Newly Published
Perioperative Medicine  |   December 2017
Four Types of Pulse Oximeters Accurately Detect Hypoxia during Low Perfusion and Motion
Author Notes
  • From the School of Medicine (A.L.), Department of Anesthesia and Perioperative Care (J.R.F., P.E.B., J.L., L.R.), University of California, San Francisco, California; and Physio Monitor LLC., San Ramon, California (M.B.).
  • Submitted for publication June 2, 2017. Accepted for publication October 30, 2017.
    Submitted for publication June 2, 2017. Accepted for publication October 30, 2017.×
  • Research Support: This study was sponsored by the University of California, San Francisco Hypoxia Research Laboratory (San Francisco, California) using unrestricted funds derived from the testing of medical devices. No manufacturer directly funded the study or was involved in study design or data analysis.
    Research Support: This study was sponsored by the University of California, San Francisco Hypoxia Research Laboratory (San Francisco, California) using unrestricted funds derived from the testing of medical devices. No manufacturer directly funded the study or was involved in study design or data analysis.×
  • Competing Interests: Drs. Feiner, Bickler, and Lucero have previously funded independent university-based research with funds collected from companies who contracted with our lab to perform evaluation of instrument performance. In the last five years the following companies contracted with the Hypoxia lab: Masimo (Irvine, California), Nonin (Plymouth, Minnesota), Bluepoint Medical (Centreville, Virginia), Xhale (Wales, England) Nihon Kohden (Tokyo, Japan), Motara (Milwaukee, Wisconsin), Medico (Tokyo, Japan), Philips (Amsterdam, The Netherlands), Renu (Everett, Washington), Scanadu (Sunnyvale, California), Sensepc (Rostock, Germany), Sentec (Therwil, Switzerland), Sharp (Osaka, Japan) Sleep Med (Peabody, Massachusetts), Solaris (San Francisco, California), Springer (Berlin, Germany), True Wearables (Rancho Santa Margarita, California), Unimed (Shenzhen, China), Verifood (Vancouver, British Columbia), Vios (Oakdale, Minnesota), Zensorium (Singapore), CAS Medica (Branford, Connecticut). Funds from this work supported the research reported in this study. However, no manufacturer directly funded the study or was involved in study design, data analysis, or any aspect of manuscript writing or editing.
    Competing Interests: Drs. Feiner, Bickler, and Lucero have previously funded independent university-based research with funds collected from companies who contracted with our lab to perform evaluation of instrument performance. In the last five years the following companies contracted with the Hypoxia lab: Masimo (Irvine, California), Nonin (Plymouth, Minnesota), Bluepoint Medical (Centreville, Virginia), Xhale (Wales, England) Nihon Kohden (Tokyo, Japan), Motara (Milwaukee, Wisconsin), Medico (Tokyo, Japan), Philips (Amsterdam, The Netherlands), Renu (Everett, Washington), Scanadu (Sunnyvale, California), Sensepc (Rostock, Germany), Sentec (Therwil, Switzerland), Sharp (Osaka, Japan) Sleep Med (Peabody, Massachusetts), Solaris (San Francisco, California), Springer (Berlin, Germany), True Wearables (Rancho Santa Margarita, California), Unimed (Shenzhen, China), Verifood (Vancouver, British Columbia), Vios (Oakdale, Minnesota), Zensorium (Singapore), CAS Medica (Branford, Connecticut). Funds from this work supported the research reported in this study. However, no manufacturer directly funded the study or was involved in study design, data analysis, or any aspect of manuscript writing or editing.×
  • Correspondence: Address correspondence to Dr. Lucero: University of California, San Francisco, 533 Parnassus Avenue, San Francisco, California 94117. jennifer.lucero@ucsf.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Respiratory System
Perioperative Medicine   |   December 2017
Four Types of Pulse Oximeters Accurately Detect Hypoxia during Low Perfusion and Motion
Anesthesiology Newly Published on December 7, 2017. doi:10.1097/ALN.0000000000002002
Anesthesiology Newly Published on December 7, 2017. doi:10.1097/ALN.0000000000002002
Abstract

Background: Pulse oximeter performance is degraded by motion artifacts and low perfusion. Manufacturers developed algorithms to improve instrument performance during these challenges. There have been no independent comparisons of these devices.

Methods: We evaluated the performance of four pulse oximeters (Masimo Radical-7, USA; Nihon Kohden OxyPal Neo, Japan; Nellcor N-600, USA; and Philips Intellivue MP5, USA) in 10 healthy adult volunteers. Three motions were evaluated: tapping, pseudorandom, and volunteer-generated rubbing, adjusted to produce photoplethsmogram disturbance similar to arterial pulsation amplitude. During motion, inspired gases were adjusted to achieve stable target plateaus of arterial oxygen saturation (SaO2) at 75%, 88%, and 100%. Pulse oximeter readings were compared with simultaneous arterial blood samples to calculate bias (oxygen saturation measured by pulse oximetry [SpO2] − SaO2), mean, SD, 95% limits of agreement, and root mean square error. Receiver operating characteristic curves were determined to detect mild (SaO2 < 90%) and severe (SaO2 < 80%) hypoxemia.

Results: Pulse oximeter readings corresponding to 190 blood samples were analyzed. All oximeters detected hypoxia but motion and low perfusion degraded performance. Three of four oximeters (Masimo, Nellcor, and Philips) had root mean square error greater than 3% for SaO2 70 to 100% during any motion, compared to a root mean square error of 1.8% for the stationary control. A low perfusion index increased error.

Conclusions: All oximeters detected hypoxemia during motion and low-perfusion conditions, but motion impaired performance at all ranges, with less accuracy at lower SaO2. Lower perfusion degraded performance in all but the Nihon Kohden instrument. We conclude that different types of pulse oximeters can be similarly effective in preserving sensitivity to clinically relevant hypoxia.