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The Sounds of Desaturation: A Survey of Commercial Pulse Oximeter Sonifications

Loeb, Robert G. MD; Brecknell, Birgit PhD; Sanderson, Penelope M. PhD

doi: 10.1213/ANE.0000000000001240
Technology, Computing, and Simulation: Research Report

BACKGROUND: The pulse oximeter has been a standard of care medical monitor for >25 years. Most manufacturers include a variable-pitch pulse tone in their pulse oximeters. Research has shown that the acoustic properties of variable-pitch tones are not standardized. In this study, we surveyed the properties of pulse tones from 21 pulse oximeters, consisting of 1 to 4 instruments of 11 different models and 8 brands. Our goals were to fully document the sounds over saturation values 0% to 100%, test whether tones become quieter at low saturation values, and create a public repository of pulse oximeter recordings for future use.

METHODS: A convenience sample of commercial pulse oximeters in use at one hospital was studied. Audiovisual recordings of each pulse oximeter’s display and sounds were taken while it monitored a simulator starting at a saturation of 100% and slowly decreasing in 1% steps until the saturation reached 0%. Recorded pulse tones were analyzed for spectral frequency and total power. Audio files for each pulse oximeter containing 100 pulse tones, one at every saturation value, were created for inclusion in the repository.

RESULTS: Recordings containing 509 to 1053 pulse tones were made from the 21 pulse oximeters. Fundamental frequencies at 100% saturation ranged from 479 to 921 Hz, and fundamental frequencies at 1% saturation ranged from 38 to 404 Hz. The pulse tones from all but one model pulse oximeter contained harmonics. Pulse tone step sizes were linear in 6 models and logarithmic in 6 models. Only 6 pulse oximeter models decreased the pulse tone pitch at every decrease in saturation; all others decreased the pitch at only select saturation thresholds. Five pulse oximeter models stopped decreasing pitch altogether once the saturation reached a certain lower threshold. Pulse tone power (perceived as loudness) changed with saturation level for all pulse oximeters, increasing above baseline as saturation decreased from 100% and decreasing to levels below baseline at low saturation values.

CONCLUSIONS: Current pulse oximeters use different techniques to address the competing goals of (1) using pitch steps that are large enough to be readily perceived, and (2) conveying saturation values from 0 to 100 within a limited range of sound frequencies. From a clinical perspective, 2 techniques for increasing perceivability (increasing the frequency range and using ratio step sizes) have no drawback, but 2 techniques (not changing pitch at every saturation change and using a lower saturation cutoff) do have potential clinical drawbacks. On the basis of our findings, we have made suggestions for clinicians and manufacturers.

From the *Department of Anesthesiology, University of Arizona College of Medicine, Tucson, Arizona; School of Psychology, The University of Queensland, St Lucia, Queensland, Australia; and Schools of Psychology, ITEE and Medicine, The University of Queensland, St Lucia, Queensland, Australia

Accepted for publication January 11, 2016.

Funding: Internal departmental.

Conflict of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Robert G. Loeb, MD, Department of Anesthesiology, University of Arizona, P.O. Box 245114, Tucson, AZ 85724. Address e-mail to

© 2016 International Anesthesia Research Society