Critical care
finger on the pulsefinger on the pulse Keep your
With a respiratory pandemic raging, pulse oximeters have become more important than ever. But alongside the benefits, previously underplayed weaknesses in their design have become more apparent. Tim Gunn speaks to Michael Sjoding, assistant professor of pulmonary and critical care and hospital medicine at the University of Michigan, and Olamide Dada, founder of UK charity Melanin Medics, about how pulse oximetry fails people of colour, and what doctors can do to make up for it.
ovid-19 put medical research in a time warp. Sequencing the pathogen’s genome took a matter of hours. Tens of thousands of papers on treating and understanding it have sped from word processors to mass audiences within days. Highly effective vaccines were developed, approved and administered in months. And, for all of that, the virus may have taken countless extra lives on account of an equipment issue known and left unaddressed since at least 1990. Inevitably, this is about bias. According to age-adjusted APM figures, as of 2 March 2021, black Americans were twice as likely to have died from Covid-19 as white or Asian Americans. For indigenous
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Americans, the multiplier rises to 3.3; for Pacific islanders, 2.6; and for Latin Americans, 2.4. The reasons for these discrepancies are too numerous and wide-ranging to fully grasp, but as Covid effectively starves its victims of oxygen, it’s notable that 31 years earlier, a piece in Chest noted that the pulse oximetry target used for white patients on ventilators (92%) often resulted in hypoxaemia for black patients. Another study in 2005 found that pulse oximeters tended to overestimate blood oxygen saturation levels by several points in non-white people – by up to 8% at low ranges and from 1–4% around the vital clinical intervention points of 88%, 90% and 92%. Although
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