Non-white ICU patients get less oxygen treatment than they need – study

A medical worker (R) holds a pulse oximeter on a woman’s finger to check her oxygen level during a door-to-door survey for the coronavirus disease (COVID-19) spread in Ahmedabad, India, June 26, 2020. puts. REUTERS/ Amit Dave/File photo

July 11 (Reuters) – A flaw in a widely used medical device that measures oxygen levels is less likely to help critically ill Asian, black and Hispanic people breathe better than white patients Getting supplemental oxygen causes that, according to data from a large study published Monday.

Pulse oximeters clip onto a fingertip and pass red and infrared light through the skin to measure oxygen levels in the blood. Since the 1970s it has been known that skin pigmentation can throw off readings, but it was not believed that anomalies affected patient care.

Among 3,069 patients treated in the Boston Intensive Care Unit (ICU) between 2008 and 2019, people of color would be considered optimal compared to white people because of inaccuracies in their pulse oximeter readings related to the pigmentation of their skin, compared with significantly Less supplemental oxygen was given. study found.

“Nurses and doctors make the wrong decisions and give people of color less oxygen because they are fooled,” said Dr. Leo Anthony Seely of Harvard Medical School and the Massachusetts Institute of Technology. study

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

The authors of a separate study involving patients with COVID-19, recently published in the same journal, observed “occult hypoxemia” — an oxygen saturation level below 88% despite a pulse oximeter reading of 92% to 96% — of 3.7% of the blood. The samples included Asian patients, 3.7% samples from Black patients, 2.8% samples from non-Black Hispanic patients versus only 1.7% samples from White patients. Whites accounted for only 17.2% of all patients with latent hypoxemia.

The authors concluded that racial and ethnic biases in pulse oximetry accuracy resulted in delayed or stopped treatment among black and Hispanic patients with COVID-19.

Seely said pulse oximetry can also be affected by obesity, drugs used in critically ill patients, and other factors.

The Emark Group market research firm has projected that the global pulse oximeter market will reach $3.25 billion by 2021, with sales of $2.14 billion.

“We think it is very appropriate at this point to ask buyers and manufacturers to make changes (to the equipment),” Dr. Eric Ward, co-author of an editorial published with the study, told Reuters.

Medtronic plc (MDT.N) executive Frank Chan said in an emailed statement that the company confirms the accuracy of its pulse oximeter “by taking synchronized blood samples at each level of blood oxygen content and by measurements made from the blood sample.” By comparing pulse aux readings with .

He added that Medtronic tests its devices on more than the required number of participants with dark skin pigmentation, “to ensure that our technology will perform as intended for all patient populations.”

Pulse oximeter maker Philips Healthcare did not respond to a request for comment.

Reporting by Nancy Lapid; Editing by Caroline Humer and Bill Bercrot

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