A Review of the Principles of Pulse Oximetry and Accuracy of Pulse Oximeter Estimates During Exercise

This article reviews the principles of pulse oximetry and assesses the accuracy of pulse oximeter measurements obtained during exercise, based on reports of 10 studies that evaluated 24 pulse oximeters. Nine of the studies used cycle exercise, and 1 study utilized treadmill running for mode of activity. Subject populations included patients with cardiovascular or pulmonary disorders, nondisabled individuals, and athletes. Studies were performed under normoxic and hypoxic conditions, and 5 of the 10 studies validated 18 pulse oximeters at arterial oxyhemoglobin saturation (%HbO2) levels of < or = 78%. Sixteen of the 24 pulse oximeters (67%), from 7 of the 10 studies, observed pulse oximeter estimates (%SpO2) during exercise to be accurate, at least when %HbO2 was > or = 85% in nonsmokers. However, the degree of accuracy of the pulse oximeters was variable, even among the same models. Recent studies suggest the current generation of finger-probe-equipped pulse oximeters may be more accurate than ear-probe-equipped models. We recommend that clinicians carefully secure the probe; monitor signal strength; be wary of %SpO2 values of < or = 68% to 78% to avoid undetected severe hypoxemia; and be alert to whether a patient is a smoker, in which case %SpO2 will likely be overestimated. Researchers interested in using pulse oximeter estimates should validate their particular pulse oximeter(s) via arterial blood sampling.