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Accuracy of pulse oximeters in measuring oxygen saturation in patients with poor peripheral perfusion: a systematic review

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Abstract

One of the most significant limitations of oximeters is their performance under poor perfusion conditions. This systematic review examines pulse oximeter model accuracy in adults under poor perfusion conditions. A multiple database search was conducted from inception to December 2020. The inclusion criteria were as follows: (1) adult participants (> 18 years) with explicitly stated conditions that cause poor peripheral perfusion (conditions localized at the oximeter placement site; or systemic conditions, including critical conditions such as hypothermia, hypotension, hypovolemia, and vasoconstricting agents use; or experimental conditions) (2) a comparison of arterial oxygen saturation and arterial blood gas values. A total of 22 studies were included and assessed for reliability and agreement using a modified Guidelines for Reporting Reliability and Agreement Studies tool. We calculated the accuracy root mean square error from bias and precision we extracted from the studies. Most oximeters (75%) were deemed accurate in patients with poor perfusion. Modern oximeters utilizing more complex algorithms were more likely to be accurate than older models. Earlobe placement of oximeters seemed more sensitive, with greater measurement accuracy, than on fingertip placement. Only one study controlled for skin pigmentation, and none strictly followed Food and Drug Association recommendations for experiments to determine oximeter accuracy. Oximeters are accurate in poorly perfused patients, especially newer oximeter models and those placed on earlobes. Further studies are needed that examine multiple oximeter models used on a diverse selection of patients while following FDA recommendations to examine oximeter accuracy.

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Abbreviations

ABG:

Arterial Blood Gas

SpO2 :

Oxyhemoglobin Saturation

FDA:

Food and Drug Administration

ED:

Emergency Department

ICU:

Intensive Care Unit

Arms :

Accuracy Root Mean Square

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Funding

Funding was provided by the ResMed Research Chair of Anesthesia, Sleep, and Perioperative Medicine Fund at University Health Network.

Author information

Authors and Affiliations

  1. Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

    Khashayar Poorzargar, Chi Pham & Frances Chung

  2. Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    Khashayar Poorzargar, Chi Pham & Frances Chung

  3. Royal College of Surgeons in Ireland, Dublin, Ireland

    Jennita Ariaratnam

  4. Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada

    Kang Lee

  5. Department of Anesthesia and Pain Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

    Matteo Parotto

  6. Library and Information Services, University Health Network, Toronto, Canada

    Marina Englesakis

  7. Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, 800 Commissioners Rd E, London, ON, Canada

    Mahesh Nagappa

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  1. Khashayar Poorzargar
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Contributions

KP, CP, JA: These authors designed the study, collected, analyzed, and interpreted the data; and prepared the manuscript. KL: This author prepared the manuscript. MP: This author prepared the manuscript. ME: This author designed and executed database search strategies and prepared the manuscript. FC: This author designed the study, interpreted the data, and prepared the manuscript. MN: This author designed the study, analyzed and interpreted the data, and prepared the manuscript.

Corresponding author

Correspondence to Mahesh Nagappa.

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Conflict of interest

Frances Chung: Reports research support from the University Health Network Foundation. Royalties from Up-To-Date. Consultant to Takeda Pharma. The STOP-Bang proprietary to University Health Network. All other authors have no conflicts to disclose.

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Khashayar Poorzargar and Chi Pham share first authorship. Frances Chung and Mahesh Nagappa shared senior authorship.

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Poorzargar, K., Pham, C., Ariaratnam, J. et al. Accuracy of pulse oximeters in measuring oxygen saturation in patients with poor peripheral perfusion: a systematic review. J Clin Monit Comput 36, 961–973 (2022). https://doi.org/10.1007/s10877-021-00797-8

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  • DOI: https://doi.org/10.1007/s10877-021-00797-8

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