Over the past two years, the pulse oximeter has become an important tool for monitoring the health of CVD-19 patients.
The small device is cut off at the fingertips to measure the amount of oxygen in the patient’s blood. However, an increasing number of data show that the device may not be accurate when measuring oxygen levels in people with dark skin.
A Study Published on Monday only adds to this concern.
Researchers examining pre-epidemic health data found that those measurements also caused patients to receive less oxygen than white patients.
“We were deceived by a pulse oximeter,” said the study’s lead author. Dr. Leo Anthony SallyWho is the Director of Clinical Research and Chief Research Scientist at MIT Laboratory of Computational Physiology?
“We were given the misconception that the patients were well. And what we showed in this study was giving us less oxygen than they needed,” he says.
These alarming findings make it even more urgent to educate patients and clinicians about pulse oximeter deficiencies and to develop new models that can work safely regardless of one’s skin color.
The doctor fights to take care of her child
Dr. Sandra Lobby-Gordon last September saw how this defect could affect her family.
Lobby-Gordon, a physician at Boston Medical Center, found herself on the phone with a tripartite nurse at a Florida hospital, arguing that her own son – who was seriously ill with COVID-19 – should be hospitalized.
Lobby-Gordon recalls that the nurse responded, “Okay, yes, he looks short of breath, but the oxygen level is good.”
The nurse based this on a reading from a pulse oximeter to a finger, but this assessment did not feel right for Lobby-Gordon.
She hung up the phone with the nurse and talked to other doctors at her clinic. One of them reminded her. 2020 text in the New England Journal of Medicine Pulse oximeter displays tend to be erroneous in people with dark skin.
“It’s my son on it – it looks weird – but it’s very dark skin,” says Luby-Gordon.
In fact, when her son underwent a more invasive test to measure blood oxygen levels, he found that the oxygen level was dangerously low.
He was hospitalized, treated, and eventually recovered from Covide-19. But according to Lobby-Gordon, most patients are unaware of pulse oximeter deficiencies.
Even as a black doctor herself, she said she did not fully know how deceptive the device could be.
Research highlights the shortcomings of the device
If anything, the epidemic emphasizes this long-term problem with a pulse oximeter.
Research Published last month Scientists at Johns Hopkins University have shown incorrect results of pulse oximeters that have not been able to identify black and Hispanic patients in need of CV-19 treatment, such as steroid de xamethasone and antiviral Remedesive.
During the CVD-19 crisis, people of color Encountered High hospitalizations and covide-19 deaths compared to whites. SIT Cowvid-19 of MIT believes it is not known how much pulse oximeters have contributed to the disproportionate impact on people of color, but he believes it has played a role.
And the issue poses a big problem in how medical devices are studied and approved.
FDA Guide Approved for pulse oximeters Clinical trials should include at least two black people or 15% subject pool – whichever is larger. But some doctors and scientists say this is not enough, especially since such skin color is so widespread.
Several manufacturers of pulse oximeters – incl Edwards Life Science, Fields And Not – They say that their own versions of the device actually give accurate results that take into account skin color.
In 2021 op-ed B New England Journal of Medicine Massimo Corporation CEO said that the findings of the study and the differences between their own internal research, including sickle cell disease and circulatory problems, could suggest a number of hypotheses that are equally harmful to blacks.
Scientists are looking for solutions
Over time, scientists and engineers are working on new technologies that can change pulse oximeters, so they work just as well for people with dark skin.
Rutodo Jacaccira, a doctoral student in optics laboratory at Brown University, explains how a pulse oximeter works.
“If you put your finger in this groove, the LED above will send light through your finger,” says Jacqueline. The device can calculate the patient’s oxygen level by determining how much hemoglobin is absorbed into the bloodstream.
“He says this is the key to the problem of people with dark skin Kimani Tussaint.Professor of Electrical and Computer Engineering, Biomedical Engineering and Mechanical Engineering at Brown University. “It is assumed that only hemoglobin retains energy.”
But in reality, skin color receives light, he says. And for people with dark skin, this can lead to a pulse oximeter reading that estimates the amount of oxygen in their blood.
Tucson stands at a table full of technology, hoping to solve the problem.
“I haven’t called this device yet,” he says.
Unlike current pulse oximeters, the non-pulsating device uses polarized light. If it works properly, Tuscant said it will work with manufacturers to reduce it to a marketable device.
Craig LeMoult / Craig LeMoult
At Tuft University, Valencia Comson He is working on a different method to solve this problem.
Her device uses the same light as the current pulse oximeters but includes technology to measure human skin color (people with darker skin have higher melanin).
“If there is a large amount of melanin, we can send more light,” said Kumson, an associate professor of electrical and computer engineering.
Kumson said the history of the pulse oximeter – and that efforts were being made to redesign it – underscored the importance of engineering and medical diversity.
“We are shaped by our environment and our identity and our identity,” she says. “This informs what kind of research is going to be done. It’s up to the people who do the research, who decide what research to do.”
Kumson and other scientists have been pushing the Food and Drug Administration to take action.
“When a patient is at home and is not closely monitored in the hospital, we need to make sure these numbers are as accurate as possible so we do clinical reviews,” said Dr. Sandra Ken-Gill, president of the department. Two sent critical care medical association Letters Problems with the pulse oximeter to the FDA.
The agency has begun to respond.
Last summer, the FDA submitted Warning Skin discoloration and other factors can affect pulse oximeter results. He is currently funding the study. Bringing expert consultants together To discuss how to make sure the tools are right for everyone later this year.
Despite years of publication on the subject, Kumson said it was unknown.
She says racist and false scientific studies have led national heritage scientists to be careful to examine the differences between people of different races.
“People are afraid to talk about physical differences because they don’t want to be discriminated against,” Kumson said. But I think we need to talk about aspects that affect people’s health and the care that is being provided. ”