To synthesize evidence on pulse oximetry accuracy and occult hypoxemia, focusing on pediatric critical care and cardiac intensive care populations, and to highlight implications for decision-making and equitable care, particularly for marginalized groups.
Key Findings:
SpO₂ systematically overestimates SaO₂ in individuals with darker skin pigmentation, particularly during hypoxemia, which can lead to misdiagnosis.
Higher rates of occult hypoxemia are observed among Black patients at equivalent SpO₂ values in both adult and pediatric cohorts, necessitating tailored clinical approaches.
In pediatric cardiac ICU settings, SpO₂ overestimation increases with illness severity and cardiopulmonary complexity, highlighting the need for vigilant monitoring.
Interpretation:
The systematic overestimation of SaO₂ by SpO₂ in darker-skinned individuals poses significant risks in pediatric critical care, where treatment decisions rely heavily on accurate pulse oximetry readings. Clinicians must adapt practices to mitigate these risks.
Limitations:
Heterogeneity in populations, devices, and definitions of occult hypoxemia complicates results synthesis, potentially affecting the reliability of conclusions.
Narrative reviews and regulatory documents were included but not weighted equally to primary datasets, which may skew the overall findings.
Conclusion:
The findings underscore the need for awareness of pulse oximetry limitations in diverse populations to ensure equitable care and accurate clinical decision-making in pediatric settings, emphasizing the urgency of addressing these disparities.
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