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Principal Investigator: Mariana Gross Figueiro
Organization: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Fiscal Year: 2024
Award: $652,377
Funding agency: National Institute of Biomedical Imaging and Bioengineering
Project Summary
Pulse oximeters are essential for physicians’ diagnosis and monitoring of respiratory anomalies in patients.
During the COVID-19 pandemic, their importance has grown because pulse-oximeter measurements of
hypoxemia have become the major indication for hospitalizing patients. Clinical studies have shown that
commercially available pulse oximeter measurements (SpO2) systematically overestimate true arterial oxygen
saturation measurements (SaO2) for persons with dark skin pigmentation at low concentrations of O2 in the blood.
This bias results in respiratory compromised persons with dark skin not meeting criteria for hospitalization or
initiation of ventilator support, thereby putting specific populations (Black, Latinx, and Native American) at
disproportionately greater risk for higher mortality or morbidity than those with light skin. No published
explanations exist for this well-documented observation and, indeed, the available literature often contrarily
states that pulse oximeter measurements are not affected by skin pigmentation. Our theoretical analysis and
pilot research, however, demonstrate that the bias is due to present-day devices’ use of red light-emitting diode
light sources, whose broad spectral bandwidth interacts with the spectral absorption of melanin concentration in
skin to systematically shift the devices’ calibration. This shift causes artificially high values of SpO2 at low blood
concentrations of O2 for patients with dark skin. The 3 proposed aims will extend our efforts to date, providing a
scientific foundation for eliminating this bias and to foster development and promotion of simple, inexpensive,
and bias-free pulse oximeters. In Aim 1, we will: (a) determine if there are other spectrally-dependent constituents
in the finger that change with each pulse; (b) determine how light-source bandwidth interacts with melanin,
including whether there are other pulse-dependent changes in spectral transmission through the fingers, and
how sensitive SpO2 measurements are to light source bandwidth; (c) specify the practical peak wavelength and
spectral bandwidth needed for bias-free pulse oximetry; and (d) fabricate an optimized light source that provides
bias-free pulse oximeter measurements for testing in Aim 2. In Aim 2, we will demonstrate that the finger probe
developed in Aim 1d provides bias-free pulse oximeter measurements (SpO2) that do not overestimate true
arterial oxygen saturation measurements (SaO2) for persons with dark skin pigmentation at low blood
concentrations of O2. In Aim 3, which will not employ human subjects as in Aims 1 and 2, we will translate our
findings (i.e., print, in-person, and social media) to physicians, hospitals, and health care facilities commonly
serving underrepresented minority populations. As part of Aim 3, in collaboration with a Stakeholder Board
convened by the Institute for Health Equity Research, we will target the medical and affected communities to
mitigate the impact of current devices through educational outreach and introduce them to bias-free pulse
oximeters once they are available. Finally, we will license the technology to major manufacturers of pulse
oximeters, giving preference to those who supply hospitals and clinics serving disadvantaged populations.
Terms: <Advocate><Affect><Air><Black><Black race><Blood><Blood Reticuloendothelial System><Breathing><COVID crisis><COVID epidemic><COVID infected patient><COVID pandemic><COVID patient><COVID positive patient><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 infected patient><COVID-19 pandemic><COVID-19 patient><COVID-19 period><COVID-19 positive patient><COVID-19 public health crisis><COVID-19 years><COVID19 patient><COVID19 positive patient><Calibration><Catheters><Clinical Research><Clinical Study><Clinics and Hospitals><Clinics or Hospitals><Collaborations><Communities><Darkness><Data><Development><Devices><Diagnosis><Diagnostic><Disparate><Disparity population><ED Physician><ER physician><Education and Outreach><Emergency Department Physician><Emergency Physician><Emergency room physician><Fingers><Fostering><Foundations><Health Facilities><Health care facility><Health equity research><Healthcare Facility><Home><Hospital Admission><Hospital Supply><Hospitalization><Hospitals><Hypoxemia><Individuals from minority><Individuals of minority><Institution><Instruction and Outreach><Latine><Latinx><Licensing><Light><Light Reflection Rheography><Literature><Manufacturer><Marketing><Measurement><Measures><Medical><Melanins><Methodology><Minority Groups><Minority People><Minority Population><Minority individual><Modeling><Monitor><Morbidity><Morbidity - disease rate><Native American group><Native American individual><Native American people><Native American population><Native Americans><O element><O2 element><Oximetry><Oxygen><Oxygen saturation measurement><Patients><Persons><Photoplethysmography><Photoradiation><Photoreflexometries><Photoreflexometry><Physicians><Physiologic pulse><Pilot Projects><Play><Policies><Population><Population Heterogeneity><Printing><Provider><Publishing><Pulse><Pulse Oximetry><Radial><Radius><Research><Research in health equity><Respiratory Aspiration><Respiratory Inspiration><Risk><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 infected patient><SARS-CoV-2 pandemic><SARS-CoV-2 patient><SARS-CoV-2 positive patient><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Skin><Skin Pigmentation><Source><Specific qualifier value><Specified><Systematic Bias><Technology><Testing><Therapeutic><Training and Outreach><Translating><Transmission><Tutoring and Outreach><Underrepresented Ethnic Minority><Underrepresented Minority><Ventilator><absorption><care facilities><clinical practice><cohort><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 infected patient><coronavirus disease 2019 pandemic><coronavirus disease 2019 patient><coronavirus disease 2019 positive patient><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease infected patient><coronavirus disease pandemic><coronavirus disease patient><coronavirus disease positive patient><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus disease-19 patient><coronavirus patient><cost><developmental><disadvantaged group><disadvantaged individual><disadvantaged people><disadvantaged population><disadvantaged subgroup><disparities across groups><disparity across subgroups><disparity among groups><disparity among subgroups><disparity between groups><disparity between subgroups><diverse populations><group disparity><group inequality><group inequity><health equity><health equity-focused research><heterogeneous population><high risk><homes><hospital care><human subject><hypoxemic><improved><inequalities among populations><inequalities between populations><inequalities in populations><inequality across populations><inequality among groups><inequality between groups><inequality in groups><inequities among populations><inequities between populations><inequities in populations><inequity across groups><inequity across populations><inequity between groups><inequity in groups><inspiration><light emission><member><mortality><operation><operations><pandemic><pandemic disease><patient infected with COVID><patient infected with COVID-19><patient infected with SARS-CoV-2><patient infected with coronavirus disease><patient infected with coronavirus disease 2019><patient infected with severe acute respiratory syndrome coronavirus 2><patient with COVID><patient with COVID-19><patient with COVID19><patient with SARS-CoV-2><patient with coronavirus disease><patient with coronavirus disease 2019><patient with severe acute respiratory distress syndrome coronavirus 2><pilot study><population diversity><population inequality><population inequity><preference><prototype><research on health equity><research related to health equity><research to attain health equity><respiratory><sensor><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><severe acute respiratory syndrome coronavirus 2 infected patient><severe acute respiratory syndrome coronavirus 2 patient><severe acute respiratory syndrome coronavirus 2 positive patient><social media><social role><subgroup disparity><tool><transmission process><under-representation of minorities><under-represented minority><underrepresentation of minorities><unequal group><unequal population>