Research Article
No access
Published Online: 30 June 2011

Pulse Oximetry at High Altitude

Publication: High Altitude Medicine & Biology
Volume 12, Issue Number 2

Abstract

Luks, Andrew M., Erik R. Swenson. Clinician's corner: pulse oximetry at high altitude. High Alt. Med. Biol. 12:109–119, 2011.—Pulse oximetry is a valuable, noninvasive, diagnostic tool for the evaluation of ill individuals at high altitude and is also being increasingly used to monitor the well-being of individuals traveling on high altitude expeditions. Although the devices are simple to use, data output may be inaccurate or hard to interpret in certain situations, which could lead to inappropriate clinical decisions. The purpose of this review is to consider such issues in greater detail. After examining the operating principles of pulse oximetry, we describe the available devices and the potential uses of oximetry at high altitude. We then consider the pitfalls of pulse oximetry in this environment and provide recommendations about how to deal with these issues. Device users should recognize that oxygen saturation changes rapidly in response to small changes in oxygen tensions at high altitude and that device accuracy declines with arterial oxygen saturations of less than 80%. The normal oxygen saturation at a given elevation may not be known with certainty and should be viewed as a range of values, rather than a specific number. For these reasons, clinical decisions should not be based on small differences in saturation over time or among individuals. Effort should also be made to minimize factors that cause measurement errors, including cold extremities, excess ambient light, and ill-fitting oximeter probes. Attention to these and other issues will help the users of these devices to apply them in appropriate situations and to minimize erroneous clinical decisions.

Get full access to this article

View all available purchase options and get full access to this article.

References

Agostoni P.Caldara G.Bussotti M.Revera M.Valentini M.Gregorini F.Faini A.Lombardi C.Bilo G.Giuliano A. et al.2010. Continuous positive airway pressure increases haemoglobin O2 saturation after acute but not prolonged altitude exposureEur. Heart J.31457-463. Agostoni P., Caldara G., Bussotti M., Revera M., Valentini M., Gregorini F., Faini A., Lombardi C., Bilo G., Giuliano A., et al. (2010). Continuous positive airway pressure increases haemoglobin O2 saturation after acute but not prolonged altitude exposure. Eur. Heart J. 31:457–463.
Baggish A.L.Fulco C.S.Muza S.Rock P.B.Beidleman B.Cymerman A.Yared K.Fagenholz P.Systrom D.Wood M.J. et al.2010. The impact of moderate-altitude staging on pulmonary arterial hemodynamics after ascent to high altitudeHigh Alt. Med. Biol.11139-145. Baggish A.L., Fulco C.S., Muza S., Rock P.B., Beidleman B., Cymerman A., Yared K., Fagenholz P., Systrom D., Wood M.J., et al. (2010). The impact of moderate-altitude staging on pulmonary arterial hemodynamics after ascent to high altitude. High Alt. Med. Biol. 11:139–145.
Bailey D.M.Davies B.2001. Acute mountain sickness: prophylactic benefits of antioxidant vitamin supplementation at high altitudeHigh Alt. Med. Biol.221-29. Bailey D.M., and Davies B. (2001). Acute mountain sickness: prophylactic benefits of antioxidant vitamin supplementation at high altitude. High Alt. Med. Biol. 2:21–29.
Bartsch P.Maggiorini M.Ritter M.Noti C.Vock P.Oelz O.1991. Prevention of high-altitude pulmonary edema by nifedipineN. Eng. J. Med.3251284-1289. Bartsch P., Maggiorini M., Ritter M., Noti C., Vock P., and Oelz O. (1991). Prevention of high-altitude pulmonary edema by nifedipine. N. Eng. J. Med. 325:1284–1289.
Bartsch P.Waber U.Haeberli A.Maggiorini M.Kriemler S.Oelz O.Straub W.P.1987. Enhanced fibrin formation in high-altitude pulmonary edemaJ. Appl. Physiol.63752-757. Bartsch P., Waber U., Haeberli A., Maggiorini M., Kriemler S., Oelz O., and Straub W.P. (1987). Enhanced fibrin formation in high-altitude pulmonary edema. J. Appl. Physiol. 63:752–757.
Basnyat B.Hargrove J.Holck P.S.Srivastav S.Alekh K.Ghimire L.V.Pandey K.Griffiths A.Shankar R.Kaul K. et al.2008. Acetazolamide fails to decrease pulmonary artery pressure at high altitude in partially acclimatized humansHigh Alt. Med. Biol.9209-2016. Basnyat B., Hargrove J., Holck P.S., Srivastav S., Alekh K., Ghimire L.V., Pandey K., Griffiths A., Shankar R., Kaul K., et al. (2008). Acetazolamide fails to decrease pulmonary artery pressure at high altitude in partially acclimatized humans. High Alt. Med. Biol. 9:209–2016.
Basnyat B.Lemaster J.Litch J.A.1999. Everest or bust: a cross sectional, epidemiological study of acute mountain sickness at 4243 meters in the HimalayasAviat. Space Environ. Med.70867-873. Basnyat B., Lemaster J., and Litch J.A. (1999). Everest or bust: a cross sectional, epidemiological study of acute mountain sickness at 4243 meters in the Himalayas. Aviat. Space Environ. Med. 70:867–873.
Bickler P.E.Feiner J.R.Severinghaus J.W.2005. Effects of skin pigmentation on pulse oximeter accuracy at low saturationAnesthesiology.102715-719. Bickler P.E., Feiner J.R., and Severinghaus J.W. (2005). Effects of skin pigmentation on pulse oximeter accuracy at low saturation. Anesthesiology. 102:715–719.
Bosch M.M.Merz T.M.Barthelmes D.Petrig B.L.Truffer F.Bloch K.E.Turk A.Maggiorini M.Hess T.Schoch O.D. et al.2009. New insights into ocular blood flow at very high altitudesJ. Appl. Physiol.106454-460. Bosch M.M., Merz T.M., Barthelmes D., Petrig B.L., Truffer F., Bloch K.E., Turk A., Maggiorini M., Hess T., Schoch O.D., et al. (2009). New insights into ocular blood flow at very high altitudes. J. Appl. Physiol. 106:454–460.
Burtscher M.Flatz M.Faulhaber M.2004. Prediction of susceptibility to acute mountain sickness by SaO2 values during short-term exposure to hypoxiaHigh Alt. Med. Biol.5335-340. Burtscher M., Flatz M., and Faulhaber M. (2004). Prediction of susceptibility to acute mountain sickness by SaO2 values during short-term exposure to hypoxia. High Alt. Med. Biol. 5:335–340.
Davies A.J.Kalson N.S.Stokes S.Earl M.D.Whitehead A.G.Frost H.Tyrell-Marsh I.Naylor J.2009. Determinants of summiting success and acute mountain sickness on Mt. Kilimanjaro (5895 m)Wilderness Environ. Med.20311-317. Davies A.J., Kalson N.S., Stokes S., Earl M.D., Whitehead A.G., Frost H., Tyrell-Marsh I., and Naylor J. (2009). Determinants of summiting success and acute mountain sickness on Mt. Kilimanjaro (5895 m). Wilderness Environ. Med. 20:311–317.
Dehnert C.Luks A.M.Schendler G.Menold E.Berger M.M.Mairbaurl H.Faoro V.Bailey D.M.Castell C.Hahn G. et al.2010. No evidence for interstitial lung oedema by extensive pulmonary function testing at 4,559 mEur. Respir. J.35812-820. Dehnert C., Luks A.M., Schendler G., Menold E., Berger M.M., Mairbaurl H., Faoro V., Bailey D.M., Castell C., Hahn G., et al. (2010). No evidence for interstitial lung oedema by extensive pulmonary function testing at 4,559 m. Eur. Respir. J. 35:812–820.
Dine C.J.Kreider M.E.2008. Hypoxia altitude simulation testChest.1331002-1005. Dine C.J., and Kreider M.E. (2008). Hypoxia altitude simulation test. Chest. 133:1002–1005.
Fagenholz P.J.Gutman J.A.Murray A.F.Harris N.S.2007. Treatment of high altitude pulmonary edema at 4240 m in NepalHigh Alt. Med. Biol.8139-146. Fagenholz P.J., Gutman J.A., Murray A.F., and Harris N.S. (2007). Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Alt. Med. Biol. 8:139–146.
Fagenholz P.J.Gutman J.A.Murray A.F.Noble V.E.Camargo C.A. Jr.Harris N.S.2009. Optic nerve sheath diameter correlates with the presence and severity of acute mountain sickness: evidence for increased intracranial pressureJ. Appl. Physiol.1061207-1211. Fagenholz P.J., Gutman J.A., Murray A.F., Noble V.E., Camargo C.A. Jr., and Harris N.S. (2009). Optic nerve sheath diameter correlates with the presence and severity of acute mountain sickness: evidence for increased intracranial pressure. J. Appl. Physiol. 106:1207–1211.
Feiner J.R.Severinghaus J.W.Bickler P.E.2007. Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and genderAnesth. Analg.105S18-S23, tables of contents. Feiner J.R., Severinghaus J.W., and Bickler P.E. (2007). Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesth. Analg. 105:S18–S23, tables of contents.
Foutch R.G.Henrichs W.1988. Carbon monoxide poisoning at high altitudesAm. J. Emerg. Med.6596-598. Foutch R.G., and Henrichs W. (1988). Carbon monoxide poisoning at high altitudes. Am. J. Emerg. Med. 6:596–598.
Ghofrani H.A.Reichenberger F.Kohstall M.G.Mrosek E.H.Seeger T.Olschewski H.Seeger W.Grimminger F.2004. Sildenafil increased exercise capacity during hypoxia at low altitudes and at Mount Everest base camp: a randomized, double-blind, placebo-controlled crossover trialAnn. Intern. Med.141169-177. Ghofrani H.A., Reichenberger F., Kohstall M.G., Mrosek E.H., Seeger T., Olschewski H., Seeger W., and Grimminger F. (2004). Sildenafil increased exercise capacity during hypoxia at low altitudes and at Mount Everest base camp: a randomized, double-blind, placebo-controlled crossover trial. Ann. Intern. Med. 141:169–177.
Grocott M.P.Martin D.S.Levett D.Z.McMorrow R.Windsor J.Montgomery H.E.2009. Arterial blood gases and oxygen content in climbers on Mount EverestN. Engl. J. Med.360140-149. Grocott M.P., Martin D.S., Levett D.Z., McMorrow R., Windsor J., and Montgomery H.E. (2009). Arterial blood gases and oxygen content in climbers on Mount Everest. N. Engl. J. Med. 360:140–149.
Howell M.2002. Pulse oximetry: an audit of nursing and medical staff understandingBr. J. Nurs.11191-197. Howell M. (2002). Pulse oximetry: an audit of nursing and medical staff understanding. Br. J. Nurs. 11:191–197.
Hupperets M.D.Hopkins S.R.Pronk M.G.Tiemessen I.J.Garcia N.Wagner P.D.Powell F.L. Increased hypoxic ventilatory response during 8 weeks at 3800 m altitudeRespir Physiol Neurobiol1422-3145-152. Hupperets M.D., Hopkins S.R., Pronk M.G., Tiemessen I.J., Garcia N., Wagner, P.D., Powell, F.L. Increased hypoxic ventilatory response during 8 weeks at 3800 m altitude. Respir Physiol Neurobiol 142(2-3):145–152.
Jubran A.2004. Pulse oximetryIntensive Care Med.302017-2020. Jubran A. (2004). Pulse oximetry. Intensive Care Med. 30:2017–2020.
Kaminsky D.A.Jones K.Schoene R.B.Voelkel N.F.1996. Urinary leukotriene E4 levels in high-altitude pulmonary edema: a possible role for inflammationChest.110939-945. Kaminsky D.A., Jones K., Schoene R.B., and Voelkel N.F. (1996). Urinary leukotriene E4 levels in high-altitude pulmonary edema: a possible role for inflammation. Chest. 110:939–945.
Karinen H.M.Peltonen J.E.Kahonen M.Tikkanen H.O.2010. Prediction of acute mountain sickness by monitoring arterial oxygen saturation during ascentHigh Alt. Med. Biol.11325-332. Karinen H.M., Peltonen J.E., Kahonen M., and Tikkanen H.O. (2010). Prediction of acute mountain sickness by monitoring arterial oxygen saturation during ascent. High Alt. Med. Biol. 11:325–332.
Kayser B.Hulsebosch R.Bosch F.2008. Low-dose acetylsalicylic acid analog and acetazolamide for prevention of acute mountain sicknessHigh Alt. Med. Biol.915-23. Kayser B., Hulsebosch R., and Bosch F. (2008). Low-dose acetylsalicylic acid analog and acetazolamide for prevention of acute mountain sickness. High Alt. Med. Biol. 9:15–23.
Koehle M.S.Guenette J.A.Warburton D.E.2010. Oximetry, heart rate variability, and the diagnosis of mild-to-moderate acute mountain sicknessEur. J. Emerg. Med.17119-122. Koehle M.S., Guenette J.A., and Warburton D.E. (2010). Oximetry, heart rate variability, and the diagnosis of mild-to-moderate acute mountain sickness. Eur. J. Emerg. Med. 17:119–122.
Kriemler S.Jansen C.Linka A.Kessel-Schaefer A.Zehnder M.Schurmann T.Kohler M.Bloch K.Brunner-La Rocca H.P.2008. Higher pulmonary artery pressure in children than in adults upon fast ascent to high altitudeEur. Respir. J.32664-669. Kriemler S., Jansen C., Linka A., Kessel-Schaefer A., Zehnder M., Schurmann T., Kohler M., Bloch K., and Brunner-La Rocca H.P. (2008). Higher pulmonary artery pressure in children than in adults upon fast ascent to high altitude. Eur. Respir. J. 32:664–669.
Lazio M.P.Van Roo J.D.Pesce C.Malik S.Courtney D.M.2010. Postexercise peripheral oxygen saturation after completion of the 6-minute walk test predicts successfully reaching the summit of AconcaguaWilderness Environ. Med.21309-317. Lazio M.P., Van Roo J.D., Pesce C., Malik S., and Courtney D.M. (2010). Postexercise peripheral oxygen saturation after completion of the 6-minute walk test predicts successfully reaching the summit of Aconcagua. Wilderness Environ. Med. 21:309–317.
Luks A.M.2009. Do lung disease patients need supplemental oxygen at high altitude? High AltMed. Biol.10321-327. Luks A.M. (2009). Do lung disease patients need supplemental oxygen at high altitude? High Alt. Med. Biol. 10:321–327.
Luks A.M.Stout K.Swenson E.R.2010. Evaluating the safety of high-altitude travel in patients with adult congenital heart diseaseCongenital Heart Dis.5220-232. Luks A.M., Stout K., and Swenson E.R. (2010). Evaluating the safety of high-altitude travel in patients with adult congenital heart disease. Congenital Heart Dis. 5:220–232.
Luks A.M.Swenson E.R.2007. Travel to high altitude with pre-existing lung diseaseEur. Respir. J.2970-92. Luks A.M., and Swenson E.R. (2007). Travel to high altitude with pre-existing lung disease. Eur. Respir. J. 29:70–92.
Martin D.S.Goedhart P.Vercueil A.Ince C.Levett D.Z.Grocott M.P.2010. Changes in sublingual microcirculatory flow index and vessel density on ascent to altitudeExp. Physiol.95880-891. Martin D.S., Goedhart P., Vercueil A., Ince C., Levett D.Z., and Grocott M.P. (2010). Changes in sublingual microcirculatory flow index and vessel density on ascent to altitude. Exp. Physiol. 95:880–891.
McElroy M.K.Gerard A.Powell F.L.Prisk G.K.Sentse N.Holverda S.West J.B.2000. Nocturnal O2 enrichment of room air at high altitude increases daytime O2 saturation without changing control of ventilationHigh Alt. Med. Biol.1197-206. McElroy M.K., Gerard A., Powell F.L., Prisk G.K., Sentse N., Holverda S., and West J.B. (2000). Nocturnal O2 enrichment of room air at high altitude increases daytime O2 saturation without changing control of ventilation. High Alt. Med. Biol. 1:197–206.
O'Connor T.Dubowitz G.Bickler P.E.2004. Pulse oximetry in the diagnosis of acute mountain sicknessHigh Alt. Med. Biol.5341-348. O'Connor T., Dubowitz G., and Bickler P.E. (2004). Pulse oximetry in the diagnosis of acute mountain sickness. High Alt. Med. Biol. 5:341–348.
Roach R.C.Greene E.R.Schoene R.B.Hackett P.H.1998. Arterial oxygen saturation for prediction of acute mountain sicknessAviat. Space Environ. Med.691182-1185. Roach R.C., Greene E.R., Schoene R.B., and Hackett P.H. (1998). Arterial oxygen saturation for prediction of acute mountain sickness. Aviat. Space Environ. Med. 69:1182–1185.
Roach R.C.Houston C.S.Honigman B.Nicholas R.A.Yaron M.Grissom C.K.Alexander J.K.Hultgren H.N.1995. How well do older persons tolerate moderate altitude? WestJ. Med.16232-36. Roach R.C., Houston C.S., Honigman B., Nicholas R.A., Yaron M., Grissom C.K., Alexander J.K., and Hultgren H.N. (1995). How well do older persons tolerate moderate altitude? West. J. Med. 162:32–36.
Roeggla G.Roeggla M.Podolsky A.Wagner A.Laggner A.N.1996. How can acute mountain sickness be quantified at moderate altitude? JRoyal Soc. Med.89141-143. Roeggla G., Roeggla M., Podolsky A., Wagner A., and Laggner A.N. (1996). How can acute mountain sickness be quantified at moderate altitude? J. Royal Soc. Med. 89:141–143.
Scherrer U.Vollenweider L.Delabays A.Savcie M.Eichenberger U.Kleger G.R.Firkle A.Ballmer P.Nicod P.Bartsch P.1996. Inhaled nitric oxide for high-altitude pulmonary edemaN. Engl. J. Med.334624-629. Scherrer U., Vollenweider L., Delabays A., Savcie M., Eichenberger U., Kleger G.R., Firkle A., Ballmer P., Nicod P., and Bartsch P. (1996). Inhaled nitric oxide for high-altitude pulmonary edema. N. Engl. J. Med. 334:624–629.
Schnapp L.M.Cohen N.H.1990. Pulse oximetry: uses and abusesChest.981244-1250. Schnapp L.M., and Cohen N.H. (1990). Pulse oximetry: uses and abuses. Chest. 98:1244–1250.
Severinghaus J.W.Naifeh K.H.Koh S.O.1989. Errors in 14 pulse oximeters during profound hypoxiaJ. Clin. Monitoring.572-81. Severinghaus J.W., Naifeh K.H., and Koh S.O. (1989). Errors in 14 pulse oximeters during profound hypoxia. J. Clin. Monitoring. 5:72–81.
Sinex J.E.1999. Pulse oximetry: principles and limitationsAm. J. Emerg. Med.1759-67. Sinex J.E. (1999). Pulse oximetry: principles and limitations. Am. J. Emerg. Med. 17:59–67.
Sonna L.A.Kain J.E.Hoyt R.W.Muza S.R.Sawka M.N.2000. Ambulatory physiological status monitoring during a mountaineering expeditionMilit. Med.165860-866. Sonna L.A., Kain J.E., Hoyt R.W., Muza S.R., and Sawka M.N. (2000). Ambulatory physiological status monitoring during a mountaineering expedition. Milit. Med. 165:860–866.
Tannheimer M.Thomas A.Gerngross H.2002. Oxygen saturation course and altitude symptomatology during an expedition to Broad Peak (8047 m)Int. J. Sports Med.23329-335. Tannheimer M., Thomas A., and Gerngross H. (2002). Oxygen saturation course and altitude symptomatology during an expedition to Broad Peak (8047 m). Int. J. Sports Med. 23:329–335.
Thomassen O.Brattebo G.Rostrup M.2004. Carbon monoxide poisoning while using a small cooking stove in a tentAm. J. Emerg. Med.22204-206. Thomassen O., Brattebo G., and Rostrup M. (2004). Carbon monoxide poisoning while using a small cooking stove in a tent. Am. J. Emerg. Med. 22:204–206.
Torre-Bouscoulet L.Chavez-Plascencia E.Vazquez-Garcia J.C.Perez-Padilla R.2006. [Precision and accuracy of "a pocket" pulse oximeter in Mexico City]Rev. Invest. Clin.5828-33. Torre-Bouscoulet L., Chavez-Plascencia E., Vazquez-Garcia J.C., and Perez-Padilla R. (2006). [Precision and accuracy of "a pocket" pulse oximeter in Mexico City]. Rev. Invest. Clin. 58:28–33.
Van Ginderdeuren F.Van Cauwelaert K.Malfroot A.2006. Influence of digital clubbing on oxygen saturation measurements by pulse-oximetry in cystic fibrosis patientsJ. Cystic Fibrosis.5125-128. Van Ginderdeuren F., Van Cauwelaert K., and Malfroot A. (2006). Influence of digital clubbing on oxygen saturation measurements by pulse-oximetry in cystic fibrosis patients. J. Cystic Fibrosis. 5:125–128.
Weil J.V.2003. Variation in human ventilatory control: genetic influence on the hypoxic ventilatory responseRespir. Physiol. Neurobiol.135239-246. Weil J.V. (2003). Variation in human ventilatory control: genetic influence on the hypoxic ventilatory response. Respir. Physiol. Neurobiol. 135:239–246.
West J.B.Lahiri S.Maret K.H.Peters R.M. Jr.Pizzo C.J.1983. Barometric pressures at extreme altitudes on Mt. Everest: physiological significanceJ. Appl. Physiol.541188-1194. West J.B., Lahiri S., Maret K.H., Peters R.M. Jr., and Pizzo C.J. (1983). Barometric pressures at extreme altitudes on Mt. Everest: physiological significance. J. Appl. Physiol. 54:1188–1194.

Information & Authors

Information

Published In

cover image High Altitude Medicine & Biology
High Altitude Medicine & Biology
Volume 12Issue Number 2Summer 2011
Pages: 109 - 119
PubMed: 21718156

History

Published online: 30 June 2011
Published in print: Summer 2011
Accepted: 4 March 2011
Received: 5 February 2011

Permissions

Request permissions for this article.

Topics

    Authors

    Affiliations

    Andrew M. Luks
    Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA.
    Erik R. Swenson
    Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA.

    Notes

    Address correspondence to:Andrew M. Luks, MDAssistant ProfessorDivision of Pulmonary and Critical Care MedicineHarborview Medical Center325 Ninth Avenue, Box 359762Seattle, WA 98104E-mail: [email protected]

    Disclosures

    The authors have no conflicts of interest or financial ties to disclose.

    Metrics & Citations

    Metrics

    Citations

    Export citation

    Select the format you want to export the citations of this publication.

    View Options

    Get Access

    Access content

    To read the fulltext, please use one of the options below to sign in or purchase access.

    Society Access

    If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

    Restore your content access

    Enter your email address to restore your content access:

    Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

    View options

    PDF/EPUB

    View PDF/ePub

    Full Text

    View Full Text

    Media

    Figures

    Other

    Tables

    Share

    Share

    Copy the content Link

    Share on social media

    Back to Top