Pulse oximetry

Pulse oximetry is a noninvasive method for monitoring

a person's oxygen saturation. Peripheral oxygen Pulse oximetry
saturation (SpO2 ) readings are typically within 2%
accuracy (within 4% accuracy in the worst 5% of cases)
of the more desirable (and invasive) reading of arterial
oxygen saturation (SaO2 ) from arterial blood gas
analysis.[1] But the two are correlated well enough that
the safe, convenient, noninvasive, inexpensive pulse
oximetry method is valuable for measuring oxygen
saturation in clinical use.

The most common approach is transmissive pulse

oximetry. In this approach, a sensor device is placed on a Tetherless pulse oximetry
thin part of the patient's body, usually a fingertip or Purpose Monitoring a person's oxygen
earlobe, or an infant's foot. Fingertips and earlobes have
saturation
higher blood flow rates than other tissues, which
facilitates heat transfer.[1] The device passes two
wavelengths of light through the body part to a photodetector. It measures the changing absorbance at each
of the wavelengths, allowing it to determine the absorbances due to the pulsing arterial blood alone,
excluding venous blood, skin, bone, muscle, fat, and (in most cases) nail polish.[2]

Reflectance pulse oximetry is a less common alternative to transmissive pulse oximetry. This method does
not require a thin section of the person's body and is therefore well suited to a universal application such as
the feet, forehead, and chest, but it also has some limitations. Vasodilation and pooling of venous blood in
the head due to compromised venous return to the heart can cause a combination of arterial and venous
pulsations in the forehead region and lead to spurious SpO2 results. Such conditions occur while
undergoing anaesthesia with endotracheal intubation and mechanical ventilation or in patients in the
Trendelenburg position.[3]

Contents
Medical uses
Advantages
Limitations
Equipment
Mechanism
Mode of operation
Derived measurements
History
See also
Notes
References
 External links

Medical uses
A pulse oximeter is a medical device that indirectly monitors the
oxygen saturation of a patient's blood (as opposed to measuring
oxygen saturation directly through a blood sample) and changes in
blood volume in the skin, producing a photoplethysmogram that
may be further processed into other measurements.[4] The pulse
oximeter may be incorporated into a multiparameter patient
monitor. Most monitors also display the pulse rate. Portable,
battery-operated pulse oximeters are also available for transport or
home blood-oxygen monitoring.[5]
A pulse oximeter probe applied to a
person's finger
Advantages

Pulse oximetry is particularly convenient for noninvasive continuous measurement of blood oxygen
saturation. In contrast, blood gas levels must otherwise be determined in a laboratory on a drawn blood
sample. Pulse oximetry is useful in any setting where a patient's oxygenation is unstable, including
intensive care, operating, recovery, emergency and hospital ward settings, pilots in unpressurized aircraft,
for assessment of any patient's oxygenation, and determining the effectiveness of or need for supplemental
oxygen. Although a pulse oximeter is used to monitor oxygenation, it cannot determine the metabolism of
oxygen, or the amount of oxygen being used by a patient. For this purpose, it is necessary to also measure
carbon dioxide (CO2 ) levels. It is possible that it can also be used to detect abnormalities in ventilation.
However, the use of a pulse oximeter to detect hypoventilation is impaired with the use of supplemental
oxygen, as it is only when patients breathe room air that abnormalities in respiratory function can be
detected reliably with its use. Therefore, the routine administration of supplemental oxygen may be
unwarranted if the patient is able to maintain adequate oxygenation in room air, since it can result in
hypoventilation going undetected.[6]

Because of their simplicity of use and the ability to provide continuous and immediate oxygen saturation
values, pulse oximeters are of critical importance in emergency medicine and are also very useful for
patients with respiratory or cardiac problems, especially COPD, or for diagnosis of some sleep disorders
such as apnea and hypopnea.[7] For patients with obstructive sleep apnea, pulse oximetry readings will be
in the 70%-90% range for much of the time spent attempting to sleep.[8]

Portable battery-operated pulse oximeters are useful for pilots operating in non-pressurized aircraft above
10,000 feet (3,000 m) or 12,500 feet (3,800 m) in the U.S.[9] where supplemental oxygen is required.
Portable pulse oximeters are also useful for mountain climbers and athletes whose oxygen levels may
decrease at high altitudes or with exercise. Some portable pulse oximeters employ software that charts a
patient's blood oxygen and pulse, serving as a reminder to check blood oxygen levels.

Connectivity advancements have made it possible for patients to have their blood oxygen saturation
continuously monitored without a cabled connection to a hospital monitor, without sacrificing the flow of
patient data back to bedside monitors and centralized patient surveillance systems.[10]

For patients with COVID-19, pulse oximetry helps with early detection of silent hypoxia, in which the
patients still look and feel comfortable, but their SpO2 is perilously low.[5] This happens to patients either in
the hospital or at home. Low SpO2 may indicate severe COVID-19-related pneumonia, requiring a
ventilator.[11]
Limitations
Pulse oximetry solely measures hemoglobin saturation, not ventilation and is not a complete measure of
respiratory sufficiency. It is not a substitute for blood gases checked in a laboratory, because it gives no
indication of base deficit, carbon dioxide levels, blood pH, or bicarbonate (HCO3 −) concentration. The
metabolism of oxygen can be readily measured by monitoring expired CO2 , but saturation figures give no
information about blood oxygen content. Most of the oxygen in the blood is carried by hemoglobin; in
severe anemia, the blood contains less hemoglobin, which despite being saturated cannot carry as much
oxygen.

Because pulse oximeter devices are calibrated in healthy subjects, the accuracy is poor for critically ill
patients and preterm newborns.[1]

Erroneously low readings may be caused by hypoperfusion of the extremity being used for monitoring
(often due to a limb being cold, or from vasoconstriction secondary to the use of vasopressor agents);
incorrect sensor application; highly calloused skin; or movement (such as shivering), especially during
hypoperfusion. To ensure accuracy, the sensor should return a steady pulse and/or pulse waveform. Pulse
oximetry technologies differ in their abilities to provide accurate data during conditions of motion and low
perfusion.[12][13]

Obesity, hypotension (low blood pressure), and some hemoglobin variants can reduce the accuracy of the
results.[7] Some home pulse oximeters have low sampling rates which can significantly underestimate dips
in blood oxygen levels.[7] The accuracy of pulse oximetry deteriorates considerably for readings below
80%.[8]

Pulse oximetry also is not a complete measure of circulatory oxygen sufficiency. If there is insufficient
bloodflow or insufficient hemoglobin in the blood (anemia), tissues can suffer hypoxia despite high arterial
oxygen saturation.

Since pulse oximetry measures only the percentage of bound hemoglobin, a falsely high or falsely low
reading will occur when hemoglobin binds to something other than oxygen:

Hemoglobin has a higher affinity to carbon monoxide than it does to oxygen, and a high
reading may occur despite the patient's actually being hypoxemic. In cases of carbon
monoxide poisoning, this inaccuracy may delay the recognition of hypoxia (low cellular
oxygen level).
Cyanide poisoning gives a high reading because it reduces oxygen extraction from arterial
blood. In this case, the reading is not false, as arterial blood oxygen is indeed high in early
cyanide poisoning.
Methemoglobinemia characteristically causes pulse oximetry readings in the mid-80s.
COPD [especially chronic bronchitis] may cause false readings.[14]

A noninvasive method that allows continuous measurement of the dyshemoglobins is the pulse CO-
oximeter, which was built in 2005 by Masimo.[15] By using additional wavelengths,[16] it provides
clinicians a way to measure the dyshemoglobins, carboxyhemoglobin, and methemoglobin along with total
hemoglobin.[17]

Research has shown that error rates in common pulse oximeter devices may be higher for adults with dark
skin color, raising concerns that inaccuracy in pulse oximetry measurements may compound systemic
racism in countries with multi-racial populations such as the United States.[18] Pulse oximetry is used for
the screening of sleep apnea and other types of sleep-disordered breathing[7] which in the United States are
conditions more prevalent among minorities.[19][20][21]
Equipment

In addition to pulse oximeters for professional use, many inexpensive "consumer" models are available.
Opinions vary about the reliability of consumer oximeters; a typical comment is "The research data on
home monitors has been mixed, but they tend to be accurate within a few percentage points".[22] Some
smart watches with activity tracking incorporate an oximeter function. An article on such devices, in the
context of diagnosing COVID-19 infection, quoted João Paulo Cunha of the University of Porto, Portugal:
"these sensors are not precise, that's the main limitation ... the ones that you wear are only for the consumer
level, not for the clinical level".[23] Pulse oximeters used for diagnosis of conditions such as COVID-19
should be Class IIB medical grade oximeters. Class IIB oximeters can be used on patients of all skin
colours, low pigmentation and in the presence of motion.

According to a report by iData Research the US pulse oximetry monitoring market for equipment and
sensors was over $700 million in 2011.[24]

Mechanism
A blood-oxygen monitor displays the percentage of
blood that is loaded with oxygen. More specifically, it
measures what percentage of hemoglobin, the protein
in blood that carries oxygen, is loaded. Acceptable
normal SaO2 ranges for patients without pulmonary
pathology are from 95 to 99 percent. For a person
breathing room air at or near sea level, an estimate of
arterial pO2 can be made from the blood-oxygen
monitor "saturation of peripheral oxygen" (SpO2 )
reading.

Absorption spectra of oxygenated hemoglobin

Mode of operation (HbO2) and deoxygenated hemoglobin (Hb) for red
and infrared wavelengths
A typical pulse oximeter uses an electronic processor
and a pair of small light-emitting diodes (LEDs)
facing a photodiode through a translucent part of the patient's body, usually a fingertip or an earlobe. One
LED is red, with wavelength of 660 nm, and the other is infrared with a wavelength of 940 nm. Absorption
of light at these wavelengths differs significantly between blood loaded with oxygen and blood lacking
oxygen. Oxygenated hemoglobin absorbs more infrared light and allows more red light to pass through.
Deoxygenated hemoglobin allows more infrared light to pass through and absorbs more red light. The
LEDs sequence through their cycle of one on, then the other, then both off about thirty times per second
which allows the photodiode to respond to the red and infrared light separately and also adjust for the
ambient light baseline.[25]

The amount of light that is transmitted (in other words, that is not absorbed) is measured, and separate
normalized signals are produced for each wavelength. These signals fluctuate in time because the amount
of arterial blood that is present increases (literally pulses) with each heartbeat. By subtracting the minimum
transmitted light from the transmitted light in each wavelength, the effects of other tissues are corrected for,
generating a continuous signal for pulsatile arterial blood.[26] The ratio of the red light measurement to the
infrared light measurement is then calculated by the processor (which represents the ratio of oxygenated
hemoglobin to deoxygenated hemoglobin), and this ratio is then converted to SpO2 by the processor via a
lookup table[26] based on the Beer–Lambert law.[25] The signal separation also serves other purposes: a
plethysmograph waveform ("pleth wave") representing the pulsatile signal is usually displayed for a visual
indication of the pulses as well as signal quality,[4] and a numeric
ratio between the pulsatile and baseline absorbance ("perfusion
index") can be used to evaluate perfusion.[27]

where HbO2 is oxygenated hemoglobin (oxyhemoglobin) and Hb

is deoxygenated hemoglobin.

Derived measurements

Due to changes in blood volumes in the skin, a plethysmographic

variation can be seen in the light signal received (transmittance) by
the sensor on an oximeter. The variation can be described as a The inner side of a pulse oximeter
periodic function, which in turn can be split into a DC component
(the peak value)[a] and an AC component (peak minus trough).[28]
The ratio of the AC component to the DC component, expressed as a percentage, is known as the
(peripheral) perfusion index (Pi) for a pulse, and typically has a range of 0.02% to 20%.[29] An earlier
measurement called the pulse oximetry plethysmographic (POP) only measures the "AC" component,
and is derived manually from monitor pixels.[30][27]

Pleth variability index (PVI) is a measure of the variability of the perfusion index, which occurs during
breathing cycles. Mathematically it is calculated as (Pimax − Pimin)/Pimax × 100%, where the
maximum and minimum Pi values are from one or many breathing cycles.[28] It has been shown to be a
useful, noninvasive indicator of continuous fluid responsiveness for patients undergoing fluid
management.[27] Pulse oximetry plethysmographic waveform amplitude (ΔPOP) is an analogous earlier
technique for use on the manually-derived POP, calculated as
(POPmax − POPmin)/(POPmax + POPmin)×2. [30]

History
In 1935, German physician Karl Matthes (1905–1962) developed the first two-wavelength ear O2
saturation meter with red and green filters (later red and infrared filters). His meter was the first device to
measure O2 saturation.[31]

The original oximeter was made by Glenn Allan Millikan in the 1940s.[32] In 1949, Wood added a pressure
capsule to squeeze blood out of the ear so as to obtain an absolute O2 saturation value when blood was
readmitted. The concept is similar to today's conventional pulse oximetry, but was difficult to implement
because of unstable photocells and light sources; today this method is not used clinically. In 1964 Shaw
assembled the first absolute reading ear oximeter, which used eight wavelengths of light.

The first pulse oximetry was developed in 1972, by Japanese bioengineers, Takuo Aoyagi and Michio
Kishi, at a Japanese medical electronic equipment manufacturer, Nihon Kohden, using the ratio of red to
infrared light absorption of pulsating components at the measuring site. Nihon Kohden manufactured the
first pulse oximeter, Ear Oximeter OLV-5100, and Susumu Nakajima, a surgeon, and his associates first
tested the device in patients, reporting it in 1975.[33] However, Nihon Kohden suspended the development
of pulse oximetry and didn't apply for a basic patent of pulse oximetry except in Japan. In 1977, Minolta
commercialized the first finger pulse oximeter OXIMET MET-1471. In the U.S., it was commercialized by
Biox in 1980.[34][33][35]

By 1987, the standard of care for the administration of a general anesthetic in the U.S. included pulse
oximetry. From the operating room, the use of pulse oximetry rapidly spread throughout the hospital, first to
recovery rooms, and then to intensive care units. Pulse oximetry was of particular value in the neonatal unit
where the patients do not thrive with inadequate oxygenation, but too much oxygen and fluctuations in
oxygen concentration can lead to vision impairment or blindness from retinopathy of prematurity (ROP).
Furthermore, obtaining an arterial blood gas from a neonatal patient is painful to the patient and a major
cause of neonatal anemia.[36] Motion artifact can be a significant limitation to pulse oximetry monitoring
resulting in frequent false alarms and loss of data. This is because during motion and low peripheral
perfusion, many pulse oximeters cannot distinguish between pulsating arterial blood and moving venous
blood, leading to underestimation of oxygen saturation. Early studies of pulse oximetry performance during
subject motion made clear the vulnerabilities of conventional pulse oximetry technologies to motion
artifact.[12][37]

In 1995, Masimo introduced Signal Extraction Technology (SET) that could measure accurately during
patient motion and low perfusion by separating the arterial signal from the venous and other signals. Since
then, pulse oximetry manufacturers have developed new algorithms to reduce some false alarms during
motion[38] such as extending averaging times or freezing values on the screen, but they do not claim to
measure changing conditions during motion and low perfusion. So, there are still important differences in
performance of pulse oximeters during challenging conditions.[13] Also in 1995, Masimo introduced
perfusion index, quantifying the amplitude of the peripheral plethysmograph waveform. Perfusion index
has been shown to help clinicians predict illness severity and early adverse respiratory outcomes in
neonates,[39][40][41] predict low superior vena cava flow in very low birth weight infants,[42] provide an
early indicator of sympathectomy after epidural anesthesia,[43] and improve detection of critical congenital
heart disease in newborns.[44]

Published papers have compared signal extraction technology to other pulse oximetry technologies and
have demonstrated consistently favorable results for signal extraction technology.[12][13][45] Signal
extraction technology pulse oximetry performance has also been shown to translate into helping clinicians
improve patient outcomes. In one study, retinopathy of prematurity (eye damage) was reduced by 58% in
very low birth weight neonates at a center using signal extraction technology, while there was no decrease
in retinopathy of prematurity at another center with the same clinicians using the same protocol but with
non-signal extraction technology.[46] Other studies have shown that signal extraction technology pulse
oximetry results in fewer arterial blood gas measurements, faster oxygen weaning time, lower sensor
utilization, and lower length of stay.[47] The measure-through motion and low perfusion capabilities it has
also allow it to be used in previously unmonitored areas such as the general floor, where false alarms have
plagued conventional pulse oximetry. As evidence of this, a landmark study was published in 2010
showing that clinicians at Dartmouth-Hitchcock Medical Center using signal extraction technology pulse
oximetry on the general floor were able to decrease rapid response team activations, ICU transfers, and
ICU days.[48] In 2020, a follow-up retrospective study at the same institution showed that over ten years of
using pulse oximetry with signal extraction technology, coupled with a patient surveillance system, there
were zero patient deaths and no patients were harmed by opioid-induced respiratory depression while
continuous monitoring was in use.[49]

In 2007, Masimo introduced the first measurement of the pleth variability index (PVI), which multiple
clinical studies have shown provides a new method for automatic, noninvasive assessment of a patient's
ability to respond to fluid administration.[50][27][51] Appropriate fluid levels are vital to reducing
postoperative risks and improving patient outcomes: fluid volumes that are too low (under-hydration) or too
high (over-hydration) have been shown to decrease wound healing and increase the risk of infection or
cardiac complications.[52] Recently, the National Health Service in the United Kingdom and the French
Anesthesia and Critical Care Society listed PVI monitoring as part of their suggested strategies for intra-
operative fluid management.[53][54]

In 2011, an expert workgroup recommended newborn screening with pulse oximetry to increase the
detection of critical congenital heart disease (CCHD).[55] The CCHD workgroup cited the results of two
large, prospective studies of 59,876 subjects that exclusively used signal extraction technology to increase
the identification of CCHD with minimal false positives.[56][57] The CCHD workgroup recommended
newborn screening be performed with motion tolerant pulse oximetry that has also been validated in low
perfusion conditions. In 2011, the US Secretary of Health and Human Services added pulse oximetry to the
recommended uniform screening panel.[58] Before the evidence for screening using signal extraction
technology, less than 1% of newborns in the United States were screened. Today, The Newborn
Foundation has documented near universal screening in the United States and international screening is
rapidly expanding.[59] In 2014, a third large study of 122,738 newborns that also exclusively used signal
extraction technology showed similar, positive results as the first two large studies.[60]

High-resolution pulse oximetry (HRPO) has been developed for in-home sleep apnea screening and testing
in patients for whom it is impractical to perform polysomnography.[61][62] It stores and records both pulse
rate and SpO2 in 1 second intervals and has been shown in one study to help to detect sleep disordered
breathing in surgical patients.[63]

See also
Arterial blood gas
Capnography – Monitoring of the concentration of carbon dioxide in respiratory gases
Integrated pulmonary index
Respiratory monitoring
Medical equipment
Mechanical ventilation – Method to mechanically assist or replace spontaneous breathing
Oxygen sensor – Device for measuring oxygen concentration
Oxygen saturation – Relative measure of the amount of oxygen that is dissolved or carried in
a given medium
Photoplethysmogram – Optically obtained plethysmogram that can be used to detect blood
volume changes in the microvascular bed of tissue.. Also, the measuring of carbon dioxide
(CO2) in the respiratory gases
Sleep apnea – Disorder involving pauses in breathing during sleep
CO-oximeter

Notes
a. This definition used by Masimo varies from the mean value used in signal processing; it is
meant to measure the pulsatile arterial blood absorbance over the baseline absorbance.

References
1. Nitzan M, Romem A, Koppel R (2014). "Pulse oximetry: fundamentals and technology
update" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099100). Medical Devices:
Evidence and Research. 7: 231–239. doi:10.2147/MDER.S47319 (https://doi.org/10.2147%
2FMDER.S47319). PMC 4099100
 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099100). PMID 25031547 (https://pubmed.
ncbi.nlm.nih.gov/25031547).
2. Brand TM, Brand ME, Jay GD (February 2002). "Enamel nail polish does not interfere with
pulse oximetry among normoxic volunteers". Journal of Clinical Monitoring and Computing.
17 (2): 93–6. doi:10.1023/A:1016385222568 (https://doi.org/10.1023%2FA%3A1016385222
568). PMID 12212998 (https://pubmed.ncbi.nlm.nih.gov/12212998). S2CID 24354030 (http
s://api.semanticscholar.org/CorpusID:24354030).
3. Jørgensen JS, Schmid ER, König V, Faisst K, Huch A, Huch R (July 1995). "Limitations of
forehead pulse oximetry". Journal of Clinical Monitoring. 11 (4): 253–6.
doi:10.1007/bf01617520 (https://doi.org/10.1007%2Fbf01617520). PMID 7561999 (https://pu
bmed.ncbi.nlm.nih.gov/7561999). S2CID 22883985 (https://api.semanticscholar.org/CorpusI
D:22883985).
4. "SpO2 monitoring in the ICU" (https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/000
5/306329/liverpoolSpO2_Monitoring.pdf) (PDF). Liverpool Hospital. Retrieved 24 March
2019.
5. Gallagher, James (21 January 2021). "Covid: How a £20 gadget could save lives" (https://w
ww.bbc.co.uk/news/health-55733527). Retrieved 21 January 2021.
6. Fu ES, Downs JB, Schweiger JW, Miguel RV, Smith RA (November 2004). "Supplemental
oxygen impairs detection of hypoventilation by pulse oximetry" (https://semanticscholar.org/p
aper/a6c3d035628f4f4e19da839a02240db7bc2a5763). Chest. 126 (5): 1552–8.
doi:10.1378/chest.126.5.1552 (https://doi.org/10.1378%2Fchest.126.5.1552).
PMID 15539726 (https://pubmed.ncbi.nlm.nih.gov/15539726). S2CID 23181986 (https://api.s
emanticscholar.org/CorpusID:23181986).
7. Schlosshan D, Elliott MW (April 2004). "Sleep . 3: Clinical presentation and diagnosis of the
obstructive sleep apnoea hypopnoea syndrome" (https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC1763828). Thorax. 59 (4): 347–52. doi:10.1136/thx.2003.007179 (https://doi.org/10.113
6%2Fthx.2003.007179). PMC 1763828 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC176
3828). PMID 15047962 (https://pubmed.ncbi.nlm.nih.gov/15047962).
8. Singh S, Khan SZ, Talwar A (2020). "The uses of overnight pulse oximetry" (https://www.ncb
i.nlm.nih.gov/pmc/articles/PMC7065557). Lung India. 37 (2): 151–157.
doi:10.4103/lungindia.lungindia_302_19 (https://doi.org/10.4103%2Flungindia.lungindia_30
2_19). PMC 7065557 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065557).
PMID 32108601 (https://pubmed.ncbi.nlm.nih.gov/32108601).
9. "FAR Part 91 Sec. 91.211 effective as of 09/30/1963" (https://web.archive.org/web/20180619
012733/http://www.airweb.faa.gov/Regulatory_and_Guidance_Library/rgFAR.nsf/0/BA9AFB
F96DBC56F0852566CF006798F9?OpenDocument&Highlight=oxygen). Airweb.faa.gov.
Archived from the original (http://www.airweb.faa.gov/Regulatory_and_Guidance_Library/rg
FAR.nsf/0/BA9AFBF96DBC56F0852566CF006798F9?OpenDocument&Highlight=oxygen)
on 2018-06-19. Retrieved 2015-04-02.
10. "Masimo Announces FDA Clearance of Radius PPG™, the First Tetherless SET® Pulse
Oximetry Sensor Solution" (https://www.businesswire.com/news/home/20190516005300/en/
Masimo-Announces-FDA-Clearance-Radius-PPG%E2%84%A2-Tetherless).
www.businesswire.com. 2019-05-16. Retrieved 2020-04-17.
11. Quaresima V, Ferrari M (13 August 2020). "COVID-19: efficacy of prehospital pulse oximetry
for early detection of silent hypoxemia" (https://doi.org/10.1186%2Fs13054-020-03185-x).
Critical Care. 24 (501): 423–427. doi:10.1186/s13054-020-03185-x (https://doi.org/10.1186%
2Fs13054-020-03185-x). PMID 26715772 (https://pubmed.ncbi.nlm.nih.gov/26715772).
12. Barker SJ (October 2002). " "Motion-resistant" pulse oximetry: a comparison of new and old
models" (https://semanticscholar.org/paper/d34a3da2fbc8baa20cb7f73f99f02989872dc302).
Anesthesia and Analgesia. 95 (4): 967–72. doi:10.1213/00000539-200210000-00033 (http
s://doi.org/10.1213%2F00000539-200210000-00033). PMID 12351278 (https://pubmed.ncb
i.nlm.nih.gov/12351278). S2CID 13103745 (https://api.semanticscholar.org/CorpusID:13103
745).
13. Shah N, Ragaswamy HB, Govindugari K, Estanol L (August 2012). "Performance of three
new-generation pulse oximeters during motion and low perfusion in volunteers". Journal of
Clinical Anesthesia. 24 (5): 385–91. doi:10.1016/j.jclinane.2011.10.012 (https://doi.org/10.10
16%2Fj.jclinane.2011.10.012). PMID 22626683
(https://pubmed.ncbi.nlm.nih.gov/22626683).
14. Amalakanti S, Pentakota MR (April 2016). "Pulse Oximetry Overestimates Oxygen
Saturation in COPD" (https://doi.org/10.4187%2Frespcare.04435). Respiratory Care. 61 (4):
423–7. doi:10.4187/respcare.04435 (https://doi.org/10.4187%2Frespcare.04435).
PMID 26715772 (https://pubmed.ncbi.nlm.nih.gov/26715772).
15. UK 2320566 (https://worldwide.espacenet.com/textdoc?DB=EPODOC&IDX=UK2320566)
16. Maisel WH, Lewis RJ (October 2010). "Noninvasive measurement of carboxyhemoglobin:
how accurate is accurate enough?". Annals of Emergency Medicine. 56 (4): 389–91.
doi:10.1016/j.annemergmed.2010.05.025 (https://doi.org/10.1016%2Fj.annemergmed.2010.
05.025). PMID 20646785 (https://pubmed.ncbi.nlm.nih.gov/20646785).
17. "Total Hemoglobin (SpHb)" (http://www.masimo.com/technology/co-oximetry/sphb/).
Masimo. Retrieved 24 March 2019.
18. Moran-Thomas A (August 5, 2020). "How a Popular Medical Device Encodes Racial Bias"
(https://web.archive.org/web/20200916141541/http://bostonreview.net/science-nature-race/a
my-moran-thomas-how-popular-medical-device-encodes-racial-bias). Boston Review.
ISSN 0734-2306 (https://www.worldcat.org/issn/0734-2306). Archived from the original (htt
p://bostonreview.net/science-nature-race/amy-moran-thomas-how-popular-medical-device-e
ncodes-racial-bias) on September 16, 2020.
19. Redline S, Tishler PV, Hans MG, Tosteson TD, Strohl KP, Spry K (January 1997). "Racial
differences in sleep-disordered breathing in African-Americans and Caucasians". American
Journal of Respiratory and Critical Care Medicine. 155 (1): 186–92.
doi:10.1164/ajrccm.155.1.9001310 (https://doi.org/10.1164%2Fajrccm.155.1.9001310).
OCLC 209489389 (https://www.worldcat.org/oclc/209489389). PMID 9001310 (https://pubm
ed.ncbi.nlm.nih.gov/9001310).
20. Kripke DF, Ancoli-Israel S, Klauber MR, Wingard DL, Mason WJ, Mullaney DJ (January
1997). "Prevalence of sleep-disordered breathing in ages 40-64 years: a population-based
survey" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758699). Sleep. 20 (1): 65–76.
doi:10.1093/sleep/20.1.65 (https://doi.org/10.1093%2Fsleep%2F20.1.65).
OCLC 8138375775 (https://www.worldcat.org/oclc/8138375775). PMC 2758699 (https://ww
w.ncbi.nlm.nih.gov/pmc/articles/PMC2758699). PMID 9130337 (https://pubmed.ncbi.nlm.nih.
gov/9130337).
21. Chen X, Wang R, Zee P, Lutsey PL, Javaheri S, Alcántara C, et al. (June 2015).
"Racial/Ethnic Differences in Sleep Disturbances: The Multi-Ethnic Study of Atherosclerosis
(MESA)" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434554). Sleep. 38 (6): 877–88.
doi:10.5665/sleep.4732 (https://doi.org/10.5665%2Fsleep.4732). OCLC 5849508571 (http
s://www.worldcat.org/oclc/5849508571). PMC 4434554 (https://www.ncbi.nlm.nih.gov/pmc/ar
ticles/PMC4434554). PMID 25409106 (https://pubmed.ncbi.nlm.nih.gov/25409106).
22. Parker-Pope T (2020-04-24). "What's a Pulse Oximeter, and Do I Really Need One at
Home?" (https://www.nytimes.com/2020/04/24/well/live/coronavirus-pulse-oximeter-oxygen.
html). The New York Times. ISSN 0362-4331 (https://www.worldcat.org/issn/0362-4331).
23. Charara S (6 May 2020). "Why can't your fitness tracker tell you if you have coronavirus?" (ht
tps://www.wired.co.uk/article/blood-oxygen-spo2-covid-wearables). Wired UK.
24. U.S. Market for Patient Monitoring Equipment. iData Research. May 2012
25. "Principles of pulse oximetry" (https://web.archive.org/web/20150224221820/http://www.frca.
co.uk/article.aspx?articleid=332). Anaesthesia UK. 11 Sep 2004. Archived from the original
(http://www.frca.co.uk/article.aspx?articleid=332) on 2015-02-24. Retrieved 2015-02-24.
26. "Pulse Oximetry" (https://web.archive.org/web/20150318054934/http://www.oximetry.org/pul
seox/principles.htm). Oximetry.org. 2002-09-10. Archived from the original (http://www.oximet
ry.org/pulseox/principles.htm) on 2015-03-18. Retrieved 2015-04-02.
27. Cannesson M, Desebbe O, Rosamel P, Delannoy B, Robin J, Bastien O, Lehot JJ (August
2008). "Pleth variability index to monitor the respiratory variations in the pulse oximeter
plethysmographic waveform amplitude and predict fluid responsiveness in the operating
theatre" (https://doi.org/10.1093%2Fbja%2Faen133). British Journal of Anaesthesia. 101 (2):
200–6. doi:10.1093/bja/aen133 (https://doi.org/10.1093%2Fbja%2Faen133).
PMID 18522935 (https://pubmed.ncbi.nlm.nih.gov/18522935).
28. U.S. Patent 8,414,499 (https://patents.google.com/patent/US8414499)
29. Lima A, Bakker J (October 2005). "Noninvasive monitoring of peripheral perfusion".
Intensive Care Medicine. 31 (10): 1316–26. doi:10.1007/s00134-005-2790-2 (https://doi.org/
10.1007%2Fs00134-005-2790-2). PMID 16170543 (https://pubmed.ncbi.nlm.nih.gov/161705
43). S2CID 21516801 (https://api.semanticscholar.org/CorpusID:21516801).
30. Cannesson M, Attof Y, Rosamel P, Desebbe O, Joseph P, Metton O, et al. (June 2007).
"Respiratory variations in pulse oximetry plethysmographic waveform amplitude to predict
fluid responsiveness in the operating room" (https://doi.org/10.1097%2F01.anes.000026759
3.72744.20). Anesthesiology. 106 (6): 1105–11. doi:10.1097/01.anes.0000267593.72744.20
(https://doi.org/10.1097%2F01.anes.0000267593.72744.20). PMID 17525584 (https://pubme
d.ncbi.nlm.nih.gov/17525584).
31. Matthes K (1935). "Untersuchungen über die Sauerstoffsättigung des menschlichen
Arterienblutes" [Studies on the Oxygen Saturation of Arterial Human Blood]. Naunyn-
Schmiedeberg's Archives of Pharmacology (in German). 179 (6): 698–711.
doi:10.1007/BF01862691 (https://doi.org/10.1007%2FBF01862691). S2CID 24678464 (http
s://api.semanticscholar.org/CorpusID:24678464).
32. Millikan GA (1942). "The oximeter: an instrument for measuring continuously oxygen
saturation of arterial blood in man". Review of Scientific Instruments. 13 (10): 434–444.
Bibcode:1942RScI...13..434M (https://ui.adsabs.harvard.edu/abs/1942RScI...13..434M).
doi:10.1063/1.1769941 (https://doi.org/10.1063%2F1.1769941).
33. Severinghaus JW, Honda Y (April 1987). "History of blood gas analysis. VII. Pulse oximetry".
Journal of Clinical Monitoring. 3 (2): 135–8. doi:10.1007/bf00858362 (https://doi.org/10.100
7%2Fbf00858362). PMID 3295125 (https://pubmed.ncbi.nlm.nih.gov/3295125).
S2CID 6463021 (https://api.semanticscholar.org/CorpusID:6463021).
34. "510(k): Premarket Notification" (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/p
mn.cfm?ID=46970). United States Food and Drug Administration. Retrieved 2017-02-23.
35. "Fact vs. Fiction" (https://web.archive.org/web/20090413014617/http://www.masimo.co.uk/N
ellcorfiction/index.htm). Masimo Corporation. Archived from the original (http://www.masimo.
co.uk/nellcorfiction/index.htm) on 13 April 2009. Retrieved 1 May 2018.
36. Lin JC, Strauss RG, Kulhavy JC, Johnson KJ, Zimmerman MB, Cress GA, Connolly NW,
Widness JA (August 2000). "Phlebotomy overdraw in the neonatal intensive care nursery" (h
ttps://doi.org/10.1542%2Fpeds.106.2.e19). Pediatrics. 106 (2): E19.
doi:10.1542/peds.106.2.e19 (https://doi.org/10.1542%2Fpeds.106.2.e19). PMID 10920175
(https://pubmed.ncbi.nlm.nih.gov/10920175).
37. Barker SJ, Shah NK (October 1996). "Effects of motion on the performance of pulse
oximeters in volunteers". Anesthesiology. 85 (4): 774–81. doi:10.1097/00000542-
199701000-00014 (https://doi.org/10.1097%2F00000542-199701000-00014).
PMID 8873547 (https://pubmed.ncbi.nlm.nih.gov/8873547).
38. Jopling MW, Mannheimer PD, Bebout DE (January 2002). "Issues in the laboratory
evaluation of pulse oximeter performance". Anesthesia and Analgesia. 94 (1 Suppl): S62–8.
PMID 11900041 (https://pubmed.ncbi.nlm.nih.gov/11900041).
39. De Felice C, Leoni L, Tommasini E, Tonni G, Toti P, Del Vecchio A, Ladisa G, Latini G
(March 2008). "Maternal pulse oximetry perfusion index as a predictor of early adverse
respiratory neonatal outcome after elective cesarean delivery" (https://semanticscholar.org/p
aper/c8fca5a34017bb2ffffa61f0cc1c099ffaa326c4). Pediatric Critical Care Medicine. 9 (2):
203–8. doi:10.1097/pcc.0b013e3181670021 (https://doi.org/10.1097%2Fpcc.0b013e318167
0021). PMID 18477934 (https://pubmed.ncbi.nlm.nih.gov/18477934). S2CID 24626430 (http
s://api.semanticscholar.org/CorpusID:24626430).
40. De Felice C, Latini G, Vacca P, Kopotic RJ (October 2002). "The pulse oximeter perfusion
index as a predictor for high illness severity in neonates". European Journal of Pediatrics.
161 (10): 561–2. doi:10.1007/s00431-002-1042-5 (https://doi.org/10.1007%2Fs00431-002-1
042-5). PMID 12297906 (https://pubmed.ncbi.nlm.nih.gov/12297906). S2CID 20910692 (http
s://api.semanticscholar.org/CorpusID:20910692).
41. De Felice C, Goldstein MR, Parrini S, Verrotti A, Criscuolo M, Latini G (March 2006). "Early
dynamic changes in pulse oximetry signals in preterm newborns with histologic
chorioamnionitis". Pediatric Critical Care Medicine. 7 (2): 138–42.
doi:10.1097/01.PCC.0000201002.50708.62 (https://doi.org/10.1097%2F01.PCC.000020100
2.50708.62). PMID 16474255 (https://pubmed.ncbi.nlm.nih.gov/16474255).
S2CID 12780058 (https://api.semanticscholar.org/CorpusID:12780058).
42. Takahashi S, Kakiuchi S, Nanba Y, Tsukamoto K, Nakamura T, Ito Y (April 2010). "The
perfusion index derived from a pulse oximeter for predicting low superior vena cava flow in
very low birth weight infants" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834357).
Journal of Perinatology. 30 (4): 265–9. doi:10.1038/jp.2009.159 (https://doi.org/10.1038%2Fj
p.2009.159). PMC 2834357 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834357).
PMID 19907430 (https://pubmed.ncbi.nlm.nih.gov/19907430).
43. Ginosar Y, Weiniger CF, Meroz Y, Kurz V, Bdolah-Abram T, Babchenko A, Nitzan M,
Davidson EM (September 2009). "Pulse oximeter perfusion index as an early indicator of
sympathectomy after epidural anesthesia". Acta Anaesthesiologica Scandinavica. 53 (8):
1018–26. doi:10.1111/j.1399-6576.2009.01968.x (https://doi.org/10.1111%2Fj.1399-6576.20
09.01968.x). PMID 19397502 (https://pubmed.ncbi.nlm.nih.gov/19397502).
S2CID 24986518 (https://api.semanticscholar.org/CorpusID:24986518).
44. Granelli A, Ostman-Smith I (October 2007). "Noninvasive peripheral perfusion index as a
possible tool for screening for critical left heart obstruction". Acta Paediatrica. 96 (10): 1455–
9. doi:10.1111/j.1651-2227.2007.00439.x (https://doi.org/10.1111%2Fj.1651-2227.2007.004
39.x). PMID 17727691 (https://pubmed.ncbi.nlm.nih.gov/17727691). S2CID 6181750 (https://
api.semanticscholar.org/CorpusID:6181750).
45. Hay WW, Rodden DJ, Collins SM, Melara DL, Hale KA, Fashaw LM (2002). "Reliability of
conventional and new pulse oximetry in neonatal patients" (https://doi.org/10.1038%2Fsj.jp.
7210740). Journal of Perinatology. 22 (5): 360–6. doi:10.1038/sj.jp.7210740 (https://doi.org/1
0.1038%2Fsj.jp.7210740). PMID 12082469 (https://pubmed.ncbi.nlm.nih.gov/12082469).
46. Castillo A, Deulofeut R, Critz A, Sola A (February 2011). "Prevention of retinopathy of
prematurity in preterm infants through changes in clinical practice and SpO₂technology" (http
s://www.ncbi.nlm.nih.gov/pmc/articles/PMC3040295). Acta Paediatrica. 100 (2): 188–92.
doi:10.1111/j.1651-2227.2010.02001.x (https://doi.org/10.1111%2Fj.1651-2227.2010.02001.
x). PMC 3040295 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3040295).
PMID 20825604 (https://pubmed.ncbi.nlm.nih.gov/20825604).
47. Durbin CG, Rostow SK (August 2002). "More reliable oximetry reduces the frequency of
arterial blood gas analyses and hastens oxygen weaning after cardiac surgery: a
prospective, randomized trial of the clinical impact of a new technology". Critical Care
Medicine. 30 (8): 1735–40. doi:10.1097/00003246-200208000-00010 (https://doi.org/10.109
7%2F00003246-200208000-00010). PMID 12163785 (https://pubmed.ncbi.nlm.nih.gov/121
63785). S2CID 10226994 (https://api.semanticscholar.org/CorpusID:10226994).
48. Taenzer AH, Pyke JB, McGrath SP, Blike GT (February 2010). "Impact of pulse oximetry
surveillance on rescue events and intensive care unit transfers: a before-and-after
concurrence study" (https://doi.org/10.1097%2Faln.0b013e3181ca7a9b). Anesthesiology.
112 (2): 282–7. doi:10.1097/aln.0b013e3181ca7a9b (https://doi.org/10.1097%2Faln.0b013e
3181ca7a9b). PMID 20098128 (https://pubmed.ncbi.nlm.nih.gov/20098128).
49. McGrath SP, McGovern KM, Perreard IM, Huang V, Moss LB, Blike GT (March 2020).
"Inpatient Respiratory Arrest Associated With Sedative and Analgesic Medications: Impact
of Continuous Monitoring on Patient Mortality and Severe Morbidity" (https://doi.org/10.109
7%2FPTS.0000000000000696). Journal of Patient Safety.
doi:10.1097/PTS.0000000000000696 (https://doi.org/10.1097%2FPTS.000000000000069
6). PMID 32175965 (https://pubmed.ncbi.nlm.nih.gov/32175965).
50. Zimmermann M, Feibicke T, Keyl C, Prasser C, Moritz S, Graf BM, Wiesenack C (June
2010). "Accuracy of stroke volume variation compared with pleth variability index to predict
fluid responsiveness in mechanically ventilated patients undergoing major surgery".
European Journal of Anaesthesiology. 27 (6): 555–61. doi:10.1097/EJA.0b013e328335fbd1
(https://doi.org/10.1097%2FEJA.0b013e328335fbd1). PMID 20035228 (https://pubmed.ncbi.
nlm.nih.gov/20035228). S2CID 45041607 (https://api.semanticscholar.org/CorpusID:450416
07).
51. Forget P, Lois F, de Kock M (October 2010). "Goal-directed fluid management based on the
pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid
management". Anesthesia and Analgesia. 111 (4): 910–4.
doi:10.1213/ANE.0b013e3181eb624f (https://doi.org/10.1213%2FANE.0b013e3181eb624f).
PMID 20705785 (https://pubmed.ncbi.nlm.nih.gov/20705785). S2CID 40761008 (https://api.s
emanticscholar.org/CorpusID:40761008).
52. Ishii M, Ohno K (March 1977). "Comparisons of body fluid volumes, plasma renin activity,
hemodynamics and pressor responsiveness between juvenile and aged patients with
essential hypertension" (https://doi.org/10.1253%2Fjcj.41.237). Japanese Circulation
Journal. 41 (3): 237–46. doi:10.1253/jcj.41.237 (https://doi.org/10.1253%2Fjcj.41.237).
PMID 870721 (https://pubmed.ncbi.nlm.nih.gov/870721).
53. "NHS Technology Adoption Centre" (http://www.ntac.nhs.uk/NewsAndEvents/NewsEvents3
420.aspx). Ntac.nhs.uk. Retrieved 2015-04-02.
54. Vallet B, Blanloeil Y, Cholley B, Orliaguet G, Pierre S, Tavernier B (October 2013).
"Guidelines for perioperative haemodynamic optimization". Annales Françaises
d'Anesthésie et de Réanimation. 32 (10): e151–8. doi:10.1016/j.annfar.2013.09.010 (https://d
oi.org/10.1016%2Fj.annfar.2013.09.010). PMID 24126197 (https://pubmed.ncbi.nlm.nih.gov/
24126197).
55. Kemper AR, Mahle WT, Martin GR, Cooley WC, Kumar P, Morrow WR, Kelm K, Pearson
GD, Glidewell J, Grosse SD, Howell RR (November 2011). "Strategies for implementing
screening for critical congenital heart disease" (https://doi.org/10.1542%2Fpeds.2011-1317).
Pediatrics. 128 (5): e1259–67. doi:10.1542/peds.2011-1317 (https://doi.org/10.1542%2Fped
s.2011-1317). PMID 21987707 (https://pubmed.ncbi.nlm.nih.gov/21987707).
56. de-Wahl Granelli A, Wennergren M, Sandberg K, Mellander M, Bejlum C, Inganäs L,
Eriksson M, Segerdahl N, Agren A, Ekman-Joelsson BM, Sunnegårdh J, Verdicchio M,
Ostman-Smith I (January 2009). "Impact of pulse oximetry screening on the detection of duct
dependent congenital heart disease: a Swedish prospective screening study in 39,821
newborns" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627280). BMJ. 338: a3037.
doi:10.1136/bmj.a3037 (https://doi.org/10.1136%2Fbmj.a3037). PMC 2627280 (https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC2627280). PMID 19131383 (https://pubmed.ncbi.nlm.nih.
gov/19131383).
57. Ewer AK, Middleton LJ, Furmston AT, Bhoyar A, Daniels JP, Thangaratinam S, Deeks JJ,
Khan KS (August 2011). "Pulse oximetry screening for congenital heart defects in newborn
infants (PulseOx): a test accuracy study". Lancet. 378 (9793): 785–94. doi:10.1016/S0140-
6736(11)60753-8 (https://doi.org/10.1016%2FS0140-6736%2811%2960753-8).
PMID 21820732 (https://pubmed.ncbi.nlm.nih.gov/21820732). S2CID 5977208 (https://api.se
manticscholar.org/CorpusID:5977208).
58. Mahle WT, Martin GR, Beekman RH, Morrow WR (January 2012). "Endorsement of Health
and Human Services recommendation for pulse oximetry screening for critical congenital
heart disease" (https://doi.org/10.1542%2Fpeds.2011-3211). Pediatrics. 129 (1): 190–2.
doi:10.1542/peds.2011-3211 (https://doi.org/10.1542%2Fpeds.2011-3211). PMID 22201143
(https://pubmed.ncbi.nlm.nih.gov/22201143).
59. "Newborn CCHD Screening Progress Map" (http://cchdscreeningmap.org/).
Cchdscreeningmap.org. 7 July 2014. Retrieved 2015-04-02.
60. Zhao QM, Ma XJ, Ge XL, Liu F, Yan WL, Wu L, Ye M, Liang XC, Zhang J, Gao Y, Jia B,
Huang GY (August 2014). "Pulse oximetry with clinical assessment to screen for congenital
heart disease in neonates in China: a prospective study". Lancet. 384 (9945): 747–54.
doi:10.1016/S0140-6736(14)60198-7 (https://doi.org/10.1016%2FS0140-6736%2814%2960
198-7). PMID 24768155 (https://pubmed.ncbi.nlm.nih.gov/24768155). S2CID 23218716 (http
s://api.semanticscholar.org/CorpusID:23218716).
61. Valenza T (April 2008). "Keeping a Pulse on Oximetry" (https://web.archive.org/web/201202
10190044/http://www.sleepreviewmag.com/issues/articles/2008-04_10.asp). Archived from
the original (http://www.sleepreviewmag.com/issues/articles/2008-04_10.asp) on February
10, 2012.
62. "PULSOX -300i" (https://web.archive.org/web/20090107051157/http://www.maxtecinc.com/a
ssets/docs/pulsox/ml187.p300iDataSheet.pdf) (PDF). Maxtec Inc. Archived from the original
(http://www.maxtecinc.com/assets/docs/pulsox/ml187.p300iDataSheet.pdf) (PDF) on
January 7, 2009.
63. Chung F, Liao P, Elsaid H, Islam S, Shapiro CM, Sun Y (May 2012). "Oxygen desaturation
index from nocturnal oximetry: a sensitive and specific tool to detect sleep-disordered
breathing in surgical patients". Anesthesia and Analgesia. 114 (5): 993–1000.
doi:10.1213/ane.0b013e318248f4f5 (https://doi.org/10.1213%2Fane.0b013e318248f4f5).
PMID 22366847 (https://pubmed.ncbi.nlm.nih.gov/22366847). S2CID 18538103 (https://api.s
emanticscholar.org/CorpusID:18538103).

External links

Retrieved from "https://en.wikipedia.org/w/index.php?title=Pulse_oximetry&oldid=1043093174"

This page was last edited on 8 September 2021, at 09:03 (UTC).

Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. By using
this site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of the Wikimedia
Foundation, Inc., a non-profit organization.