MedEd Bytes series

MedEd Bytes is a video series that offers a quick and digestible learning format that can help solidify your understanding of different therapies leveraged in patient monitoring and respiratory interventions. In this series, we’ll cover topics such as capnography waveforms, the technology behind pulse oximetry, modes of ventilation, and more. To stay up to date with the series, please subscribe to our YouTube channel or start watching the series below.

Pulse oximetry and equitable monitoring

During the COVID-19 pandemic clinicians published several studies showing that pulse oximetry readings, which rely on light absorption technology, can overestimate arterial saturation in patients with dark skin pigmentation.1–4 Additionally, evidence showed that these inaccuracies place patients at risk for delayed or missed treatment.2 While pulse oximetry bias in patients with dark skin pigmentation had been documented for decades,5 these new studies provided additional information on the clinical significance of racial bias in pulse oximetry. This, in turn, has triggered a new discussion of approaches to evaluate the performance of pulse oximeters.6

The following series of bytes will outline the factors that influence pulse oximetry. Topics covered include:

  • How darker skin pigmentation may influence pulse oximetry accuracy
  • Steps healthcare providers can take to improve pulse oximeter performance
  • Future steps being taken to alleviate pulse oximeter performance issues in patients with darker skin pigmentation

Byte 1: Introduction to pulse oximetry and equitable monitoring

While pulse oximetry bias in patients with dark skin pigmentation had been documented for decades,5 new studies have provided additional information on the clinical significance of racial bias in pulse oximetry This, in turn, triggered a new discussion of approaches to evaluate the performance of pulse oximeters.6

2:13

Byte 2: Factors that influence SpO2

There are multiple technology, environment, and patient-related factors that can influence pulse oximetry accuracy.7

2:30

Byte 3: Correct usage of pulse oximetry

It’s important to keep in mind that not all pulse oximetry technology is the same. Using either the wrong type of sensor for the situation or incorrect sensor placement may lead to suboptimal performance.8,9

2:15

Byte 4: Standards for accuracy

Studies highlighting the clinical impact of pulse oximetry bias due to skin pigmentation have caused us to reconsider the methods we use to evaluate pulse oximeter accuracy.6,10,11

2:24

Byte 5: The issue of occult hypoxemia and skin pigmentation

Patients with darker skin pigmentation have more melanin, which absorbs some of the light from the emitter. This absorption prevents the light from penetrating through the tissue and blood to be read by the pulse oximeter and may in some circumstances compromise the accuracy of the oximeter.12

2:44

Byte 6: Performance of Nellcor™ pulse oximetry across varying skin pigmentations

Several prospective studies have evaluated the impact of skin pigmentation on Nellcor™ pulse oximetry and other pulse oximeters in healthy volunteers.13,14

2:54

Byte 7: Future steps — The Monk scale

As there is a direct relationship between the amount of melanin in the skin and the amount light absorption, an essential element to performing research on this topic is the ability to measure skin pigmentation with granularity and consistency.

2:30

Byte 8: Future steps — multidisciplinary collaboration

Since 2020, a multidisciplinary effort has begun to confront the issue of pulse oximetry accuracy in patients with darker skin pigmentation in an open and collaborative way.15

3:05