Background

Pulse oximeters may produce less accurate results in non-White patients.

Research Question

Do pulse oximeters detect arterial hypoxemia less effectively in Black, Hispanic, and/or Asian patients than in White patients in respiratory failure and about to undergo extracorporeal membrane oxygenation (ECMO)?

Study Design and Methods

Data on adult patients with respiratory failure readings 6 h before ECMO were provided by the Extracorporeal Life Support Organization registry. Data was collected from 324 centers between January 2019 and July 2020. Our primary analysis was of rates of occult hypoxemia—low arterial oxygen saturation (Sao₂ ≤ 88%) on arterial blood gas measurement despite a pulse oximetry reading in the range of 92% to 96%.

Results

The rate of pre-ECMO occult hypoxemia, that is, arterial oxygen saturation (Sao₂) ≤ 88%, was 10.2% (95% CI, 6.2%-15.3%) for 186 White patients with peripheral oxygen saturation (Spo₂) of 92% to 96%; 21.5% (95% CI, 11.3%-35.3%) for 51 Black patients (P = .031 vs White); 8.6% (95% CI, 3.2%-17.7%) for 70 Hispanic patients (P = .693 vs White); and 9.2% (95% CI, 3.5%-19.0%) for 65 Asian patients (P = .820 vs White). Black patients with respiratory failure had a statistically significantly higher risk of occult hypoxemia with an OR of 2.57 (95% CI, 1.12-5.92) compared with White patients (P = .026). The risk of occult hypoxemia for Hispanic and Asian patients was equivalent to that of White patients. In a secondary analysis of patients with Sao₂ ≤ 88% despite Spo₂ > 96%, Black patients had more than three times the risk compared with White patients (OR, 3.52; 95% CI, 1.12-11.10; P = .032).

Interpretation

Compared with White patients, the prevalence of occult hypoxemia was higher in Black patients than in White patients about to undergo ECMO for respiratory failure, but it was comparable in Hispanic and Asian patients compared with White patients.

中文翻译：

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2019-2020 年即将接受体外膜肺氧合的患者脉搏血氧仪测量中的种族偏见

背景

脉搏血氧计在非白人患者中可能会产生不太准确的结果。

研究问题

脉搏血氧计检测黑人、西班牙裔和/或亚裔患者的动脉低氧血症的效率是否低于呼吸衰竭和即将接受体外膜肺氧合 (ECMO) 的白人患者？

研究设计和方法

体外生命支持组织登记处提供了 ECMO 前 6 小时呼吸衰竭成年患者读数的数据。_{数据是在 2019年}1 月至 2020 年 7 月期间从 324 个中心收集的。我们的主要分析是隐匿性低氧血症的发生率——尽管脉搏 血氧饱和度读数在 92 % 至 96%。

结果

对于 186 名外周血氧饱和_度( Sp o ₂ ) 的 92% 至 96%；51 名黑人患者为 21.5%（95% CI，11.3%-35.3%）（P  = .031 vs 白人）；70 名西班牙裔患者为 8.6%（95% CI，3.2%-17.7%）（P  = .693 vs 白人）；65 名亚裔患者为 9.2%（95% CI，3.5%-19.0%）（P  = .820 vs 白人）。与白人患者相比，患有呼吸衰竭的黑人患者发生隐匿性低氧血症的风险在统计学上显着更高，OR 为 2.57（95% CI，1.12-5.92）（P =.026）。西班牙裔和亚裔患者隐匿性低氧血症的风险与白人患者相当。在对 Sa o ₂  ≤ 88% 尽管 Sp o ₂ > 96%的患者进行的二次分析中，黑人患者的风险是白人患者的三倍多（OR，3.52；95% CI，1.12-11.10；P  = . 032).

解释

与白人患者相比，黑人患者隐匿性低氧血症的患病率高于即将接受 ECMO 治疗呼吸衰竭的白人患者，但与白人患者相比，西班牙裔和亚裔患者的患病率相当。