Accuracy of Multiple Pulse Oximeters in Stable Critically Ill Patients

• Published in: Respiratory care 2023-05, Vol.68 (5), p.565-574
• Main Authors: Blanchet, Marie-Anne, Mercier, Gabriel, Delobel, Antoine, Nayet, Emi, Bouchard, Pierre-Alexandre, Simard, Serge, L'Her, Erwan, Branson, Richard D, Lellouche, François
• Format: Article
• Language: English
• Subjects: Adult; Aged; Care and treatment; Critical Illness - therapy; Critically ill; Humans; Hypoxia - diagnosis; Male; Medical care; Medical research; Medicine, Experimental; Original Research; Oximetry; Oxygen; Prospective Studies; Quality management; Respiration Disorders
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.10582

An accurate S value is critical in order to optimally titrate oxygen delivery to patients and to follow oxygenation guidelines. Limited prospective data exist on real-world performance of pulse oximeters in critically ill patients. The objective of this study was to assess accuracy and bias of the S values measured by several oximeters in hospitalized subjects. We included stable adults in the ICU with an arterial catheter in place. Main exclusion criteria were poor S signal and S > 96%. In each subject, we simultaneously evaluated 4 oximeters: Nonin (Plymouth, Minnesota) embedded in the FreeO device (OxyNov, Québec City, Québec, Canada), Masimo (Radical-7, Masimo, Irvine, California), Philips (FAST, Philips, Amsterdam, the Netherlands), and Nellcor (N-600, Medtronic, Minneapolis, Minnesota). Arterial blood gases were drawn and simultaneously each oximeters' S values were collected. S values were compared to the reference (arterial oxygen saturation [S ] value) to determine bias and accuracy. The ability for oximeters to detect hypoxemia and the impact of oximeters on oxygen titration were evaluated. We included 193 subjects (153 male, mean age 66 y) in whom 211 sets of measurements were performed. The skin pigmentation evaluated by Fitzpatrick scale showed 96.2% of subjects were light skin (types 1 and 2). One oximeter overestimated S (Philips, +0.9%), whereas the 3 others underestimated S (Nonin -3.1%, Nellcor -0.3%, Masimo -0.2%). S was underestimated with Nonin oximeter in 91.3% of the cases, whereas it was overestimated in 55.2% of the cases with Philips oximeter. Moderate hypoxemia (S 86-90% or P 55-60 mm Hg) was detected in 92, 33, 42, and 11% of the cases with Nonin, Nellcor, Masimo, and Philips, respectively. We found significant bias and moderate accuracy between the tested oximeters and the arterial blood gases in the studied population. These discrepancies may have important clinical impact on the detection of hypoxemia and management of oxygen therapy.