Dark Skin Decreases the Accuracy of Pulse Oximeters at Low Oxygen Saturation: The Effects of Oximeter Probe Type and Gender

Feiner, John; Severinghaus, John W.; Bickler, Philip E.

doi:10.1213/01.ane.0000285988.35174.d9

Cited by 308 publications

(268 citation statements)

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“…3,4 The SpO 2 overestimation may also be dependent on location of measurement, 4,5 perfusion to the extremity where the pulse oximeter is located, and skin color. 6,7 The population of children with lower baseline oxygen saturations is growing. There are many children with cyanotic congenitalheartdisease(CCHD)undergoing and surviving palliative procedures.…”

mentioning

confidence: 99%

Accuracy of Pulse Oximetry in Children

2014

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WHAT'S KNOWN ON THIS SUBJECT: Saturations from pulse oximetry (SpO 2 ) may overestimate arterial oxygen saturations measured by CO-oximetry (SaO 2 ). The overestimation can be affected by location of measurement, perfusion, and skin color. Previous studies are limited by small numbers of observations in a hypoxemic range. WHAT THIS STUDY ADDS:This large sample of hypoxemic patients identified that SpO 2 typically overestimates SaO 2 . Bias and precision varied throughout the SpO 2 range. The SpO 2 range of 81% to 85% had the greatest bias: median SpO 2 6% higher than SaO 2 measured by CO-oximetry. abstract OBJECTIVE: For children with cyanotic congenital heart disease or acute hypoxemic respiratory failure, providers frequently make decisions based on pulse oximetry, in the absence of an arterial blood gas. The study objective was to measure the accuracy of pulse oximetry in the saturations from pulse oximetry (SpO 2 ) range of 65% to 97%. METHODS:This institutional review board-approved prospective, multicenter observational study in 5 PICUs included 225 mechanically ventilated children with an arterial catheter. With each arterial blood gas sample, SpO 2 from pulse oximetry and arterial oxygen saturations from CO-oximetry (SaO 2 ) were simultaneously obtained if the SpO 2 was #97%. RESULTS:The lowest SpO 2 obtained in the study was 65%. In the range of SpO 2 65% to 97%, 1980 simultaneous values for SpO 2 and SaO 2 were obtained. The bias (SpO 2 -SaO 2 ) varied through the range of SpO 2 values. The bias was greatest in the SpO 2 range 81% to 85% (336 samples, median 6%, mean 6.6%, accuracy root mean squared 9.1%). SpO 2 measurements were close to SaO 2 in the SpO 2 range 91% to 97% (901 samples, median 1%, mean 1.5%, accuracy root mean squared 4.2%).CONCLUSIONS: Previous studies on pulse oximeter accuracy in children present a single number for bias. This study identified that the accuracy of pulse oximetry varies significantly as a function of the SpO 2 range. Saturations measured by pulse oximetry on average overestimate SaO 2 from CO-oximetry in the SpO 2 range of 76% to 90%. Better pulse oximetry algorithms are needed for accurate assessment of children with saturations in the hypoxemic range. KEY WORDS oximetry, hypoxia, heart defects, congenital heart disease/ defects, pediatric, mechanical ventilation ABBREVIATIONS ABG-arterial blood gas ABG/SpO 2 pairs-simultaneous measurement of ABG and SpO 2 AHRF-acute hypoxemic respiratory failure A rms -accuracy root mean squared CCHD-cyanotic congenital heart disease FDA-US Food and Drug Administration SaO 2 -arterial oxygen saturations from CO-oximetry SpO 2 -saturations from pulse oximetry

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confidence: 99%

Accuracy of Pulse Oximetry in Children

2014

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“…It Table 1 -Descriptive measurements of oxygen saturation (%) by finger, nail polish color, and the right hand (without enamel) and the left hand (with enamel). represents a significant advance because it allows for reliable measurements of oxygen saturation, avoiding the discomfort and the risk caused by arterial punctures, as well as quickly identifying situations of hypoxia, facilitating clinical decisions (7)(8)14,17,(21)(22)(23)(24)(25)(26)(27)(28) .…”

Section: Discussionmentioning

confidence: 99%

“…But factors exist that lead to inaccuracy of pulse oximetry, among these are: the situation in which the oxygen saturation is below 70%; skin pigmentation; nail polish; light in the environment, such as surgical lamps; fluorescent and fiberoptic instruments; movement of the sensor; sensor is not compatible with the device; shock state in which there is poor tissue perfusion, carboxyhemoglobin (COHb) -hemoglobin that has a higher affinity to carbon monoxide, reducing the bond to oxygen, methemoglobin (MetHb) -oxidation of ferrous ion to ferric form which impedes the hemoglobin from binding to oxygen; errors in readings due to increases in serum lipid and bilirubin levels artificially altering the levels of COHb and MetHb; lack of calibration of the device; intravascular dyes such as blue methylene, indocyanine green and indigo red and onychomycosis (7,(14)(15)(16)(17)(18)(19) .…”

Section: Introductionmentioning

confidence: 99%

Avaliação das medidas de oximetria de pulso em indivíduos sadios com esmalte de unha

Diccini

Pereira

Im³

et al. 2011

Acta paul. enferm.

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Objective: To evaluate the changes in measurements of pulse oximetry in healthy individuals with nail polish. Methods: Cross sectional study with 80 healthy volunteers. The colors of enamel used to assess oxygen saturation (SpO2) were: coffee with milk, coffee, chocolate, red and plum. These colors were distributed among the finger nails of his left hand. The fingers of the right hand were the controls. Results: The colors red (p = 0.047) and coffee (p = 0.024) showed lower values in SpO2 in comparison to the control. The other colors did not change the measurement of SpO2. Conclusion: The colors red and coffee caused reduction in the measurement of SpO2, but the clinical relevance of this finding is questionable, because the values were within the normal range. Keywords: Cosmetics/adverse effects; Nails; Oximetry; Monitoring; Nursing RESUMOObjetivo: Avaliar as alterações nas medidas da oximetria de pulso em indivíduos sadios com esmaltes de unha. Métodos: Estudo transversal com 80 voluntárias sadias. As cores de esmalte utilizadas para avaliar a saturação periférica de oxigênio (SpO 2 ) foram: café com leite, café, chocolate, vermelho e ameixa. Estas cores foram distribuídas entre as unhas dos dedos da mão esquerda. Os dedos da mão direita foram os controles. Resultados: As cores vermelha (p=0,047) e café (p=0,024) mostraram valores menores na SpO 2 quando comparados ao controle. As outras cores não alteraram a medida da SpO 2 . Conclusão: As cores vermelha e café causaram redução na medida da SpO 2 , porém a relevância clínica deste achado é questionável, pois os valores estavam dentro do intervalo de normalidade. Descritores: Cosméticos/efeitos adversos; Unhas; Oximetria; Monitoramento; Enfermagem RESUMEN Objetivo: Evaluar las alteraciones en las medidas de la oximetría de pulso en individuos sanos con esmalte de uña. Métodos: Estudio transversal realizado con 80 voluntarias sanas. Los colores de esmalte utilizados para evaluar la saturación periférica de oxígeno (SpO 2 ) fueron: café con leche, café, chocolate, rojo y ciruela. Estos colores fueron distribuidos entre las uñas de los dedos de la mano izquierda. Los dedos de la mano derecha fueron los controles. Resultados: Los colores rojo (p=0,047) y café (p=0,024) mostraron valores menores en la SpO 2 cuando fueron comparados al control. Los otros colores no alteraron la medida del SpO 2 . Conclusión: Los colores rojo y café causaron reducción en la medida del SpO 2 , sin embargo la relevancia clínica de este hallazgo es cuestionable, pues los valores estaban dentro del intervalo de normalidad.

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“…The darker pigmentation of the Hispanic population can also have impact on pulse oximetry readings [10]. A study by Feiner et al [10] found that pulse oximeters generally overestimate blood oxygenation saturation in patients with hypoxia defined as saturations less than 80 percent.…”

Section: Anesthetic Considerationsmentioning

confidence: 99%

“…A study by Feiner et al [10] found that pulse oximeters generally overestimate blood oxygenation saturation in patients with hypoxia defined as saturations less than 80 percent. …”

Section: Anesthetic Considerationsmentioning

confidence: 99%

Anesthetic Implications for the Hispanic Population

Schneider¹

2017

JACCOA

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Dark Skin Decreases the Accuracy of Pulse Oximeters at Low Oxygen Saturation: The Effects of Oximeter Probe Type and Gender

Cited by 308 publications

References 3 publications

Accuracy of Pulse Oximetry in Children

Accuracy of Pulse Oximetry in Children

Avaliação das medidas de oximetria de pulso em indivíduos sadios com esmalte de unha

Anesthetic Implications for the Hispanic Population

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