Four Types of Pulse Oximeters Accurately Detect Hypoxia during Low Perfusion and Motion
Abstract
Background Pulse oximeter performance is degraded by motion artifacts and low perfusion. Manufacturers developed algorithms to improve instrument performance during these challenges. There have been no independent comparisons of these devices. Methods We evaluated the performance of four pulse oximeters (Masimo Radical-7, USA; Nihon Kohden OxyPal Neo, Japan; Nellcor N-600, USA; and Philips Intellivue MP5, USA) in 10 healthy adult volunteers. Three motions were evaluated: tapping, pseudorandom, and volunteer-generated rubbing, adjusted to produce photoplethsmogram disturbance similar to arterial pulsation amplitude. During motion, inspired gases were adjusted to achieve stable target plateaus of arterial oxygen saturation (SaO2) at 75%, 88%, and 100%. Pulse oximeter readings were compared with simultaneous arterial blood samples to calculate bias (oxygen saturation measured by pulse oximetry [SpO2] - SaO2), mean, SD, 95% limits of agreement, and root mean square error. Receiver operating characteristic curves were determined to detect mild (SaO2 Results Pulse oximeter readings corresponding to 190 blood samples were analyzed. All oximeters detected hypoxia but motion and low perfusion degraded performance. Three of four oximeters (Masimo, Nellcor, and Philips) had root mean square error greater than 3% for SaO2 70 to 100% during any motion, compared to a root mean square error of 1.8% for the stationary control. A low perfusion index increased error. Conclusions All oximeters…
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Pulse oximeters underperform under circumstances of low perfusion.
“it is known that pulse oximeters underperform under circumstances of low perfusion [33]”
From Investigating the accuracy of blood oxygen saturation measurements in common consumer smartwatches (2023) · cites this paper as [33]
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- Authors
- Louie, A., Feiner, J. R., Bickler, P. E., Rhodes, L., Bernstein, M., & Lucero, J.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Lucero, Jennifer
- Venue
- Anesthesiology
- Published
- 2018-03
- Volume
- 128
- Issue
- 3
- Pages
- 520-530
- ISSN
- 0003-3022 (ISSN-L)
- OpenAlex
- W2773802879
- Cited by
- 106
- References
- 24
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 11 · 2023: 13 · 2022: 17 · 2021: 26 · 2020: 9 · 2019: 7 · 2018: 4
- FWCI
- 2.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anesthesiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- pulse oximeter, hypoxemia detection, motion artifacts, low perfusion, arterial oxygen saturation, photoplethysmography, pulse oximetry accuracy, device comparison, hypoxia sensitivity
- MeSH terms
- Adult, Algorithms, Hypoxia, Female, Humans, Male, Motion, Oximetry, Oxygen, Reference Values, Reproducibility of Results, Artifacts, Young Adult
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