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Utility of Pulse Oximetry to Detect Aspiration: An Evidence-Based Systematic Review

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Abstract

Pulse oximetry is a commonly used means to measure peripheral capillary oxyhemoglobin saturation (SpO2). Potential use of pulse oximetry to detect aspiration is attractive to clinicians, as it is readily available, quick, and noninvasive. However, research regarding validity has been mixed. This systematic review examining evidence on the use of pulse oximetry to detect a decrease in SpO2 indicating aspiration during swallowing is undertaken to further inform clinical practice in dysphagia assessment. A multi-engine electronic search was conducted on 8/25/16 and updated on 4/8/17 in accordance with standards published by the Preferred Reporting for Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA). Inclusion criteria included use of pulse oximetry to detect aspiration with simultaneous confirmation of aspiration via a gold standard instrumental study. Keywords included dysphagia or aspiration AND pulse oximetry. Articles meeting criteria were reviewed by two blinded co-investigators. The search yielded 294 articles, from which 19 were judged pertinent and reviewed in full. Ten met the inclusion criteria and all were rated at Level III-2 on the Australian Diagnostic Levels of Evidence. Study findings were mixed with sensitivity ranging from 10 to 87%. Potentially confounding variables were observed in all studies reviewed, and commonly involved defining “desaturation” within a standard measurement error range (~ 2%), mixed populations, mixed viscosities/textures observed during swallowing, and lack of comparison group. The majority of studies failed to demonstrate an association between observed aspiration and oxygen desaturation. Current evidence does not support the use of pulse oximetry to detect aspiration.

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Fig. 1
Fig. 2

Image source Wikimedia Commons contributors, 'File:Oxyhaemoglobin dissociation curve.png', Wikimedia Commons, the free media repository, 19 February 2017, 01:04 UTC, (https://commons.wikimedia.org/w/index.php?title=File:Oxyhaemoglobin_dissociation_curve.png&oldid=234162700) [accessed 26 November 2017]

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Acknowledgements

The authors would like to thank Breanna Schwarz, B.S., for her assistance with literature searches and data organization.

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Authors and Affiliations

  1. Department of Speech & Hearing Sciences, Portland State University (PSU), Portland, OR, USA

    Deanna Britton & Cassie Quinn

  2. Northwest Clinic for Voice and Swallowing (NWCVS), Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Sciences University (OHSU), Portland, OR, USA

    Deanna Britton & Donna Graville

  3. Providence Sacred Heart Medical Center, Spokane, WA, USA

    Amy Roeske

  4. Auburn, AL, USA

    Stephanie K. Ennis

  5. Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center (UWMC), Seattle, WA, USA

    Joshua O. Benditt

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  1. Deanna Britton
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  2. Amy Roeske
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  5. Cassie Quinn
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  6. Donna Graville
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Correspondence to Deanna Britton.

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Conflict of interest

Deanna Britton continues to receive royalties from Plural Publishing, Pro-Ed, Inc., and Medbridge Education. She is additionally affiliated (Affiliate Assistant Professor) with the Department of Rehabilitation Medicine at the University of Washington, Seattle, WA. Joshua O. Benditt owns stock in Ventec. The remaining authors indicate no conflicts of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Britton, D., Roeske, A., Ennis, S.K. et al. Utility of Pulse Oximetry to Detect Aspiration: An Evidence-Based Systematic Review. Dysphagia 33, 282–292 (2018). https://doi.org/10.1007/s00455-017-9868-1

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  • DOI: https://doi.org/10.1007/s00455-017-9868-1

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