Journal of Clinical Monitoring and Computing

, Volume 31, Issue 5, pp 1019–1026 | Cite as

Determination of saturation, heart rate, and respiratory rate at forearm using a Nellcor™ forehead SpO2-saturation sensor

  • Jarkko HarjuEmail author
  • Antti Vehkaoja
  • Ville Lindroos
  • Pekka Kumpulainen
  • Sasu Liuhanen
  • Arvi Yli-Hankala
  • Niku Oksala
Original Research


Alterations in arterial blood oxygen saturation, heart rate (HR), and respiratory rate (RR) are strongly associated with intra-hospital cardiac arrests and resuscitations. A wireless, easy-to-use, and comfortable method for monitoring these important clinical signs would be highly useful. We investigated whether the Nellcor™ OxiMask MAX-FAST forehead sensor could provide data for vital sign measurements when located at the distal forearm instead of its intended location at the forehead to provide improved comfortability and easy placement. In a prospective setting, we recruited 30 patients undergoing surgery requiring postoperative care. At the postoperative care unit, patients were monitored for two hours using a standard patient monitor and with a study device equipped with a Nellcor™ Forehead SpO2 sensor. The readings were electronically recorded and compared in post hoc analysis using Bland–Altman plots, Spearman’s correlation, and root-mean-square error (RMSE). Bland–Altman plot showed that saturation (SpO2) differed by a mean of −0.2 % points (SD, 4.6), with a patient-weighted Spearman’s correlation (r) of 0.142, and an RMSE of 4.2 points. For HR measurements, the mean difference was 0.6 bpm (SD, 2.5), r = 0.997, and RMSE = 1.8. For RR, the mean difference was −0.5 1/min (4.1), r = 0.586, and RMSE = 4.0. The SpO2 readings showed a low mean difference, but also a low correlation and high RMSE, indicating that the Nellcor™ saturation sensor cannot reliably assess oxygen saturation at the forearm when compared to finger PPG measurements.


Intraoperative monitoring Plethysmography Pulse oximetry Heart rate Respiratory rate 



The authors wish to thank the Paulo Foundation, Finnish Society of Anaesthesiologists and the Finnish Cultural Foundation, Pirkanmaa Regional Fund for grants, as well as the Medieta Oy (Helsinki, Finland), which provided the study device.

Compliance with ethical standards

Conflicts of interest

SL and NO have a pending patent on RR measurement. NO has been a shareholder on a former company Medieta. AV and PK have been former employees on a former company Medieta. JH, VL, and AY-H declare no conflicts of interest.

Ethical approval

This study was approved by the Pirkanmaa Hospital district ethics committee. All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee, as well as with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Jarkko Harju
    • 1
    Email author
  • Antti Vehkaoja
    • 2
  • Ville Lindroos
    • 3
  • Pekka Kumpulainen
    • 2
  • Sasu Liuhanen
    • 4
  • Arvi Yli-Hankala
    • 1
    • 3
  • Niku Oksala
    • 3
    • 5
  1. 1.Department of AnesthesiaTampere University HospitalTampereFinland
  2. 2.Tampere University of TechnologyTampereFinland
  3. 3.Medical SchoolUniversity of TampereTampereFinland
  4. 4.Department of AnesthesiaHelsinki University HospitalHelsinkiFinland
  5. 5.Department of SurgeryTampere University HospitalTampereFinland

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