ.Low-perfusionresistant pulseoximetry. JournalofClinicalMonitoring1995;11(4):284. 1. 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