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"apellidos" => "Martín-Escudero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Estudiante Semillero de Investigación, Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Física, Facultad de Ciencias, Universidad de Tarapacá, Arica, Chile" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Escuela de Medicina del Deporte, Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Medicina. UCM" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores determinantes de la precisión de la oximetría de pulso: revisión bibliográfica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1343 "Ancho" => 1667 "Tamanyo" => 152618 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart consisting of the statement of preferred reporting items for systematic reviews (PRISMA).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pulse oximetry, a non-invasive method for measuring blood oxygen saturation, has garnered increasing significance since the start of the COVID-19 pandemic given the need to monitor this clinical variable. This device is practical and provides accurate results in both home and hospital settings.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is extensively used across many medical specialties and in patients of all ages.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> However, despite the increasing pulse oximetry use, the United States Food and Drug Administration (FDA) has issued warnings about the limitations of pulse oximetry devices, emphasising its potential for inaccurate readings in certain situations.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Specifically, the oximeter accuracy may be affected by alitutud,e<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> movement and physical exercise,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> different haemoglobin variants,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> sensor placement sites,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> nail polish colour,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> skin pigmentation,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> heart arrhythmia,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> low perfusion, hypoxemia and postoperative hypoxemia<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a>, or mask wearing.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> On the other hand, technical device features including the type of LED light, wave detectors<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> or bipolar or tetrapolar measurement can also impact their accuracy.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">While multiple studies have been conducted on the factors affecting pulse oximetry accuracy, there is still no consensus in the literature due to the many variables stated by the authors.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this paper is to examine the literature to establish a consensus regarding the variables affecting pulse oximetry measurements. The objective is to identify research from the past decade using the PRISMA method to synthesize factors affecting accuracy and to determine the geographic and temporal distribution of the studies that meet the inclusion criteria.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0030" class="elsevierStylePara elsevierViewall">We searched the literature for studies featuring variables that interfere with oxygen saturation measurement results. This was done by evaluating scientific articles published in indexed journals, searching the bibliographic databases ProQuest, Science Direct, Cochrane, Ebsco, Web of Science, Scopus, Epistemonikos, Proquest, Google Scholar, SciELO, Dialnet, and PubMed and searching open-access websites. A total of 23 articles were selected (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The research was conducted via a literature review using the “Preferred Reporting Items in Systematic Reviews and Meta Analyses” (PRISMA) method.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> We performed an advanced search of the cited databases. For our systematic review, we used a combination of key words and descriptors specially selected to thoroughly encompass terms related to pulse oximetry and variables that affect oxygen saturation measurements. The descriptors used included primary terms such as “pulse oximetry”, with linguistic adaptations to allow for an inclusive search across multiple languages. The search strategy was meticulously designed using Boolean operators to refine the results. The use of the operator “AND” was used to ensure that publications included both topics related to pulse oximetry as well as those related to measurement precision and accuracy. On the other hand, the operator “OR” was used to connect synonymous or related terms, thus broadening the search spectrum to include a wider range of relevant studies. The search aimed to identify literature that, in addition to addressing pulse oximetry technology and applications and photoplethysmography, also discussed precision, accuracy, and possible measurement errors, as well as factors affecting these parameters.</p><p id="par0040" class="elsevierStylePara elsevierViewall">An exhaustive filter with a qualitative analysis was applied to the selected articles to identify studies concerning variables that impact oxygen saturation measurements including, but not limited to, saturation over- and underestimations, effects of altitude, movement, skin pigmentation, use of henna dye, perfusion levels, haemoglobinopathies, skin temperature, heart rate, hypoxemia and the technology used in the pulse oximeters. In addition, an iterative approach was taken during the search, regularly assessing the results to ensure relevance and focus. We kept a detailed record of the search strategy and adjustments made throughout the process and repeated the search at the end of our review to include any new literature published in the interim since the beginning our research. The search was refined with date filters from 2013 to 2023, focusing on articles from open-access indexed journals.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In terms of the procedure, three researchers conducted the analysis in an independent manner according to the predefined inclusion and exclusion criteria and then came to an agreement regarding the results. In the event of discrepancies, two researchers intervened as mediators to reach an agreement.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The selection process was conducted in stages: first, a preliminary scan of the titles; second, a detailed review of the titles and abstracts; third, and lastly, a full read-through of the texts that met the inclusion criteria.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The selected studies met the following inclusion criteria:</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Inclusion criteria</span><p id="par0060" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Articles with publication dates between 2013–2023</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Articles featuring variables that interfere with oxygen saturation measurement results</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Research published in open-access indexed journals</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Exclusion criteria</span><p id="par0080" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Studies that, despite addressing the topic, do not include content such as variables involved in the results of oxygen saturation readings.</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">Lastly, we ruled out studies that, though related to the topic at hand, did not describe variables affecting SpO<span class="elsevierStyleInf">2</span> measurements or that were of poor methodological quality according to the Newcastle Ottawa scale.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> This scale allowed us to assess the quality of the non-randomised studies in the systematic review. The studies were judged according to three components: study group selection; comparability of the groups; and the determination of exposure or outcome of interest for case studies. Ultimately, the results were compared to an Ottawa quality assessment scale, with quality expressed as the number of stars achieved. Studies with fewer than 5 stars were not considered. On the other hand, to analyse the methodological quality of the systematic reviews, it was necessary to use a study quality confirmation list adapted to each project; likewise, we had to identify the most likely biases in each of the included designs, which facilitated the subsequent study quality evaluation, allowing us to select studies whose scores classified them as acceptable. To do so, we tabulated data extracted during the quality assessment in order to classify the rigour of the articles in the systematic review.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Bias risk in the individual studies</span><p id="par0095" class="elsevierStylePara elsevierViewall">The risk of bias was assessed during article selection by means of the COCHRANE guide,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> taking into consideration domains such as assignment, blinding, follow-up, exclusions and potential biases, thus ensuring a selection of data with low risk of bias.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">From the aforementioned analysis, 151 articles were identified, of which 23 articles were selected that met the inclusion criteria.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The selected articles came from the following locations: one from Morocco<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>, four from Argentina,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,25,28,36</span></a> two from Austria,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,35</span></a> two from Chile,<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,29</span></a> one from China,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> two from Korea,<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32,33</span></a> three from the United States,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,34,39</span></a> two from England,<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31,40</span></a> three from Mexico,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,23,26</span></a> one from Switzerland,<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> one from Bolivia,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and one from Colombia.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the geographic locations of the selected articles.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Timeline of the selected articles</span><p id="par0110" class="elsevierStylePara elsevierViewall">Articles from the past ten years were selected, with the following publication dates: one from 2013,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> one from 2015,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> two from 2016,<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,24</span></a> one from 2017,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> one from 2018,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> one from 2019,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> four from 2020,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,26,27,39</span></a> six from 2021,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,28,33–35,37</span></a> four from 2022<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,29,36,40</span></a> and two from 2023.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,30</span></a> Year 2021 had the largest number of publications, possibly due to increased pulse oximetry use during the COVID-19 pandemic and the special attention placed on oxygen saturation measurement accuracy.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results of the literature analysis</span><p id="par0115" class="elsevierStylePara elsevierViewall">As primary outcomes (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), five articles were identified that highlighted technology as one of the most influential factors in oxygen saturation measurement. One study confirmed<span class="elsevierStyleSup">24</span> that the two main error factors found were motion artifacts and hypoperfusion. It underscored that when a patient moves, a “venous pulse waveform” appears that the oximeter cannot distinguish from an arterial pulse waveform, and since venous blood saturation is lower than arterial saturation, this results in an under-recording. In hypoperfusion, low signal intensity also generated an under-recording.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">In another study,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the authors designed a low-cost pulse oximeter with the aim of making this type of equipment more affordable. In building their oximeter, they used a MAX30102 board, Arduino UNO board, and an OLED SSD1306 display. They compared this product against the standard methods, concluding the oxygen saturation readings were similar and suggesting that the entire system be tested prior to launching on the market.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Likewise, Santos et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> reflected on technological elements that may contribute to the quality of saturation readings in three oximeters (Onyx II, Hergom and SB220), highlighting a certain degree of variability. The authors stated that the SB220 presents wide variability while the Onyx II and Hergom maintained precision and accuracy. They stressed that the most influential variabilities regarding measurement were those related to quality issues when obtaining the photoplethysmography signal, the operation of the instrument, low manufacturing quality, and measurement site. Rapid desaturation, hypotension, hypothermia, dyshemoglobinemia, hypoperfusion, and acute and chronic hypoxemia were factors that also affected results.</p><p id="par0130" class="elsevierStylePara elsevierViewall">On the other hand, one article<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> considered the use of tetrapolar oximeters, using the impedance audiometry technique in the tetrapolar configuration to obtain the plethysmography signal more broadly. In this regard, two articles<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,27</span></a> stressed the importance of considering technologies such as near-infrared spectroscopy (NIRS) as a necessary tool to be used when caring for neonates, stating that this technology allows for non-invasive real-time oxygen consumption measurements in various somatic tissues such as the brain, intestine, and kidneys.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Four articles<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,28,37,40</span></a> related to oximeter technology in patients with respiratory failure due to COVID-19 and other pulmonary diseases were considered. Those articles emphasised the need to improve oxygen saturation assessment technology, stressing that, while oximeters have been designed with advanced technology, these still present shortcomings, as certain variables that can affect monitoring accuracy are yet to be addressed, specifically: talking, laughing, physical activity, lack of pulse flow, accuracy in patients with hypoxemia, hyperbilirubinemia, dyshemoglobinemia, excessive movement, ambient light interference, nail polish, darker skin pigmentation, individuals with high body mass index, and others.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Two other articles<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,30</span></a> reported that results can be falsified due to environmental interference such as altitude. In this case, the human body is exposed to reduced oxygen availability (hypoxia) due to the decrease in barometric pressure and associated partial pressure of oxygen; as a result, various physiological responses are triggered to counteract the hypoxia and associated risk of falling ill. In the study, the authors reference Rahn & Otis<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> and Lenfant & Sullivan,<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> who suggested that, during the first days at high altitude, as compared to acute exposure, a progressive increase in ventilation at rest (ventilatory acclimatization) occurs accompanied by an increase in the partial pressure of arterial oxygen and a decrease in the alveolar partial pressure of carbon dioxide. Similarly, they underscored the suggestion from Sato et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a>; Bender et al.,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> who reported that ventilatory acclimatization is characterised by an initial decrease and subsequent increase in partial oxygen pressure at rest, reaching a maximum between four and eight days, at least at an altitude of up to 4300 m. Unlike passive activity at altitude, physical activity at altitude can delay recovery of the partial pressure of oxygen.</p><p id="par0145" class="elsevierStylePara elsevierViewall">One article referenced light interference,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> stating that ambient light interferes with green (500–550 nm) and red wavelengths (645–700 nm). This is because the absorption coefficients of oxygenated and deoxygenated haemoglobin are opposite to each other at blue (380–500 nm) and red wavelengths. In the case of green light, oxygenated haemoglobin absorbs green light more strongly than deoxygenated haemoglobin. On the other hand, in the case of red light, deoxygenated haemoglobin absorbs red light more strongly than oxygenated haemoglobin.</p><p id="par0150" class="elsevierStylePara elsevierViewall">By the same token, six articles were identified<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,29,32,36</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> that evaluated the influence of skin pigmentation. Those authors stressed that patients with darker pigmentation were three times more likely to present occult hypoxemia not detected by pulse oximetry because oximeter devices have limited accuracy when evaluating subjects with darker skin, particularly patients with low saturation or hypoxemia. They also noted how melanin interferes with the quality of the signal reflected, and how an increase in pigmentation can absorb light emitted by the equipment and interfere with the detection and measurement of oxygenated haemoglobin.</p><p id="par0155" class="elsevierStylePara elsevierViewall">One article<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> mentioned how organic nail polish lowered saturation levels, which subsequently rose after removing the nail polish. The authors reported that organic nail polish can absorb the light emitted by equipment and interfere with the detection and measurement of oxygenated haemoglobin and interfere with the capacity of the pulse oximeter to interpret oxygen saturation.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Another article<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> mentioned that skin dyes and black henna also interfere with measurements. The authors stated that henna causes a black discolouration of the skin. During this initial phase, it absorbs all wavelengths of visible light, allowing only infrared rays to pass through. This results in a failure to monitor oxygen saturation using pulse oximeters as it provides inaccurate results.</p><p id="par0165" class="elsevierStylePara elsevierViewall">One of the articles analysed<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> reported how the use of NIRS offers more parameters to evaluate oxygen delivery and consumption in deep tissues, while pulse oximetry only assesses the state of oxygen delivery. In this study, the authors stressed that for evaluation in the finger with NIRS and partial pressure of oxygen in the forearm in patients with venous occlusion, no significant drop from baseline was observed. However, during total occlusion, all the indexes indicated the change in blood perfusion. Deoxyhaemoglobin, oxyhaemoglobin, and total haemoglobin changes estimated by photoplethysmography presented high correlation with the same parameters obtained by NIRS during venous occlusion and during total occlusion. The system demonstrated the ability to extract valuable information from photoplethysmography signals for a broader assessment of tissue blood perfusion.</p><p id="par0170" class="elsevierStylePara elsevierViewall">One article<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> compared non-invasive oxygen saturation monitoring via pulse oximetry with oxygen saturation measurements based on blood samples from premature and full-term babies and included foetal haemoglobin measurements. The majority reported partial oxygen saturation bias; however, it remains unclear whether this could be explained by the elevated haemoglobin fractions only in neonatal blood. Based on the physiological characteristics of the foetal oxyhaemoglobin dissociation curve, there might be an influence of foetal haemoglobin on oxygen saturation readings, resulting in oxygen saturation overestimation for lower saturation ranges.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">This systematic review identified key factors modifying the accuracy of pulse oximetry. Device technology significantly impacts the measurement quality, with tetrapolar oximeters standing out as being reliable.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,24,26</span></a> These findings are in line with Barea<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> and Hernández,<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> who indicated that signal quality and electrode surface contact are determining factors.</p><p id="par0180" class="elsevierStylePara elsevierViewall">In addition, it emphasises the need to improve oxygen saturation assessment technology in clinical conditions such as respiratory failure and other lung diseases, particularly in the COVID-19 era.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,28,37,40</span></a> Berna & Mendoza<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and Jubran,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> together with Hess,<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> also highlighted differences in oxygen saturation accuracy measured via blood gas.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Altitude is another environmental factor that affects oxygen saturation readings due to the decrease in barometric pressure and partial pressure of oxygen, as seen in studies from Novillo & Mata<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> and the two articles selected.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,30</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Light interference is also acknowledged as an element that distorts saturation readings, as stated in one article<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> and corroborated by Mejía & Mejía,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> who suggest covering the sensor to prevent this problem.</p><p id="par0195" class="elsevierStylePara elsevierViewall">In terms of skin pigmentation, multiple studies<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,29,32,34</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36,39</span></a> support evidence from the FDA (2023)<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and Bickler et al.,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> who state that dark pigmentation can result in overestimated readings.</p><p id="par0200" class="elsevierStylePara elsevierViewall">The presence of organic nail polish and dyes such as henna were also identified as factors that can affect oximetry accuracy.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,38</span></a> These results differ from those reported by Çiçek et al.,<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> who did not find any significant differences with nail polishes of different colours.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Lastly, NIRS use was assessed using a supplementary technique to evaluate oxygen saturation and consumption in deep tissue.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> This approach coincides that the perspective of Casasola,<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> who highlighted the influence of melanin on readings.</p><p id="par0210" class="elsevierStylePara elsevierViewall">Lastly, Pritišanac et al.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> addressed the possible influence of foetal haemoglobin on saturation readings in neonates, an aspect that Ortega<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> did not agree with but rather suggests that abnormal haemoglobin does not affect pulse oximetry but does affect tissue oxygenation.</p><p id="par0215" class="elsevierStylePara elsevierViewall">In summary, <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the leading limitations of pulse oximeters divided into three main categories: factors that cause oxygen saturation (SpO<span class="elsevierStyleInf">2</span>) underestimation, factors leading to SpO<span class="elsevierStyleInf">2</span> overestimation, and factors that distort the photoplethysmography signal (PPG).<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">Oxygen saturation readings may be underestimated due to factors such as inadequate peripheral perfusion, skin thickness or low temperature, nail polish or tattoos, anaemic hypoxia, low perfusion, training at high altitudes, the use of nerve blocks, and intravenous dyes. On the other hand, SpO<span class="elsevierStyleInf">2</span> overestimation can be caused by skin pigmentation, hemoglobinopathies, high skin temperature, or smoking. What’s more, PPG signals may become distorted by motion artifacts, light contamination, elevated pump frequencies, electromagnetic interference, incorrect sensor placement, and irregular cardiac rhythms or arrhythmias.</p><p id="par0225" class="elsevierStylePara elsevierViewall">These findings highlight the importance of taking into consideration a range of physiological, environmental, and technical variables when interpreting pulse oximetry readings in order to guarantee the precision and reliability of clinical assessment.</p><p id="par0230" class="elsevierStylePara elsevierViewall">In our review, we considered our rigorous methodology featuring inclusion and exclusion criteria to be a strength, as was the updated systematic review of databases up to December 2023, thus ensuring the relevance and quality of the included studies. The review encompassed a wide range of databases and open-access websites, and we ultimately selected a total of 23 relevant articles, indicating a thorough coverage of the topic. On the other hand, the results underscore the importance of considering multiple variables when interpreting pulse oximetry readings, which have important implications for clinical practice and future research. However, we can point out as possible weaknesses in our research the variability and heterogeneity in the designs of the studies included, which could limit evidence consistency and precision. On the other hand, while we highlight the importance of technology for precise readings, the study recognises that current pulse oximetry technology still presents certain shortcomings. Likewise, we noted a lack of research considering the influence of physiological and environmental factors, which have not been widely examined, suggesting that factors capable of altering oxygen saturation results require more in-depth and detailed exploration.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0235" class="elsevierStylePara elsevierViewall">The findings from this study indicate that the technology used in oximeters is a critical component when it comes to the accuracy of readings, and tetrapolar devices are superior due to their greater precision. By contrast, less advanced technologies tend to be less accurate, particularly in patients with respiratory compromise, such as those affected by COVID-19.</p><p id="par0240" class="elsevierStylePara elsevierViewall">In terms of environmental factors, altitude stands out as causing low oxygen saturation levels due to environmental hypoxia. At the same time, ambient light has been observed to significantly alter measurement by interfering with the red and green wavelengths, as deoxygenated haemoglobin absorbs more red light than oxygenated haemoglobin, thus impacting the reliability of the oximetry readings.</p><p id="par0245" class="elsevierStylePara elsevierViewall">Other identified elements include skin colour bias and factors such as nail polish, skin dyes, and black henna dye. In addition, we acknowledge the relevance of NIRS and the need to consider blood oxygen saturation measurements for neonates and full-term babies as variables that can impact pulse oximetry readings.</p><p id="par0250" class="elsevierStylePara elsevierViewall">These findings highlight the importance of taking into consideration a range of physiological, environmental, and technical variables when interpreting pulse oximetry readings in order to guarantee the precision and reliability of clinical assessment.</p><p id="par0255" class="elsevierStylePara elsevierViewall">Given the complexity of the factors affecting pulse oximetry accuracy, we recommend expanding the research to include a larger number of references from the literature. Considering a diverse range of age groups and sexes and examining in greater detail the causes that can alter oxygen saturation results are key. These efforts can contribute to improving diagnostic precision and patient monitoring, thus optimising clinical care.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0260" class="elsevierStylePara elsevierViewall">This review was funded by project number SA2210178.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0265" class="elsevierStylePara elsevierViewall">The authors deny any conflicts of interest of any kind.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2153252" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1827630" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2153251" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1827631" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methodology" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Inclusion criteria" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Exclusion criteria" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Bias risk in the individual studies" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Timeline of the selected articles" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Results of the literature analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack747188" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-01-18" "fechaAceptado" => "2024-03-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1827630" "palabras" => array:5 [ 0 => "Oxygen saturation" 1 => "Skin pigmentation" 2 => "Accuracy" 3 => "Precision" 4 => "Photoplethysmography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1827631" "palabras" => array:5 [ 0 => "Saturación de oxígeno" 1 => "Pigmentación de la piel" 2 => "Exactitud" 3 => "Precisión" 4 => "Fotopletismografía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Identify and reach consensus on the variables that affect the measurement of oxygen saturation using pulse oximetry.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We applied inclusion and exclusion criteria to select relevant studies in databases such as Ebsco and PubMed. The search strategies, carried out until December 2023, focused on publications that addressed the technology of pulse oximeters and variables that influence their accuracy. We assessed the risk of bias of the included studies and used standardized methods for synthesis of results.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">23 studies were included. The synthesis of the results highlighted that equipment with tetrapolar technology showed greater precision in oxygen saturation measurements. Increased skin pigmentation, hemoglobinopathies and high skin temperatures can lead to an overestimation of SpO<span class="elsevierStyleInf">2</span>, while factors such as low perfusion, cold skin temperature, nail polish or tattoos, hypoxemia, anemia and high altitude training, they may underestimate it. On the other hand, motion artifacts, light pollution, frequency >150 beats per minute, electromagnetic interference and location of the sensor can cause distortion of the photoplethymography signal.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The synthesis of the results highlighted that skin pigmentation and light interference can lead to an overestimation of SpO<span class="elsevierStyleInf">2</span>, while other factors such as low perfusion and altitude tend to underestimate it. The studies presented variability and heterogeneity in their designs, evidencing limitations in the consistency and precision of the evidence. Despite these limitations, the results underscore the importance of considering multiple variables when interpreting pulse oximetry measurements to ensure their reliability. The findings have significant implications for clinical practice and future research.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Identificar y alcanzar un consenso sobre las variables que afectan la medición de la saturación de oxígeno mediante la oximetría de pulso.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Aplicamos criterios de inclusión y exclusión para seleccionar estudios relevantes en bases de datos como Ebsco y PubMed. Las estrategias de búsqueda, realizadas hasta diciembre de 2023, se centraron publicaciones que abordaran la tecnología de los oxímetros de pulso y variables que influyen en su precisión. Evaluamos el riesgo de sesgo de los estudios incluidos y utilizamos métodos estandarizados para la síntesis de resultados.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 23 estudios. La síntesis de los resultados destacó que los equipos con tecnología tetrapolar mostraron mayor precisión en las mediciones de saturación de oxígeno. Una mayor pigmentación de la piel, hemoglobinopatías y altas temperaturas de la piel pueden llevar a una sobreestimación de la SpO<span class="elsevierStyleInf">2</span>, mientras que factores como baja perfusión, temperatura de la piel fría, esmalte de uñas o tatuajes, hipoxemia, anemia y entrenamiento a gran altitud, pueden subestimarla. Por otra parte, artefactos de movimiento, contaminación lumínica, frecuencia >150 latidos por minutos, interferencia electromagnética y lugar de colocación del sensor, pueden provocar distorsión de la señal de fotoplestimografía.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La síntesis de los resultados destacó que la pigmentación de la piel y las interferencias luminosas pueden llevar a una sobreestimación de la SpO<span class="elsevierStyleInf">2</span>, mientras que otros factores como la baja perfusión y la altitud tienden a subestimarla. Los estudios presentaron variabilidad y heterogeneidad en sus diseños, evidenciando limitaciones en la consistencia y precisión de la evidencia. A pesar de estas limitaciones, los resultados subrayan la importancia de considerar múltiples variables al interpretar las mediciones de la oximetría de pulso para garantizar su confiabilidad. Los hallazgos tienen implicaciones significativas para la práctica clínica y la investigación futura.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1343 "Ancho" => 1667 "Tamanyo" => 152618 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart consisting of the statement of preferred reporting items for systematic reviews (PRISMA).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1788 "Ancho" => 2675 "Tamanyo" => 320310 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Geographic location of the selected articles.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Databases \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Article name \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coding for case–control study selection \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Systematic review methodological quality analysis \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="10" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Google Scholar</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pletismografía de impedancia basada en electrodos de Polipirrol para el sensado de la frecuencia cardiaca \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hernández & Suaste, (2016).<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulse oximetry. the best equipment is…? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perillán, (2016).<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qualitative evaluation- acceptable(Literature review) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aplicación de nuevas tecnologías en el cuidado neonatal: monitorización de la saturación regional de oxígeno \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arnaudo, (2019).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qualitative evaluation- acceptable(Literature review) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Differences in partial oxygen saturation obtained from three pulse oximeters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Santos, et al. (2020).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">¿La espectroscopia de infrarrojo cercano (NIRS) podría ser útil en el monitoreo hemodinámico del paciente critico pediátrico? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Puentes, et al. (2020).<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qualitative evaluation-acceptable(Literature review) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective study to describe the concordance between two pulse oximeters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bosio, et al. (2021).<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Esmaltes de uñas ecológicos y medición de la saturación periférica de oxígeno en pacientes quirúrgicos. Presentación de casos \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Díaz, et al. (2022).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Skin pigmentation effect on the accuracy of pulse oximetry: a systematic review \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cabanas, et al. (2022).<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acceptable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Design and construction of a pulse oximeter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barrera, et al. (2023).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variaciones fenotípicas relacionadas a respuestas hipóxicas entre andinos a distintas altitudes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Luna, et al. (2023).<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CrossRef</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reflectance photoplethysmography as noninvasive monitoring of tissue blood perfusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abay & Kyriacou, (2015).<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The effect of optical crosstalk on accuracy of reflectance-type pulse oximeter for mobile healthcare \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baek, et al. (2018).<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-contact oxygen saturation measurement using YCgCr colour space with an RGB camera \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kim, et al. (2021).<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The use of pulse oximetry in the assessment of acclimatization to high altitude \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dünnwald, et al. (2021).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qualitative evaluation-acceptable(Literature review) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Analysis of discrepancies between pulse oximetry and arterial oxygen saturation measurements by race and ethnicity and association with organ dysfunction and mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wong, et al. (2021).<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qualitative evaluation-acceptable(Literature review) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Accuracy of pulse oximetry in the presence of foetal hemoglobin—a systematic review \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pritišanac, et al. (2021).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acceptable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The effects of skin pigmentation on the accuracy of pulse oximetry in measuring oxygen saturation: a systematic review and meta-analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Shi, et al. (2022).<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qualitative evaluation-acceptable(Literature review) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Springer Link \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COVID-19: pulse oximeters in the spotlight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Michard, et al. (2021).<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qualitative evaluation-acceptable(Literature review) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">National Library of Medicine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Henna dye: a cause of erroneous pulse oximetry readings \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bensghir, et al. (2013).<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PubMed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A multi-wavelength opto-electronic patch sensor to effectively detect physiological changes against human skin types \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yan, et al. (2017).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulse oximetry for monitoring patients with COVID-19 at home. Potential pitfalls and practical guidance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Luks & Swenson, (2020).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qualitative evaluation-acceptable(Literature review) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Racial bias in pulse oximetry measurement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sjoding, et al. (2020).<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Exploring the impact of pulse oximeter selection within the COVID-19 home-use pulse oximetry pathways \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stell, et al. (2022).<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3548637.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Article selection by database.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results from the literature search</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors (year) country \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">General research objective \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study methodology applied \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Principle outcomes or findings \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bensghir, et al. (2013),<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Marruecos. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To highlight how patient hand and foot skin pigmentation impacts oxygen saturation measurement results. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Case study considering the presence of henna dye on a patient scheduled for general anaesthesia. Study focused on one of the factors that can alter pulse oximetry accuracy. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Interference from light transmission, dark skin pigmentation caused by certain skin dyes, and black henna dye can cause incorrect oxygen saturation readings. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abay & Kyriacou, (2015),<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> London. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To explore the use of dual wavelength photoplethysmography via the use of pulse and continuous photoplethysmography for estimating arterial oxygen saturation in conventional postoperative care. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">They applied dual wavelength photoplethysmography via the use of pulse and continuous photoplethysmography for estimating arterial oxygen saturation. The system was evaluated on the forearms of 21 healthy volunteers during induction of venous occlusion and total occlusion. A reflectance photoplethysmography probe and NIRS sensor were applied above the brachioradialis, postoperative sensors were applied to the fingers, and all the signals were acquired simultaneously. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The system demonstrated the ability to extract valuable information from photoplethysmography signals for a broader assessment of tissue blood perfusion. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hernández & Suaste, (2016),<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Mexico. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To obtain the plethysmograph signal by exploiting the properties of a conductive polymer to manufacture the strip electrodes needed for this pulse oximetry technique. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Case study that applied the impedance meter technique in the tetrapolar configuration to obtain the plethysmograph signal in the subject under assessment, in which external strip electrodes supplied an electric current and the two internal electrodes measured the resulting voltage. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The use of the impedance meter technique in the tetrapolar configuration to obtain the subject’s plethysmography signal was more uniform in the region recorded by the internal electrodes, resulting in a more reliable reading than conventional methods. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perillán, (2016),<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Chile. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To compare the factors affecting oxygen saturation evaluation measurements for the Masimo and Nellcor N-200 devices. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A literature analysis was carried out considering studies that compared Masimo devices to others such as: Nellcor N-200, Agilent Viridia M3, Masimo SET, Nellcor N3000 Oxismart and Philips FAST.Highlighting the main factors that impact pulse oximetry measurement. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The main error factors were motion artifacts, hypoperfusion, environmental noise, intense ambient light, drugs that affect perfusion, skin pigmentation, carboxyhaemoglobin, foetal haemoglobin, methaemoglobin, temperature and height. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yan, et al. (2017),<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> China. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To research the effectiveness of multi-wavelength illumination measurement based on an opto-electronic patch sensor against skin pigments using a new architecture of electronics with auto-adaptive signal adjustment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Case study; a protocol was designed to investigate the impact of five skin types (white Caucasian, white European, light brown, moderate brown, dark brown) according to Von Luschan’s chromatic scale. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A multi-wavelength opto-electronic patch sensor effectively detected physiological changes against human skin pigments.However, different opto-electronic patch measurement locations on the skin with peripheral blood vessels, optimum wavelength illuminations, motion artifacts, and even electronic noise, can alter the oxygen saturation measurement results. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baek, et al. (2018),<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>Korea. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To design a sensor that prevents direct crosstalk in pulse oximetry reflectance-type sensor through theoretical analysis and experiments. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Crosstalk sensors and crosstalk-free sensors were made, and desaturation experiments were performed with respiratory gas control on subjects with various skin colours to perform oxygen saturation measurements. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The presence of crosstalk increases the probability of error in oxygen saturation measurement depending on skin colour. Most of the errors in oxygen saturation in conventional sensors are due to optical crosstalk that occurs in dark-skinned subjects. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arnaudo, (2019),<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Argentina. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To research the literature for the use of new technologies in neonatal care (NIRS) and the principles on which their operation is based. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Information regarding the use of new technologies (NIRS) in neonatal care was collected, principles on which its operation is based, and nursing care in relation to equipment and newborns. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sensor measurements vary depending on the characteristics of the head, extracranial structures, blood flow and depth of the cerebral surface. In newborn babies, it is possible to measure regional oxygenation of the deepest organs, such as the kidneys or intestines. It is also possible to measure oxygenation of peripheral tissue, such as the forearm, calf, upper arm and thigh. It is recommended to avoid placing the sensor on fatty deposits, hematomas, nerves and dermal lesions, as this can cause erroneous readings. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Santos, et al. (2020),<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Mexico. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To discover the variability of measurements depending on the pulse oximeter used in clinical practice. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A cross-sectional design was used. A desaturation measurement was taken to reduce oxygen saturation to 70% using respiratory gas control. The oxygen saturation measurement results were evaluated, and a comparison was made using sensors with and without crosstalk prevention. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The three oximeters discussed in this study (Onyx II, Hergom and SB220) presented some degree of variability. The SB220 presented wide variability and was not recommended for clinical use. The Onyx II and Hergom maintained accuracy and precision. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sjoding, et al. (2020),<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> USA. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To discover the clinical importance of possible racial bias in pulse oximetry measurement. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paired pulse oximetry measures of oxygen saturation and measures of arterial oxygen saturation in arterial blood gas were analysed, with all evaluations performed within 10 min of each other. To ensure that the arterial oxygen saturation was directly measured by co-oximetry, the analyses were limited to measures of arterial blood gas that included carboxyhaemoglobin and methaemoglobin saturations.They then tested for occult hypoxemia among patients who identified their race as Black or White. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with darker pigmentation (Black) had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as patients with lighter pigmentation (White). Therefore, supplemental oxygen levels may place patients with darker pigmentation at increased risk for hypoxemia. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Puentes, et al. (2020),<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Colombia. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To provide a brief description of non-invasive cerebral oximetry using NIRS technology. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The authors conducted a literature review focused on non-invasive cerebral oximetry using NIRS technology. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Continuous cerebral monitoring via NIRS in paediatric pathologies is aimed at preventing brain damage secondary to hypoxia or ischaemia, however large-scale studies with better designs, such as randomised controlled trials, are needed prior to routine use. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Luks & Swenson, (2020),<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> USA. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To assess the accuracy of monitoring devices and examine the available data on the performance of inexpensive pulse oximeters and smart phone–based systems. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Literature review; the authors reviewed the types of available devices and their operating principles, while also analysing the main tools for assessing the accuracy of monitoring devices. They reviewed some potential pitfalls with pulse oximetry monitoring that could affect accuracy and implementation of a monitoring program. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of the variables that can affect the accuracy of monitoring in pulse oximetry results, they found: position on the haemoglobin-oxygen dissociation curve and some actions that entail ventilation. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bosio, et al. (2021),<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Argentina. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To compare the measurements of two pulse oximeters for assessing oxygenation in patients with pulmonary pathology using CO-oximetry as the reference technique. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plethysmograph sensitivity and specificity was calculated for patients desaturating or not, according to a cut-off point established at 93% for blood gases. Two pulse oximeters were used (first brand: pulse oximeter 1; second brand: pulse oximeter 2). The blood gas sample was taken from the same hand for which the pulse oximetry reading was taken. For patients requiring oxygen, this was removed 20 min prior to the blood draw. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In the comparison of the two pulse oximeters studied, it was found that the pulse oximeter that used only two wavelengths was not able to differentiate between oxyhaemoglobin and carboxyhaemoglobin, and when the latter was at levels greater than 3 to 4%, this generated an oxygen saturation level that was above the percentage of hyperbaric oxygen therapy of the blood. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Michard, et al. (2021),<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> Switzerland. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To describe recent innovations in pulse oximetry that could be useful in coronavirus disease 2019 (COVID-19) patients. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Literature review. Describes the use of a disposable wireless finger sensor that enables continuous oxygen saturation monitoring at home. A command centre receives measurements and alerts via the patient’s smartphone. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">From the home to intensive care units, innovations in pulse oximetry go beyond oxygen saturation monitoring and present the potential to improve the quality of care for patients that develop acute respiratory failure, and particularly those with COVID-19. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kim, et al. (2021),<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Korea. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To measure oxygen saturation via a non-contact method using a red, green, blue camera in an ambient light environment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">They utilized the opposite absorption characteristics of haemoglobin at the green and red wavelengths. The signals were extracted by converting the red, green, blue colour space of the signal extracted from facial images to the colour space. After obtaining each extracted signal, the peak and valley points were found, and the logarithms of the peak/valley ratio were taken. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">When considering the opposite absorption characteristics of haemoglobin in red and green wavelengths, it was possible to identify the behaviour of oxygen saturation according to the light environment.The raw signal contained motion artifacts and noise that could affect the quality of the signal. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dünnwald, et al. (2021),<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Austria. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To provide information on the operation of pulse oximeters, appropriate measurement methods, and published time courses of pulse oximetry data (peripheral oxygen saturation) and heart rate, recorded at rest and submaximal exercise during exposure to various altitudes. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Literature review. The authors considered the basic principles of operation, the most relevant pitfalls, and possible countermeasures for pulse oximetry, particularly concerning healthy people travelling to high altitudes. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">There exist variations in pulse oximetry measures and heart rate during acute exposure and acclimatization to high altitude.The levels of partial pressure of oxygen decrease with acute exposure to altitude/hypoxia and partially recover during acclimatization, whereas the heart rate presents an opposite trend. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wong, et al. (2021),<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> USA. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To examine racial and ethnic discrepancies between oxygen saturation and partial pressure of oxygen measurements and associations with the clinical results. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospitalised adult patients receiving supplemental oxygen and patients in intensive care units from 178 hospitals were studied. The incidence and clinical results of occult hypoxemia were assessed across the racial and ethnic groups (Asian, Black, Hispanic, or White). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">It was shown that all the racial and ethnic groups experienced pulse oximetry discrepancies that resulted in occult hypoxemia; however, this was more frequent in Asian, Black and Hispanic patients than in White patients. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pritišanac, et al. (2021),<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Austria. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To identify studies examining the effect of foetal haemoglobin in pulse oximetry monitoring in full-term and premature newborn babies, between 24 and 42 weeks. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Systematic review, including the following key words: newborn, neonate, premature, term, infant, foetal haemoglobin, after birth, postnatal, oxygenation, arterial oxygen saturation, pulse oximetry, arterial oxygen saturation and oxygen saturation. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">They stated that the presence of foetal haemoglobin in neonate blood affects oxygen saturation readings, resulting in overestimation. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Díaz, et al. (2022),<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Mexico. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To evaluate the influence of organic nail polish on peripheral oxygen saturation measurement in patients undergoing surgery. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical case. Presentation of two patients with organic or vegan nail polish who underwent oxygen saturation measurements using a finger pulse oximeter, first with nail polish on and then after its removal, prior to surgical intervention. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">They concluded that the presence of nail polish influenced the oxygen saturation results. In the two cases analysed, oxygen saturation levels in the presence of polish started in a range of 92% for the first patient and 94% for the second, with increases in saturation after removing the nail polish up to 98% in the first patient and 99% in the second. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cabanas, et al. (2022),<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Chile. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To summarise the literature available in leading scientific databases that examines the impact of skin pigmentation on pulse oximetry. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preferred reporting items were used for systematic reviews and meta-analyses. A total of 41 references were identified that met the established inclusion criteria. A bibliometric and scientometric approach was used to assess the results. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The last studies showed that pulse oximetry devices present some limitations for individuals with darker skin, particularly in conditions of low saturation or hypoxemia. Melanin diminishes the wavelength of incidental light and limits penetration into subcutaneous tissue because it absorbs a lot of light due to darker skin containing more melanin, which results in a higher risk of occult hypoxemia. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Shi, et al, (2022),<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Argentina. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To evaluate the effects of skin pigmentation on oxygen saturation measurement accuracy via pulse oximetry compared to the gold standard, oxygen saturation measured via CO-oximeter. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple databases were searched. Studies were identified that compared oxygen saturation values in any population and care setting, using any type of pulse oximetry equipment, with oxygen saturation via standard Co-oximeter. The impact of skin pigmentation or ethnic origin on pulse oximetry accuracy was measured. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulse oximetry can overestimate oxygen saturation in individuals with dark skin and individuals whose ethnic origin can be described as Black/African American, in comparison to oxygen saturation, although overestimations may be minimal in hospital settings. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stell, et al. (2022),<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> London. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To evaluate the performance characteristics of five portable pulse oximeters and their suitability for deployment in home-use pulse oximetry pathways created during the COVID-19 pandemic. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A total of 915 oxygen saturation measurements, paired with measurements from a hospital-standard pulse oximeter, were taken from 50 patients recruited from respiratory wards and the intensive care units. The effects of device model and several patient characteristics on bias, false negative and false positive likelihood were evaluated using multiple regression analyses. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The five portable pulse oximeters (Oxywatch MD300C19, Oxywatch MD300C29, PC-60 F, Contec CMS50D and AM801) seemed to exceed the standard to which they were manufactured. Device model, patient oxygen saturation, and patient skin colour were significant predictors of measurement bias. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barrera, et al. (2023),<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Argentina. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To discuss the development of a low-cost pulse oximeter featuring a MAX30102 board, an Arduino UNO board and an OLED SS1306 display. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concordance between two quantitative measurement methods was evaluated by comparing a new measurement method (pulse oximeter featuring a MAX30102 board, Arduino UNO board and an OLED SS1306 visor) with a standard method. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">While the presented prototype made the correct calculations, the system’s performance cannot be guaranteed over the long-term. Therefore, it would be advisable to perform a simulation to be able to continuously test the system in its entirety. In terms of oxygen saturation measurements, it can be guaranteed that the results were reliable since the deviation was very slight. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Luna, et al. (2023),<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Bolivia. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To determine phenotypic variations of haemoglobin (Hb), oxygen saturation (SpO2), P50 and lactate in Bolivian Andeans living between 400, 4000 or 5000 m. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral blood was collected from Bolivian Andeans (<span class="elsevierStyleItalic">n</span> = 124) born at 4000 m but living at different altitudes (400 m, 4000 m, 5000 m), as well as those with pathological erythrocytosis. In addition, samples were collected from European individuals living at 4000 m (<span class="elsevierStyleItalic">n</span> = 11). Hemogram, oximetry, and blood gas tests were performed. P50 was calculated with Lichtman’s formula. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oxygen saturation levels showed different variations at different altitudes. Healthy Andean inhabitants, compared among each other at different altitudes, showed lower levels of oxygen saturation as the altitude was higher. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3548636.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Results from the literature search (factors involved in oxygen saturation measurement).</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Factors affecting pulse oximetry accuracy</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SpO<span class="elsevierStyleInf">2</span>Underestimation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SpO<span class="elsevierStyleInf">2</span>Overestimation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PPGDistortion \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral perfusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Skin pigmentation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Motion artifacts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">States of low perfusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemoglobinopathies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Light contamination \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cold skin temperature \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Warm skin temperature \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heart rate of more than 150 beats per minute \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nail polish or tattoos \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Electromagnetic interference (EMI) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypoxemia Anaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sensor placement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Training at high altitude or hypoxia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Henna dye \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3548638.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Factors impacting pulse oximetry accuracy and interpretation of readings.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:56 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nivel de conocimiento del uso del oxímetro de pulso para evaluar hipoxia en presuntos casos Covid-19, en alumnos de la Universidad Norbert Wiener, Lima-2021 [Trabajo de Grado]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.G. 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