Determining factors of pulse oximetry accuracy: a literature review

Objective

Identify and reach consensus on the variables that affect the measurement of oxygen saturation using pulse oximetry.

Methods

We applied inclusion and exclusion criteria to select relevant studies in databases such as Ebsco and PubMed. The search strategies, carried out until December 2023, focused on publications that addressed the technology of pulse oximeters and variables that influence their accuracy. We assessed the risk of bias of the included studies and used standardized methods for synthesis of results.

Results

23 studies were included. The synthesis of the results highlighted that equipment with tetrapolar technology showed greater precision in oxygen saturation measurements. Increased skin pigmentation, hemoglobinopathies and high skin temperatures can lead to an overestimation of SpO₂, while factors such as low perfusion, cold skin temperature, nail polish or tattoos, hypoxemia, anemia and high altitude training, they may underestimate it. On the other hand, motion artifacts, light pollution, frequency >150 beats per minute, electromagnetic interference and location of the sensor can cause distortion of the photoplethymography signal.

Conclusions

The synthesis of the results highlighted that skin pigmentation and light interference can lead to an overestimation of SpO₂, while other factors such as low perfusion and altitude tend to underestimate it. The studies presented variability and heterogeneity in their designs, evidencing limitations in the consistency and precision of the evidence. Despite these limitations, the results underscore the importance of considering multiple variables when interpreting pulse oximetry measurements to ensure their reliability. The findings have significant implications for clinical practice and future research.