Pulse oximetry in pediatric care: Balancing advantages and limitations

Table 4 The diseases or conditions, the problems they pose to pulse oximetry, and potential solutions to address these challenges

Disease/condition	Problem with pulse oximetry	Solution
Anaemia	Reduced accuracy of SpO2 readings due to lower hemoglobin levels affecting oxygen saturation	Interpret readings cautiously, consider other clinical indicators, and perform arterial blood gas analysis for severe cases
Polycythaemia	Falsely elevated SpO2 readings due to increased hemoglobin levels and altered blood viscosity	Be aware of potential inaccuracies and consider alternative assessment methods, such as arterial blood gas analysis
Metabolic derangement	Shifts in the oxygen dissociation curve and peripheral vasoconstriction can affect SpO2 readings	Interpret readings cautiously, consider other clinical parameters, and be aware of acidosis-induced left shifts or alkalosis-induced right shifts
Cardiac arrhythmia	Irregular blood flow causes fluctuations in pulsatile signal, leading to inaccurate readings	Use pulse oximeters with advanced signal processing algorithms, monitor waveform quality, and consider alternative assessments such as arterial blood gas analysis
Hypothermia	Reduced peripheral perfusion and altered oxygen dissociation curve affecting SpO2 accuracy	Apply local heating to improve perfusion, use pulse oximeters with enhanced low-perfusion algorithms, and consider supplemental assessments
Jaundice	Minimal interference from bilirubin with pulse oximetry readings, though COHb may cause inaccuracies	Monitor for COHb levels in severe cases; rely on pulse oximetry for most jaundiced patients
Electromagnetic field	Interference with pulse oximetry readings from sources such as electrosurgical units and cellular phones	Use fiberoptic pulse oximetry during MRI procedures to minimize exposure to electromagnetic fields

COHb: Carboxyhemoglobin; MRI: Magnetic resonance imaging; SpO₂: Oxygen saturation.