Harnessing color vision for visual oximetry in central cyanosis

Central cyanosis refers to a bluish discoloration of the skin, lips, tongue, nails, and mucous membranes, and is due to poor arterial oxygenation. Although skin color is one of its characteristic properties, it has long been realized that by the time skin color signs become visible, oxygen saturation is dangerously low. Here we investigate the visibility of cyanosis in light of recent discoveries on what color vision evolved for in primates. We elucidate why low arterial oxygenation is visible at all, why it is perceived as blue, and why it can be so difficult to perceive. With a better understanding of the relationship between color vision and blood physiology, we suggest two simple techniques for greatly enhancing the clinician's ability to detect cyanosis and other clinical color changes. The first is called "skin-tone adaptation", wherein sheets, gowns, walls and other materials near a patient have a color close to that of the patient's skin, thereby optimizing a color-normal viewer's ability to sense skin color modulations. The second technique is called "biosensor color tabs", wherein adhesive tabs with a color matching the patient's skin tone are placed in several spots on the skin, and subsequent skin color changes have the effect of making the initially-invisible tabs change color, their hue and saturation indicating the direction and magnitude of the skin color shift.