The Washington Post

People of color get less oxygen treatment in ICUS due to errors in pulse-oximeter devices


A flaw in a widely used medical device that measures oxygen levels causes critically ill Asian, Black and Hispanic patients to receive less supplement­al oxygen to help them breathe than White patients, according to data from a large study published last week.

Pulse oximeters clip onto a fingertip and pass red and infrared light through the skin to gauge oxygen levels in the blood. It has been known since the 1970s that skin pigmentati­on can throw off readings, but the discrepanc­ies were not believed to affect patient care.

Among 3,069 patients treated in a Boston intensive care unit between 2008 and 2019, people of color were given significan­tly less supplement­al oxygen than would be considered optimal compared with White people because of inaccuraci­es in pulse-oximeter readings related to their skin pigment, the study found.

“Nurses and doctors make the wrong decisions and end up giving less oxygen to people of color because they are fooled” by incorrect readings from pulse oximeters, said Leo Anthony Celi of Harvard Medical School and the Massachuse­tts Institute of Technology, a physician who oversaw the study

For the study published in JAMA Internal Medicine, pulseoxime­try readings were checked against direct measuremen­t of blood oxygen levels, which is not practical in the average patient because it requires a painful invasive procedure.

The authors of a separate study involving patients with the coronaviru­s — published recently in the same journal — saw “occult hypoxemia,” an oxygen saturation level below 88 percent, despite pulse oximeter readings of 92 to 96 percent — in 3.7 percent of blood samples from Asian patients, 3.7 percent of samples from Black patients, 2.8 percent of samples from non-black Hispanic patients vs. just 1.7 percent of samples from White patients. White people accounted for only 17.2 percent of all patients with occult hypoxemia.

The authors concluded that racial and ethnic biases in pulse-oximetry accuracy have resulted in delayed or withheld treatments among Black and Hispanic patients with covid-19, the disease caused by the coronaviru­s.

Pulse oximetry can also be affected by obesity, medication­s used to treat critically ill patients and other factors, Celi said.

The market research firm Imarc Group said the global pulseoxime­ter market may reach $3.25 billion by 2027.

“We think it’s very reasonable at this point to call upon purchasers and manufactur­ers to make changes” to the devices, said Eric Ward, a physician and co-author of an editorial published with the study.

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