Pulse oximetry

Pulse oximetry
A pulse oximeter.
Purpose	Monitoring a person's oxygen saturation

Pulse oximetry is a noninvasive method for monitoring blood oxygen saturation. Peripheral oxygen saturation (SpO₂) readings are typically within 2% accuracy (within 4% accuracy in 95% of cases) of the more accurate (and invasive) reading of arterial oxygen saturation (SaO₂) from arterial blood gas analysis.^[1]

A standard pulse oximeter passes two wavelengths of light through tissue to a photodetector. Taking advantage of the pulsate flow of arterial blood, it measures the change in absorbance over the course of a cardiac cycle, allowing it to determine the absorbance due to arterial blood alone, excluding unchanging absorbance due to venous blood, skin, bone, muscle, fat, and, in many cases, nail polish.^[2] The two wavelengths measure the quantities of bound (oxygenated) and unbound (non-oxygenated) hemoglobin, and from their ratio, the percentage of bound hemoglobin is computed. The most common approach is transmissive pulse oximetry. In this approach, one side of a thin part of the patient's body, usually a fingertip or earlobe, is illuminated, and the photodetector is on the other side. Fingertips and earlobes have disproportionately high blood flow relative to their size, in order to keep warm, but this will be lacking in hypothermic patients.^[1] Other convenient sites include an infant's foot or an unconscious patient's cheek or tongue.

Reflectance pulse oximetry is a less common alternative, placing the photodetector on the same surface as the illumination. This method does not require a thin section of the person's body and therefore may be used almost anywhere on the body, such as the forehead, chest, or feet, but it still has some limitations. Vasodilation and pooling of venous blood in the head due to compromised venous return to the heart can cause a combination of arterial and venous pulsations in the forehead region and lead to spurious SpO₂ results. Such conditions occur while undergoing anaesthesia with endotracheal intubation and mechanical ventilation or in patients in the Trendelenburg position.^[3]