Acta Anaesthesiol Scand 2001; 45: 550–552
Printed in Denmark. All rights reserved
Evaluation of two methods to calculate p50 from
a single blood sample
N. P. EKELOEF, J. ERIKSEN and C. B. KANCIR
Department of Anaesthesia, Holstebro County Hospital, Holstebro, Denmark
Background: The hemoglobin-oxygen affinity is conveniently
described as the oxygen tension at which the hemoglobin is 50%
saturated (p50). We compared two methods of single-point
analysis for p50 calculation, using clinical data.
Methods: From patients submitted to anesthesia for major
surgery, 114 arterial or venous blood samples were analyzed by
using the Sigaard-Andersen oxygen status algorithm (p50OSA)
and Doyle’s method (p50Doyle) based on Hill’s equation.
Results: The oxygen saturation and tension varied respectively
between 0.64–0.96 and 3.8 kPa–11.0 kPa. A Bland-Altman analy-
sis showed a mean difference of 0.04 kPa (SD 0.12 kPa). The
limits of agreement were ª0.20 kPa and π0.28 kPa.
T HE HEMOGLOBIN-OXYGEN affinity can conveniently
be described as the oxygen tension at which the
hemoglobin is 50% saturated (p50). Estimation of p50
is often of clinical relevance in the analysis of oxygen
uptake and delivery, especially in critical illness. Tra-
ditional procedures to determine p50 require either
multiple-point analysis or single-point analysis pro-
vided the hemoglobin saturation does not exceed 0.80
(1, 2). The Siggaard-Andersen Oxygen Status Algo-
rithm (OSA) extends this limitation to saturation not
exceeding 0.97 (3). Doyle has recently proposed a very
simple method to calculate p50 from a single pair of
oxygen tension/saturation measurements using a
pocket calculator (4). His equation was validated by
using the experimental results provided by Severing-
haus in 1966 (5). The aim of our study was to evalu-
ate the two methods to calculate p50 using clinical
data.
Materials and methods
The study was performed at Holstebro County Hospi-
tal, Denmark, and was approved by the ethics com-
mittee of Ribe, Ringkjoebing and Southern Jutland
counties.
550
Copyright C Acta Anaesthesiol Scand 2001
ACTA ANAESTHESIOLOGICA SCANDINAVICA
ISSN 0001-5172
Conclusions: The Siggaard-Andersen oxygen status algorithm
is presently the most clinically useful single-point method of p50
calculation.
Received 15 May, accepted for publication 4 December 2000
Key words: Hemoglobin-oxygen affinity; p50 for oxygen; oxy-
gen saturation; oxygen tension.
c Acta Anaesthesiologica Scandinavica 45 (2001)
Blood sampling
Blood samples were drawn from the radial artery and
the vena cava superior of patients submitted to anes-
thesia for major surgery.
Analytical methods
Arterial and venous blood was investigated. pCO2,
pO2 and pH were determined with electrochemical
measurements (ABL 500, Radiometer A/S, Denmark).
Hemoglobin oxygen saturation (sO2), carboxyhemo-
globin (COHb), methemoglobin (MetHb), and total
hemoglobin (ctHb) were determined with a multiwa-
velength spectrophotometer (OSM 3 Hemoximeter,
Radiometer A/S, Denmark).
These variables were used as input parameters in
the software package ‘‘Oxygen Status Algorithm OSA
3.0’’ by Siggaard-Andersen. The measured quantities
allow the calculation of p50OSA on the basis of the pa-
tient’s hemoglobin-oxygen equilibrium curve (6).
Only oxygen saturation less than 0.97 was used.
The mathematical model is described by:
p50OSA Ω p50æ¿exp. (f æ¿Aa), p50æ Ω 3.578 kPa, f æ Ω 1.121
Behind Aa lies equations for pH, pCO2, MetHb and
sO2 (3, 6).
 p50 calculation

Fig. 1. Bland-Altman plot comparing p50-OSA with p50-Doyle.

Doyle’s method (p50Doyle) is based on Hill’s equa-

tion (7).
Discussion

冋 册
1
In many clinical settings, one of the major challenges is
1ªSaO2 n to optimize and maintain adequate tissue oxygenation
p50 Ω pO2 ¡ , n Ω 2711
SaO2 by improving arterial oxygen tension, hemoglobin con-
centration or/and cardiac output (9). In daily practice,
Statistical methods it is uncommon to take the positioning of the oxyhemo-
The two methods of calculating p50 were compared globin dissociation curve into account. In critically ill
using the statistical method proposed by Bland and patients, the impact of changes in the hemoglobin-oxy-
Altman (8). gen affinity is difficult to interpret, as the affinity affects
both oxygen uptake in the lungs and oxygen unloading
to the tissues. The first step regarding the use of the
Results
hemoglobin-oxygen affinity must be a quantification of
A total of 114 arterial or venous blood samples were p50 from a single pair of oxygen tension/saturation
analyzed. Median sO2 was 0.78 (range: 0.64–0.96). Me- measurements. During surgery and in the immediate
dian pO2 was 5.47 kPa (range: 3.76 kPa–11.0 kPa). A postoperative period, supplemental oxygen is given,
plot of the difference between the methods against and oxygen saturation in arterial blood therefore al-
their mean is shown in Fig. 1. The mean difference most never exceeds 0.97. Therefore, in clinical practice,
was π0.04 kPa and the standard deviation was 0.12 p50 often has to be calculated from venous blood
kPa: The limits of agreement were ª0.20 kPa and samples, as we did in this study.
π0.28 kPa. The p50Doyle sligthly overestimated the p50 by a

551
N. P. Ekeloef et al.
value of 0.04 kPa. The limits of agreement are ª0.20
kPa and π0.28 kPa, meaning that with the Doyle-
method of p50 calculation, the p50 value could be 0.28
kPa above or 0.20 kPa below the value obtained by
OSA; in other words a p50 value obtained by the OSA
calculation of for instance 3.2 kPa could just as well
be 3.5 kPa or 3.0 kPa by the Doyle-method.
We find this variation less acceptable from af clin-
ical point of view. If the two methods are to be used
interchangeably, the limits of agreement should be
much smaller, for instance ∫0.1–0.15 kPa.
Morgan et al. have previously shown that the Sig-
gaard-Andersen oxygen status algorithm calculation
of p50 is accurate up to saturations of 0.97, in the ab-
sence of severe acid-base pertubations (10). We there-
fore conclude that the Siggaard-Andersen oxygen sta-
tus algorithm, which uses a TAHN equation, for the
time being is the most clinical useful single-point
method of in vivo p50 calculation. Whether the quanti-
fication of the hemoglobin-oxygen affinity will im-
prove patient management or outcome needs further
evaluation.
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Address:
Peter Ekeloef, MD
Department of Anaesthesia
Holstebro County Hospital
Lægårdvej 12
DK-7500 Holstebro
Denmark
e-mail: anpe/ringamt.dk