A Two Centre Observational Study of Simultaneous Pulse Oximetry and Arterial Oxygen Saturation Recordings in Intensive Care Unit Patients
Open accessAbstract
The influence of variables that might affect the accuracy of pulse oximetry (SpO 2 ) recordings in critically ill patients is not well established. We sought to describe the relationship between paired SpO 2 /SaO 2 (oxygen saturation via arterial blood gas analysis) in adult intensive care unit (ICU) patients and to describe the diagnostic performance of SpO 2 in detecting low SaO 2 and PaO 2 . A paired SpO 2 /SaO 2 measurement was obtained from 404 adults in ICU. Measurements were used to calculate bias, precision, and limits of agreement. Associations between bias and variables including vasopressor and inotrope use, capillary refill time, hand temperature, pulse pressure, body temperature, oximeter model, and skin colour were estimated. There was no overall statistically significant bias in paired SpO 2 /SaO 2 measurements; observed limits of agreement were +/-4.4%. However, body temperature, oximeter model, and skin colour, were statistically significantly associated with the degree of bias. SpO 2 <89% had a sensitivity of 3/7 (42.9%; 95% confidence intervals, CI, 9.9% to 81.6%) and a specificity of 344/384 (89.6%; 95% CI 86.1% to 92.5%) for detecting SaO 2 <89%. The absence of statistically significant bias in paired SpO 2 /SaO 2 in adult ICU patients provides support for the use of pulse oximetry to titrate oxygen therapy. However, SpO 2 recordings alone should be used cautiously when SaO 2 recordings of 4.4% higher or lower than the observed SpO 2 would be of concern. A range of variables relevant to the critically ill had little or no effect on bias.
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SpO2 measurements provided by conventional pulse oximeters are susceptible to errors.
“SpO2 measurements provided by conventional pulse oximeters are susceptible to errors”
From Wearable Photoplethysmography for Cardiovascular Monitoring (2022) · cites this paper as [143]
Objective scales such as the Fitzpatrick Skin Pigmentation (FSP) scale or the Munsell scale were used by 6/37 studies (16.21%) and 4/37 studies (10.81%), respectively.
“We find that objective scales such as the Fitzpatrick Skin Pigmentation (FSP) scale or the Munsell scale were used by 6/37 studies (16.21%) [61,69,70,71,76,77] and 4/37 studies (10.81%) [47,48,74,89], respectively.”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [76]
A small but statistically significant difference between SaO2 and SpO2 in light and dark skin phototypes was found in 404 ICU patients classified by FSP.
“A small but statistically significant difference between SaO2 and SpO2 in light and dark skin phototypes [76] was found.”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [76]
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- Authors
- Ebmeier, S. J., Barker, M., Bacon, M., Beasley, R. C., Bellomo, R., Chong, C. K., Eastwood, G. M., Gilchrist, J., Kagaya, H., Pilcher, J., Reddy, S. K., Ridgeon, E., Sarma, N., Spragas, S., Tanaka, A., Tweedie, M., Weatherall, M., & Young, P. J.
- Affiliations
- Medical Research Institute of New Zealand (NZ)
- Austin Hospital (AU)
- University of Otago (NZ)
- Wellington Hospital (NZ)
- Corresponding author
- Young, P. J.
- ORCID
- Venue
- Anaesthesia and Intensive Care
- Publisher
- SAGE Publications
- Published
- 2018-05
- Volume
- 46
- Issue
- 3
- Pages
- 297-303
- ISSN
- 0310-057X (ISSN-L)
- 1448-0271
- OpenAlex
- W2889446176
- Cited by
- 92
- References
- 16
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 16 · 2023: 7 · 2022: 38 · 2021: 10 · 2020: 2 · 2019: 4 · 2018: 1
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Anaesthesia and Intensive Care (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- pulse oximetry, arterial oxygen saturation, measurement bias, limits of agreement, critically ill patients, intensive care unit, body temperature, skin colour, vasopressors, inotropic agents, capillary refill time
- MeSH terms
- Aged, Female, Humans, Intensive Care Units, Male, Middle Aged, New Zealand, Oximetry, Oxygen, Prospective Studies, Pulmonary Gas Exchange
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