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Cited by 438Non-Invasive Vital Sign MonitoringHemodynamic Monitoring and TherapyOptical Imaging and Spectroscopy Techniques

Pulse oximetry: fundamentals and technology update

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Nitzan, Meir, Romem, Ayal, Koppel, Robert·2014·Medical Devices: Evidence and Research
DOI 10.2147/mder.s47319PMC PMC4099100
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Abstract

Oxygen saturation in the arterial blood (SaO2) provides information on the adequacy of respiratory function. SaO2 can be assessed noninvasively by pulse oximetry, which is based on photoplethysmographic pulses in two wavelengths, generally in the red and infrared regions. The calibration of the measured photoplethysmographic signals is performed empirically for each type of commercial pulse-oximeter sensor, utilizing in vitro measurement of SaO2 in extracted arterial blood by means of co-oximetry. Due to the discrepancy between the measurement of SaO2 by pulse oximetry and the invasive technique, the former is denoted as SpO2. Manufacturers of pulse oximeters generally claim an accuracy of 2%, evaluated by the standard deviation (SD) of the differences between SpO2 and SaO2, measured simultaneously in healthy subjects. However, an SD of 2% reflects an expected error of 4% (two SDs) or more in 5% of the examinations, which is in accordance with an error of 3%-4%, reported in clinical studies. This level of accuracy is sufficient for the detection of a significant decline in respiratory function in patients, and pulse oximetry has been accepted as a reliable technique for that purpose. The accuracy of SpO2 measurement is insufficient in several situations, such as critically ill patients receiving supplemental oxygen, and can be hazardous if it leads to elevated values of oxygen partial pressure in blood. In particular, preterm newborns are vulnerable to retinopathy of prematurity induced by high oxygen concentration in the blood. The low accuracy of SpO2 measurement in critically ill patients and newborns can be attributed to the empirical calibration process, which is performed on healthy volunteers. Other limitations of pulse oximetry include the presence of dyshemoglobins, which has been addressed by multiwavelength pulse oximetry, as well as low perfusion and motion artifacts that are partially rectified by sophisticated algorithms and also by reflection pulse oximetry.

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  • Darker skin contains more melanin, which absorbs more green light than lighter skin.

    “likely because darker skin contains more melanin which absorbs more green light than lighter skin.”

    From Investigating sources of inaccuracy in wearable optical heart rate sensors (2020) · cites this paper as [30]

    The “Pulse oximetry – the technique” section says melanin can absorb light in the red and near-infrared regions. It does not address green light or compare melanin content and light absorption in darker versus lighter skin. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Inaccurate PPG heart rate measurements occur up to 15% more frequently in dark skin than in light skin.

    “previous research demonstrated that inaccurate PPG HR measurements occur up to 15% more frequently in dark skin as compared to light skin”

    From Investigating sources of inaccuracy in wearable optical heart rate sensors (2020) · cites this paper as [30]

    The 'Pulse oximetry – the technique' section says melanin can absorb light used in PPG, but it does not compare measurement accuracy by skin tone. The accuracy section concerns oxygen-saturation measurements, not PPG heart-rate errors. Searches for skin pigmentation, heart rate, and 15% found no passage supporting the claimed difference. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Nitzan, M., Romem, A., & Koppel, R.
Affiliations
  • Jerusalem College of Technology (IL)
  • Shaare Zedek Medical Center (IL)
  • Northwell Health (US)
Corresponding author
Nitzan, Meir
ORCID
Venue
Medical Devices: Evidence and Research
Publisher
Informa UK Limited
Published
2014-07
Volume
7
Pages
231
ISSN
1179-1470 (ISSN-L)
DOI
10.2147/mder.s47319
PMC
PMC4099100
OpenAlex
W2087851757
Cited by
438
References
0
Citations by year
2026: 30 · 2025: 37 · 2024: 57 · 2023: 66 · 2022: 43 · 2021: 53 · 2020: 43 · 2019: 27 · 2018: 28 · 2017: 18 · 2016: 20 · 2015: 16
FWCI
1.55
Type
journal article
Language
en
Open access
Licence
Locations
  • Medical Devices Evidence and Research (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
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, oxygen saturation, arterial oxygen saturation, photoplethysmography, supplemental oxygen, retinopathy of prematurity, preterm infants, critically ill patients, motion artifacts, low perfusion

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