Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation?
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Introduction: This study investigates the relation between changes in pulse oximeter oxygen saturation (Sp O2) and changes in arterial oxygen saturation (Sa O2) in the critically ill, and the effects of acidosis and anaemia on precision of using pulse oximetry to predict Sa O2. Patients and methods: Forty-one consecutive patients were recruited from a nine-bed general intensive care unit into a 2-month study. Patients with significant jaundice (bilirubin >40 μmol/l) or inadequate pulse oximetry tracing were excluded. Results: A total of 1085 paired readings demonstrated only moderate correlation (r= 0.606; P < 0.01) between changes in Sp O2 and those in Sa O2, and the pulse oximeter tended to overestimate actual changes in Sa O2. Anaemia increased the degree of positive bias whereas acidosis reduced it. However, the magnitude of these changes was small. Conclusion: Changes in Sp O2 do not reliably predict equivalent changes in Sa O2 in the critically ill. Neither anaemia nor acidosis alters the relation between Sp O2 and Sa O2 to any clinically important extent.
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Pulse oximetry should remain an important diagnostic tool in patients with anemia and sickle cell anemia.
“pulse oximetry should remain an important diagnostic tool in these patients”
From Investigating the accuracy of blood oxygen saturation measurements in common consumer smartwatches (2023) · cites this paper as [30]
The Conclusion calls pulse oximetry a valuable tool in ICU care and reports that anaemia did not alter measurement precision to a clinically important extent. But the Discussion says no patients were known to have sickle cell anaemia or trait, so this study does not support extending that finding specifically to those patients. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn patients with anemia and sickle cell anemia, variability in the relationship between SpO2 and true arterial saturation measurements is not clinically significant.
“although there is some variability in the relationship between SpO2 and the true arterial saturation measurements, this was not a clinically significant difference”
From Investigating the accuracy of blood oxygen saturation measurements in common consumer smartwatches (2023) · cites this paper as [30]
The Discussion says anaemia affects the relationship between SpO2 and SaO2, but that the clinical significance of this effect is small. It also says no patients were known to have sickle cell anaemia or trait, so the finding cannot be extended to that group. The paper further cautions that changes in SpO2 do not reliably predict equivalent changes in SaO2 overall. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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References 26 · Cited by 136
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- Authors
- Perkins, G. D., McAuley, D. F., Giles, S., Routledge, H., & Gao, F.
- Affiliations
- Heartlands Hospital (GB)
- Corresponding author
- Gao, Fang
- Venue
- Critical Care
- Published
- 2003-06-11
- Volume
- 7
- Issue
- 4
- Pages
- R67-R67
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC270702
- OpenAlex
- W1757861364
- Cited by
- 136
- References
- 26
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 7 · 2023: 11 · 2022: 15 · 2021: 15 · 2020: 6 · 2019: 5 · 2018: 9 · 2017: 8 · 2016: 5 · 2015: 10 · 2014: 6 · 2013: 5 · 2012: 5
- FWCI
- 1.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, other-oa)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Research Portal (Queen's University Belfast) (submittedVersion)
- 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, critically ill patients, acidosis, anemia, measurement bias, jaundice, intensive care unit
- MeSH terms
- Acidosis, Aged, Aged, 80 and over, Anemia, Arteries, Female, United Kingdom, Humans, Intensive Care Units, Male, Middle Aged, Oximetry, Oxygen, Oxygen Consumption, Critical Illness
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