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Yoo JH, Park SH, Oh HC, Ha JW, Yoon HK. Efficacy of pulse oximetry for early diagnosis of pulmonary embolism after total knee arthroplasty. Knee Surg Relat Res 2024; 36:6. [PMID: 38246998 PMCID: PMC10801930 DOI: 10.1186/s43019-023-00207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Early diagnosis and aggressive treatment of pulmonary embolism (PE) are crucial for preventing severe complications after total knee arthroplasty (TKA). This study aimed to examine the efficacy of measuring oxygen saturation (SpO2) using a pulse oximeter for early diagnosis of PE after total knee arthroplasty (TKA). MATERIALS AND METHODS We consecutively examined 1645 patients who underwent TKA between January 2015 and November 2019. Postoperative SpO2 was measured with a pulse oximeter, which was stopped if SpO2 was maintained at ≥ 95% until postoperative day 2 (POD2). To diagnose PE, computed tomographic pulmonary angiography (CTPA) was performed for specific indications, including persistently low SpO2 < 95% (group 1), sudden decrease in SpO2 (group 2), and decrease in SpO2 after POD3 with presenting symptoms (group 3). Also, we divided the patients into unilateral, simultaneous and sequential TKA groups and compared the results with specific statistical techniques. RESULTS Of the 1645 patients who underwent TKA, there were 20 patients with PE (1.2%), and symptomatic PE was observed in only 4 patients (0.24%). CTPA was performed in 58 (3.5%) patients, of whom 20 were diagnosed with PE. In groups 1 (n = 34), 2 (n = 21), and 3 (n = 3), CTPA was performed 2.4, 2.6, and 8.3 days after TKA, respectively, and 12, 8, and 0 patients were diagnosed with PE, respectively. Of the 782, 416, and 447 unilateral, simultaneous, and sequential (done in same admission with interval 1 or 2 weeks) patients with TKA, 38, 18, and 2 received CTPA, and 13, 6, and 1 were diagnosed with PE, respectively. All patients diagnosed with PE have persistently low SpO2 < 95% (group 1), or sudden decrease in SpO2 (group 2) until POD2. Of the patients diagnosed with PE, SpO2 decreased without the presentation of symptoms in 16 patients (11 and 5 from groups 1 and 2, respectively) and with the presentation of symptoms, such as mild dyspnea and chest discomfort, in 4 patients (1 and 3 from groups 1 and 2, respectively). CONCLUSIONS Measuring SpO2 using a pulse oximeter until POD2 was an effective method for early diagnosis of PE after TKA. No case of morbidity or mortality was observed after early diagnosis with early stage CTPA and management of PE. We recommend measuring SpO2 with a pulse oximeter for early diagnosing of PE in TKA.
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Affiliation(s)
- Ju-Hyung Yoo
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, Ilsandong-gu, Goyang, 10444, South Korea
- Department of Orthopedic Surgery, Seran Hospital, Seoul, Korea
| | - Sang-Hoon Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, Ilsandong-gu, Goyang, 10444, South Korea.
| | - Hyun-Cheol Oh
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, Ilsandong-gu, Goyang, 10444, South Korea
| | - Joong-Won Ha
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, Ilsandong-gu, Goyang, 10444, South Korea
| | - Han-Kook Yoon
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Ilsan-ro 100, Ilsandong-gu, Goyang, 10444, South Korea
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Zeng Y, Yamamoto Y, Hayashi Y, Uchida T. Evaluation of fibrinogen concentration by clot firmness using a dielectric blood coagulation test system. J Anesth 2023; 37:56-63. [PMID: 36316533 DOI: 10.1007/s00540-022-03131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To determine if fibrinogen concentration can be evaluated by dielectric permittivity changes in dielectric blood coagulation testing (DBCM) during cardiovascular surgery with cardiopulmonary bypass (CPB). METHODS We performed a single-center prospective observational study at a university hospital. One hundred patients undergoing cardiovascular surgery with CPB were enrolled. Whole-blood samples were obtained after weaning from CPB, and dielectric clot strength (DCS) was measured by intrinsic pathway testing with or without heparinase in DBCM. The FIBTEM test was performed during rotational thromboelastometry using the same samples, and maximum clot firmness (MCF) was evaluated. Spearman's correlation analysis was performed, and receiver operating characteristics (ROC) curve analyses were used to evaluate the performance of hypofibrinogenemia detection. RESULTS DCS showed a strong positive correlation with plasma fibrinogen concentration (Rs = 0.76, P < 0.0001). The area under the ROC curve for evaluating plasma fibrinogen concentration < 200 mg/dL was 0.91 (95% confidence interval (CI) 0.85-0.97) for DCS, compared with 0.88 (95% CI 0.81-0.94) for FIBTEM MCF. The optimal cutoff value of DCS was 17.0 (sensitivity 94%, specificity 80%). CONCLUSIONS DCS variables showed a significantly strong correlation with plasma fibrinogen concentration, and the diagnostic performance for hypofibrinogenemia was comparable to that for FIBTEM MCF. This novel methodology has the potential to provide a point-of-care test with sufficient accuracy for the detection of perioperative hypofibrinogenemia during cardiovascular surgery with CPB.
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Affiliation(s)
- Yulin Zeng
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Yudai Yamamoto
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Yoshihito Hayashi
- Biomedical R&D Department, R&D Division, Medical Business Group, Sony Imaging Products & Solutions Inc., Bunkyo-Ku, Tokyo, 113-8519, Japan
- Tokyo Laboratory 11, R&D Center, Sony Group Corporation, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tokujiro Uchida
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
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Takayama W, Endo A, Morishita K, Otomo Y. Dielectric Blood Coagulometry for the Early Detection of Sepsis-Induced Disseminated Intravascular Coagulation: A Prospective Observational Study. Crit Care Med 2022; 50:e31-e39. [PMID: 34369427 PMCID: PMC8670337 DOI: 10.1097/ccm.0000000000005231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the utility of dielectric blood coagulometry for early sepsis-induced disseminated intravascular coagulation diagnosis. DESIGN Single-center, prospective observational study. SETTING Patients with sepsis or septic shock at the Tokyo Medical and Dental University Hospital of Medicine between September 2019 and September 2020. PATIENTS The patients were divided into three groups according to the timing of disseminated intravascular coagulation diagnosis based on the Disseminated Intravascular Coagulation score by the Japanese Association for Acute Medicine: 1) no disseminated intravascular coagulation group, 2) late-diagnosed disseminated intravascular coagulation group: not diagnosed with disseminated intravascular coagulation on day 1 but diagnosed within 48 hours after admission, and 3) disseminated intravascular coagulation group: diagnosed with disseminated intravascular coagulation on day 1. The study evaluated 80 patients (no disseminated intravascular coagulation, 31 [38.8%]; late-diagnosed disseminated intravascular coagulation, 34 (42.5%); disseminated intravascular coagulation, 15 [18.8%]). MEASUREMENTS AND MAIN RESULTS We compared the clinical severity scores and mortality of the groups and assessed the correlation between the dielectric blood coagulometry-derived coagulation marker, thrombin levels, and Disseminated Intravascular Coagulation score using Spearman rank correlation. The mortality rate was 0% (0/31) in the no disseminated intravascular coagulation group, 35.3% (12/34) in the late-diagnosed disseminated intravascular coagulation group, and 33.3% (5/15) in the disseminated intravascular coagulation group. Although the Disseminated Intravascular Coagulation score on day 1 did not reflect disseminated intravascular coagulation in approximately 70% of patients who developed disseminated intravascular coagulation by day 2, dielectric clot strength measured by dielectric blood coagulometry on day 1 strongly correlated with disseminated intravascular coagulation development by day 2 (Spearman ρ = 0.824; p < 0.05) and with thrombin level on day 1 (Spearman ρ = 0.844; p < 0.05). CONCLUSIONS Dielectric blood coagulometry can be used to detect early-phase disseminated intravascular coagulation in patients with sepsis and is strongly correlated with thrombin levels. Larger studies are needed to verify our results for developing clinical applications.
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Affiliation(s)
- Wataru Takayama
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Koji Morishita
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
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Hayashi Y, Brun MA, Machida K, Lee S, Murata A, Omori S, Uchiyama H, Inoue Y, Kudo T, Toyofuku T, Nagasawa M, Uchimura I, Nakamura T, Muneta T. Simultaneous assessment of blood coagulation and hematocrit levels in dielectric blood coagulometry. Biorheology 2018; 54:25-35. [PMID: 28800301 PMCID: PMC5676769 DOI: 10.3233/bir-16118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND In a whole blood coagulation test, the concentration of any in vitro diagnostic agent in plasma is dependent on the hematocrit level but its impact on the test result is unknown. OBJECTIVE The aim of this work was to clarify the effects of reagent concentration, particularly Ca2+, and to find a method for hematocrit estimation compatible with the coagulation test. METHODS Whole blood coagulation tests by dielectric blood coagulometry (DBCM) and rotational thromboelastometry were performed with various concentrations of Ca2+ or on samples with different hematocrit levels. DBCM data from a previous clinical study of patients who underwent total knee arthroplasty were re-analyzed. RESULTS Clear Ca2+ concentration and hematocrit level dependences of the characteristic times of blood coagulation were observed. Rouleau formation made hematocrit estimation difficult in DBCM, but use of permittivity at around 3 MHz made it possible. The re-analyzed clinical data showed a good correlation between permittivity at 3 MHz and hematocrit level (R2=0.83). CONCLUSIONS Changes in the hematocrit level may affect whole blood coagulation tests. DBCM has the potential to overcome this effect with some automated correction using results from simultaneous evaluations of the hematocrit level and blood coagulability.
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Affiliation(s)
- Yoshihito Hayashi
- LE Development Department, R&D Division, Medical Business Unit, Imaging Products & Solutions Sector, Sony Corporation, Tokyo, Japan
| | - Marc-Aurèle Brun
- Life Science Department, Biomedical R&D Division, RDS Platform, Sony Corporation, Tokyo, Japan
| | - Kenzo Machida
- LE Development Department, R&D Division, Medical Business Unit, Imaging Products & Solutions Sector, Sony Corporation, Tokyo, Japan
| | - Seungmin Lee
- LE Development Department, R&D Division, Medical Business Unit, Imaging Products & Solutions Sector, Sony Corporation, Tokyo, Japan
| | - Aya Murata
- LE Development Department, R&D Division, Medical Business Unit, Imaging Products & Solutions Sector, Sony Corporation, Tokyo, Japan
| | - Shinji Omori
- LE Development Department, R&D Division, Medical Business Unit, Imaging Products & Solutions Sector, Sony Corporation, Tokyo, Japan
| | - Hidetoshi Uchiyama
- Department of Surgical Specialities, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yoshinori Inoue
- Department of Surgical Specialities, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Surgical Specialities, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Takahiro Toyofuku
- Department of Surgical Specialities, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Masayuki Nagasawa
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Pediatrics, Musashino Red Cross Hospital, Musashino-city, Tokyo, Japan
| | - Isao Uchimura
- Department of Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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