Critical care trainees call for pulse oximetry reform

Hidalgo, Daniel Colon; Olusanya, Olusegun; Harlan, Emily A

doi:10.1016/s2213-2600(21)00102-8

Cited by 19 publications

(14 citation statements)

References 5 publications

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“…Large integrated health systems such as the Veterans Health Administration and NHS could have a role to purchase and use only pulse oximeters proven to provide equivalent accuracy in black patients rather than devices of unproven equity. 33 34 …”

Section: Discussionmentioning

confidence: 99%

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Valbuena

Seelye

Sjoding

et al. 2022

BMJ

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ObjectivesTo evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care.DesignMulticenter, retrospective cohort study using electronic medical records from general care medical and surgical inpatients.SettingVeteran Health Administration, a national and racially diverse integrated health system in the United States, from 2013 to 2019.ParticipantsAdult inpatients in general care (medical and surgical), in Veteran Health Administration medical centers.Main outcomes measuresOccult hypoxemia (defined as arterial blood oxygen saturation (SaO2) of <88% despite a pulse oximetry (SpO2) reading of ≥92%), and whether rates of occult hypoxemia varied by race and ethnic origin.ResultsA total of 30 039 pairs of SpO2-SaO2 readings made within 10 minutes of each other were identified during the study. These pairs were predominantly among non-Hispanic white (21 918 (73.0%)) patients; non-Hispanic black patients and Hispanic or Latino patients accounted for 6498 (21.6%) and 1623 (5.4%) pairs in the sample, respectively. Among SpO2 values greater or equal to 92%, unadjusted probabilities of occult hypoxemia were 15.6% (95% confidence interval 15.0% to 16.1%) in white patients, 19.6% (18.6% to 20.6%) in black patients (P<0.001 v white patients, with similar P values in adjusted models), and 16.2% (14.4% to 18.1%) in Hispanic or Latino patients (P=0.53 v white patients, P<0.05 in adjusted models). This result was consistent in SpO2-SaO2 pairs restricted to occur within 5 minutes and 2 minutes. In white patients, an initial SpO2-SaO2 pair with little difference in saturation was associated with a 2.7% (95% confidence interval −0.1% to 5.5%) probability of SaO2 <88% on a later paired SpO2-SaO2 reading showing an SpO2 of 92%, but black patients had a higher probability (12.9% (−3.3% to 29.0%)).ConclusionsIn general care inpatient settings across the Veterans Health Administration where paired readings of arterial blood gas (SaO2) and pulse oximetry (SpO2) were obtained, black patients had higher odds than white patients of having occult hypoxemia noted on arterial blood gas but not detected by pulse oximetry. This difference could limit access to supplemental oxygen and other more intensive support and treatments for black patients.

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Section: Discussionmentioning

confidence: 99%

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Valbuena

Seelye

Sjoding

et al. 2022

BMJ

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“…Other potential avenues for wearable technology in postoperative patients include recording of gastrointestinal activity (with acoustic or electrical signals) 44 , 45 , 114 , 115 , continuous glucose monitoring for subclinical insulin resistance driven by the surgical stress response 116 , 117 , sensing of postoperative pain 118 , 119 , or other novel biomarkers of autonomic tone 120 . Continuous oximetry using wearable patches also remains an avenue of further development; however, care must be taken during sensor design to ensure compatibility with different skin tones and prevent the reinforcement of existing healthcare inequities 121 .…”

Section: Discussionmentioning

confidence: 99%

Wearable devices to monitor recovery after abdominal surgery: scoping review

Wells

Penfold

et al. 2022

BJS Open

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Background Wearable devices have been proposed as a novel method for monitoring patients after surgery to track recovery, identify complications early, and improve surgical safety. Previous studies have used a heterogeneous range of devices, methods, and analyses. This review aimed to examine current methods and wearable devices used for monitoring after abdominal surgery and identify knowledge gaps requiring further investigation. Methods A scoping review was conducted given the heterogeneous nature of the evidence. MEDLINE, EMBASE, and Scopus databases were systematically searched. Studies of wearable devices for monitoring of adult patients within 30 days after abdominal surgery were eligible for inclusion. Results A total of 78 articles from 65 study cohorts, with 5153 patients were included. Thirty-one different wearable devices were used to measure vital signs, physiological measurements, or physical activity. The duration of postoperative wearable device use ranged from 15 h to 3 months after surgery. Studies mostly focused on physical activity metrics (71.8 per cent). Continuous vital sign measurement and physical activity tracking both showed promise for detecting postoperative complications earlier than usual care, but conclusions were limited by poor device precision, adherence, occurrence of false alarms, data transmission problems, and retrospective data analysis. Devices were generally well accepted by patients, with high levels of acceptance, comfort, and safety. Conclusion Wearable technology has not yet realized its potential to improve postoperative monitoring. Further work is needed to overcome technical limitations, improve precision, and reduce false alarms. Prospective assessment of efficacy, using an intention-to-treat approach should be the focus of further studies.

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“…Although we believe this to be the most accurate depiction of the degree of respiratory failure, we cannot exclude added bias due to this selection. Furthermore, during the pandemic, shortcomings of pulse oximetry have been emphasized especially in patients with a darker skin tone, where under detection of hypoxemia occurs more frequently than in white patients [ [38] , [39] , [40] , [41] ]. Unfortunately, our database had no data available on patient skin color, impeding any assessment on the effect of skin color on SpO 2 /FiO 2 accuracy in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Prognostication using SpO2/FiO2 in invasively ventilated ICU patients with ARDS due to COVID-19 – Insights from the PRoVENT-COVID study

Mazzinari

Neto

Hollmann

et al. 2022

Journal of Critical Care

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Background The SpO 2 /FiO 2 is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO 2 /FiO 2 for mortality in patients with ARDS due to COVID–19. Methods This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID–19. The primary endpoint was 28–day mortality. Results In 869 invasively ventilated patients, 28–day mortality was 30.1%. The SpO 2 /FiO 2 on day 1 had no prognostic value. The SpO 2 /FiO 2 on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO 2 /FiO 2 on day 2 (OR, 0.66 [95%–CI 0.46–0.96]) and on day 3 (OR, 0.70 [95%–CI 0.51–0.96]) were associated with 28–day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76–0.79]). The measured PaO 2 /FiO 2 and the PaO 2 /FiO 2 calculated from SpO 2 /FiO 2 were strongly correlated (Spearman's r = 0.79). Conclusions In this cohort of patients with ARDS due to COVID–19, the SpO 2 /FiO 2 on day 2 and day 3 are independently associated with and have prognostic capacity for 28–day mortality. The SpO 2 /FiO 2 is a useful metric for risk stratification in invasively ventilated COVID–19 patients.

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Critical care trainees call for pulse oximetry reform

Cited by 19 publications

References 5 publications

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Wearable devices to monitor recovery after abdominal surgery: scoping review

Prognostication using SpO2/FiO2 in invasively ventilated ICU patients with ARDS due to COVID-19 – Insights from the PRoVENT-COVID study

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