Pulse oximetry: application in the pediatric and neonatal critical care unit

The use of pulse oximetry in the pediatric and neonatal intensive care units has grown tremendously in recent years. Opinions about this growth are divergent. Arriving at a generalized statement about the accuracy of pulse oximeters is difficult, but it has generally been found to be acceptably accurate in most patient populations under most conditions. However, there are limitations to its application. Pulse oximetry accuracy can be adversely affected by elevated levels of certain abnormal hemoglobin varieties as well as motion artifact and low peripheral perfusion. Some authors suggest a caveat against the use of pulse oximetry to prevent hyperoxemia in the neonatal population, whereas others suggest it is an important advancement. The affect of the use of pulse oximetry on respiratory morbidity and mortality has not been established, and suggestions that all mechanically ventilated patients should be continuously monitored are unsubstantiated.