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Racial Bias in Pulse Oximetry Measurement Among Patients About to Undergo Extracorporeal Membrane Oxygenation in 2019-2020: A Retrospective Cohort Study.
Valbuena, Valeria S M; Barbaro, Ryan P; Claar, Dru; Valley, Thomas S; Dickson, Robert P; Gay, Steven E; Sjoding, Michael W; Iwashyna, Theodore J.
  • Valbuena VSM; Department of Surgery, University of Michigan, Ann Arbor, MI; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI. Electronic address: vvaleria@med.umich.edu.
  • Barbaro RP; Department of Pediatrics, University of Michigan, Ann Arbor, MI.
  • Claar D; Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
  • Valley TS; Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
  • Dickson RP; Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
  • Gay SE; Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
  • Sjoding MW; Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
  • Iwashyna TJ; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Chest ; 161(4): 971-978, 2022 04.
Article in English | MEDLINE | ID: covidwho-1439285
ABSTRACT

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / Extracorporeal Membrane Oxygenation / Racism Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adult / Humans Language: English Journal: Chest Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / Extracorporeal Membrane Oxygenation / Racism Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adult / Humans Language: English Journal: Chest Year: 2022 Document Type: Article