Accuracy of pulse oximetry in preterm and term infants is insufficient to determine arterial oxygen saturation and tension

Wackernagel, Dirk; Blennow, Mats; Hellström, Ann

doi:10.1111/apa.15225

Cited by 24 publications

(17 citation statements)

References 27 publications

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“…SpO 2 overestimates arterial oxygen saturation (SaO 2 ) readings, especially in cases of hypoxemia. Thus, SpO 2 might be too muted to allow the degree of impairment in oxygenation status to be judged by the decline in SpO 2 [ 24 , 25 ]. In addition, pulse oximetry recordings are typically performed on the extremities, and poor peripheral perfusion can interfere with SpO 2 monitoring accuracy.…”

Section: Other Non-specific Factors Causing the Discrepancy Between Pulse Oximetric Oxygen Saturation And The Partial Pressure Of Oxygenmentioning

confidence: 99%

Silent Hypoxemia in Patients with COVID-19 Pneumonia: A Review

et al. 2021

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During the coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, patients presented with COVID-19 pneumonia of varying severity. The phenomenon of severe hypoxemia without signs of respiratory distress is also known as silent or hidden hypoxemia. Although silent hypoxemia is not unique to pneumonia due to SARS-CoV-2 infection, this phenomenon is now recognized to be associated with severe COVID-19 pneumonia. Proper management of critically ill patients is the key to reducing mortality. Herein, we summarize the possible and rare factors contributing to silent hypoxemia in patients with COVID-19. Microvascular thrombosis causes dead space ventilation in the lungs, and the flow of pulmonary capillaries is reduced, which leads to an imbalance in the V/Q ratio. The dissociation curve of oxyhemoglobin shifts to the left and limits the release of oxygen to the tissue. SARS-CoV-2 interferes with the synthesis of hemoglobin and reduces the ability to carry oxygen. The accumulation of endogenous carbon monoxide and carboxyhemoglobin will reduce the total oxygen carrying capacity and interfere with pulse oxygen saturation readings. There are also some non-specific factors that cause the difference between pulse oximetry and oxygen partial pressure. We propose some potentially more effective clinical alternatives and recommendations for optimizing the clinical management processes of patients with COVID-19. This review aims to describe the prevalence of silent hypoxemia in COVID-19 pneumonia, to provide an update on what is known of the pathophysiology, and to highlight the importance of diagnosing silent hypoxemia in patients with COVID-19 pneumonia.

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Section: Other Non-specific Factors Causing the Discrepancy Between Pulse Oximetric Oxygen Saturation And The Partial Pressure Of Oxygenmentioning

confidence: 99%

Silent Hypoxemia in Patients with COVID-19 Pneumonia: A Review

et al. 2021

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“…Moreover, within the saturation target range for preterm infants (89–95%), pulse oximetry exceeded the 4% error quality margin in the latest published study, which included 1908 neonates. SpO2 values were overestimated by an average of 2.9% with a standard deviation (SD) of 5.8% in this study [ 14 ].…”

Section: Introductionmentioning

confidence: 82%

“…The studies also did not report the influence of oxygen supplementation on the SpO2-SaO2 bias. The largest study in neonates, which compared more than twenty-seven thousand SpO2 readings to SaO2 and paO2, however, reported a three-fold higher likelihood of SpO2 overestimation in infants treated with supplemental oxygen [ 14 ]. An additional explanation for the SpO2 differences in neonates and adults is that the sensors used in the calibration process of pulse oximeters have a different optical-path length in an adult compared to an infant, which may affect the accuracy of pulse oximeters in neonates [ 9 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Pulse Oximetry in the Presence of Fetal Hemoglobin—A Systematic Review

et al. 2021

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Continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) is the main method to guide respiratory and oxygen support in neonates during postnatal stabilization and after admission to neonatal intensive care unit. The accuracy of these devices is therefore crucial. The presence of fetal hemoglobin (HbF) in neonatal blood might affect SpO2 readings. We performed a systematic qualitative review to investigate the impact of HbF on SpO2 accuracy in neonates. PubMed/Medline, Embase, Cumulative Index to Nursing & Allied Health database (CINAHL) and Cochrane library databases were searched from inception to January 2021 for human studies in the English language, which compared arterial oxygen saturations (SaO2) from neonatal blood with SpO2 readings and included HbF measurements in their reports. Ten observational studies were included. Eight studies reported SpO2-SaO2 bias that ranged from −3.6%, standard deviation (SD) 2.3%, to +4.2% (SD 2.4). However, it remains unclear to what extent this depends on HbF. Five studies showed that an increase in HbF changes the relation of partial oxygen pressure (paO2) to SpO2, which is physiologically explained by the leftward shift in oxygen dissociation curve. It is important to be aware of this shift when treating a neonate, especially for the lower SpO2 limits in preterm neonates to avoid undetected hypoxia.

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“…Guidance for giving neonates oxygen in intensive care units is commonly based on pulse oximetry monitoring. Wackernagel et al 5 explored the accuracy of this method by retrospectively pairing 27 237 peripheral capillary oxygen saturation (SpO 2 ) readings with arterial oxygen saturation and partial pressure of oxygen blood. Pulse oximetry readings within the saturation target range for preterm infants exceeded sometimes or often the 4% error quality margin and did not fulfil the quality requirements.…”

Section: Accuracy Of Pulse Oximetry Monitoringmentioning

confidence: 99%