Arterial blood gas estimation is a more reliable indication of ventilation and gas exchange than pulse oximetry as it shows

the actual partial pressures of dissolved gases in the blood. Pulse oximetry conversely measures the saturation of haemoglobin with (only) oxygen and then indirectly infers the arterial PO2 and as such there are several constraints to measurement. Firstly, the scale over which inference of arterial PO2 is possible is limited. That is, haemoglobin is almost completely saturated at PO2 100mm Hg thus PO2 beyond this still indicates complete saturation and thus adequate ventilation, when in reality PO2 may be insufficient and hypercapnoea (and acidosis) may have developed. Secondly, the measurement of haemoglobin saturation is affected by movement, ambient light, pigmented skin and factors which alter blood flow to the device (hypothermia, hypotension, vasoconstriction). As a result accurate measurement of Hb saturation may be unreliable, limiting the accuracy of using this parameter to infer arterial PO2. Finally, there is inherent error in the assumption that haemoglobin saturation indicates arterial PO2. Pulse oximetry only measures the saturation of the haemoglobin molecules present, not whether the haemoglobin content of the blood is adequate for gas exchange. Therefore, even if there is severe anaemia and hypoxia the pulse oximeter may show near absolute saturation which would indicate satisfactory arterial PO2. As ABG estimation indicates partial pressures directly, assessment of the alveolar-arterial oxygen tension difference and pulmonary pressure gradient (of all gases) is possible, which allows the capability for gas exchange between lungs/blood/tissue and the effect of ventilation to be assessed. Pulse oximetry only shows the oxygen saturation of present haemoglobin, which is not strictly correlated with PO2, is inaccurate over PO2 of ~100mm Hg and neglects the effect of PCO2 rendering it inadequate for assessing ventilation and gas exchange.