Burnett Garrett W, Stannard Blaine, Wax David B, Lin Hung-Mo, Pyram-Vincent Chantal, DeMaria Samuel, Levin Matthew A
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Anesthesiology. 2022 May 1;136(5):688-696. doi: 10.1097/ALN.0000000000004153.
Pulse oximetry is ubiquitous in anesthesia and is generally a reliable noninvasive measure of arterial oxygen saturation. Concerns regarding the impact of skin pigmentation and race/ethnicity on the accuracy of pulse oximeter accuracy exist. The authors hypothesized a greater prevalence of occult hypoxemia (arterial oxygen saturation [Sao2] less than 88% despite oxygen saturation measured by pulse oximetry [Spo2] greater than 92%) in patients undergoing anesthesia who self-reported a race/ethnicity other than White.
Demographic and physiologic data, including self-reported race/ethnicity, were extracted from a departmental data warehouse for patients receiving an anesthetic that included at least one arterial blood gas between January 2008 and December 2019. Calculated Sao2 values were paired with concurrent Spo2 values for each patient. Analysis to determine whether Black, Hispanic, Asian, or Other race/ethnicities were associated with occult hypoxemia relative to White race/ethnicity within the Spo2 range of 92 to 100% was completed.
In total, 151,070 paired Sao2-Spo2 readings (70,722 White; 16,011 Black; 21,223 Hispanic; 8,121 Asian; 34,993 Other) from 46,253 unique patients were analyzed. The prevalence of occult hypoxemia was significantly higher in Black (339 of 16,011 [2.1%]) and Hispanic (383 of 21,223 [1.8%]) versus White (791 of 70,722 [1.1%]) paired Sao2-Spo2 readings (P < 0.001 for both). In the multivariable analysis, Black (odds ratio, 1.44 [95% CI, 1.11 to 1.87]; P = 0.006) and Hispanic (odds ratio, 1.31 [95% CI, 1.03 to 1.68]; P = 0.031) race/ethnicity were associated with occult hypoxemia. Asian and Other race/ethnicity were not associated with occult hypoxemia.
Self-reported Black and Hispanic race/ethnicity are associated with a greater prevalence of intraoperative occult hypoxemia in the Spo2 range of 92 to 100% when compared with self-reported White race/ethnicity.
脉搏血氧饱和度测定在麻醉中广泛应用，通常是一种可靠的无创动脉血氧饱和度测量方法。人们担心皮肤色素沉着以及种族/民族会对脉搏血氧仪的准确性产生影响。作者推测，在自我报告种族/民族非白人的麻醉患者中，隐匿性低氧血症（尽管脉搏血氧饱和度测定值[Spo2]大于92%，但动脉血氧饱和度[Sao2]低于88%）的发生率更高。
从部门数据仓库中提取人口统计学和生理学数据，包括自我报告的种族/民族，这些数据来自2008年1月至2019年12月期间接受麻醉且至少进行过一次动脉血气分析的患者。计算出每位患者的Sao2值，并与同时测得的Spo2值配对。完成分析以确定在Spo2范围为92%至100%时，黑人、西班牙裔、亚洲人或其他种族/民族相对于白人种族/民族是否与隐匿性低氧血症相关。
总共分析了来自46253名独特患者的151070对Sao2 - Spo2读数（70722名白人；16011名黑人；21223名西班牙裔；8121名亚洲人；34993名其他种族）。与白人的配对Sao2 - Spo2读数（70722对中的791对[1.1%]）相比，黑人（16011对中的339对[2.1%]）和西班牙裔（21223对中的383对[1.8%]）隐匿性低氧血症的发生率显著更高（两者P均<0.001）。在多变量分析中，黑人（比值比，1.44[95%置信区间，1.11至1.87]；P = 0.006）和西班牙裔（比值比，1.31[95%置信区间，1.03至1.68]；P = 0.031）种族/民族与隐匿性低氧血症相关。亚洲人和其他种族/民族与隐匿性低氧血症无关。
与自我报告为白人种族/民族相比，自我报告为黑人及西班牙裔种族/民族的患者在Spo2范围为92%至100%时，术中隐匿性低氧血症的发生率更高。
