The theoretical effect of carboxyhemoglobin on the pulse oximeter

Abstract

The relationship between arterial oxygen saturation as measured by the pulse oximeter (SpO2) and the fractional arterial oxygen saturation (SaO2) in the presence and absence of carboxyhemoglobin (COHb) has been derived according to the theory of absorption spectroscopy. We find that our theoretically derived correction equation is similar to that found in the technical literature of Nellcor. However, the correction equations presented by Barker and Tremper and the technical literature of Ohmeda differ substantially from our equation when sufficient quantities of reduced hemoglobin are present and the fractional COHb saturation (SaCO) is high. Our approximated equation, derived from the Lambert-Beer law, is SaO2 = SpO2 (1 - 0.932 SaCO) + 0.032 SaCO. The equation of Barker and Tremper is SaO2 = SpO2 - 0.9 SaCO. The Nellcor equation is SaO2 = SpO2 (1 - SaCO).

Alveolar gas equation

“…Oximeters do not differentiate hemoglobin bound to carbon monoxide from hemoglobin bound to oxygen; the machines report the sum of both values as oxyhemoglobin. [30][31][32][33][34] In contrast to blood co-oximeters, which utilize four wavelengths of light to separate out oxyhemoglobin from reduced hemoglobin, methemoglobin and carboxyhemoglobin, pulse oximeters utilize only two wavelengths of light [33][34] . As a result, pulse oximeters measure COHb and part of any MetHb along with oxyhemoglobin, and combine the three into a single reading, the SpO2.…”