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The Evaluation Of Skin Pigmentation Effects On Pulse Oximetry Monitoring Using A Novel Porcine Deoxygenation Model
Tara Sara Saffari, MD, MS, Joe G. Ribaudo, BS, Michael Butler, BS, Leonid Shmuylovich, MD, PhD, Mitchell A. Pet, MD.
Washington University in St. Louis, St. Louis, MO, USA.
Purpose: The purpose of this study was to investigate the impact of skin pigmentation on the accuracy of pulse oximetry using a modified porcine model with controlled systemic deoxygenation and alternately pigmented ears. Methods: Two Hampshire pigs with naturally occurring oppositely pigmented ears were utilized. Pulse-oximetry (SpO
2) data was continuously and simultaneously collected from each ear using research grade open data stream (Maxim-86171 pulseoximeter) and clinical standard proprietary pulse oximeters (Masimo-K181956). Starting from normoxemia, progressive hypoxemia (SaO
2 60-100%) was induced by decreasing the fraction of inhaled oxygen in a stepwise manner. Arterial blood gas samples were intermittentlydrawn from an indwelling catheter, and co-oximetry was used to define the gold standard SaO
2. Results: During normoxemia, pulse oximetry readings were similar for both pigmented and non-pigmented ears. During hypoxemia, oximeters overestimated oxygen saturation in pigmented ears by +16% at 70% SaO
2, while non-pigmented skin showed only a +1% discrepancy.This discrepancy was recapitulated in the Maxim oximetry data, where the slope of the modulation ratio (R)-vs SaO
2 curve was 5.9% steeper in the non-pigmented compared to the pigmented ear (Figure 1). Conclusion: This study provides the first internally controlled animal model showing that skin pigmentation affects the accuracy of pulse oximetry, with comparable estimation of oxygen saturation between pigmented and non-pigmented skin, but overestimation in pigmented skin during hypoxemia.
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