Occult Hypoxemia More Common in Patients With Darker Skin?

Sadye Matula

Patients who self-report as Black or Hispanic look much more possible than White individuals to expertise occult hypoxemia in the course of anesthesia, a massive retrospective cohort analyze suggests. Dr Matthew Levin “The rate of occult hypoxemia — arterial blood oxygen saturation much less than 88{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa} despite a pulse oximetry […]

Patients who self-report as Black or Hispanic look much more possible than White individuals to expertise occult hypoxemia in the course of anesthesia, a massive retrospective cohort analyze suggests.



Dr Matthew Levin

“The rate of occult hypoxemia — arterial blood oxygen saturation much less than 88{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa} despite a pulse oximetry looking at greater than 92{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa} — was considerably greater in clients with self-noted Black or Hispanic race or ethnicity in comparison to those of self-documented White race or ethnicity,” senior research author Matthew A. Levin, MD, informed Medscape Healthcare News.

“Clinicians count on the pulse oximeter to be highly correct. While the device’s bias due to limits of physics and measurement is regarded, it is not normally appreciated,” added Levin, professor of anesthesiology, perioperative and suffering medicine, and of genetics and genomics, at the Mount Sinai Wellbeing Technique in New York Metropolis.

Pulse oximetry is part of the American Culture of Anesthesiologists’ Criteria for Essential Anesthetic Monitoring, nevertheless darker skin has been connected with elevated pulse oximeter values. And a new short article, printed in the New England Journal of Medicine, has questioned the precision of pulse oximetry in detecting hypoxemia in patients with darker skin.

But “this challenge had not been looked at in the perioperative setting,” stated Levin.

Utilizing Pulse Oximetry Values

Pulse oximetry values can enable figure out optimum time for respiration tube removal at the conclusion of surgical procedure, and whether or not the client goes from surgery to a vital care device, a recovery space, or household.

As described in the journal Anesthesiology, Levin and colleagues at Mount Sinai examined the digital documents of all people at 1 healthcare middle who experienced been through anesthesia for operation and whose records contained at least a single arterial blood gas (ABG) during surgical treatment amongst 2008 and 2019.

Every single patient’s ABG oxygen saturation (SaO2) was as opposed to their concurrent pulse oximeter reading. The investigate team investigated the occurrence of occult hypoxemia — ABG oxygen saturation (SaO2) < 88{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa} despite a pulse oximeter reading (SpO2)> 92{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa}, and they stratified the benefits by self-documented race or ethnicity.

The researchers analyzed 151,070 paired SaO2 –SpO2 readings (70,722 White 16,011 Black 21,223 Hispanic 8,121 Asian 34,993 “other”) from 46,253 exclusive individuals.

In paired SaO2 –SpO2 readings, the prevalence of occult hypoxemia was significantly increased in Black (2.1{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa}) and Hispanic (1.8{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa}) patients than in White patients (1.1{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa}), even following altering for other affected individual aspects (P < .001 for both). 

And in multivariable analysis, Black (OR, 1.44 95{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa} CI, 1.11 – 1.87 P = .006) and Hispanic (OR, 1.31 95{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa} CI, 1.03 – 1.68 P = .031) — but not Asian or “other” — race/ethnicity were linked with occult hypoxemia.

This is another example of a racial disparity in patient care.
Dr Angela Christine Argento, Johns Hopkins Medicine

Angela Christine Argento, MD, associate professor of pulmonary and respiratory medicine and director of bronchoscopy at Johns Hopkins Medicine in Baltimore, Maryland, was surprised by the degree of inaccuracy the study found in pulse oximetry in Black and Hispanic patients.

“While 2{0b665730f5e195e56f45088ce75c7e365ca1afa067b6c9c0bf555aa77d6d2cfa} of patients doesn’t seem like a lot, using pulse oximetry on every patient undergoing anesthesia or sedation puts many people at risk for occult hypoxemia,” Argento, who was not involved in the study, told Medscape Medical News.

“We clinicians need to be aware of these findings so we can be vigilant and thoughtful when caring for this group of patients in order to keep them safe,” she said in an email. “Low oxygen levels can lead to some significant problems.

“This is another example of a racial disparity in patient care. We need to continue to move toward precision medicine. We need to identify safe parameters to use with these patients or develop better technology that is not limited by skin tone.”

The field of medicine is making strong efforts to address bias against various groups of people and to provide everyone with the same quality of care regardless of their race or ethnicity, Levin said.

“We can do better at ensuring that everyone gets the same level of care in the operating room,” he added. “When we’re caring for non-White patients, we need to be aware of the potential bias inherent in pulse oximeters.”

Manufacturers Urged to Improve Devices

“Our findings may help motivate pulse oximeter manufacturers to improve their devices by conducting larger studies that include more Black and Hispanic patients,” said Levin.

He pointed out that the large sample size is a strength of the study, but he also acknowledged that the retrospective design introduced limitations.

“We don’t know the exact circumstances surrounding the measurements taken,” he said. “Also, we don’t have an absolute measure of skin pigmentation. Skin color varies widely among Blacks and Hispanics, and we used patient self-reported race and ethnicity as a proxy for skin color.”

Levin and colleagues plan to continue their research.

“We plan to use this large cohort to look at rates of occult hypoxemia in specific patient populations and types of procedures, such as in women undergoing labor and delivery,” Levin explained. “We plan to investigate whether a correlation exists between rates of occult hypoxemia and 30-day mortality.”

The study received no outside funding. The authors and Argento have disclosed no relevant financial relationships.

Anesthesiology. Published online March 18, 2022. Full text

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