Philip E Bickler1, John R Feiner, John W Severinghaus. 1. Department of Anesthesia and Perioperative Care, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA. bicklerp@anesthesia.ucsf.edu
Abstract
BACKGROUND: It is uncertain whether skin pigmentation affects pulse oximeter accuracy at low HbO2 saturation. METHODS: The accuracy of finger pulse oximeters during stable, plateau levels of arterial oxygen saturation (Sao2) between 60 and 100% were evaluated in 11 subjects with darkly pigmented skin and in 10 with light skin pigmentation. Oximeters tested were the Nellcor N-595 with the OxiMax-A probe (Nellcor Inc., Pleasanton, CA), the Novametrix 513 (Novametrix Inc., Wallingford, CT), and the Nonin Onyx (Nonin Inc., Plymouth, MN). Semisupine subjects breathed air-nitrogen-carbon dioxide mixtures through a mouthpiece. A computer used end-tidal oxygen and carbon dioxide concentrations determined by mass spectrometry to estimate breath-by-breath Sao2, from which an operator adjusted inspired gas to rapidly achieve 2- to 3-min stable plateaus of desaturation. Comparisons of oxygen saturation measured by pulse oximetry (Spo2) with Sao2 (by Radiometer OSM3) were used in a multivariate model to determine the interrelation between saturation, skin pigmentation, and oximeter bias (Spo2 - Sao2). RESULTS: At 60-70% Sao2, Spo2 (mean of three oximeters) overestimated Sao2 (bias +/- SD) by 3.56 +/- 2.45% (n = 29) in darkly pigmented subjects, compared with 0.37 +/- 3.20% (n = 58) in lightly pigmented subjects (P < 0.0001). The SD of bias was not greater with dark than light skin. The dark-light skin differences at 60-70% Sao2 were 2.35% (Nonin), 3.38% (Novametrix), and 4.30% (Nellcor). Skin pigment-related differences were significant with Nonin below 70% Sao2, with Novametrix below 90%, and with Nellcor at all ranges. Pigment-related bias increased approximately in proportion to desaturation. CONCLUSIONS: The three tested pulse oximeters overestimated arterial oxygen saturation during hypoxia in dark-skinned individuals.
BACKGROUND: It is uncertain whether skin pigmentation affects pulse oximeter accuracy at low HbO2 saturation. METHODS: The accuracy of finger pulse oximeters during stable, plateau levels of arterial oxygen saturation (Sao2) between 60 and 100% were evaluated in 11 subjects with darkly pigmented skin and in 10 with light skin pigmentation. Oximeters tested were the Nellcor N-595 with the OxiMax-A probe (Nellcor Inc., Pleasanton, CA), the Novametrix 513 (Novametrix Inc., Wallingford, CT), and the Nonin Onyx (Nonin Inc., Plymouth, MN). Semisupine subjects breathed air-nitrogen-carbon dioxide mixtures through a mouthpiece. A computer used end-tidal oxygen and carbon dioxide concentrations determined by mass spectrometry to estimate breath-by-breath Sao2, from which an operator adjusted inspired gas to rapidly achieve 2- to 3-min stable plateaus of desaturation. Comparisons of oxygen saturation measured by pulse oximetry (Spo2) with Sao2 (by Radiometer OSM3) were used in a multivariate model to determine the interrelation between saturation, skin pigmentation, and oximeter bias (Spo2 - Sao2). RESULTS: At 60-70% Sao2, Spo2 (mean of three oximeters) overestimated Sao2 (bias +/- SD) by 3.56 +/- 2.45% (n = 29) in darkly pigmented subjects, compared with 0.37 +/- 3.20% (n = 58) in lightly pigmented subjects (P < 0.0001). The SD of bias was not greater with dark than light skin. The dark-light skin differences at 60-70% Sao2 were 2.35% (Nonin), 3.38% (Novametrix), and 4.30% (Nellcor). Skin pigment-related differences were significant with Nonin below 70% Sao2, with Novametrix below 90%, and with Nellcor at all ranges. Pigment-related bias increased approximately in proportion to desaturation. CONCLUSIONS: The three tested pulse oximeters overestimated arterial oxygen saturation during hypoxia in dark-skinned individuals.
Authors: Wei Chen; David R Janz; Ciara M Shaver; Gordon R Bernard; Julie A Bastarache; Lorraine B Ware Journal: Chest Date: 2015-12 Impact factor: 9.410
Authors: Keita Ikeda; David B MacLeod; Hilary P Grocott; Eugene W Moretti; Warwick Ames; Charles Vacchiano Journal: Anesth Analg Date: 2014-12 Impact factor: 5.108
Authors: Samuel M Brown; Abhijit Duggal; Peter C Hou; Mark Tidswell; Akram Khan; Matthew Exline; Pauline K Park; David A Schoenfeld; Ming Liu; Colin K Grissom; Marc Moss; Todd W Rice; Catherine L Hough; Emanuel Rivers; B Taylor Thompson; Roy G Brower Journal: Crit Care Med Date: 2017-08 Impact factor: 7.598
Authors: Derek M Culnan; Beretta Craft-Coffman; Genevieve H Bitz; Karel D Capek; Yiji Tu; William C Lineaweaver; Maggie J Kuhlmann-Capek Journal: Ann Plast Surg Date: 2018-03 Impact factor: 1.539
Authors: Elizabeth E Foglia; Robin K Whyte; Aasma Chaudhary; Antonio Mott; Jodi Chen; Kathleen J Propert; Barbara Schmidt Journal: J Pediatr Date: 2016-12-09 Impact factor: 4.406
Authors: John R Feiner; Mark D Rollins; Jeffrey W Sall; Helge Eilers; Paul Au; Philip E Bickler Journal: Anesth Analg Date: 2013-03-11 Impact factor: 5.108