Pulse oximeter bench tests under different simulated skin tones

Pulse oximeters' (POs) varying performance based on skin tones has been highly publicised. Compared to arterial blood gas analysis, POs tend to overestimate oxygen saturation (SpO₂) values for people with darker skin (occult hypoxemia). The objective is to develop a test bench for assessing commercial home and hospital-based POs in controlled laboratory conditions. A laboratory simulator was used to mimic different SpO₂ values (~ 70 to 100%). Different neutral density and synthetic melanin filters were used to reproduce low signal and varying melanin attenuation levels. Six devices consisting of commercial home (Biolight, N = 13; ChoiceMMed, N = 18; MedLinket, N = 9) and hospital-based (Masimo Radical 7 with Neo L, N = 1; GE B450 Masimo SET with LNCS Neo L, N = 1; Nonin 9550 Onyx II™, N = 1) POs were reviewed and their response documented. Significant variations were observed in the recorded SpO₂ values among different POs when exposed to identical simulated signals. Differences were greatest for lower SpO₂ (< 80%) where empirical data is limited. All PO responses under low signal and melanin attenuation did not change across various simulated SpO₂ values. The bench tests do not provide conclusive evidence that melanin does not affect in vivo SpO₂ measurements. Research in the areas of instrument calibration, theory and design needs to be further developed.