Accuracy and Reliability of Commercial Wrist-Worn Pulse Oximeter During Normobaric Hypoxia Exposure Under Resting Conditions

Lauterbach, Claire J.; Romano, P; Greisler, Luke A.; Brindle, Richard; Ford, Kevin R.; Kuennen, Matthew R.

doi:10.1080/02701367.2020.1759768

Cited by 29 publications

(25 citation statements)

References 37 publications

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“…2) provides the "ideal" SpO 2 level where this gap between Garmin and Nonin is minimal, between 92 and 93 %. On a side note, these values are similar to those observed in the sole paper about the accuracy of another wrist-worn oximeter from the same brand, which could explain its very good reliability until ~3500 m [13], and therefore would be coherent with our data at this level of SpO 2 .…”

Section: Discussionsupporting

confidence: 91%

Accuracy and Reliability of Pulse O2 Saturation Measured by a Wrist-worn Oximeter

et al. 2021

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This study aims to evaluate the accuracy of the Garmin Forerunner 245 heart rate (HR) and pulse O2 saturation (SpO2) sensors compared with electrocardiogram and medical oximeter, from sea level to high altitude. Ten healthy subjects underwent five tests in normoxia and hypoxia (simulated altitudes from 3000 to 5500 m), consisting in a 5-min rest phase, followed by 5-min of mild exercise. Absolute error (±10 bpm for HR and ±3% for SpO2, around criterion) and intraclass correlations (ICC) were calculated. Error rates for HR remained under 10%, except at 3000 m, and ICCs evidenced a good reliability between Garmin and criterion. Overall SpO2 was higher than criterion (P<0.001) with a >50% error rate (>80% above 4800 m), and a poor reliability with criterion. The Garmin device displayed acceptable HR data at rest and exercise for all altitudes, but failed to provide trustworthy SpO2 values, especially at high altitude, where a pronounced arterial O2 desaturation could lead to acute mountain sickness in hypoxia-sensitive subjects, and its life-threatening complications; moreover, readings of overestimated SpO2 values might induce trekkers into further hazardous behavior by pursuing an ascent while being already at risk. Therefore, its use to assess SpO2 should be proscribed in altitude for acclimatization evaluation.

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Section: Discussionsupporting

confidence: 91%

Accuracy and Reliability of Pulse O2 Saturation Measured by a Wrist-worn Oximeter

et al. 2021

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“…These are accurate within the range required to detect desaturation requiring hospitalization. Many wrist-worn oximeters and smartphone-based oximeters are generally unreliable [ 21 - 23 ]. Raised respiratory rate, a strong predictor of poor outcomes, is more challenging to measure remotely [ 24 , 25 ]; however, recently, pulse oximeters that can estimate respiratory rate using the photoplethysmography waveform and its amplitude variation have become available [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study

et al. 2021

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Background Most people with COVID-19 self-manage at home. However, the condition can deteriorate quickly, and some people may develop serious hypoxia with relatively few symptoms. Early identification of deterioration allows effective management with oxygen and steroids. Telemonitoring of symptoms and physiological signs may facilitate this. Objective The aim of this study was to design, implement, and evaluate a telemonitoring system for people with COVID-19 who are self-managing at home and are considered at significant risk of deterioration. Methods A multidisciplinary team developed a telemonitoring protocol using a commercial platform to record symptoms, pulse oximetry, and temperature. If symptoms or physiological measures breached targets, patients were alerted and asked to phone for an ambulance (red alert) or for advice (amber alert). Patients attending COVID-19 assessment centers, who were considered fit for discharge but at risk of deterioration, were shown how to use a pulse oximeter and the monitoring system, which they were to use twice daily for 2 weeks. Patients could interact with the system via app, SMS, or touch-tone phone. Written guidance on alerts was also provided. Following consent, patient data on telemonitoring usage and alerts were linked to data on the use of service resources. Subsequently, patients who had either used or not used the telemonitoring service, including those who had not followed advice to seek help, agreed to brief telephone interviews to explore their views on, and how they had interacted with, the telemonitoring system. Interviews were recorded and analyzed thematically. Professionals involved in the implementation were sent an online questionnaire asking them about their perceptions of the service. Results We investigated the first 116 patients who used the service. Of these patients, 71 (61.2%) submitted data and the remainder (n=45, 38.8%) chose to self-monitor without electronic support. Of the 71 patients who submitted data, 35 (49%) received 152 alerts during their 2-week observation. A total of 67 red alerts were for oxygen saturation (SpO2) levels of ≤93%, and 15 red alerts were because patients recorded severe breathlessness. Out of 71 patients, 14 (20%) were admitted to hospital for an average stay of 3.6 (SD 4.5) days. Of the 45 who used written guidance alone, 7 (16%) were admitted to hospital for an average stay of 4.0 (SD 4.2) days and 1 (2%) died. Some patients who were advised to seek help did not do so, some because parameters improved on retesting and others because they felt no worse than before. All patients found self-monitoring to be reassuring. Of the 11 professionals who used the system, most found it to be useful and easy to use. Of these 11 professionals, 5 (45%) considered the system “very safe,” 3 (27%) thought it “could be safer,” and 3 (27%) wished to have more experience with it before deciding. In total, 2 (18%) felt that SpO2 trigger thresholds were too high. Conclusions Supported self-monitoring of patients with COVID-19 at home is reassuring to patients, is acceptable to clinicians, and can detect important signs of deterioration. Worryingly, some patients, because they felt well, occasionally ignored important signs of deterioration. It is important, therefore, to emphasize the importance of the early investigation and treatment of asymptomatic hypoxia at the time when patients are initiated and in the warning messages that are sent to patients.

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“…All of them were performed only at simulated altitude, using medical transcutaneous oximeters for criterion measurement with conflicting results. Lauterbach et al evaluated the accuracy of SpO 2 readings derived from the same Garmin device as used in the present study at simulated altitudes up to 3660 m. The authors concluded that GAR exhibits minimal overestimation (mean difference: 3.3%; limits of agreement: −1.9; 8.6%) of SpO 2 and that the device may be a viable method to monitor SpO 2 at high altitude [ 13 ]. However, in Lauterbach’s study, only Bland–Altman analysis was used to assess validity.…”

Section: Discussionmentioning

confidence: 96%

Validity of Peripheral Oxygen Saturation Measurements with the Garmin Fēnix® 5X Plus Wearable Device at 4559 m

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Treff

et al. 2021

Sensors

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Decreased oxygen saturation (SO2) at high altitude is associated with potentially life-threatening diseases, e.g., high-altitude pulmonary edema. Wearable devices that allow continuous monitoring of peripheral oxygen saturation (SpO2), such as the Garmin Fēnix® 5X Plus (GAR), might provide early detection to prevent hypoxia-induced diseases. We therefore aimed to validate GAR-derived SpO2 readings at 4559 m. SpO2 was measured with GAR and the medically certified Covidien Nellcor SpO2 monitor (COV) at six time points in 13 healthy lowlanders after a rapid ascent from 1130 m to 4559 m. Arterial blood gas (ABG) analysis served as the criterion measure and was conducted at four of the six time points with the Radiometer ABL 90 Flex. Validity was assessed by intraclass correlation coefficients (ICCs), mean absolute percentage error (MAPE), and Bland–Altman plots. Mean (±SD) SO2, including all time points at 4559 m, was 85.2 ± 6.2% with GAR, 81.0 ± 9.4% with COV, and 75.0 ± 9.5% with ABG. Validity of GAR was low, as indicated by the ICC (0.549), the MAPE (9.77%), the mean SO2 difference (7.0%), and the wide limits of agreement (−6.5; 20.5%) vs. ABG. Validity of COV was good, as indicated by the ICC (0.883), the MAPE (6.15%), and the mean SO2 difference (0.1%) vs. ABG. The GAR device demonstrated poor validity and cannot be recommended for monitoring SpO2 at high altitude.

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Accuracy and Reliability of Commercial Wrist-Worn Pulse Oximeter During Normobaric Hypoxia Exposure Under Resting Conditions

Cited by 29 publications

References 37 publications

Accuracy and Reliability of Pulse O2 Saturation Measured by a Wrist-worn Oximeter

Accuracy and Reliability of Pulse O2 Saturation Measured by a Wrist-worn Oximeter

The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study

Validity of Peripheral Oxygen Saturation Measurements with the Garmin Fēnix® 5X Plus Wearable Device at 4559 m

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