Potential errors in pulse oximetry: I. Pulse oximeter evaluation*
Open accessAbstract
There is no absolute reference for oxygen saturation, although multiwavelength in vitro oximeters are accepted as the 'gold standard'. Regardless of whether fractional or functional saturation is used by manufacturers to calibrate their oximeters, evaluation against fractional saturation is recommended since this is the clinically relevant variable. The use of standard notation and comparisons based on bias and precision is recommended. The accuracy of pulse oximetry is intrinsically limited by the use of only two wavelengths, and is dependent on the initial calibration population. The empirical algorithms used to convert the signal to its 'readout value' and the quality control of hardware may both be important sources of variability between oximeters. Change in blood temperature may introduce errors in pulse oximeter and in vitro oximeter saturation readings, but these will be clinically insignificant. Changes in blood pH should not decrease pulse oximetry accuracy.
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A review of 13 models of pulse oximeters suggested that a high percentage of carboxyhemoglobin or methaemoglobin are related to failures in saturation readings and can hide hypoxemia.
“A review of 13 models of pulse oximeters suggested that a high percentage of carboxyhemoglobin or methaemoglobin are related to failures in saturation readings and can hide hypoxemia [86].”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [86]
In 1991, commercial pulse oximeters had measurement error caused by ambient light.
“In 1991, it was found that commercial pulse oximeters had measurement error caused by ambient light [199].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [199]
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Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring
Fine, J., Branan, K. L., Rodriguez, A. J., Boonya-ananta, T., Ajmal, Ramella-Roman, J. C., McShane, M. J., & Coté, G. L. (2021) · Biosensors · doi:10.3390/bios11040126 · Cited by 348 · see citing works
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- Authors
- RALSTON, A. C., WEBB, R. K., & RUNCIMAN, W. B.
- Affiliations
- Royal Adelaide Hospital (AU)
- Corresponding author
- RUNCIMAN, W. B.
- ORCID
- RUNCIMAN, W. B.
- Venue
- Anaesthesia
- Publisher
- Wiley
- Published
- 1991-03
- Volume
- 46
- Issue
- 3
- Pages
- 202-206
- ISSN
- 0003-2409 (ISSN-L)
- 1365-2044
- OpenAlex
- W2766731651
- Cited by
- 166
- References
- 13
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 7 · 2023: 8 · 2022: 5 · 2021: 11 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 6 · 2016: 6 · 2015: 4 · 2014: 1 · 2013: 2 · 2012: 2
- FWCI
- 10.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Anaesthesia (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 › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Keywords
- pulse oximetry, measurement error, oxygen saturation, bias and precision, empirical algorithms, blood temperature, blood pH
- MeSH terms
- Humans, Hydrogen-Ion Concentration, Oximetry, Oxygen, Oxyhemoglobins, Reference Standards, Signal Processing, Computer-Assisted, Statistics as Topic, Temperature
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