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Flaw in medical device causing issues with care for non-white patients: research

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A new study has determined that critically-ill Black, Asian and Hispanic patients receive less supplemental oxygen than white patients due to a flaw in the device that measures oxygen in the blood.

The study, called the ‘Assessment of Racial and Ethnic Differences in Oxygen Supplementation Among Patients in the Intensive Care Unit, was co-authored by the University of Manitoba’s Dr. Barret Rush, assistant professor of critical care, and Dr. Jennifer Ziegler, a critical care fellow.

The research looked at pulse oximeter clamps, which are the device used to determine how much supplemental oxygen a patient needs.

Though scientists have known for decades that pigmentation can impact pulse oximeter readings, only in recent studies has it been determined that pulse oximeters overestimate the oxygen levels of non-white patients.

Rush and Ziegler’s report is the first to document the impact of this on patient care.

“On average in non-white patients, the error is anywhere between two and five per cent,” Rush said in an interview on Wednesday.

“So if somebody’s oxygen saturation on the pulse oximeter showed 92 per cent, it could actually be as low as 87 [to] 88 per cent.”

The study looked at data from more than 3,000 critically ill patients who were admitted to the ICU in Boston from 2008 to 2019. It found that pulse oximeters were overestimating the oxygen levels of Black, Asian and Hispanic patients and that these patients were receiving less oxygen than they should have.

“The non-white patients got less supplemental oxygen in the ICU,” Rush explained.

“Instead of being on five litres or six litres, they might have been on three or four litres. The average is about 1.5 to two litres less oxygen for non-white patients, which would lead to worse outcomes potentially.”

For the next steps in their research, Rush, Ziegler and their colleagues in Boston are consulting with bioengineers to help solve the issue of racial bias in pulse oximeter readings.

Rush also said they would like also like to do a similar study in Canada looking at Indigenous populations.

The study, which was led by Harvard’s Dr. Eric Raphael Gottlieb and Massachusetts Institute of Technology’s Dr. Leo Celi, was published in ‘JAMA Internal Medicine’ and can be found online.  

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