{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:40:21Z","timestamp":1787726421322,"version":"build-2784847793"},"reference-count":79,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Commercial pulse oximeters may not be well calibrated for oxygen saturations below 70%, conditions that may be met in high altitude aviation and mountaineering. We therefore examined the bias and variability of heart rate (HR) and blood oxygen saturation (SpO<jats:sub>2<\/jats:sub>) of four different pulse oximeters (PO) at arterial blood oxygen saturation (SaO<jats:sub>2<\/jats:sub>) between 55 and 100%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Seventeen healthy participants (age 33\u2009\u00b1\u200911 (mean\u2009\u00b1\u2009standard deviation (SD)) yr) were exposed to controlled desaturation at rest by stepwise reduction of the oxygen fraction in the breathing air between 20.9 and 8%. Parallel measurements of HR (<jats:italic>n<\/jats:italic>\u2009=\u2009383) and blood oxygen saturation (<jats:italic>n<\/jats:italic>\u2009=\u2009304) from four pulse oximeters (RAD-97, PM100N, M7500 and Nell1-SR) and from reference instruments (by hemoximetry and electrocardiography (ECG)) were taken during the exposure. The validity was assessed in intervals of 55\u201370%, 70\u201385% and 85\u2013100% SaO<jats:sub>2<\/jats:sub> using the Bland-Altman method (bias and 95% limits of agreement (LoA)) and the root mean square error for variability. The demarcation criteria for agreement between methods were \u00b16 percentage points O<jats:sub>2<\/jats:sub>Hb saturation and \u00b16 bpm HR.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>At the 85\u2013100% SaO<jats:sub>2<\/jats:sub> interval, all POs but the Nell1-SR were in agreement with the reference for O<jats:sub>2<\/jats:sub> saturation. Only M7500 agreed with the reference for the 70\u201385% interval and none of the POs were in agreement with the reference for the 55\u201370% interval. The pulse oximeters and ECG were not in agreement for HR at neither the 55\u201370% nor the 85\u2013100% interval but agreed at the 70\u201385% interval except the RAD-97. All pulse oximeters increased the bias or the variability for SpO<jats:sub>2<\/jats:sub> significantly by reductions in oxygen saturation, while no systematic differences were found for HR.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The study shows that medically approved pulse oximeters are not in agreement with reference measurements of neither blood oxygen saturation nor HR at SaO<jats:sub>2<\/jats:sub> levels below 70%, and their readings should therefore be interpreted cautiously during severe desaturation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0326674","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T17:38:37Z","timestamp":1750700317000},"page":"e0326674","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Validity of pulse oximetry measures for heart rate and oxygen saturation during profound hypoxia in normobaric simulated extreme altitudes"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7800-7614","authenticated-orcid":true,"given":"Harald","family":"Vikne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon Arild","family":"Kjeserud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willy","family":"Westgaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Baalsrud Westlie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Ivar","family":"K\u00e5sin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5152-9778","authenticated-orcid":true,"given":"Jon Ingulf","family":"Medb\u00f8","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terje","family":"Gj\u00f8vaag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils Henrik","family":"Holmedahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"issue":"2","key":"pone.0326674.ref001","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S1474-4422(09)70014-6","article-title":"The cerebral effects of ascent to high altitudes","volume":"8","author":"MH Wilson","year":"2009","journal-title":"Lancet Neurol"},{"key":"pone.0326674.ref002","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.neubiorev.2017.01.019","article-title":"Effect of acute hypoxia on cognition: A systematic review and meta-regression analysis","volume":"74","author":"T McMorris","year":"2017","journal-title":"Neurosci Biobehav Rev"},{"issue":"6","key":"pone.0326674.ref003","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1152\/japplphysiol.00169.2017","article-title":"Acute hypoxia in a simulated high-altitude airdrop scenario due to oxygen system failure","volume":"123","author":"W Ottestad","year":"2017","journal-title":"J Appl Physiol (1985)"},{"key":"pone.0326674.ref004","volume-title":"Manual of the ICAO standard atmosphere. Extended to 80 kilometres (262 500 feet)","author":"ICAO","year":"1993"},{"issue":"7165","key":"pone.0326674.ref005","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1136\/bmj.317.7165.1063","article-title":"ABC of oxygen: oxygen at high altitude","volume":"317","author":"AJ Peacock","year":"1998","journal-title":"BMJ"},{"issue":"1","key":"pone.0326674.ref006","doi-asserted-by":"crossref","first-page":"00535","DOI":"10.1183\/23120541.00535-2021","article-title":"Arterial blood gas analysis: as safe as we think? A multicentre historical cohort study","volume":"8","author":"SC Rowling","year":"2022","journal-title":"ERJ Open Res"},{"issue":"4","key":"pone.0326674.ref007","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s00540-003-0192-6","article-title":"Pulse oximetry: its invention, theory, and future","volume":"17","author":"T Aoyagi","year":"2003","journal-title":"J Anesth"},{"issue":"5","key":"pone.0326674.ref008","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s00540-021-02967-z","article-title":"Tribute to Dr. Takuo Aoyagi, inventor of pulse oximetry","volume":"35","author":"K Miyasaka","year":"2021","journal-title":"J Anesth"},{"key":"pone.0326674.ref009","first-page":"231","article-title":"Pulse oximetry: fundamentals and technology update","volume":"7","author":"M Nitzan","year":"2014","journal-title":"Med Devices (Auckl)"},{"issue":"6","key":"pone.0326674.ref010","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/j.rmed.2013.02.004","article-title":"Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations","volume":"107","author":"ED Chan","year":"2013","journal-title":"Respir Med"},{"issue":"10","key":"pone.0326674.ref011","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.1249\/MSS.0000000000001658","article-title":"Pulse oximetry and arterial oxygen saturation during cardiopulmonary exercise testing","volume":"50","author":"M Ascha","year":"2018","journal-title":"Med Sci Sports Exerc"},{"key":"pone.0326674.ref012","doi-asserted-by":"crossref","first-page":"663674","DOI":"10.3389\/fspor.2021.663674","article-title":"Exercise-induced hypoxemia in endurance athletes: consequences for altitude exposure","volume":"3","author":"F Durand","year":"2021","journal-title":"Front Sports Act Living"},{"issue":"3","key":"pone.0326674.ref013","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1089\/152702903769192287","article-title":"Flunarizine in prevention of headache, ataxia, and memory deficits during decompression to 4559 m","volume":"4","author":"RW Baumgartner","year":"2003","journal-title":"High Alt Med Biol"},{"issue":"4","key":"pone.0326674.ref014","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.3390\/s21041263","article-title":"The use of pulse oximetry in the assessment of acclimatization to high altitude","volume":"21","author":"T D\u00fcnnwald","year":"2021","journal-title":"Sensors (Basel)"},{"key":"pone.0326674.ref015","volume-title":"Rad-97\u00ae Pulse CO-Oximeter. Operator\u2019s Manual","author":"Masimo","year":"2020"},{"key":"pone.0326674.ref016","volume-title":"Bedside SpO2 Patient Monitoring System. Operators;s Manual","author":"Covidien","year":"2018"},{"key":"pone.0326674.ref017","volume-title":"Operator\u2019s Manual. Model 7500FO. Pulse Oximeter","author":"Nonin","year":"2019"},{"issue":"3","key":"pone.0326674.ref018","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/ALN.0000000000002002","article-title":"Four types of pulse oximeters accurately detect hypoxia during low perfusion and motion","volume":"128","author":"A Louie","year":"2018","journal-title":"Anesthesiology"},{"issue":"5","key":"pone.0326674.ref019","doi-asserted-by":"crossref","DOI":"10.1088\/1361-6579\/acd51a","article-title":"A review of the effect of skin pigmentation on pulse oximeter accuracy","volume":"44","author":"R Al-Halawani","year":"2023","journal-title":"Physiol Meas"},{"issue":"9","key":"pone.0326674.ref020","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.4187\/respcare.10399","article-title":"Impact of fingernail polish on pulse oximetry measurements: a systematic review","volume":"68","author":"AN Aggarwal","year":"2023","journal-title":"Respir Care"},{"issue":"6","key":"pone.0326674.ref021","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1007\/s10877-023-01029-x","article-title":"Comparative analysis of signal accuracy of three SpO2 monitors during motion and low perfusion conditions","volume":"37","author":"KK Giuliano","year":"2023","journal-title":"J Clin Monit Comput"},{"issue":"4","key":"pone.0326674.ref022","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1007\/s10877-021-00797-8","article-title":"Accuracy of pulse oximeters in measuring oxygen saturation in patients with poor peripheral perfusion: a systematic review","volume":"36","author":"K Poorzargar","year":"2022","journal-title":"J Clin Monit Comput"},{"key":"pone.0326674.ref023","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s12912-018-0283-1","article-title":"Accuracy of pulse oximetry in detection of oxygen saturation in patients admitted to the intensive care unit of heart surgery: comparison of finger, toe, forehead and earlobe probes","volume":"17","author":"S Seifi","year":"2018","journal-title":"BMC Nurs"},{"key":"pone.0326674.ref024","doi-asserted-by":"crossref","DOI":"10.1213\/01.ane.0000285988.35174.d9","article-title":"Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender","volume":"105","author":"JR Feiner","year":"2007","journal-title":"Anesth Analg"},{"issue":"4","key":"pone.0326674.ref025","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1378\/chest.114.4.1036","article-title":"Pulse oximetry in severe carbon monoxide poisoning","volume":"114","author":"NB Hampson","year":"1998","journal-title":"Chest"},{"issue":"1","key":"pone.0326674.ref026","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1213\/ANE.0b013e3181c91bb6","article-title":"Accuracy of methemoglobin detection by pulse CO-oximetry during hypoxia","volume":"111","author":"JR Feiner","year":"2010","journal-title":"Anesth Analg"},{"issue":"4","key":"pone.0326674.ref027","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1213\/ANE.0b013e31828610a0","article-title":"Accuracy of carboxyhemoglobin detection by pulse CO-oximetry during hypoxemia","volume":"117","author":"JR Feiner","year":"2013","journal-title":"Anesth Analg"},{"issue":"6","key":"pone.0326674.ref028","article-title":"Comparative evaluation of accuracy of pulse oximeters and factors affecting their performance in a tertiary intensive care unit","volume":"11","author":"AK Singh","year":"2017","journal-title":"J Clin Diagn Res"},{"key":"pone.0326674.ref029","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1471-227X-10-9","article-title":"The accuracy of pulse oximetry in emergency department patients with severe sepsis and septic shock: a retrospective cohort study","volume":"10","author":"BJ Wilson","year":"2010","journal-title":"BMC Emerg Med"},{"key":"pone.0326674.ref030","doi-asserted-by":"crossref","DOI":"10.1213\/01.ane.0000268495.35207.ab","article-title":"Maximizing the laboratory setting for testing devices and understanding statistical output in pulse oximetry","volume":"105","author":"PB Batchelder","year":"2007","journal-title":"Anesth Analg"},{"issue":"3","key":"pone.0326674.ref031","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.vaa.2019.08.051","article-title":"Evaluation of the reliability of pulse oximetry, at different attachment sites, to detect hypoxaemia in immobilized impala (Aepyceros melampus)","volume":"47","author":"TK Mtetwa","year":"2020","journal-title":"Vet Anaesth Analg"},{"issue":"5","key":"pone.0326674.ref032","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/j.1467-2995.2005.00271.x","article-title":"Accuracy of a third (Dolphin Voyager) versus first generation pulse oximeter (Nellcor N-180) in predicting arterial oxygen saturation and pulse rate in the anesthetized dog","volume":"33","author":"PM Burns","year":"2006","journal-title":"Vet Anaesth Analg"},{"issue":"2","key":"pone.0326674.ref033","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.slsci.2014.09.003","article-title":"Sleep apnea and oxygen saturation in adults at 2640 m above sea level","volume":"7","author":"MA Bazurto Zapata","year":"2014","journal-title":"Sleep Sci"},{"issue":"9","key":"pone.0326674.ref034","doi-asserted-by":"crossref","first-page":"857","DOI":"10.3357\/ASEM.2640.2010","article-title":"Hypoxia awareness training for aircrew: a comparison of two techniques","volume":"81","author":"B Singh","year":"2010","journal-title":"Aviat Space Environ Med"},{"issue":"10","key":"pone.0326674.ref035","doi-asserted-by":"crossref","first-page":"785","DOI":"10.3357\/AMHP.5634.2020","article-title":"Psychophysiological responses of pilots in hypoxia training at 7000 and 7500 m","volume":"91","author":"D Wen","year":"2020","journal-title":"Aerospace Med Human Perf"},{"issue":"5","key":"pone.0326674.ref036","doi-asserted-by":"crossref","DOI":"10.1093\/jtm\/tax041","article-title":"Oxygen saturation increases over the course of the night in mountaineers at high altitude (3050-6354 m)","volume":"24","author":"M Tannheimer","year":"2017","journal-title":"J Travel Med"},{"issue":"4","key":"pone.0326674.ref037","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1152\/jappl.1988.64.4.1309","article-title":"Operation Everest II: oxygen transport during exercise at extreme simulated altitude","volume":"64","author":"JR Sutton","year":"1988","journal-title":"J Appl Physiol (1985)"},{"issue":"1","key":"pone.0326674.ref038","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3357\/AMHP.4335.2016","article-title":"Physiological and cognitive effects of acute normobaric hypoxia and modulations from oxygen breathing","volume":"87","author":"C Malle","year":"2016","journal-title":"Aerosp Med Hum Perform"},{"issue":"3","key":"pone.0326674.ref039","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1183\/20734735.001415","article-title":"Relating oxygen partial pressure, saturation and content: the haemoglobin-oxygen dissociation curve","volume":"11","author":"J-A Collins","year":"2015","journal-title":"Breathe (Sheff)"},{"issue":"8476","key":"pone.0326674.ref040","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"1","author":"JM Bland","year":"1986","journal-title":"Lancet"},{"issue":"1","key":"pone.0326674.ref041","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s10877-014-9577-3","article-title":"Improvements in the application and reporting of advanced Bland-Altman methods of comparison","volume":"29","author":"E Olofsen","year":"2015","journal-title":"J Clin Monit Comput"},{"issue":"4","key":"pone.0326674.ref042","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1080\/10543400701329422","article-title":"Agreement between methods of measurement with multiple observations per individual","volume":"17","author":"JM Bland","year":"2007","journal-title":"J Biopharm Stat"},{"issue":"2","key":"pone.0326674.ref043","article-title":"Sample size for assessing agreement between two methods of measurement by Bland-Altman method","volume":"12","author":"MJ Lu","year":"2016","journal-title":"Int J Biostat"},{"key":"pone.0326674.ref044","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/1471-2288-8-63","article-title":"Reliability and validity of the international physical activity questionnaire in the Nord-Tr\u00f8ndelag health study (HUNT) population of men","volume":"8","author":"N Kurtze","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"pone.0326674.ref045","volume-title":"ROBD2 - Reduced Oxygen Breathing Device 2. Programming and Technical Guide","author":"Environics","year":"2013"},{"issue":"9","key":"pone.0326674.ref046","doi-asserted-by":"crossref","first-page":"902","DOI":"10.3357\/ASEM.3046.2012","article-title":"An independent, objective calibration check for the reduced oxygen breathing device","volume":"83","author":"DL Still","year":"2012","journal-title":"Aviat Space Environ Med"},{"issue":"1","key":"pone.0326674.ref047","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s10877-019-00289-w","article-title":"Measuring arterial oxygen saturation from an intraosseous photoplethysmographic signal derived from the sternum","volume":"34","author":"E N\u00e4slund","year":"2020","journal-title":"J Clin Monit Comput"},{"issue":"6","key":"pone.0326674.ref048","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1093\/bja\/aeu095","article-title":"Feasibility and accuracy of nasal alar pulse oximetry","volume":"112","author":"TE Morey","year":"2014","journal-title":"Br J Anaesth"},{"issue":"5","key":"pone.0326674.ref049","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/bja\/aew320","article-title":"Reporting of method comparison studies: a review of advice, an assessment of current practice, and specific suggestions for future reports","volume":"117","author":"A Abu-Arafeh","year":"2016","journal-title":"Br J Anaesth"},{"issue":"11","key":"pone.0326674.ref050","doi-asserted-by":"crossref","first-page":"2216","DOI":"10.1373\/clinchem.2004.036095","article-title":"Interpreting method comparison studies by use of the bland-altman plot: reflecting the importance of sample size by incorporating confidence limits and predefined error limits in the graphic","volume":"50","author":"D St\u00f6ckl","year":"2004","journal-title":"Clin Chem"},{"key":"pone.0326674.ref051","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.resp.2007.03.011","article-title":"The role of hemoglobin oxygen affinity in oxygen transport at high altitude","volume":"158","author":"RM Winslow","year":"2007","journal-title":"Respir Physiol Neurobiol"},{"key":"pone.0326674.ref052","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1164\/ajrccm.160.5.9806006","article-title":"Arterial blood gas reference values for sea level and an altitude of 1,400 meters","volume":"160","author":"RO Crapo","year":"1999","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0326674.ref053","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S1569-9048(03)00048-X","article-title":"Variation in human ventilatory control-genetic influence on the hypoxic ventilatory response","volume":"135","author":"JV Weil","year":"2003","journal-title":"Respir Physiol Neurobiol"},{"issue":"2","key":"pone.0326674.ref054","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1152\/physrev.00012.2009","article-title":"The ventilatory response to hypoxia in mammals: mechanisms, measurement, and analysis","volume":"90","author":"LJ Teppema","year":"2010","journal-title":"Physiol Rev"},{"issue":"6","key":"pone.0326674.ref055","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1152\/jappl.1967.22.6.1124","article-title":"Cardiopulmonary responses of resting man during early exposure to high altitude","volume":"22","author":"JA Vogel","year":"1967","journal-title":"J Appl Physiol"},{"issue":"3","key":"pone.0326674.ref056","doi-asserted-by":"crossref","DOI":"10.1111\/apha.13779","article-title":"Regulation of heart rate in vertebrates during hypoxia: A comparative overview","volume":"234","author":"W Joyce","year":"2022","journal-title":"Acta Physiol (Oxf)"},{"issue":"2","key":"pone.0326674.ref057","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.bjae.2019.10.004","article-title":"Detection and response to acute systemic hypoxia","volume":"20","author":"AD Kane","year":"2020","journal-title":"BJA Educ"},{"issue":"4","key":"pone.0326674.ref058","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/j.1365-2044.2011.07021.x","article-title":"An assessment of the accuracy of pulse oximeters","volume":"67","author":"QJW Milner","year":"2012","journal-title":"Anaesthesia"},{"issue":"3","key":"pone.0326674.ref059","doi-asserted-by":"crossref","first-page":"371","DOI":"10.17085\/apm.20028","article-title":"Performance of the MP570T pulse oximeter in volunteers participating in the controlled desaturation study: a comparison of seven probes","volume":"15","author":"B-M Choi","year":"2020","journal-title":"Anesth Pain Med (Seoul)"},{"key":"pone.0326674.ref060","doi-asserted-by":"crossref","first-page":"105051","DOI":"10.1016\/j.ebiom.2024.105051","article-title":"The performance of 11 fingertip pulse oximeters during hypoxemia in healthy human participants with varied, quantified skin pigment","volume":"102","author":"G Leeb","year":"2024","journal-title":"EBioMedicine"},{"issue":"4","key":"pone.0326674.ref061","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/PCC.0000000000000660","article-title":"Accuracy of pulse oximeters intended for hypoxemic pediatric patients","volume":"17","author":"BU Harris","year":"2016","journal-title":"Pediatr Crit Care Med"},{"issue":"5","key":"pone.0326674.ref062","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1001\/jamapediatrics.2023.0071","article-title":"Evaluating the accuracy of pulse oximetry in children according to race","volume":"177","author":"H Ruppel","year":"2023","journal-title":"JAMA Pediatr"},{"issue":"1","key":"pone.0326674.ref063","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1183\/09031936.93.04010115","article-title":"Accuracy and precision of fourteen pulse oximeters","volume":"4","author":"B Hannhart","year":"1991","journal-title":"Eur Respir J"},{"issue":"4","key":"pone.0326674.ref064","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/00000542-198710000-00017","article-title":"Accuracy of response of six pulse oximeters to profound hypoxia","volume":"67","author":"JW Severinghaus","year":"1987","journal-title":"Anesthesiology"},{"issue":"2","key":"pone.0326674.ref065","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1007\/BF01617877","article-title":"Errors in 14 pulse oximeters during profound hypoxia","volume":"5","author":"JW Severinghaus","year":"1989","journal-title":"J Clin Monit"},{"issue":"4","key":"pone.0326674.ref066","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/00000542-200504000-00004","article-title":"Effects of skin pigmentation on pulse oximeter accuracy at low saturation","volume":"102","author":"PE Bickler","year":"2005","journal-title":"Anesthesiology"},{"issue":"9","key":"pone.0326674.ref067","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1177\/08850666231185752","article-title":"Everything about pulse oximetry-part 1: history, principles, advantages, limitations, inaccuracies, cost analysis, the level of knowledge about pulse oximeter among clinicians, and pulse oximetry versus tissue oximetry","volume":"38","author":"K Tekin","year":"2023","journal-title":"J Intensive Care Med"},{"issue":"17","key":"pone.0326674.ref068","doi-asserted-by":"crossref","first-page":"4844","DOI":"10.3390\/s20174844","article-title":"The various oximetric techniques used for the evaluation of blood oxygenation","volume":"20","author":"M Nitzan","year":"2020","journal-title":"Sensors (Basel)"},{"issue":"1","key":"pone.0326674.ref069","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0735-6757(99)90019-0","article-title":"Pulse oximetry: principles and limitations","volume":"17","author":"JE Sinex","year":"1999","journal-title":"Am J Emerg Med"},{"key":"pone.0326674.ref070","doi-asserted-by":"crossref","DOI":"10.1213\/01.ane.0000268713.58174.cc","article-title":"Hemoximetry as the \u201cgold standard\u201d? Error assessment based on differences among identical blood gas analyzer devices of five manufacturers","volume":"105","author":"H Gehring","year":"2007","journal-title":"Anesth Analg"},{"issue":"9","key":"pone.0326674.ref071","doi-asserted-by":"crossref","first-page":"90901","DOI":"10.1117\/1.JBO.17.9.090901","article-title":"Optical properties of human skin","volume":"17","author":"T Lister","year":"2012","journal-title":"J Biomed Opt"},{"issue":"2","key":"pone.0326674.ref072","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/BF02828282","article-title":"Effect of anemia on pulse oximeter accuracy at low saturation","volume":"6","author":"JW Severinghaus","year":"1990","journal-title":"J Clin Monit"},{"issue":"1","key":"pone.0326674.ref073","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.resuscitation.2006.06.024","article-title":"Effect of nail polish on oxygen saturation determined by pulse oximetry in critically ill patients","volume":"72","author":"J Hinkelbein","year":"2007","journal-title":"Resuscitation"},{"issue":"6","key":"pone.0326674.ref074","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s10877-023-01060-y","article-title":"Optical crosstalk and other forms of light interference in pulse oximeter comparison studies","volume":"37","author":"PA Kyriacou","year":"2023","journal-title":"J Clin Monit Comput"},{"issue":"4","key":"pone.0326674.ref075","doi-asserted-by":"crossref","first-page":"357","DOI":"10.3233\/NPM-16162","article-title":"Alarms, oxygen saturations, and SpO2 averaging time in the NICU","volume":"9","author":"C McClure","year":"2016","journal-title":"J Neonatal Perinatal Med"},{"key":"pone.0326674.ref076","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1186\/s40064-015-1360-5","article-title":"Comparison of SpO2 values from different fingers of the hands","volume":"4","author":"G Basaranoglu","year":"2015","journal-title":"Springerplus"},{"issue":"7","key":"pone.0326674.ref077","article-title":"How well are pulses measured? Practice-based evidence from an observational study of acutely ill medical patients during hospital admission","volume":"130","author":"Kitovu Hospital Study Group","year":"2017","journal-title":"Am J Med"},{"issue":"10","key":"pone.0326674.ref078","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1111\/apa.12329","article-title":"Comparison of heart rate and oxygen saturation measurements from Masimo and Nellcor pulse oximeters in newly born term infants","volume":"102","author":"JA Dawson","year":"2013","journal-title":"Acta Paediatr"},{"key":"pone.0326674.ref079","doi-asserted-by":"crossref","first-page":"104086","DOI":"10.1016\/j.resp.2023.104086","article-title":"Ventilatory function and oxygen delivery at high altitude in the Himalayas","volume":"314","author":"P Prosperi","year":"2023","journal-title":"Respir Physiol Neurobiol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326674","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T17:38:57Z","timestamp":1750700337000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326674"}},"subtitle":[],"editor":[{"given":"Agnese","family":"Sbrollini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":79,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0326674","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]}}}