BACKGROUND: Oxygen administration is often guided by pulse oximeter readings. However, inaccuracies have been reported, particularly in patients with darker skin tones. During the COVID-19 pandemic, racial and ethnic disparities in hypoxemia detection emerged, with studies showing a higher incidence of hidden hypoxemia in Black and Hispanic patients. However, limited data exists regarding the Asian population. RESEARCH QUESTION: How accurate are SpO STUDY DESIGN AND METHODS: We conducted a single-center observational study in an ICU at a tertiary care hospital in Japan, including all adult patients admitted from October 2013 through September 2021. We collected data from electronic records and analyzed for agreement between SpO2 and SaO RESULTS: Clinical data from 10,698 patients admitted to the ICU were analyzed. The mean bias between SpO INTERPRETATION: Dissociation between SpO2 and SaO2 in Asian patients in the ICU was small
however, overestimation and underestimation were associated with increased mortality risk, particularly among patients with chronic hemodialysis or impaired peripheral perfusion.