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Martins F, Fragoso E, Plácido da Silva H, Dias MS, Rosário LB. Validation of an mHealth System for Monitoring Fundamental Physiological Parameters in the Clinical Setting. SENSORS (BASEL, SWITZERLAND) 2024; 24:5164. [PMID: 39204858 PMCID: PMC11359666 DOI: 10.3390/s24165164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/16/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
The aim of this work was to validate the measurements of three physiological parameters, namely, body temperature, heart rate, and peripheral oxygen saturation, captured with an out-of-the-lab device using measurements taken with clinically proven devices. The out-of-the-lab specialized device was integrated into a customized mHealth application, e-CoVig, developed within the AIM Health project. To perform the analysis, single consecutive measurements of the three vital parameters obtained with e-CoVig and with the standard devices from patients in an intensive care unit were collected, preprocessed, and then analyzed through classical agreement analysis, where we used Lin's concordance coefficient to assess the agreement correlation and Bland-Altman plots with exact confidence intervals for the limits of agreement to analyze the paired data readings. The existence of possible systematic errors was also addressed, where we found the presence of additive errors, which were corrected, and weak proportional biases. We obtained the mean overall agreement between the measurements taken with the novel e-CoVig device and the reference devices for the measured quantities. Although some limitations in this study were encountered, we present more advanced methods for their further assessment.
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Affiliation(s)
- Filipe Martins
- Instituto Superior Técnico, University of Lisbon, 1049-001 Lisbon, Portugal
| | - Elsa Fragoso
- Pulmonology Department, Santa Maria University Hospital (CHULN), Santa Maria Local Health Unit, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal;
- Pulmonology Clinic, Lisbon School of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
| | - Hugo Plácido da Silva
- Instituto de Telecomunicações, Instituto Superior Técnico, 1049-001 Lisbon, Portugal
- Department of Bioengineering, Instituto Superior Técnico, University of Lisbon, 1649-004 Lisbon, Portugal
- Lisbon Unit for Learning and Intelligent Systems (LUMLIS), European Laboratory for Learning and Intelligent Systems (ELLIS), 1049-001 Lisbon, Portugal
| | - Miguel Sales Dias
- Information Sciences and Technologies and Architecture Reasearch Center (ISTAR), University Institute of Lisbon (ISCTE-IUL), 1600-189 Lisbon, Portugal;
| | - Luís Brás Rosário
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, 1649-028 Lisbon, Portugal;
- Centro Cardiovascular, Faculdade de Medicina, University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
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Lungu N, Popescu DE, Jura AMC, Zaharie M, Jura MA, Roșca I, Boia M. Enhancing Early Detection of Sepsis in Neonates through Multimodal Biosignal Integration: A Study of Pulse Oximetry, Near-Infrared Spectroscopy (NIRS), and Skin Temperature Monitoring. Bioengineering (Basel) 2024; 11:681. [PMID: 39061763 PMCID: PMC11273471 DOI: 10.3390/bioengineering11070681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Sepsis continues to be challenging to diagnose due to its non-specific clinical signs and symptoms, emphasizing the importance of early detection. Our study aimed to enhance the accuracy of sepsis diagnosis by integrating multimodal monitoring technologies with conventional diagnostic methods. The research included a total of 121 newborns, with 39 cases of late-onset sepsis, 35 cases of early-onset sepsis, and 47 control subjects. Continuous monitoring of biosignals, including pulse oximetry (PO), near-infrared spectroscopy (NIRS), and skin temperature (ST), was conducted. An algorithm was then developed in Python to identify early signs of sepsis. The model demonstrated the capability to detect sepsis 6 to 48 h in advance with an accuracy rate of 87.67 ± 7.42%. Sensitivity and specificity were recorded at 76% and 90%, respectively, with NIRS and ST having the most significant impact on predictive accuracy. Despite the promising results, limitations such as sample size, data variability, and potential biases were noted. These findings highlight the critical role of non-invasive biosensing methods in conjunction with conventional biomarkers and cultures, offering a strong foundation for early sepsis detection and improved neonatal care. Further research should be conducted to validate these results across different clinical settings.
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Affiliation(s)
- Nicoleta Lungu
- Department of Obstetrics-Gynecology and Neonatology, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timisoara, Romania; (N.L.)
- Department of Neonatology, “Louis Țurcanu” Children Emergency Clinical Hospital Timișoara, 300011 Timisoara, Romania
| | - Daniela-Eugenia Popescu
- Department of Obstetrics-Gynecology and Neonatology, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timisoara, Romania; (N.L.)
- Department of Neonatology, Première Hospital, Regina Maria Health Network, 300645 Timisoara, Romania
| | - Ana Maria Cristina Jura
- Department of Obstetrics-Gynecology and Neonatology, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timisoara, Romania; (N.L.)
- Department of Neonatology, Première Hospital, Regina Maria Health Network, 300645 Timisoara, Romania
| | - Mihaela Zaharie
- Department of Obstetrics-Gynecology and Neonatology, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timisoara, Romania; (N.L.)
- Department of Neonatology, “Louis Țurcanu” Children Emergency Clinical Hospital Timișoara, 300011 Timisoara, Romania
| | - Mihai-Andrei Jura
- Department of Health Evaluation and Promotion, Romanian National Public Health Institute, 300226 Timisoara, Romania
| | - Ioana Roșca
- Neonatology Department, Clinical Hospital of Obstetrics and Gynecology, 060251 Bucharest, Romania
- Faculty of Midwifery and Nursery, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | - Mărioara Boia
- Department of Obstetrics-Gynecology and Neonatology, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timisoara, Romania; (N.L.)
- Department of Neonatology, “Louis Țurcanu” Children Emergency Clinical Hospital Timișoara, 300011 Timisoara, Romania
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Kalra A, Shou BL, Zhao D, Wilcox C, Keller SP, Kim BS, Whitman GJR, Cho SM. Extracorporeal Membrane Oxygenation Physiological Factors Influence Pulse Oximetry and Arterial Oxygen Saturation Discrepancies. Ann Thorac Surg 2024; 117:1221-1228. [PMID: 37748529 PMCID: PMC10959762 DOI: 10.1016/j.athoracsur.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Cannulation strategy, vasopressors, and hemolysis are important physiological factors that influence hemodynamics in extracorporeal membrane oxygenation (ECMO). We hypothesized these factors influence the discrepancy between oxygen saturation measured by pulse oximetry (Spo2) and arterial blood gas (Sao2) in patients on ECMO. METHODS We retrospectively analyzed adults (aged ≥18 years) on venoarterial or venovenous ECMO at a tertiary academic ECMO center. Spo2-Sao2 pairs with oxygen saturation ≥70% and measured within 10 minutes were included. Occult hypoxemia was defined as Sao2 ≤88% with a time-matched Spo2 ≥92%. Adjusted linear mixed-effects modeling was used to assess the Spo2-Sao2 discrepancy with preselected demographics and time-matched laboratory variables. Vasopressor use was quantified by vasopressor dose equivalences. RESULTS Of 139 venoarterial-ECMO and 88 venovenous-ECMO patients, we examined 20,053 Spo2-Sao2 pairs. The Spo2-Sao2 discrepancy was greater in venovenous-ECMO (1.15%) vs venoarterial-ECMO (-0.35%, P < .001). Overall, 81 patients (35%) experienced occult hypoxemia during ECMO. Occult hypoxemia was more common in venovenous-ECMO (65%) than in venoarterial-ECMO (17%, P < .001). In linear mixed-effects modeling, Spo2 underestimated Sao2 by 9.48% in central vs peripheral venoarterial-ECMO (95% CI, -17.1% to -1.79%; P = .02). Higher vasopressor dose equivalences significantly worsened the Spo2-Sao2 discrepancy (P < .001). In linear mixed-effects modeling, Spo2 overestimated Sao2 by 25.43% in single lumen-cannulated vs double lumen-cannulated venovenous-ECMO (95% CI, 5.27%-45.6%; P = .03). Higher vasopressor dose equivalences and lactate dehydrogenase levels significantly worsened the Spo2-Sao2 discrepancy (P < .001). CONCLUSIONS Venovenous-ECMO patients are at higher risk for occult hypoxemia compared with venoarterial-ECMO. A higher vasopressor requirement and different cannulation strategies (central venoarterial-ECMO; single-lumen venovenous-ECMO) were significant factors for clinically significant Spo2-Sao2 discrepancy in both ECMO modes.
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Affiliation(s)
- Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin L Shou
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - David Zhao
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christopher Wilcox
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven P Keller
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Bo Soo Kim
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
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Nguyen T, Park S, Park J, Sodager A, George T, Gandjbakhche A. Application of the Single Source-Detector Separation Algorithm in Wearable Neuroimaging Devices: A Step toward Miniaturized Biosensor for Hypoxia Detection. Bioengineering (Basel) 2024; 11:385. [PMID: 38671806 PMCID: PMC11048477 DOI: 10.3390/bioengineering11040385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Most currently available wearable devices to noninvasively detect hypoxia use the spatially resolved spectroscopy (SRS) method to calculate cerebral tissue oxygen saturation (StO2). This study applies the single source-detector separation (SSDS) algorithm to calculate StO2. Near-infrared spectroscopy (NIRS) data were collected from 26 healthy adult volunteers during a breath-holding task using a wearable NIRS device, which included two source-detector separations (SDSs). These data were used to derive oxyhemoglobin (HbO) change and StO2. In the group analysis, both HbO change and StO2 exhibited significant change during a breath-holding task. Specifically, they initially decreased to minimums at around 10 s and then steadily increased to maximums, which were significantly greater than baseline levels, at 25-30 s (p-HbO < 0.001 and p-StO2 < 0.05). However, at an individual level, the SRS method failed to detect changes in cerebral StO2 in response to a short breath-holding task. Furthermore, the SSDS algorithm is more robust than the SRS method in quantifying change in cerebral StO2 in response to a breath-holding task. In conclusion, these findings have demonstrated the potential use of the SSDS algorithm in developing a miniaturized wearable biosensor to monitor cerebral StO2 and detect cerebral hypoxia.
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Affiliation(s)
| | | | | | | | | | - Amir Gandjbakhche
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 49 Convent Drive, Bethesda, MD 20892-4480, USA; (T.N.); (S.P.); (J.P.); (A.S.); (T.G.)
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Arslan B, Sener K, Guven R, Kapci M, Korkut S, Sutasir MN, Tekindal MA. Accuracy of the Apple Watch in measuring oxygen saturation: comparison with pulse oximetry and ABG. Ir J Med Sci 2024; 193:477-483. [PMID: 37440093 DOI: 10.1007/s11845-023-03456-w] [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: 05/08/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Smartwatches have gained tremendous attention in recent years and have become widely accepted by patients, despite not being intended for medical diagnosis. OBJECTIVE This study aimed to determine the accuracy of Apple Watch oxygen saturation measurement in patients with acute exacerbation of COPD by comparing it with medical-grade pulse oximetry and ABG. METHOD This single-center, prospective, cross-sectional study involved 167 patients. Patients presenting with cardiac arrest, life-threatening symptoms, severe hypoxia, or obvious jaundice were excluded. Additionally, patients whose SpO2 measurements with the Apple Watch took more than 2 min or required eight attempts were also excluded. Vital signs were measured simultaneously using the IntelliVue MX500 monitor with the Masimo Rainbow Set pulse oximeter and the Apple Watch. Concurrently, arterial blood gas (ABG) samples were drawn. RESULTS A strong correlation between the Apple Watch 6 and medical-grade pulse oximetry (r = 0.89, ICC = 0.940) was noted. The Bland-Altman analysis revealed a mean error of 0.458% between the Apple Watch 6 and ABG (SD: 2.78, level of agreement: - 5.912 to 4.996). The mean error between pulse oximetry and ABG (SD: 5.086, level of agreement; - 10.983 to 8.953) was 1.015%. There was a correlation between respiratory rate and the number of attempts to measure SpO2 with the Apple Watch 6 (r = 0.75, p < 0.05). CONCLUSION Apple Watch 6 is an accurate and reliable method for measuring SpO2 levels in emergency patients who presented with acute exacerbation of COPD. However, tachypneic patients may encounter challenges due to the potential need for multiple attempts to measure their oxygen saturation.
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Affiliation(s)
- Banu Arslan
- Department of Emergency Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Kemal Sener
- Department of Emergency Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ramazan Guven
- Department of Emergency Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Mucahit Kapci
- Department of Emergency Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Semih Korkut
- Department of Emergency Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Mehmet N Sutasir
- Department of Emergency Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Mustafa A Tekindal
- Department of Biostatistics, İzmir Katip Celebi University Faculty of Medicine, İzmir, Turkey
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Zanusso F, De Benedictis GM, Zemko P, Bellini L. Non-invasive assessment of oxygenation status using the oxygen reserve index in dogs. BMC Vet Res 2023; 19:241. [PMID: 37980491 PMCID: PMC10657143 DOI: 10.1186/s12917-023-03804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND The oxygen reserve index (ORi) is a real-time, continuous index measured with multi-wavelength pulse CO-oximetry technology. It estimates mild hyperoxemia in humans, which is defined as a partial pressure of oxygen (PaO2) level between 100 and 200 mmHg. The objectives of this study were to assess the correlation between ORi and PaO2, as well as to determine its ability in detecting mild hyperoxemia in dogs. METHODS This prospective observational study enrolled 37 anaesthetised and mechanically ventilated dogs undergoing elective procedures. Simultaneous measurements of ORi and PaO2 were collected, using a multi-wavelength pulse CO-oximeter with a probe placed on the dog's tongue, and a blood gas analyser, respectively. A mixed-effects model was used to calculate the correlation (r2) between simultaneous measurements of ORi and PaO2. The trending ability of ORi to identify dependable and proportional changes of PaO2 was determined. The diagnostic performances of ORi to detect PaO2 ≥ 150 mmHg and ≥ 190 mmHg were estimated using the area under the receiver operating characteristic curve (AUROC). The effects of perfusion index (PI), haemoglobin (Hb), arterial blood pH and partial pressure of carbon dioxide (PaCO2) on AUROC for PaO2 ≥ 150 mmHg were evaluated. RESULTS A total of 101 paired measurements of ORi and PaO2 were collected. PaO2 values ranged from 74 to 258 mmHg. A strong positive correlation (r2 = 0.52, p < 0.001) was found between ORi and PaO2. The trending ability ORi was 90.7%, with 92% sensitivity and 89% specificity in detecting decreasing PaO2. An ORi value ≥ 0.53 and ≥ 0.76 indicated a PaO2 ≥ 150 and ≥ 190 mmHg, respectively, with ≥ 82% sensitivity, ≥ 77% specificity and AUROC ≥ 0.75. The AUROC of ORi was not affected by PI, Hb, pH and PaCO2. CONCLUSIONS In anaesthetised dogs, ORi may detect mild hyperoxaemia, although it does not replace blood gas analysis for measuring the arterial partial pressure of oxygen. ORi monitoring could be used to non-invasively assess oxygenation in dogs receiving supplemental oxygen, limiting excessive hyperoxia.
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Affiliation(s)
- Francesca Zanusso
- Department of Animal Medicine, Productions and Health, University of Padova, Legnaro, Padova, 35020, Italy
| | - Giulia Maria De Benedictis
- Department of Animal Medicine, Productions and Health, University of Padova, Legnaro, Padova, 35020, Italy
| | - Polina Zemko
- Department of Animal Medicine, Productions and Health, University of Padova, Legnaro, Padova, 35020, Italy
| | - Luca Bellini
- Department of Animal Medicine, Productions and Health, University of Padova, Legnaro, Padova, 35020, Italy.
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Abraham EA, Verma G, Arafat Y, Acharya S, Kumar S, Pantbalekundri N. Comparative Analysis of Oxygen Saturation by Pulse Oximetry and Arterial Blood Gas in Hypoxemic Patients in a Tertiary Care Hospital. Cureus 2023; 15:e42447. [PMID: 37637606 PMCID: PMC10449267 DOI: 10.7759/cureus.42447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Oxygen saturation is essential for medical care and is closely regulated within the body. Arterial blood gas (ABG) analysis is used to evaluate critically ill individuals' ventilation, oxygenation, acid-base status, and metabolic condition. Pulse oximetry is an easy and non-invasive way to measure the status of oxygen saturation non-invasively in clinical settings and provides a quick and precise assessment of oxygenation and reduces medical errors. SpO2 may not always be a reliable predictor of arterial oxygen saturation (SaO2), and hypoxemic, hemodynamically compromised, and critically ill patients may have lower SpO2 accuracy. A study is needed to assess and compare various oxygen saturation methods. AIMS AND OBJECTIVES The study aimed to compare the oxygen saturation levels measured by pulse oximetry and ABG analysis in hypoxemic patients. The objectives were to compare the values between SaO2, PaO2, and SpO2 values obtained from the patients, and correlate the study parameters among both techniques. MATERIALS AND METHODS The study was conducted from February 2021 to June 2022 among the 102 hypoxemic patients who were admitted to the emergency and surgical intensive care unit (ICU) of Sree Balaji Medical College and Hospital in Chennai. Primary data on ABG analysis and pulse oximetry readings were collected from the study subjects. The patient and their past medical records, physical exam, chest x-ray findings, pulse oximetry, and ABG results were all reviewed. Each patient had their ABG, and pulse oximetry measured simultaneously. A comparison was made between SpO2 and partial pressure of oxygen (PaO2) and arterial oxygen saturation (SaO2) parameters using a paired t-test. The correlation was done against the SpO2 and ABG parameters and assessed for association using the correlation coefficient value; gender was also considered while correlating. RESULTS AND DISCUSSION An observational study was done among 102 study samples to comparatively analyze the oxygen saturation by two methods, namely pulse oximetry and ABG, in hypoxemic patients. While comparing the mean values of SaO2 and SpO2, they were 84.41 ± 4.24 and 80.58 ± 5.77, respectively, and this difference was statistically very significant (p < 0.001). While comparing the mean values of PaO2 and SaO2, they were 61.02 ± 5.01 and 84.41 ± 4.24, respectively, and this difference was statistically significant (p = 0.043). While comparing the mean values of PaO2 and SpO2, they were 61.02 ± 5.01 and 80.58 ± 5.77, respectively, and this difference was statistically significant (p = 0.054). Among the study population, with regard to the correlation factor, there is notably a very high and strong positive correlation between SaO2 and SpO2 and between SpO2 and PaO2. There was a negative correlation between SpO2 and finger abnormalities and between SpO2 and blood pressure. CONCLUSION The ABG method is considered the gold standard. When SpO2 levels fall below 90%, pulse oximetry may not be accurate enough to reliably assess oxygenation. In such cases, where alveolar hypoventilation is suspected, it is recommended to complement pulse oximetry with ABG studies. This is because ABG analysis provides a more comprehensive assessment of oxygenation and acid-base status, which can aid in the diagnosis and management of respiratory conditions.
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Affiliation(s)
- Elen A Abraham
- Department of Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Ghanshyam Verma
- Department of Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Yasar Arafat
- Department of Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Nikhil Pantbalekundri
- Department of Medicine, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Wardha, IND
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Blanchet MA, Mercier G, Delobel A, Nayet E, Bouchard PA, Simard S, L'Her E, Branson RD, Lellouche F. Accuracy of Multiple Pulse Oximeters in Stable Critically Ill Patients. Respir Care 2023; 68:565-574. [PMID: 36596654 PMCID: PMC10171338 DOI: 10.4187/respcare.10582] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND An accurate SpO2 value is critical in order to optimally titrate oxygen delivery to patients and to follow oxygenation guidelines. Limited prospective data exist on real-world performance of pulse oximeters in critically ill patients. The objective of this study was to assess accuracy and bias of the SpO2 values measured by several oximeters in hospitalized subjects. METHODS We included stable adults in the ICU with an arterial catheter in place. Main exclusion criteria were poor SpO2 signal and SpO2 > 96%. In each subject, we simultaneously evaluated 4 oximeters: Nonin (Plymouth, Minnesota) embedded in the FreeO2 device (OxyNov, Québec City, Québec, Canada), Masimo (Radical-7, Masimo, Irvine, California), Philips (FAST, Philips, Amsterdam, the Netherlands), and Nellcor (N-600, Medtronic, Minneapolis, Minnesota). Arterial blood gases were drawn and simultaneously each oximeters' SpO2 values were collected. SpO2 values were compared to the reference (arterial oxygen saturation [SaO2 ] value) to determine bias and accuracy. The ability for oximeters to detect hypoxemia and the impact of oximeters on oxygen titration were evaluated. RESULTS We included 193 subjects (153 male, mean age 66 y) in whom 211 sets of measurements were performed. The skin pigmentation evaluated by Fitzpatrick scale showed 96.2% of subjects were light skin (types 1 and 2). One oximeter overestimated SaO2 (Philips, +0.9%), whereas the 3 others underestimated SaO2 (Nonin -3.1%, Nellcor -0.3%, Masimo -0.2%). SaO2 was underestimated with Nonin oximeter in 91.3% of the cases, whereas it was overestimated in 55.2% of the cases with Philips oximeter. Moderate hypoxemia (SaO2 86-90% or PaO2 55-60 mm Hg) was detected in 92, 33, 42, and 11% of the cases with Nonin, Nellcor, Masimo, and Philips, respectively. CONCLUSIONS We found significant bias and moderate accuracy between the tested oximeters and the arterial blood gases in the studied population. These discrepancies may have important clinical impact on the detection of hypoxemia and management of oxygen therapy.
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Affiliation(s)
- Marie-Anne Blanchet
- Department of Medicine, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Gabriel Mercier
- Department of Medicine, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Antoine Delobel
- Department of Medicine, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Emi Nayet
- Department of Medicine, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Pierre-Alexandre Bouchard
- Department of Medicine, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Serge Simard
- Department of Medicine, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | - Erwan L'Her
- Medical Intensive Care Unit, CHRU Brest, La Cavale Blanche, Brest, France
| | - Richard D Branson
- Department of Surgery, Division of Trauma and Critical Care, University Cincinnati, Cincinnati, Ohio
| | - François Lellouche
- Department of Medicine, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada.
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Mulder E, Sieber A, McKnight C, Schagatay E. Underwater pulse oximetry reveals increased rate of arterial oxygen desaturation across repeated freedives to 11 metres of freshwater. Diving Hyperb Med 2023; 53:16-23. [PMID: 36966518 PMCID: PMC10318178 DOI: 10.28920/dhm53.1.16-23] [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: 05/13/2022] [Accepted: 11/26/2022] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Recreational freedivers typically perform repeated dives to moderate depths with short recovery intervals. According to freediving standards, these recovery intervals should be twice the dive duration; however, this has yet to be supported by scientific evidence. METHODS Six recreational freedivers performed three freedives to 11 metres of freshwater (mfw), separated by 2 min 30 s recovery intervals, while an underwater pulse oximeter measured peripheral oxygen saturation (SpO2) and heart rate (HR). RESULTS Median dive durations were 54.0 s, 103.0 s and 75.5 s (all dives median 81.5 s). Median baseline HR was 76.0 beats per minute (bpm), which decreased during dives to 48.0 bpm in dive one, 40.5 bpm in dive two and 48.5 bpm in dive three (all P < 0.05 from baseline). Median pre-dive baseline SpO2 was 99.5%. SpO2 remained similar to baseline for the first half of the dives, after which the rate of desaturation increased during the second half of the dives with each subsequent dive. Lowest median SpO2 after dive one was 97.0%, after dive two 83.5% (P < 0.05 from baseline) and after dive three 82.5% (P < 0.01 from baseline). SpO2 had returned to baseline within 20 s after all dives. CONCLUSIONS We speculate that the enhanced rate of arterial oxygen desaturation across the serial dives may be attributed to a remaining 'oxygen debt', leading to progressively increased oxygen extraction by desaturated muscles. Despite being twice the dive duration, the recovery period may be too short to allow full recovery and to sustain prolonged serial diving, thus does not guarantee safe diving.
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Affiliation(s)
- Eric Mulder
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Corresponding author: Eric Mulder, Mid Sweden University, Kunskapens väg 8, 83125 Östersund, Sweden
| | - Arne Sieber
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- OXYGEN Scientific GmbH, Feldkirchen, Austria
| | - Chris McKnight
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, St Andrews, Scotland
| | - Erika Schagatay
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
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10
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Crooks CJ, West J, Morling J, Simmonds M, Juurlink I, Briggs S, Cruickshank S, Hammond-Pears S, Shaw D, Card T, Fogarty AW. Inverse association between blood pressure and pulse oximetry accuracy: an observational study in patients with suspected or confirmed COVID-19 infection. Emerg Med J 2023; 40:216-220. [PMID: 36600468 DOI: 10.1136/emermed-2022-212443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pulse oximeters are a standard non-invasive tool to measure blood oxygen levels, and are used in multiple healthcare settings. It is important to understand the factors affecting their accuracy to be able to use them optimally and safely. This analysis aimed to explore the association of the measurement error of pulse oximeters with systolic BP, diastolic BP and heart rate (HR) within ranges of values commonly observed in clinical practice. METHODS The study design was a retrospective observational study of all patients admitted to a large teaching hospital with suspected or confirmed COVID-19 infection from February 2020 to December 2021. Data on systolic and diastolic BPs and HR levels were available from the same time period as the pulse oximetry measurements. RESULTS Data were available for 3420 patients with 5927 observations of blood oxygen saturations as measured by pulse oximetry and ABG sampling within 30 min. The difference in oxygen saturation using the paired pulse oximetry and arterial oxygen saturation difference measurements was inversely associated with systolic BP, increasing by 0.02% with each mm Hg decrease in systolic BP (95% CI 0.00% to 0.03%) over a range of 80-180 mm Hg. Inverse associations were also observed between the error for oxygen saturation as measured by pulse oximetry and with both diastolic BP (+0.03%; 95% CI 0.00% to 0.05%) and HR (+0.04%; 95% CI 0.02% to 0.06% for each unit decrease in the HR). CONCLUSIONS Care needs to be taken in interpreting pulse oximetry measurements in patients with lower systolic and diastolic BPs, and HRs, as oxygen saturation is overestimated as BP and HR decrease. Confirmation of the oxygen saturation with an ABG may be appropriate in some clinical scenarios.
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Affiliation(s)
- Colin J Crooks
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joe West
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jo Morling
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mark Simmonds
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Irene Juurlink
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Steve Briggs
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Dominick Shaw
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tim Card
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew W Fogarty
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
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11
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Elron E, Bromiker R, Gleisner O, Yosef-Hai O, Goldberg O, Nitzan I, Nitzan M. Overestimation of Oxygen Saturation Measured by Pulse Oximetry in Hypoxemia. Part 1: Effect of Optical Pathlengths-Ratio Increase. SENSORS (BASEL, SWITZERLAND) 2023; 23:1434. [PMID: 36772474 PMCID: PMC9921559 DOI: 10.3390/s23031434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
On average, arterial oxygen saturation measured by pulse oximetry (SpO2) is higher in hypoxemia than the true oxygen saturation measured invasively (SaO2), thereby increasing the risk of occult hypoxemia. In the current article, measurements of SpO2 on 17 cyanotic newborns were performed by means of a Nellcor pulse oximeter (POx), based on light with two wavelengths in the red and infrared regions (660 and 900 nm), and by means of a novel POx, based on two wavelengths in the infrared region (761 and 820 nm). The SpO2 readings from the two POxs showed higher values than the invasive SaO2 readings, and the disparity increased with decreasing SaO2. SpO2 measured using the two infrared wavelengths showed better correlation with SaO2 than SpO2 measured using the red and infrared wavelengths. After appropriate calibration, the standard deviation of the individual SpO2-SaO2 differences for the two-infrared POx was smaller (3.6%) than that for the red and infrared POx (6.5%, p < 0.05). The overestimation of SpO2 readings in hypoxemia was explained by the increase in hypoxemia of the optical pathlengths-ratio between the two wavelengths. The two-infrared POx can reduce the overestimation of SpO2 measurement in hypoxemia and the consequent risk of occult hypoxemia, owing to its smaller increase in pathlengths-ratio in hypoxemia.
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Affiliation(s)
- Eyal Elron
- Neonatal Intensive Care Unit, Schneider Children’s Medical Center, Petah Tikva 4920235, Israel
| | - Ruben Bromiker
- Neonatal Intensive Care Unit, Schneider Children’s Medical Center, Petah Tikva 4920235, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | | | | | - Ori Goldberg
- Neonatal Intensive Care Unit, Schneider Children’s Medical Center, Petah Tikva 4920235, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pediatric Pulmonology Institute, Schneider Children’s Medical Center, Petach Tikva 4920235, Israel
| | - Itamar Nitzan
- Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Department of Pediatrics, Hebrew University of Jerusalem Medical School, Jerusalem 9112102, Israel
| | - Meir Nitzan
- Lev Academic Center, Jerusalem 9116001, Israel
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12
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James A, Petit M, Biancale F, Bougle A, Degos V, Monsel A, Vieillard-Baron A, Constantin JM. Agreement between pulse oximetry and arterial oxygen saturation measurement in critical care patients during COVID-19: a cross-sectional study. J Clin Monit Comput 2023:10.1007/s10877-022-00959-2. [PMID: 36670340 PMCID: PMC9859741 DOI: 10.1007/s10877-022-00959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/30/2022] [Indexed: 01/22/2023]
Abstract
Some publications suggest that pulse oximetry measurement (SpO2) might overestimate arterial oxygen saturation (SaO2) measurement in COVID-19 patients. This study aims to evaluate the agreement between SpO2 and SaO2 among COVID-19 and non-COVID-19 patients. We conducted a multicenter, prospective study including consecutive intensive care patients from October 15, 2020, to March 4, 2021, and compared for each measurement the difference between SpO2 and SaO2, also called the systematic bias. The primary endpoint was the agreement between SpO2 and SaO2 measured with the Lin concordance coefficient and illustrated using the Bland and Altman method. Factors associated with systematic bias were then identified using a generalised estimating equation. The study included 105 patients, 66 COVID-19 positive and 39 COVID-19 negative, allowing for 1539 measurements. The median age was 66 [57; 72] years with median SOFA and SAPSII scores of, respectively, 4 [3; 6] and 37 [31; 47]. The median SpO2 and SaO2 among all measurements was respectively 97 [96-99] and 94 [92-96] with a systematic bias of 0.80 [- 0.6; 2.4]. This difference was, respectively, 0.80 [- 0.7; 2.5] and 0.90 [- 0.3; 2.0] among COVID-19 positive and negative patients. Overall agreement measured with the Lin correlation coefficient was 0.65 [0.63; 0.68] with 0.61 [0.57; 0.64] and 0.53 [0.45; 0.60] among the COVID-19 positive and negative groups, respectively. Factors independently associated with the variation of the SpO2-SaO2 difference were the PaO2/FiO2 ratio and need for mechanical ventilation. In our population, agreement between SpO2 and SaO2 is acceptable. During the COVID-19 pandemic, SaO2 remains an efficient monitoring tool to characterise the level of hypoxemia and follow therapeutic interventions. As is already known about general intensive care unit patients, the greater hypoxemia, the weaker the correlation between SpO2 and SaO2.
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Affiliation(s)
- Arthur James
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Matthieu Petit
- grid.463845.80000 0004 0638 6872Intensive Care Unit CHU Ambroise Paré, Université Paris-Saclay, UMR 1018, CESP, Villejuif, Boulogne, France
| | - Flore Biancale
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Adrien Bougle
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Vincent Degos
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Antoine Monsel
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
| | - Antoine Vieillard-Baron
- grid.463845.80000 0004 0638 6872Intensive Care Unit CHU Ambroise Paré, Université Paris-Saclay, UMR 1018, CESP, Villejuif, Boulogne, France
| | - Jean-Michel Constantin
- grid.462844.80000 0001 2308 1657Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, GRC 29, DMU DREAM, AP-HP, 75013 Paris, France
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13
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Lucas F, Connell NT, Tolan NV. Correctly Establishing and Interpreting Oxygenation Status in Sickle Cell Disease. J Appl Lab Med 2023; 8:583-597. [PMID: 36592159 DOI: 10.1093/jalm/jfac096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND As hypoxemia and hypoxia are central elements of disease pathophysiology and disease-related morbidity and mortality in individuals affected by sickle cell disease (SCD), clinical management aims to optimize oxygenation. CONTENT Hypoxemia is primarily screened for with pulse oximetry. However, in SCD pulse oximetry can inaccurately reflect arterial saturation, posing the risk of undetected (occult) hypoxemia. Solely relying on pulse oximetry might therefore lead to misdiagnosis or mismanagement, with devastating effects on tissue oxygenation. The interpretation of oxygenation status is multifaceted, and "oxygen saturation" is often used as an umbrella term to refer to distinctly different measured quantities-estimated oxygen saturation (O2Sat), hemoglobin oxygen saturation (SO2) by either pulse oximetry or co-oximetry, and fractional oxyhemoglobin (FO2Hb). While in many clinical situations this ambiguous use is of little consequence, O2Sat, SO2, and FO2Hb cannot be used interchangeably in the setting of SCD, as dyshemoglobins, anemia, cardiopulmonary comorbidities, concomitant medications, and frequent transfusions need to be accounted for. This article describes the parameters that determine blood and tissue oxygen concentration, discusses laboratory method performance characteristics and the correct interpretation of currently available clinical laboratory testing, and reviews the literature on noninvasive vs invasive oxygenation measurements in SCD. SUMMARY By correctly establishing and interpreting oxygenation parameters, clinical and laboratory teams can ensure high-quality, equitable healthcare, counteracting systemic exacerbations of health disparities frequently experienced by individuals with SCD.
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Affiliation(s)
- Fabienne Lucas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nathan T Connell
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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14
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Ganzleben I, Klett D, Hartz W, Götzfried L, Vitali F, Neurath MF, Waldner MJ. Multispectral optoacoustic tomography for the non-invasive identification of patients with severe anemia in vivo. PHOTOACOUSTICS 2022; 28:100414. [PMID: 36276233 PMCID: PMC9583176 DOI: 10.1016/j.pacs.2022.100414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
The immediate diagnosis of severe anemia is crucial for patient outcome. However, reliable non-invasive point-of-care diagnostic tools for e.g., ICU monitoring are currently lacking. Using an advanced Multispectral Optoacoustic Tomography (MSOT) research device, we first substantiated a strong positive correlation of MSOT-signal and absolute hemoglobin concentration ex vivo in blood samples. In a clinical exploratory proof-of-concept study, we then evaluated 19 patients with different severities of anemia and controls by non-invasive in vivo measurement of hemoglobin in the radial artery. Our approach proved excellent in identifying patients with severe anemia triggering RBC transfusion based on a strong positive correlation of MSOT-signal intensity and hemoglobin concentration for 700 nm single wavelength and HbR unmixed MSOT-parameter analysis. In conclusion, our study lays the foundation to further develop MSOT-based real-time quantitative perfusion analyses in follow-up preclinical and clinical imaging studies and as a promising diagnostic tool to improve patient care in the future. DRKS00021442.
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Affiliation(s)
- Ingo Ganzleben
- Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Ludwig-Demling-Center for Molecular Imaging, Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Daniel Klett
- Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Ludwig-Demling-Center for Molecular Imaging, Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Wiebke Hartz
- Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Ludwig-Demling-Center for Molecular Imaging, Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Lisa Götzfried
- Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Ludwig-Demling-Center for Molecular Imaging, Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Francesco Vitali
- Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Ludwig-Demling-Center for Molecular Imaging, Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Ludwig-Demling-Center for Molecular Imaging, Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Deutsches Zentrum Immuntherapie, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Maximilian J. Waldner
- Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Ludwig-Demling-Center for Molecular Imaging, Department of Medicine 1, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Deutsches Zentrum Immuntherapie, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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15
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Hassan EA, Mohamed SN, Hamouda EH, Ahmed NT. Clinical evaluation for the pharyngeal oxygen saturation measurements in shocked patients. BMC Nurs 2022; 21:290. [PMID: 36316710 PMCID: PMC9624017 DOI: 10.1186/s12912-022-01073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background Monitoring oxygen saturation in shocked patients is a challenging nursing procedure. Shock syndrome alters peripheral tissue perfusion and hinders peripheral capillary oxygen saturation (SpO2) measurements. Our study aimed to find a solution to this problem. The pharynx is expected to be an accurate SpO2 measurement site in shocked patients. We clinically evaluated the pharyngeal SpO2 measurements against the arterial oxygen saturation (SaO2) measurements. Methods A prospective cohort research design was used. This study included 168 adult shocked patients. They were admitted to five intensive care units from March to December 2020 in an Egyptian hospital. A wrap oximeter sensor was attached to the posterior surface of an oropharyngeal airway (OPA) by adhesive tape. The optical component of the sensor adhered to the pharyngeal surface after the OPA insertion. Simultaneous pharyngeal peripheral capillary oxygen saturation (SpO2) and arterial oxygen saturation (SaO2) measurements were recorded. The pharyngeal SpO2 was clinically evaluated. Also, variables associated with the SpO2 bias were evaluated for their association with the pharyngeal SpO2 bias. Results The pharyngeal SpO2 bias was − 0.44% with − 1.65 to 0.78% limits of agreement. The precision was 0.62, and the accuracy was 0.05. The sensitivity to detect mild and severe hypoxemia was 100%, while specificity to minimize false alarm of hypoxemia was 100% for mild hypoxemia and 99.4% for severe hypoxemia. None of the studied variables were significantly associated with the pharyngeal SpO2 bias. Conclusion The pharyngeal SpO2 has a clinically acceptable bias, which is less than 0.5% with high precision, which is less than 2%.
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Affiliation(s)
- Eman Arafa Hassan
- grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Sherouk Nasser Mohamed
- grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Emad Hamdy Hamouda
- grid.7155.60000 0001 2260 6941Critical Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nadia Taha Ahmed
- grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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16
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Wick KD, Matthay MA, Ware LB. Pulse oximetry for the diagnosis and management of acute respiratory distress syndrome. THE LANCET. RESPIRATORY MEDICINE 2022; 10:1086-1098. [PMID: 36049490 PMCID: PMC9423770 DOI: 10.1016/s2213-2600(22)00058-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/30/2022] [Accepted: 02/10/2022] [Indexed: 02/07/2023]
Abstract
The diagnosis of acute respiratory distress syndrome (ARDS) traditionally requires calculation of the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) using arterial blood, which can be costly and is not possible in many resource-limited settings. By contrast, pulse oximetry is continuously available, accurate, inexpensive, and non-invasive. Pulse oximetry-based indices, such as the ratio of pulse-oximetric oxygen saturation to FiO2 (SpO2/FiO2), have been validated in clinical studies for the diagnosis and risk stratification of patients with ARDS. Limitations of the SpO2/FiO2 ratio include reduced accuracy in poor perfusion states or above oxygen saturations of 97%, and the potential for reduced accuracy in patients with darker skin pigmentation. Application of pulse oximetry to the diagnosis and management of ARDS, including formal adoption of the SpO2/FiO2 ratio as an alternative to PaO2/FiO2 to meet the diagnostic criterion for hypoxaemia in ARDS, could facilitate increased and earlier recognition of ARDS worldwide to advance both clinical practice and research.
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Affiliation(s)
- Katherine D Wick
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine and Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA.
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17
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Min JY, Chang HJ, Chu SJ, Chung MY. The Perfusion Index of the Ear as a Predictor of Hypotension Following the Induction of Anesthesia in Patients with Hypertension: A Prospective Observational Study. J Clin Med 2022; 11:6342. [PMID: 36362569 PMCID: PMC9657609 DOI: 10.3390/jcm11216342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 09/23/2023] Open
Abstract
Patients with hypertension develop hemodynamic instability more frequently during anesthesia-particularly post-induction. Therefore, different monitoring methods may be required in patients with hypertension. Perfusion index-the ratio of the pulsatile blood flow to the non-pulsatile static blood flow in a patient's peripheral tissues, such as the fingers or ears-can show the hemodynamic status of the patient in a non-invasive way. Among the sites used for measuring the perfusion index, it is assumed that the ear is more reliable than the finger for hemodynamic monitoring, because proximity to the brain ensures appropriate perfusion. We hypothesized that the low value of preoperative ear PI could be a predictor of post-induction hypotension in patients with hypertension. Thirty patients with hypertension were enrolled. The perfusion index and pleth variability index were measured using the ear, finger, and blood pressure, and heart rate was recorded to monitor hypotension. After insertion of the supraglottic airway, 20 patients developed post-induction hypotension. Those who developed hypotension showed a significantly lower preoperative perfusion index of the ear. The preoperative perfusion index of the ear could predict post-induction hypotension in patients with hypertension.
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Affiliation(s)
- Ji Young Min
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea
| | - Hyun Jae Chang
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea
| | - Su Jung Chu
- Department of Anesthesiology and Pain Medicine, T. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon-si 16247, Gyeonggi-do, Korea
| | - Mee Young Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea
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18
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Agor JK, Li R, Özaltın OY. Septic shock prediction and knowledge discovery through temporal pattern mining. Artif Intell Med 2022; 132:102406. [DOI: 10.1016/j.artmed.2022.102406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022]
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19
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Nemomssa HD, Raj H. Evaluation of a New Smartphone Powered Low-cost Pulse Oximeter Device. Ethiop J Health Sci 2022; 32:841-848. [PMID: 35950062 PMCID: PMC9341018 DOI: 10.4314/ejhs.v32i4.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Measurement of blood oxygen saturation is a vital part of monitoring coronavirus 2019 (COVID-19) patients. Pulse oximetry is commonly used to measure blood oxygen saturation and pulse rate for appropriate clinical intervention. But the majority of direct-to-consumer grade pulse oximeters did not pass through in-vivo testing, which results in their accuracy being questionable. Besides this, the ongoing COVID-19 pandemic exposed the limitations of the device in resource limited areas since independent monitoring is needed for COVID-19 patients. The purpose of this study was to perform an in-vivo evaluation of a newly developed smartphone powered low-cost pulse oximeter. Methods The new prototype of a smartphone powered pulse oximeter was evaluated against the standard pulse oximeter by taking measurements from fifteen healthy volunteers. The accuracy of measurement was evaluated by calculating the percentage error and standard deviation. A repeatability and reproducibility test were carried out using the ANOVA method. Results The average accuracy for measuring spot oxygen saturation (SPO2) and pulse rate (PR) was 99.18% with a standard deviation of 0.57 and 98.78% with a standard deviation of 0.61, respectively, when compared with the standard pulse oximeter device. The repeatability and reproducibility of SPO2 measurements were 0.28 and 0.86, respectively, which is in the acceptable range. Conclusion The new prototype of smartphone powered pulse oximeter demonstrated better performance compared to the existing low-cost fingertip pulse oximeters. The device could be used for independent monitoring of COVID-19 patients at health institutions and also for home care.
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Affiliation(s)
- Hundessa Daba Nemomssa
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
| | - Hakkins Raj
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
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20
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Koons NJ, Moses CD, Thompson P, Strandenes G, Convertino VA. Identifying critical DO 2 with compensatory reserve during simulated hemorrhage in humans. Transfusion 2022; 62 Suppl 1:S122-S129. [PMID: 35733031 DOI: 10.1111/trf.16958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Based on previous experiments in nonhuman primates, we hypothesized that DO2 crit in humans is 5-6 ml O2 ·kg-1 min-1 . STUDY DESIGN AND METHODS We measured the compensatory reserve (CRM) and calculated oxygen delivery (DO2 ) in 166 healthy, normotensive, nonsmoking subjects (97 males, 69 females) during progressive central hypovolemia induced by lower body negative pressure as a model of ongoing hemorrhage. Subjects were classified as having either high tolerance (HT; N = 111) or low tolerance (LT; N = 55) to central hypovolemia. RESULTS HT and LT groups were matched for age, weight, BMI, and vital signs, DO2 and CRM at baseline. The CRM-DO2 relationship was best fitted to a logarithmic model in HT subjects (amalgamated R2 = 0.971) and a second-order polynomial model in the LT group (amalgamated R2 = 0.991). Average DO2 crit for the entire subject cohort was estimated at 5.3 ml O2 ·kg-1 min-1 , but was ~14% lower in HT compared with LT subjects. The reduction in DO2 from 40% CRM to 20% CRM was 2-fold greater in the LT compared with the HT group. CONCLUSIONS Average DO2 crit in humans is 5.3 ml O2 ·kg-1 min-1 , but is ~14% lower in HT compared with LT subjects. The CRM-DO2 relationship is curvilinear in humans, and different when comparing HT and LT individuals. The threshold for an emergent monitoring signal should be recalibrated from 30% to 40% CRM given that the decline in DO2 from 40% CRM to 20% CRM for LT subjects is located on the steepest part of the CRM-DO2 relationship.
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Affiliation(s)
- Natalie J Koons
- Battlefield Health & Trauma Center for Human Integrative Physiology, U. S. Army Institute of Surgical Research, San Antonio, Texas, USA
| | - Catherine D Moses
- Battlefield Health & Trauma Center for Human Integrative Physiology, U. S. Army Institute of Surgical Research, San Antonio, Texas, USA
| | | | - Geir Strandenes
- Norwegian Armed Forces, Haukeland University Hospital, Bergen, Norway
| | - Victor A Convertino
- Battlefield Health & Trauma Center for Human Integrative Physiology, U. S. Army Institute of Surgical Research, San Antonio, Texas, USA
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21
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Abstract
This paper provides a review of a selection of papers published in the Journal of Clinical Monitoring and Computing in 2020 and 2021 highlighting what is new within the field of respiratory monitoring. Selected papers cover work in pulse oximetry monitoring, acoustic monitoring, respiratory system mechanics, monitoring during surgery, electrical impedance tomography, respiratory rate monitoring, lung ultrasound and detection of patient-ventilator asynchrony.
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22
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Nemomssa HD, Raj H. Development of Low-Cost and Portable Pulse Oximeter Device with Improved Accuracy and Accessibility. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:121-129. [PMID: 35547098 PMCID: PMC9084508 DOI: 10.2147/mder.s366053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Hundessa Daba Nemomssa
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
- Correspondence: Hundessa Daba Nemomssa, Tel +251913763777, Email
| | - Hakkins Raj
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
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23
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Sirohiya P, Vig S, Pandey K, Meena JK, Singh R, Ratre BK, Kumar B, Pandit A, Bhatnagar S. A Correlation Analysis of Peripheral Oxygen Saturation and Arterial Oxygen Saturation Among COVID-19 Patients. Cureus 2022; 14:e24005. [PMID: 35547430 PMCID: PMC9088087 DOI: 10.7759/cureus.24005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective It has been observed that peripheral oxygen saturation (SpO2) measured by pulse oximeter is consistently lower than arterial oxygen saturation (SaO2) measured directly by blood gas analysis. In this study, we aimed to evaluate the correlation between SpO2 and SaO2, and SpO2 and partial pressure of oxygen (PaO2), and compare the SpO2/FiO2 (SF) and PaO2/FiO2 (PF) ratios in patients with coronavirus disease 2019 (COVID-19). Methods In this observational study, SpO2 was recorded and arterial blood gas analysis was performed among 70 COVID-19 patients presenting on room air (FiO2 = 0.21). SaO2 and PaO2 were recorded from arterial blood gas analysis. The SF and PF ratios were then calculated. Results The strength of correlations between SpO2 and SaO2, and SpO2 and PaO2, were significant (p<0.001) and moderately positive [Pearson coefficient (r) = 0.68, 0.53]. SpO2 value (85%), i.e., SF ratio (404.7 or below), was the best estimate for mild ARDS (acute respiratory distress syndrome) [PF ratio (300 or below)] with a sensitivity of 80.6% and specificity of 53%. Conclusion A pulse oximeter is a vital tool in the diagnosis and management of COVID-19. In our study, SpO2 was found to have a positive correlation with SaO2 and PaO2 with acceptable sensitivity but low specificity in estimating mild ARDS. Therefore, pulse oximetry can be used as a tool for the early diagnosis of mild COVID-19 ARDS as per the given considerations and clinical correlation.
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Affiliation(s)
- Prashant Sirohiya
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Saurabh Vig
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Khushboo Pandey
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Jitendra K Meena
- Preventive Oncology, All India Institute of Medical Sciences, New Delhi, IND
| | - Ram Singh
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Brajesh K Ratre
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Balbir Kumar
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Anuja Pandit
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Sushma Bhatnagar
- Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
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24
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Barnett A, Beasley R, Buchan C, Chien J, Farah CS, King G, McDonald CF, Miller B, Munsif M, Psirides A, Reid L, Roberts M, Smallwood N, Smith S. Thoracic Society of Australia and New Zealand Position Statement on Acute Oxygen Use in Adults: 'Swimming between the flags'. Respirology 2022; 27:262-276. [PMID: 35178831 PMCID: PMC9303673 DOI: 10.1111/resp.14218] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/28/2021] [Accepted: 01/03/2022] [Indexed: 12/14/2022]
Abstract
Oxygen is a life-saving therapy but, when given inappropriately, may also be hazardous. Therefore, in the acute medical setting, oxygen should only be given as treatment for hypoxaemia and requires appropriate prescription, monitoring and review. This update to the Thoracic Society of Australia and New Zealand (TSANZ) guidance on acute oxygen therapy is a brief and practical resource for all healthcare workers involved with administering oxygen therapy to adults in the acute medical setting. It does not apply to intubated or paediatric patients. Recommendations are made in the following six clinical areas: assessment of hypoxaemia (including use of arterial blood gases); prescription of oxygen; peripheral oxygen saturation targets; delivery, including non-invasive ventilation and humidified high-flow nasal cannulae; the significance of high oxygen requirements; and acute hypercapnic respiratory failure. There are three sections which provide (1) a brief summary, (2) recommendations in detail with practice points and (3) a detailed explanation of the reasoning and evidence behind the recommendations. It is anticipated that these recommendations will be disseminated widely in structured programmes across Australia and New Zealand.
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Affiliation(s)
- Adrian Barnett
- Department of Respiratory and Sleep MedicineMater Public HospitalSouth BrisbaneQueenslandAustralia
| | - Richard Beasley
- Medical Research Institute of New Zealand & Capital Coast District Health BoardWellingtonNew Zealand
| | - Catherine Buchan
- Department of Respiratory and Sleep MedicineThe Alfred HospitalMelbourneVictoriaAustralia
- Department of Immunology and Respiratory MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jimmy Chien
- Department of Respiratory and Sleep MedicineWestmead Hospital, Ludwig Engel Centre for Respiratory Research and University of SydneySydneyNew South WalesAustralia
| | - Claude S. Farah
- Department of Respiratory Medicine, Concord HospitalMacquarie University and University of SydneySydneyNew South WalesAustralia
| | - Gregory King
- Department of Respiratory and Sleep Medicine, Royal North Shore HospitalWoolcock Institute of Medical Research and University of SydneySydneyNew South WalesAustralia
| | - Christine F. McDonald
- Department of Respiratory and Sleep MedicineAustin Health and University of MelbourneMelbourneVictoriaAustralia
| | - Belinda Miller
- Department of Respiratory MedicineThe Alfred Hospital and Monash UniversityMelbourneVictoriaAustralia
| | - Maitri Munsif
- Department of Respiratory and Sleep MedicineAustin Health and University of MelbourneMelbourneVictoriaAustralia
| | - Alex Psirides
- Intensive Care UnitWellington Regional Hospital, Capital and Coast District Health BoardWellingtonNew Zealand
| | - Lynette Reid
- Respiratory MedicineRoyal Hobart HospitalHobartTasmaniaAustralia
| | - Mary Roberts
- Department of Respiratory and Sleep MedicineWestmead Hospital, Ludwig Engel Centre for Respiratory Research and University of SydneySydneyNew South WalesAustralia
| | - Natasha Smallwood
- Department of Respiratory and Sleep MedicineThe Alfred HospitalMelbourneVictoriaAustralia
- Department of Immunology and Respiratory MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sheree Smith
- School of Nursing and MidwiferyWestern Sydney UniversitySydneyNew South WalesAustralia
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25
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Accuracy of pulse oximeters in measuring oxygen saturation in patients with poor peripheral perfusion: a systematic review. J Clin Monit Comput 2022; 36:961-973. [PMID: 35119597 DOI: 10.1007/s10877-021-00797-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
One of the most significant limitations of oximeters is their performance under poor perfusion conditions. This systematic review examines pulse oximeter model accuracy in adults under poor perfusion conditions. A multiple database search was conducted from inception to December 2020. The inclusion criteria were as follows: (1) adult participants (> 18 years) with explicitly stated conditions that cause poor peripheral perfusion (conditions localized at the oximeter placement site; or systemic conditions, including critical conditions such as hypothermia, hypotension, hypovolemia, and vasoconstricting agents use; or experimental conditions) (2) a comparison of arterial oxygen saturation and arterial blood gas values. A total of 22 studies were included and assessed for reliability and agreement using a modified Guidelines for Reporting Reliability and Agreement Studies tool. We calculated the accuracy root mean square error from bias and precision we extracted from the studies. Most oximeters (75%) were deemed accurate in patients with poor perfusion. Modern oximeters utilizing more complex algorithms were more likely to be accurate than older models. Earlobe placement of oximeters seemed more sensitive, with greater measurement accuracy, than on fingertip placement. Only one study controlled for skin pigmentation, and none strictly followed Food and Drug Association recommendations for experiments to determine oximeter accuracy. Oximeters are accurate in poorly perfused patients, especially newer oximeter models and those placed on earlobes. Further studies are needed that examine multiple oximeter models used on a diverse selection of patients while following FDA recommendations to examine oximeter accuracy.
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26
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Rehman I, Ali S, O’Brien C, Goodall C. Assessing the impact of FFP3 masks to oxygen saturation and pulse rate in the Oral Surgery department at the Glasgow Dental Hospital during the COVID-19 pandemic: an observational study. ORAL SURGERY 2022; 15:30-35. [PMID: 34548881 PMCID: PMC8447064 DOI: 10.1111/ors.12648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/06/2021] [Accepted: 06/23/2021] [Indexed: 12/01/2022]
Abstract
Aim The impact on physiological parameters and well-being from potential respiratory distress caused by FFP3 masks, particularly during extensive clinical sessions, has been widely speculated during the COVID-19 pandemic. This study aims to investigate the effect of FFP3 mask wear on clinicians' pulse rate and oxygen saturation. Material & Methods Clinical staff within the Oral Surgery department recorded their oxygen saturation (SpO2) and pulse rate prior to donning an FFP3 mask, prior to doffing FFP3 mask and after doffing FFP3 mask using a finger pulse oximeter for a two-week period in May-June 2020. The duration of wear, the session (AM/PM), the brand of mask and the presence of previous COVID-19 symptoms were also recorded. Results Twenty-eight data sets were collected from twelve participants (1M:11F). Of the FFP3 masks worn, nineteen (67.86%) were ARCOTM, eight (28.57%) were 3MTM masks and one (3.57%) was 3M+TM. At baseline, the mean SpO2 was 98.39% and the mean pulse rate was 72.11. Prior to mask removal, the mean SpO2 was 97.82% and the mean pulse rate was 70.04. At the end of the session, the mean SpO2 was 98.14% and the mean pulse rate was 69.54. The mean duration of wear was 150.34 min. Data sets were collected evenly across AM (14) and PM (14) sessions. Five participants (17.86%) reported previous COVID-19 symptoms. Conclusion The data demonstrated a mean reduction of 0.25% in oxygen saturation and 3.56% in pulse rate, following the use of an FFP3 mask. These changes in physiological parameters are not clinically significant and sessional use appears to be safe.
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Affiliation(s)
- Ilyaas Rehman
- Department of Oral SurgerySchool of Medicine Dentistry and NursingCollege of MVLSUniversity of GlasgowScotlandUK
| | - Sarah Ali
- Department of Oral SurgerySchool of Medicine Dentistry and NursingCollege of MVLSUniversity of GlasgowScotlandUK
| | - Conor O’Brien
- Department of Oral SurgerySchool of Medicine Dentistry and NursingCollege of MVLSUniversity of GlasgowScotlandUK
| | - Christine Goodall
- Department of Oral SurgerySchool of Medicine Dentistry and NursingCollege of MVLSUniversity of GlasgowScotlandUK
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27
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Nguyen LS, Helias M, Raia L, Nicolas E, Jaubert P, Benghanem S, Ait Hamou Z, Dupland P, Charpentier J, Pène F, Cariou A, Mira JP, Chiche JD, Jozwiak M. Impact of COVID-19 on the association between pulse oximetry and arterial oxygenation in patients with acute respiratory distress syndrome. Sci Rep 2022; 12:1462. [PMID: 35087122 PMCID: PMC8795352 DOI: 10.1038/s41598-021-02634-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
Managing patients with acute respiratory distress syndrome (ARDS) requires frequent changes in mechanical ventilator respiratory settings to optimize arterial oxygenation assessed by arterial oxygen partial pressure (PaO2) and saturation (SaO2). Pulse oxymetry (SpO2) has been suggested as a non-invasive surrogate for arterial oxygenation however its accuracy in COVID-19 patients is unknown. In this study, we aimed to investigate the influence of COVID-19 status on the association between SpO2 and arterial oxygenation. We prospectively included patients with ARDS and compared COVID-19 to non-COVID-19 patients, regarding SpO2 and concomitant arterial oxygenation (SaO2 and PaO2) measurements, and their association. Bias was defined as mean difference between SpO2 and SaO2 measurements. Occult hypoxemia was defined as a SpO2 ≥ 92% while concomitant SaO2 < 88%. Multiple linear regression models were built to account for confounders. We also assessed concordance between positive end-expiratory pressure (PEEP) trial-induced changes in SpO2 and in arterial oxygenation. We included 55 patients, among them 26 (47%) with COVID-19. Overall, SpO2 and SaO2 measurements were correlated (r = 0.70; p < 0.0001), however less so in COVID-19 than in non-COVID-19 patients (r = 0.55, p < 0.0001 vs. r = 0.84, p < 0.0001, p = 0.002 for intergroup comparison). Bias was + 1.1%, greater in COVID-19 than in non-COVID-19 patients (2.0 vs. 0.3%; p = 0.02). In multivariate analysis, bias was associated with COVID-19 status (unstandardized β = 1.77, 95%CI = 0.38–3.15, p = 0.01), ethnic group and ARDS severity. Occult hypoxemia occurred in 5.5% of measurements (7.7% in COVID-19 patients vs. 3.4% in non-COVID-19 patients, p = 0.42). Concordance rate between PEEP trial-induced changes in SpO2 and SaO2 was 84%, however less so in COVID-19 than in non-COVID-19 patients (69% vs. 97%, respectively). Similar results were observed for PaO2 regarding correlations, bias, and concordance with SpO2 changes. In patients with ARDS, SpO2 was associated with arterial oxygenation, but COVID-19 status significantly altered this association.
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Affiliation(s)
- Lee S Nguyen
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France.,Research and Innovation Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Marion Helias
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France
| | - Lisa Raia
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France
| | - Estelle Nicolas
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France
| | - Paul Jaubert
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France
| | - Sarah Benghanem
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France
| | - Zakaria Ait Hamou
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France
| | - Pierre Dupland
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France
| | - Julien Charpentier
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France
| | - Frédéric Pène
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France
| | - Alain Cariou
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France
| | - Jean-Paul Mira
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France
| | - Jean-Daniel Chiche
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France
| | - Mathieu Jozwiak
- Hôpital Cochin, Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, 27 rue du faubourg Saint Jacques, 75014, Paris, France. .,Université de Paris, Paris, France. .,Equipe 2 CARRES, UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur UCA, Nice, France.
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28
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Leppänen T, Kainulainen S, Korkalainen H, Sillanmäki S, Kulkas A, Töyräs J, Nikkonen S. Pulse Oximetry: The Working Principle, Signal Formation, and Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:205-218. [PMID: 36217086 DOI: 10.1007/978-3-031-06413-5_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulse oximeters are routinely used in various medical-grade and consumer-grade applications. They can be used to estimate, for example, blood oxygen saturation, autonomic nervous system activity and cardiac function, blood pressure, sleep quality, and recovery through the recording of photoplethysmography signal. Medical-grade devices often record red and infra-red light-based photoplethysmography signals while smartwatches and other consumer-grade devices usually rely on a green light. At its simplest, a pulse oximeter can consist of one or two photodiodes and a photodetector attached, for example, a fingertip or earlobe. These sensors are used to record light absorption in a medium as a function of time. This time-varying absorption information is used to form a photoplethysmography signal. In this chapter, we discuss the working principles of pulse oximeters and the formation of the photoplethysmography signal. We will further discuss the advantages and disadvantages of pulse oximeters, which kind of applications exist in the medical field, and how pulse oximeters are utilized in daily health monitoring.
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Affiliation(s)
- Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
| | - Samu Kainulainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Henri Korkalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Saara Sillanmäki
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kulkas
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Sami Nikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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29
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Park JY, Lee Y, Heo R, Park HK, Cho SH, Cho SH, Lim YH. Preclinical evaluation of noncontact vital signs monitoring using real-time IR-UWB radar and factors affecting its accuracy. Sci Rep 2021; 11:23602. [PMID: 34880335 PMCID: PMC8655004 DOI: 10.1038/s41598-021-03069-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
Recently, noncontact vital sign monitors have attracted attention because of issues related to the transmission of contagious diseases. We developed a real-time vital sign monitor using impulse-radio ultrawideband (IR-UWB) radar with embedded processors and software; we then evaluated its accuracy in measuring heart rate (HR) and respiratory rate (RR) and investigated the factors affecting the accuracy of the radar-based measurements. In 50 patients visiting a cardiology clinic, HR and RR were measured using IR-UWB radar simultaneously with electrocardiography and capnometry. All patients underwent HR and RR measurements in 2 postures—supine and sitting—for 2 min each. There was a high agreement between the RR measured using radar and capnometry (concordance correlation coefficient [CCC] 0.925 [0.919–0.926]; upper and lower limits of agreement [LOA], − 2.21 and 3.90 breaths/min). The HR measured using radar was also in close agreement with the value measured using electrocardiography (CCC 0.749 [0.738–0.760]; upper and lower LOA, − 12.78 and 15.04 beats/min). Linear mixed effect models showed that the sitting position and an HR < 70 bpm were associated with an increase in the absolute biases of the HR, whereas the sitting position and an RR < 18 breaths/min were associated with an increase in the absolute biases of the RR. The IR-UWB radar sensor with embedded processors and software can measure the RR and HR in real time with high precision. The sitting position and a low RR or HR were associated with the accuracy of RR and HR measurement, respectively, using IR-UWB radar.
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Affiliation(s)
- Jun-Young Park
- Department of Electronics and Computer Engineering, College of Engineering, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea
| | - Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Seok-Hyun Cho
- Department of Otorhinolaryngology, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Sung Ho Cho
- Department of Electronics and Computer Engineering, College of Engineering, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea.
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea.
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30
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Gürün Kaya A, Öz M, Akdemir Kalkan İ, Gülten E, Çınar G, Azap A, Kaya A. Is pulse oximeter a reliable tool for non-critically ill patients with COVID-19? Int J Clin Pract 2021; 75:e14983. [PMID: 34637170 PMCID: PMC8646536 DOI: 10.1111/ijcp.14983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/10/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Guidelines recommend using a pulse oximeter rather than arterial blood gas (ABG) for COVID-19 patients. However, significant differences can be observed between oxygen saturation measured by pulse oximetry (SpO2 ) and arterial oxygen saturation (SaO2 ) in some clinical conditions. We aimed to assess the reliability of the pulse oximeter in patients with COVID-19. METHODS We retrospectively reviewed ABG analyses and SpO2 levels measured simultaneously with ABG in patients hospitalised in COVID-19 wards. RESULTS We categorised total 117 patients into two groups, in whom the difference between SpO2 and SaO2 was ≤4% (acceptable difference) and >4% (large difference). A large difference group exhibited higher neutrophil count, C-reactive protein, ferritin, fibrinogen, D-dimer and lower lymphocyte count. Multivariate analyses revealed that increased fibrinogen, increased ferritin and decreased lymphocyte count were independent risk factors for a large difference between SpO2 and SaO2 . The total study group demonstrated the negative bias of 4.02% with the limits of agreement of -9.22% to 1.17%. The bias became significantly higher in patients with higher ferritin, fibrinogen levels and lower lymphocyte count. CONCLUSION Pulse oximeters may not be sufficient to assess actual oxygen saturation, especially in COVID-19 patients with high ferritin and fibrinogen levels and low lymphocyte count with low SpO2 measurements.
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Affiliation(s)
- Aslıhan Gürün Kaya
- Department of Chest DiseasesAnkara University Faculty of MedicineAnkaraTurkey
| | - Miraç Öz
- Department of Chest DiseasesAnkara University Faculty of MedicineAnkaraTurkey
| | - İrem Akdemir Kalkan
- Department of Infectious Diseases and Clinical MicrobiologyAnkara University Faculty of MedicineAnkaraTurkey
| | - Ezgi Gülten
- Department of Infectious Diseases and Clinical MicrobiologyAnkara University Faculty of MedicineAnkaraTurkey
| | - Güle Çınar
- Department of Infectious Diseases and Clinical MicrobiologyAnkara University Faculty of MedicineAnkaraTurkey
| | - Alpay Azap
- Department of Infectious Diseases and Clinical MicrobiologyAnkara University Faculty of MedicineAnkaraTurkey
| | - Akın Kaya
- Department of Chest DiseasesAnkara University Faculty of MedicineAnkaraTurkey
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31
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Wong AKI, Charpignon M, Kim H, Josef C, de Hond AAH, Fojas JJ, Tabaie A, Liu X, Mireles-Cabodevila E, Carvalho L, Kamaleswaran R, Madushani RWMA, Adhikari L, Holder AL, Steyerberg EW, Buchman TG, Lough ME, Celi LA. Analysis of Discrepancies Between Pulse Oximetry and Arterial Oxygen Saturation Measurements by Race and Ethnicity and Association With Organ Dysfunction and Mortality. JAMA Netw Open 2021; 4:e2131674. [PMID: 34730820 PMCID: PMC9178439 DOI: 10.1001/jamanetworkopen.2021.31674] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Discrepancies in oxygen saturation measured by pulse oximetry (Spo2), when compared with arterial oxygen saturation (Sao2) measured by arterial blood gas (ABG), may differentially affect patients according to race and ethnicity. However, the association of these disparities with health outcomes is unknown. OBJECTIVE To examine racial and ethnic discrepancies between Sao2 and Spo2 measures and their associations with clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS This multicenter, retrospective, cross-sectional study included 3 publicly available electronic health record (EHR) databases (ie, the Electronic Intensive Care Unit-Clinical Research Database and Medical Information Mart for Intensive Care III and IV) as well as Emory Healthcare (2014-2021) and Grady Memorial (2014-2020) databases, spanning 215 hospitals and 382 ICUs. From 141 600 hospital encounters with recorded ABG measurements, 87 971 participants with first ABG measurements and an Spo2 of at least 88% within 5 minutes before the ABG test were included. EXPOSURES Patients with hidden hypoxemia (ie, Spo2 ≥88% but Sao2 <88%). MAIN OUTCOMES AND MEASURES Outcomes, stratified by race and ethnicity, were Sao2 for each Spo2, hidden hypoxemia prevalence, initial demographic characteristics (age, sex), clinical outcomes (in-hospital mortality, length of stay), organ dysfunction by scores (Sequential Organ Failure Assessment [SOFA]), and laboratory values (lactate and creatinine levels) before and 24 hours after the ABG measurement. RESULTS The first Spo2-Sao2 pairs from 87 971 patient encounters (27 713 [42.9%] women; mean [SE] age, 62.2 [17.0] years; 1919 [2.3%] Asian patients; 26 032 [29.6%] Black patients; 2397 [2.7%] Hispanic patients, and 57 632 [65.5%] White patients) were analyzed, with 4859 (5.5%) having hidden hypoxemia. Hidden hypoxemia was observed in all subgroups with varying incidence (Black: 1785 [6.8%]; Hispanic: 160 [6.0%]; Asian: 92 [4.8%]; White: 2822 [4.9%]) and was associated with greater organ dysfunction 24 hours after the ABG measurement, as evidenced by higher mean (SE) SOFA scores (7.2 [0.1] vs 6.29 [0.02]) and higher in-hospital mortality (eg, among Black patients: 369 [21.1%] vs 3557 [15.0%]; P < .001). Furthermore, patients with hidden hypoxemia had higher mean (SE) lactate levels before (3.15 [0.09] mg/dL vs 2.66 [0.02] mg/dL) and 24 hours after (2.83 [0.14] mg/dL vs 2.27 [0.02] mg/dL) the ABG test, with less lactate clearance (-0.54 [0.12] mg/dL vs -0.79 [0.03] mg/dL). CONCLUSIONS AND RELEVANCE In this study, there was greater variability in oxygen saturation levels for a given Spo2 level in patients who self-identified as Black, followed by Hispanic, Asian, and White. Patients with and without hidden hypoxemia were demographically and clinically similar at baseline ABG measurement by SOFA scores, but those with hidden hypoxemia subsequently experienced higher organ dysfunction scores and higher in-hospital mortality.
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Affiliation(s)
- An-Kwok Ian Wong
- Division of Pulmonary, Allergy, Critical Care,
and Sleep Medicine, Emory University, Atlanta, Georgia
- Division of Pulmonary, Allergy, and Critical
Care Medicine, Duke University, Durham, North Carolina
| | - Marie Charpignon
- MIT Institute for Data, Systems and Society,
Cambridge, Massachusetts
| | - Han Kim
- Department of Biomedical Engineering, Johns
Hopkins University, Baltimore, Maryland
| | | | - Anne A. H. de Hond
- Leiden University Medical Centre, Department of
Biomedical Data Sciences, Leiden, the Netherlands
- Leiden University Medical Centre, Department of
Information Technology and Digital Innovation, Leiden, the Netherlands
| | - Jhalique Jane Fojas
- Department of Neurology, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Azade Tabaie
- Department of Biomedical Informatics, Emory
University, Atlanta, Georgia
| | - Xiaoli Liu
- School of Biological Science and Medical
Engineering, Beihang University, Beijing, China
| | | | - Leandro Carvalho
- Respiratory Institute, Cleveland Clinic,
Cleveland, Ohio
- Sociedade Mineira de Terapia Intensiva, Belo
Horizonte, Brazil
| | | | | | - Lasith Adhikari
- Connected Care and Personal Health, Philips
Research North America, Cambridge, Massachusetts
| | - Andre L. Holder
- Division of Pulmonary, Allergy, Critical Care,
and Sleep Medicine, Emory University, Atlanta, Georgia
| | - Ewout W. Steyerberg
- Leiden University Medical Centre, Department of
Biomedical Data Sciences, Leiden, the Netherlands
| | | | - Mary E. Lough
- Medicine–Primary Care and Population
Health, Stanford University, California
- Office of Research, Stanford Health Care,
Stanford, California
| | - Leo Anthony Celi
- Massachusetts Institute of Technology,
Laboratory for Computational Physiology, Cambridge
- Division of Pulmonary, Critical Care, and
Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan
School of Public Health, Boston, Massachusetts
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32
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Xu J, Li C, Tang H, Tan D, Fu Y, Zong L, Jing D, Ding B, Cao Y, Lu Z, Tian Y, Chai Y, Meng Y, Wang Z, Zheng YA, Zhao X, Zhang X, Liang L, Zeng Z, Li Y, Walline JH, Song PP, Zheng L, Sun F, Shao S, Sun M, Huang M, Zeng R, Zhang S, Yang X, Yao D, Yu M, Liao H, Xiong Y, Zheng K, Qin Y, An Y, Liu Y, Chen K, Zhu H, Yu X, Du B. Pulse oximetry waveform: A non-invasive physiological predictor for the return of spontaneous circulation in cardiac arrest patients ---- A multicenter, prospective observational study. Resuscitation 2021; 169:189-197. [PMID: 34624410 DOI: 10.1016/j.resuscitation.2021.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to investigate the predictive value of pulse oximetry plethysmography (POP) for the return of spontaneous circulation (ROSC) in cardiac arrest (CA) patients. METHODS This was a multicenter, observational, prospective cohort study of patients hospitalized with cardiac arrest at 14 teaching hospitals cross China from December 2013 through November 2014. The study endpoint was ROSC, defined as the restoration of a palpable pulse and an autonomous cardiac rhythm lasting for at least 20 minutes after the completion or cessation of CPR. RESULTS 150 out-of-hospital cardiac arrest (OHCA) patients and 291 in-hospital cardiac arrest (IHCA) patients were enrolled prospectively. ROSC was achieved in 20 (13.3%) and 64 (22.0%) patients in these cohorts, respectively. In patients with complete end-tidal carbon dioxide (ETCO2) and POP data, patients with ROSC had significantly higher levels of POP area under the curve (AUCp), wave amplitude (Amp) and ETCO2 level during CPR than those without ROSC (all p < 0.05). Pairwise comparison of receiver operating characteristic (ROC) curve analysis indicated no significant difference was observed between ETCO2 and Amp (p = 0.204) or AUCp (p = 0.588) during the first two minutes of resuscitation. CONCLUSION POP may be a novel and effective method for predicting ROSC during resuscitation, with a prognostic value similar to ETCO2 at early stage.
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Affiliation(s)
- Jun Xu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chen Li
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China; Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hanqi Tang
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Dingyu Tan
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China; Department of Emergency Medicine, Northern Jiangsu People's Hospital, Yangzhou 225001, China
| | - Yangyang Fu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Liang Zong
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Daoyuan Jing
- Department of Emergency Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Banghan Ding
- Department of Emergency Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou 510120, China
| | - Yu Cao
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhongqiu Lu
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yingping Tian
- Department of Emergency Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yanfen Chai
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yanli Meng
- Department of Emergency Medicine, HuaBei Petroleum General Hospital, Renqiu 062552, China
| | - Zhen Wang
- Department of Emergency Medicine, Beijing Shijitan Hospital Capital Medical University, Beijing 100038, China
| | - Ya-An Zheng
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Xiaodong Zhao
- Department of Emergency Medicine, First Affiliated Hospital of PLA Hospital, Beijing 100048, China
| | - Xinyan Zhang
- Department of Emergency Medicine, Beijing Haidian Hospital, Beijing 100080, China
| | - Lu Liang
- Department of Emergency Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China
| | - Zhongyi Zeng
- Department of Emergency Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, China
| | - Yan Li
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Joseph H Walline
- Centre for the Humanities and Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Priscilla P Song
- Centre for the Humanities and Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Liangliang Zheng
- Beijing Hospital, National Center of Gerontology, China, Beijing 100730, China
| | - Feng Sun
- Department of Emergency Medicine, Jiangsu Province Hospital, Yangzhou 210029, China
| | - Shihuan Shao
- Department of Emergency Medicine, Peking University People's Hospital, Beijing 100044, China; Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ming Sun
- Department of Emergency Medicine, Affiliated Suqian Hospital of Xuzhou Medical University, Xuzhou 221004, China
| | - Mingwei Huang
- Department of Emergency Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Ruifeng Zeng
- Department of Emergency Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou 510120, China
| | - Shu Zhang
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoya Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Dongqi Yao
- Department of Emergency Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Muming Yu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hua Liao
- Department of Emergency Medicine, HuaBei Petroleum General Hospital, Renqiu 062552, China
| | - Yingxia Xiong
- Department of Emergency Medicine, Beijing Shijitan Hospital Capital Medical University, Beijing 100038, China
| | - Kang Zheng
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Yuhong Qin
- Department of Emergency Medicine, First Affiliated Hospital of PLA Hospital, Beijing 100048, China
| | - Yingbo An
- Department of Emergency Medicine, Beijing Haidian Hospital, Beijing 100080, China
| | - Yuxiang Liu
- Department of Emergency Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China
| | - Kun Chen
- Department of Emergency Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Huadong Zhu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xuezhong Yu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
| | - Bin Du
- Department of Medical Intensive Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
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Holbery-Morgan L, Carew J, Angel C, Simpson N, Steinfort D, Radford S, Murphy M, Douglas N, Johnson D. Feasibility of pulse oximetry after water immersion. Resusc Plus 2021; 7:100147. [PMID: 34553181 PMCID: PMC8441519 DOI: 10.1016/j.resplu.2021.100147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022] Open
Abstract
Objective This study aimed to determine if pulse oximetry could reliably be used after immersion in water, and if so, which of the finger, earlobe or nose most reliably produced a functional waveform. Method Pulse oximetry data was recorded from the ear, nose and finger before and after 30 min of immersion in water. The primary outcome was the ability to measure pulse oximetry at any of the sites. Results A total of 119 participants were enrolled (with a median age of 16 years, 55% male). A useful pulse oximetry waveform was obtained after immersion from at least one of the measurement sites in 118 (99.2%) participants. Waveforms were usable after immersion in 96% of participants at the nostril, compared to 92% at the finger, and 41% at the ear lobe. The likelihood of success at the ear was significantly lower than either the finger or the nose (41% vs 92% and 96% respectively, p < 0.0001 for both comparisons). The finger and nostril were similar. Oxygen saturations were not significantly different after immersion at the nostril (100% vs 100%, p = 0.537) and finger (100% vs 100%, p = 0.032) sites but were different at the ear (100% vs 96%, p < 0.0001). Conclusion This study demonstrates that pulse oximetry is feasible and reliable in a large cohort of participants who have been immersed in water for 30 min. The results support the nostril as the most reliable location. Only pulse oximeters registered for clinical use should be employed for patient care.
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Affiliation(s)
- Lachlan Holbery-Morgan
- Lifesaving Victoria, Port Melbourne, VIC 3207, Australia
- Barwon Health — University Hospital Geelong, Geelong, VIC 3220, Australia
| | - James Carew
- Lifesaving Victoria, Port Melbourne, VIC 3207, Australia
- Ambulance Victoria, Doncaster, VIC 3108, Australia
| | - Cara Angel
- Barwon Health — University Hospital Geelong, Geelong, VIC 3220, Australia
| | - Nick Simpson
- Barwon Health — University Hospital Geelong, Geelong, VIC 3220, Australia
| | - Dan Steinfort
- Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | | | - Michelle Murphy
- Lifesaving Victoria, Port Melbourne, VIC 3207, Australia
- Ambulance Victoria, Doncaster, VIC 3108, Australia
| | - Ned Douglas
- Lifesaving Victoria, Port Melbourne, VIC 3207, Australia
- Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Ambulance Victoria, Doncaster, VIC 3108, Australia
- Centre for Integrated Critical Care, University of Melbourne, Parkville, VIC 3050, Australia
- Corresponding author at: Lifesaving Victoria, Port Melbourne, VIC 3207, Australia.
| | - Douglas Johnson
- Lifesaving Victoria, Port Melbourne, VIC 3207, Australia
- Royal Melbourne Hospital, Parkville, VIC 3050, Australia
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34
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Wiles MD, El-Nayal A, Elton G, Malaj M, Winterbottom J, Gillies C, Moppett IK, Bauchmuller K. The effect of patient ethnicity on the accuracy of peripheral pulse oximetry in patients with COVID-19 pneumonitis: a single-centre, retrospective analysis. Anaesthesia 2021; 77:143-152. [PMID: 34542168 PMCID: PMC8653100 DOI: 10.1111/anae.15581] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
Pulse oximetry is used widely to titrate oxygen therapy and for triage in patients who are critically ill. However, there are concerns regarding the accuracy of pulse oximetry in patients with COVID‐19 pneumonitis and in patients who have a greater degree of skin pigmentation. We aimed to determine the impact of patient ethnicity on the accuracy of peripheral pulse oximetry in patients who were critically ill with COVID‐19 pneumonitis by conducting a retrospective observational study comparing paired measurements of arterial oxygen saturation measured by co‐oximetry on arterial blood gas analysis (SaO2) and the corresponding peripheral oxygenation saturation measured by pulse oximetry (SpO2). Bias was calculated as the mean difference between SaO2 and SpO2 measurements and limits of agreement were calculated as bias ±1.96 SD. Data from 194 patients (135 White ethnic origin, 34 Asian ethnic origin, 19 Black ethnic origin and 6 other ethnic origin) were analysed consisting of 6216 paired SaO2 and SpO2 measurements. Bias (limits of agreement) between SaO2 and SpO2 measurements was 0.05% (−2.21–2.30). Patient ethnicity did not alter this to a clinically significant degree: 0.28% (1.79–2.35), −0.33% (−2.47–2.35) and −0.75% (−3.47–1.97) for patients of White, Asian and Black ethnic origin, respectively. In patients with COVID‐19 pneumonitis, SpO2 measurements showed a level of agreement with SaO2 values that was in line with previous work, and this was not affected by patient ethnicity.
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Affiliation(s)
- M D Wiles
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,University of Sheffield Medical School, Sheffield, UK
| | - A El-Nayal
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G Elton
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Malaj
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Winterbottom
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - C Gillies
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - I K Moppett
- Department of Anaesthesia and Peri-operative Medicine, University of Nottingham, Nottingham, UK
| | - K Bauchmuller
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, König M, Markewitz A, Nothacker M, Roiter S, Unverzagt S, Veit W, Volk T, Witt C, Wildenauer R, Worth H, Fühner T. [German S3 Guideline - Oxygen Therapy in the Acute Care of Adult Patients]. Pneumologie 2021; 76:159-216. [PMID: 34474487 DOI: 10.1055/a-1554-2625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiologic properties, a range of effective doses and may have side effects. In 2015, 14 % of over 55 000 hospital patients in the UK were using oxygen. 42 % of patients received this supplemental oxygen without a valid prescription. Healthcare professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A S3-guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. Literature search was performed until Feb 1st 2021 to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used and for assessing the quality of evidence and for grading guideline recommendation and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses healthcare professionals using oxygen in acute out-of-hospital and in-hospital settings. The guideline will be valid for 3 years until June 30, 2024.
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Affiliation(s)
- Jens Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
| | - Philipp Capetian
- Klinik für Neurologie, Neurologische Intensivstation, Universitätsklinikum Würzburg
| | - Uwe Hamsen
- Fachbereich für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | - Uwe Janssens
- Innere Medizin und internistische Intensivmedizin, Sankt Antonius Hospital GmbH, Eschweiler
| | - Christian Karagiannidis
- Abteilung für Pneumologie und Beatmungsmedizin, ARDS/ECMO Zentrum, Lungenklinik Köln-Merheim
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg
| | - Marco König
- Deutscher Berufsverband Rettungsdienst e. V., Lübeck
| | - Andreas Markewitz
- ehem. Klinik für Herz- und Gefäßchirurgie Bundeswehrzentralkrankenhaus Koblenz
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg
| | | | | | - Wolfgang Veit
- Bundesverband der Organtransplantierten e. V., Marne
| | - Thomas Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Christian Witt
- Seniorprofessor Innere Medizin und Pneumologie, Charité Berlin
| | | | | | - Thomas Fühner
- Krankenhaus Siloah, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Region Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
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36
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Patrician A, Pernett F, Lodin-Sundström A, Schagatay E. Association Between Arterial Oxygen Saturation and Lung Ultrasound B-Lines After Competitive Deep Breath-Hold Diving. Front Physiol 2021; 12:711798. [PMID: 34421654 PMCID: PMC8371971 DOI: 10.3389/fphys.2021.711798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Breath-hold diving (freediving) is an underwater sport that is associated with elevated hydrostatic pressure, which has a compressive effect on the lungs that can lead to the development of pulmonary edema. Pulmonary edema reduces oxygen uptake and thereby the recovery from the hypoxia developed during freediving, and increases the risk of hypoxic syncope. We aimed to examine the efficacy of SpO2, via pulse-oximetry, as a tool to detect pulmonary edema by comparing it to lung ultrasound B-line measurements after deep diving. SpO2 and B-lines were collected in 40 freedivers participating in an international deep freediving competition. SpO2 was measured within 17 ± 6 min and lung B-lines using ultrasound within 44 ± 15 min after surfacing. A specific symptoms questionnaire was used during SpO2 measurements. We found a negative correlation between B-line score and minimum SpO2 (rs = −0.491; p = 0.002) and mean SpO2 (rs = −0.335; p = 0.046). B-line scores were positively correlated with depth (rs = 0.408; p = 0.013), confirming that extra-vascular lung water is increased with deeper dives. Compared to dives that were asymptomatic, symptomatic dives had a 27% greater B-line score, and both a lower mean and minimum SpO2 (all p < 0.05). Indeed, a minimum SpO2 ≤ 95% after a deep dive has a positive predictive value of 29% and a negative predictive value of 100% regarding symptoms. We concluded that elevated B-line scores are associated with reduced SpO2 after dives, suggesting that SpO2 via pulse oximetry could be a useful screening tool to detect increased extra-vascular lung water. The practical application is not to diagnose pulmonary edema based on SpO2 – as pulse oximetry is inexact – rather, to utilize it as a tool to determine which divers require further evaluation before returning to deep freediving.
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Affiliation(s)
- Alexander Patrician
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Okanagan, BC, Canada
| | - Frank Pernett
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | | | - Erika Schagatay
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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Röttgering JG, de Man AME, Schuurs TC, Wils EJ, Daniels JM, van den Aardweg JG, Girbes ARJ, Smulders YM. Determining a target SpO2 to maintain PaO2 within a physiological range. PLoS One 2021; 16:e0250740. [PMID: 33983967 PMCID: PMC8118260 DOI: 10.1371/journal.pone.0250740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE In the context of an ongoing debate on the potential risks of hypoxemia and hyperoxemia, it seems prudent to maintain the partial arterial oxygen pressure (PaO2) in a physiological range during administration of supplemental oxygen. The PaO2 and peripheral oxygen saturation (SpO2) are closely related and both are used to monitor oxygenation status. However, SpO2 values cannot be used as an exact substitute for PaO2. The aim of this study in acutely ill and stable patients was to determine at which SpO2 level PaO2 is more or less certain to be in the physiological range. METHODS This is an observational study prospectively collecting data pairs of PaO2 and SpO2 values in patients admitted to the emergency room or intensive care unit (Prospective Inpatient Acutely ill cohort; PIA cohort). A second cohort of retrospective data of patients who underwent pulmonary function testing was also included (Retrospective Outpatient Pulmonary cohort; ROP cohort). Arterial hypoxemia was defined as PaO2 < 60 mmHg and hyperoxemia as PaO2 > 125 mmHg. The SpO2 cut-off values with the lowest risk of hypoxemia and hyperoxemia were determined as the 95th percentile of the observed SpO2 values corresponding with the observed hypoxemic and hyperoxemic PaO2 values. RESULTS 220 data pairs were collected in the PIA cohort. 95% of hypoxemic PaO2 measurements occurred in patients with an SpO2 below 94%, and 95% of hyperoxemic PaO2 measurements occurred in patients with an SpO2 above 96%. Additionally in the 1379 data pairs of the ROP cohort, 95% of hypoxemic PaO2 measurements occurred in patients with an SpO2 below 93%. CONCLUSION The SpO2 level marking an increased risk of arterial hypoxemia is not substantially different in acutely ill versus stable patients. In acutely ill patients receiving supplemental oxygen an SpO2 target of 95% maximizes the likelihood of maintaining PaO2 in the physiological range.
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Affiliation(s)
- Jantine G. Röttgering
- Department of Intensive Care, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- Institute for Cardiovascular Research (ICaR-VU), Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Angelique M. E. de Man
- Department of Intensive Care, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- Institute for Cardiovascular Research (ICaR-VU), Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Thomas C. Schuurs
- Department of Emergency Medicine, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| | - Johannes M. Daniels
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | | | - Armand R. J. Girbes
- Department of Intensive Care, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- Institute for Cardiovascular Research (ICaR-VU), Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Yvo M. Smulders
- Institute for Cardiovascular Research (ICaR-VU), Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
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Mulder E, Schagatay E, Sieber A. First Evaluation of a Newly Constructed Underwater Pulse Oximeter for Use in Breath-Holding Activities. Front Physiol 2021; 12:649674. [PMID: 33981249 PMCID: PMC8107719 DOI: 10.3389/fphys.2021.649674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
Studying risk factors in freediving, such as hypoxic blackout, requires development of new methods to enable remote underwater monitoring of physiological variables. We aimed to construct and evaluate a new water- and pressure proof pulse oximeter for use in freediving research. The study consisted of three parts: (I) A submersible pulse oximeter (SUB) was developed on a ruggedized platform for recording of physiological parameters in challenging environments. Two MAX30102 sensors were used to record plethysmograms, and included red and infra-red emitters, diode drivers, photodiode, photodiode amplifier, analog to digital converter, and controller. (II) We equipped 20 volunteers with two transmission pulse oximeters (TPULS) and SUB to the fingers. Arterial oxygen saturation (SpO2) and heart rate (HR) were recorded, while breathing room air (21% O2) and subsequently a hypoxic gas (10.7% O2) at rest in dry conditions. Bland-Altman analysis was used to evaluate bias and precision of SUB relative to SpO2 values from TPULS. (III) Six freedivers were monitored with one TPULS and SUB placed at the forehead, during a maximal effort immersed static apnea. For dry baseline measurements (n = 20), SpO2 bias ranged between −0.8 and −0.6%, precision between 1.0 and 1.5%; HR bias ranged between 1.1 and 1.0 bpm, precision between 1.4 and 1.9 bpm. For the hypoxic episode, SpO2 bias ranged between −2.5 and −3.6%, precision between 3.6 and 3.7%; HR bias ranged between 1.4 and 1.9 bpm, precision between 2.0 and 2.1 bpm. Freedivers (n = 6) performed an apnea of 184 ± 53 s. Desaturation- and resaturation response time of SpO2 was approximately 15 and 12 s shorter in SUB compared to TPULS, respectively. Lowest SpO2 values were 76 ± 10% for TPULS and 74 ± 13% for SUB. HR traces for both pulse oximeters showed similar patterns. For static apneas, dropout rate was larger for SUB (18%) than for TPULS (<1%). SUB produced similar SpO2 and HR values as TPULS, both during normoxic and hypoxic breathing (n = 20), and submersed static apneas (n = 6). SUB responds more quickly to changes in oxygen saturation when sensors were placed at the forehead. Further development of SUB is needed to limit signal loss, and its function should be tested at greater depth and lower saturation.
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Affiliation(s)
- Eric Mulder
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Erika Schagatay
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| | - Arne Sieber
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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Katayama S, Shima J, Tonai K, Koyama K, Nunomiya S. Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study. Sci Rep 2021; 11:9001. [PMID: 33903716 PMCID: PMC8076307 DOI: 10.1038/s41598-021-88608-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 04/15/2021] [Indexed: 12/26/2022] Open
Abstract
Recently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable. Trial registration UMIN000027671. Registered 7 June 2017.
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Affiliation(s)
- Shinshu Katayama
- Division of Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Jun Shima
- Division of Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Ken Tonai
- Division of Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kansuke Koyama
- Division of Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shin Nunomiya
- Division of Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Schrading WA, McCafferty B, Grove J, Page DB. Portable, consumer-grade pulse oximeters are accurate for home and medical use: Implications for use in the COVID-19 pandemic and other resource-limited environments. J Am Coll Emerg Physicians Open 2020. [PMID: 33392548 DOI: 10.1002/emp2.v1.610.1002/emp2.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE To determine the correlation between 3 lightweight portable pulse oximeter devices compared to a standard wall mount pulse oximetry device. METHODS We performed a single-center, prospective, observational study of 4 pulse oximetry devices, 3 of which are commercially available to the public. A convenience sample of 200 emergency department (ED) patients with chief complaints of cardiopulmonary origin or a peripheral capillary oxygen saturation ≤ 94 percent were enrolled. Analysis of variance was performed to compare SpO2s and test characteristics of the 3 devices compared to control. RESULTS Although differences in measured SpO2s were observed (P < 0.001) across groups, the differences were small (mean differences ranged from 1.00% to 1.87%). The correlation between test devices and the control were high (r range 0.70-0.79). Although the test characteristics were not perfect, the devices did have good sensitivity using a cutoff value of 94% (sensitivity ranging from 90% to 92%), which improved with lower SpO2 cutoff values to 92% (sensitivity ranging from 96% to 97%). CONCLUSION The 3 commercially available devices were accurate enough to be clinically useful when compared to a hospital bedside monitor pulse oximeter. Consumer-grade portable pulse oximeters may be useful if overwhelming numbers of patients require oxygen saturation monitoring, such as during the COVID-19 pandemic.
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Affiliation(s)
- Walter A Schrading
- Office of Wilderness Medicine, Department of Emergency Medicine University of Alabama at Birmingham Birmingham Alabama USA
| | - Ben McCafferty
- University of Alabama School of Medicine Birmingham Alabama USA
| | - Jordan Grove
- University of Alabama School of Medicine Birmingham Alabama USA
| | - David B Page
- Department of Medicine Division of Pulmonary Allergy and Critical Care Medicine University of Alabama at Birmingham Birmingham Alabama USA
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Thangthong J, Anugulruengkitt S, Lauhasurayotin S, Chiengthong K, Poparn H, Sosothikul D, Techavichit P. Predictive Factors of Severe Adverse Events in Pediatric Oncologic Patients with Febrile Neutropenia. Asian Pac J Cancer Prev 2020; 21:3487-3492. [PMID: 33369443 PMCID: PMC8046322 DOI: 10.31557/apjcp.2020.21.12.3487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Febrile neutropenia (FN) is severe and potentially life-threatening in oncologic patients. The objective of this study is to define the factors associated with severe adverse outcomes of pediatric FN. METHODS A retrospective and prospective descriptive study performed in pediatric patients diagnosed with FN at King Chulalongkorn Memorial Hospital from January 2013 to December 2017. Severe adverse events defined as the presence in one of these following oxygen therapies, mechanical ventilator, shock, admission to ICU, renal dysfunction, and liver dysfunction. RESULTS The study included 267 patients with 563 febrile neutropenia episodes. The median (range) age was 5.1 years (1 month-15 year). Among 563 febrile neutropenia episodes, 115 episodes (20%) developed severe adverse events. The FN patients were classified into low and high-risk groups, 91% of patients with severe adverse events and all 21 patients who died were in high risk group. The overall mortality rate was 3.1%. Factors associated with severe adverse events were fungal infection (aOR 6.51, 95%CI 2.29-18.56), central venous catheter insertion (aOR 4.28, 95% CI 2.51-7.29), CPG defined high risk (aOR 3.35, 95%CI 1.56-7.17), viral infection (aOR 2.72, 95%CI 1.05-7.06), lower respiratory tract infection (aOR 2.52, 95%CI 1.09-5.82) and treatment not according to CPG (aOR 2.47, 95% CI 1.51-4.03). CONCLUSIONS Fungal and viral infection, central venous catheter insertion, lower respiratory tract infection, CPG defined high risk and treatment not according to CPG were associated factors of increased risk for severe adverse events. Our current institutional CPG for FN in children was applicable and improved clinical outcomes for this group of patients. <br />.
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Affiliation(s)
- Jutarat Thangthong
- Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial hospital, Chulalongkorn University, Bangkok, Thailand
| | - Suvaporn Anugulruengkitt
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Supanun Lauhasurayotin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,STAR Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kanhatai Chiengthong
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,STAR Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hansamon Poparn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,STAR Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Darintr Sosothikul
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,STAR Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piti Techavichit
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,STAR Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Schrading WA, McCafferty B, Grove J, Page DB. Portable, consumer-grade pulse oximeters are accurate for home and medical use: Implications for use in the COVID-19 pandemic and other resource-limited environments. J Am Coll Emerg Physicians Open 2020; 1:1450-1458. [PMID: 33392548 PMCID: PMC7771801 DOI: 10.1002/emp2.12292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the correlation between 3 lightweight portable pulse oximeter devices compared to a standard wall mount pulse oximetry device. METHODS We performed a single-center, prospective, observational study of 4 pulse oximetry devices, 3 of which are commercially available to the public. A convenience sample of 200 emergency department (ED) patients with chief complaints of cardiopulmonary origin or a peripheral capillary oxygen saturation ≤ 94 percent were enrolled. Analysis of variance was performed to compare SpO2s and test characteristics of the 3 devices compared to control. RESULTS Although differences in measured SpO2s were observed (P < 0.001) across groups, the differences were small (mean differences ranged from 1.00% to 1.87%). The correlation between test devices and the control were high (r range 0.70-0.79). Although the test characteristics were not perfect, the devices did have good sensitivity using a cutoff value of 94% (sensitivity ranging from 90% to 92%), which improved with lower SpO2 cutoff values to 92% (sensitivity ranging from 96% to 97%). CONCLUSION The 3 commercially available devices were accurate enough to be clinically useful when compared to a hospital bedside monitor pulse oximeter. Consumer-grade portable pulse oximeters may be useful if overwhelming numbers of patients require oxygen saturation monitoring, such as during the COVID-19 pandemic.
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Affiliation(s)
- Walter A. Schrading
- Office of Wilderness Medicine, Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ben McCafferty
- University of Alabama School of MedicineBirminghamAlabamaUSA
| | - Jordan Grove
- University of Alabama School of MedicineBirminghamAlabamaUSA
| | - David B. Page
- Department of MedicineDivision of PulmonaryAllergy and Critical Care MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Wackernagel D, Blennow M, Hellström A. Accuracy of pulse oximetry in preterm and term infants is insufficient to determine arterial oxygen saturation and tension. Acta Paediatr 2020; 109:2251-2257. [PMID: 32043645 DOI: 10.1111/apa.15225] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
AIM Oxygen saturation is frequently monitored with pulse oximetry to assess vital signs in critically ill patients. Optimally, pulse oximetry closely tracks arterial oxygen tension (PaO2 ), which provides guidance in oxygen titration. We investigated whether monitoring peripheral oxygen saturation (SpO2 ) could accurately guide oxygen titration in newborn infants. METHODS Twenty seven thousand two hundred thirty seven SpO2 readings were retrospectively paired with arterial oxygen saturation (SaO2 ) and PaO2 results from blood gas analyses performed in infants with arterial catheters in place. RESULTS SpO2 overestimated SaO2 readings by 2.9 ± 5.8%. When pulse oximetry readings were within the defined oxygen saturation target range, 7809 (20.9%) SaO2 values were below and 2830 (7.6%) exceeded the target range. In 57% of patients, PaO2 levels < 6 kPa was diagnosed while SpO2 readings were > 90%. PaO2 > 11 kPa was recorded in 19% of cases, when SpO2 readings were < 95%. Infants treated with supplemental oxygen showed a threefold increased risk of hypoxaemia compared to infants breathing room air. Sensitivity and specificity for detecting upper and lower target range limits were fair to good. For SpO2 values below 91%, ISO quality criteria were no longer fulfilled. CONCLUSIONS Based on arterial blood gas analyses as reference, pulse oximetry readings did not fulfil the performance requirements for titrating oxygen in neonatal patients.
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Affiliation(s)
- Dirk Wackernagel
- Department of Neonatal Medicine Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Mats Blennow
- Department of Neonatal Medicine Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Ann Hellström
- Department of Ophthalmology Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Nitzan M, Nitzan I, Arieli Y. The Various Oximetric Techniques Used for the Evaluation of Blood Oxygenation. SENSORS 2020; 20:s20174844. [PMID: 32867184 PMCID: PMC7506757 DOI: 10.3390/s20174844] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022]
Abstract
Adequate oxygen delivery to a tissue depends on sufficient oxygen content in arterial blood and blood flow to the tissue. Oximetry is a technique for the assessment of blood oxygenation by measurements of light transmission through the blood, which is based on the different absorption spectra of oxygenated and deoxygenated hemoglobin. Oxygen saturation in arterial blood provides information on the adequacy of respiration and is routinely measured in clinical settings, utilizing pulse oximetry. Oxygen saturation, in venous blood (SvO2) and in the entire blood in a tissue (StO2), is related to the blood supply to the tissue, and several oximetric techniques have been developed for their assessment. SvO2 can be measured non-invasively in the fingers, making use of modified pulse oximetry, and in the retina, using the modified Beer–Lambert Law. StO2 is measured in peripheral muscle and cerebral tissue by means of various modes of near infrared spectroscopy (NIRS), utilizing the relative transparency of infrared light in muscle and cerebral tissue. The primary problem of oximetry is the discrimination between absorption by hemoglobin and scattering by tissue elements in the attenuation measurement, and the various techniques developed for isolating the absorption effect are presented in the current review, with their limitations.
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Affiliation(s)
- Meir Nitzan
- Department of Physics/Electro-Optics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., Jerusalem 91160, Israel;
- Correspondence:
| | - Itamar Nitzan
- Monash Newborn, Monash Children’s Hospital, Melbourne 3168, Australia;
- Department of Neonatology, Shaare Zedek Medical Center, Shmuel Bait St 12, Jerusalem 9103102, Israel
| | - Yoel Arieli
- Department of Physics/Electro-Optics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., Jerusalem 91160, Israel;
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Costello JT, Bhogal AS, Williams TB, Bekoe R, Sabir A, Tipton MJ, Corbett J, Mani AR. Effects of Normobaric Hypoxia on Oxygen Saturation Variability. High Alt Med Biol 2020; 21:76-83. [PMID: 32069121 DOI: 10.1089/ham.2019.0092] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The study is the first to evaluate the effects of graded normobaric hypoxia on SpO2 variability in healthy individuals. Materials and Methods: Twelve healthy males (mean [standard deviation] age 22 [4] years) were exposed to four simulated environments (fraction of inspired oxygen [FIO2]: 0.12, 0.145, 0.17, and 0.21) for 45 minutes, in a balanced crossover design. Results: Sample entropy, a tool that quantifies the irregularity of pulse oximetry fluctuations, was used as a measure of SpO2 variability. SpO2 entropy increased as the FIO2 decreased, and there was a strong significant negative correlation between mean SpO2 and its entropy during hypoxic exposure (r = -0.841 to -0.896, p < 0.001). In addition, SpO2 sample entropy, but not mean SpO2, was correlated (r = 0.630-0.760, p < 0.05) with dyspnea in FIO2 0.17, 0.145, and 0.12 and importantly, SpO2 sample entropy at FIO2 0.17 was correlated with dyspnea at FIO2 0.145 (r = 0.811, p < 0.01). Conclusions: These findings suggest that SpO2 variability analysis may have the potential to be used in a clinical setting as a noninvasive measure to identify the negative sequelae of hypoxemia.
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Affiliation(s)
- Joseph T Costello
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Amar S Bhogal
- Network Physiology Laboratory, UCL Division of Medicine, University College London, London, United Kingdom
| | - Thomas B Williams
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Richard Bekoe
- Network Physiology Laboratory, UCL Division of Medicine, University College London, London, United Kingdom
| | - Amin Sabir
- Network Physiology Laboratory, UCL Division of Medicine, University College London, London, United Kingdom
| | - Michael J Tipton
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Jo Corbett
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Ali R Mani
- Network Physiology Laboratory, UCL Division of Medicine, University College London, London, United Kingdom
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A multicentre prospective observational study comparing arterial blood gas values to those obtained by pulse oximeters used in adult patients attending Australian and New Zealand hospitals. BMC Pulm Med 2020; 20:7. [PMID: 31918697 PMCID: PMC6953261 DOI: 10.1186/s12890-019-1007-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 11/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background Pulse oximetry is widely used in the clinical setting. The purpose of this validation study was to investigate the level of agreement between oxygen saturations measured by pulse oximeter (SpO2) and arterial blood gas (SaO2) in a range of oximeters in clinical use in Australia and New Zealand. Methods Paired SpO2 and SaO2 measurements were collected from 400 patients in one Australian and two New Zealand hospitals. The ages of the patients ranged from 18 to 95 years. Bias and limits of agreement were estimated. Sensitivity and specificity for detecting hypoxaemia, defined as SaO2 < 90%, were also estimated. Results The majority of participants were recruited from the Outpatient, Ward or High Dependency Unit setting. Bias, oximeter-measured minus arterial blood gas-measured oxygen saturation, was − 1.2%, with limits of agreement − 4.4 to 2.0%. SpO2 was at least 4% lower than SaO2 for 10 (2.5%) of the participants and SpO2 was at least 4% higher than the SaO2 in 3 (0.8%) of the participants. None of the participants with a SpO2 ≥ 92% were hypoxaemic, defined as SaO2 < 90%. There were no clinically significant differences in oximetry accuracy in relation to clinical characteristics or oximeter brand. Conclusions In the majority of the participants, pulse oximetry was an accurate method to assess SaO2 and had good performance in detecting hypoxaemia. However, in a small proportion of participants, differences between SaO2 and SpO2 could have clinical relevance in terms of patient monitoring and management. A SpO2 ≥ 92% indicates that hypoxaemia, defined as a SaO2 < 90%, is not present. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12614001257651). Date of registration: 2/12/2014.
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47
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Thijssen M, Janssen L, le Noble J, Foudraine N. Facing SpO 2 and SaO 2 discrepancies in ICU patients: is the perfusion index helpful? J Clin Monit Comput 2019; 34:693-698. [PMID: 31392655 PMCID: PMC7366881 DOI: 10.1007/s10877-019-00371-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/03/2019] [Indexed: 12/30/2022]
Abstract
Peripheral oxygen saturation (SpO2) measured by pulse oximetry is an unreliable surrogate marker for arterial oxygenation (SaO2) in critically ill patients. We hypothesized that a higher perfusion index (PFI) would be associated with better accuracy of SpO2 measurement. We retrospectively collected SaO2, SpO2, and PFI data for each arterial blood gas (ABG) analysis in a cohort of intensive care unit patients. PFI was categorised as low (PFI < 1.0), intermediate (1.0 ≤ PFI ≤ 2.5), or high (PFI > 2.5). The correlation between SpO2 and SaO2 was studied using Pearson’s correlation. The Bland–Altman plot was used to analyse the agreement between SpO2 and SaO2. Furthermore, the correlation between the (SpO2–SaO2) difference and PFI was assessed. The level of (dis)agreement was calculated for the three PFI categories separately. Overall, 281 patients and 1281 data points were analysed. There was a significant correlation between SaO2 and SpO2 (r = 0.69, p < 0.01). The Bland–Altman analysis revealed a mean difference between SaO2 and SpO2 of 0.2% with limits of agreement of ± 6% (SD ± 2%). The correlation between the PFI and the (SpO2–SaO2) difference was low; the (SpO2–SaO2) difference improved only marginally with higher PFI values. The accuracy of pulse oximetry for estimating arterial oxygenation was moderate and improved little with increasing PFI values. Thus, the additive value of PFI in clinical decision making is limited. Therefore, we advise performing an ABG before adjusting fraction of inspired oxygen (FiO2) settings.
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Affiliation(s)
- Mark Thijssen
- Department of Intensive Care, VieCuri Medical Center, Tegelseweg 210, 5912BL, Venlo, The Netherlands.
| | - Loes Janssen
- Department of Statistics and Epidemiology, VieCuri Medical Center, Tegelseweg 210, 5912BL, Venlo, The Netherlands
| | - Jos le Noble
- Department of Intensive Care, VieCuri Medical Center, Tegelseweg 210, 5912BL, Venlo, The Netherlands
| | - Norbert Foudraine
- Department of Intensive Care, VieCuri Medical Center, Tegelseweg 210, 5912BL, Venlo, The Netherlands
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Jordan TB, Meyers CL, Schrading WA, Donnelly JP. The utility of iPhone oximetry apps: A comparison with standard pulse oximetry measurement in the emergency department. Am J Emerg Med 2019; 38:925-928. [PMID: 31471076 DOI: 10.1016/j.ajem.2019.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To determine if a correlation exists between 3 iphone pulse ox applications' measurements and the standard pulse oximetry (SpO2) and whether these applications can accurately determine hypoxia. METHODS Three applications reportedly measuring SpO2 were downloaded onto an iPhone 5s. Two of these applications used the onboard light and camera lens "Pulse Oximeter" (Pox) and "Heart Rate and Pulse Oximeter" (Ox) and one used an external device that plugged into the iphone (iOx). Patients in the ED were enrolled with chief complaints of cardiac/pulmonary origin or a SpO2 ≤ 94%. All measurements were compared to controls. Concordance correlation coefficients, sensitivity, and specificity were calculated. RESULTS A total of 191 patients were enrolled. The concordance correlation of iOx with control was 0.55 (CI 0.46, 0.63), POx was 0.01 (CI -0.09, 0.11), and Ox was 0.07 (CI -0.02, 0.15). 68/191 patients (35%) were found to have hypoxemia. Sensitivities for detecting hypoxia were 69%, 0%, and 7% for iOx, POx, and Ox, respectively. Specificities were 89%, 100%, and 89%. Even iOx (the most accurate) 21 (11%) were incorrectly classified nonhypoxic, and 22 (12%) were incorrectly classified hypoxic. CONCLUSIONS While iOx has modest concordance with control, Ox and POx showed almost none. The iOx device was best in correctly identifying hypoxia patients, but almost 1/4 of patients were incorrectly classified. The three apps provided inaccurate SpO2 measurements and had limited to no ability to accurately detect hypoxia. These apps should not be relied upon to provide accurate SpO2 measurements in emergent, even austere conditions.
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Affiliation(s)
- Taylor B Jordan
- University of Alabama at Birmingham School of Medicine, United States of America
| | | | - Walter A Schrading
- University of Alabama at Birmingham, Department of Emergency Medicine, Office of Wilderness Medicine, United States of America.
| | - John P Donnelly
- University of Michigan School of Medicine, Department of Learning and Health Sciences, United States of America
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Schjørring OL, Rasmussen BS. The paramount parameter: arterial oxygen tension versus arterial oxygen saturation as target in trials on oxygenation in intensive care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:324. [PMID: 30466486 PMCID: PMC6251193 DOI: 10.1186/s13054-018-2257-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Olav Lilleholt Schjørring
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
| | - Bodil Steen Rasmussen
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
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Abstract
PURPOSE Continuous peripheral pulse oximetry for monitoring adequacy of oxygenation is probably the most important technological advance for patients' monitoring and safety in the last decades. Pulse oximetry has the disadvantage of measuring the peripheral circulation, and the only mean to measure oxygen content of the central circulation is by invasive technology. Determination of blood oxyhaemoglobin saturation in the retinal vessels of the eye can be achieved noninvasively through spectrophotometric retinal oximetry which provides access to the central nervous system circulation. The aim of the thesis was to determine whether retinal oximetry technique can be applied for estimation of the central nervous system circulation which until now has only been possible invasively. This was achieved by measuring oxyhaemoglobin saturation in three adult subject study groups: in people with central retinal vein occlusion (CRVO) to observe local tissue hypoxia, in patients with severe chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy to observe systemic hypoxaemia and in healthy subjects during hyperoxic breathing to observe systemic hyperoxemia. In addition, the fourth study that is mentioned was performed to test whether retinal oximetry is feasible for neonates. METHODS Retinal oximetry in central retinal vein occlusion: Sixteen subjects with central retinal vein occlusion participated in the study. The oxyhaemoglobin saturation of the central retinal vein occlusion affected eye was compared with the fellow unaffected eye. Retinal oximetry in healthy people under hyperoxia: Thirty healthy subjects participated in the study, and the oxyhaemoglobin saturation of retinal arterioles and venules was compared between normoxic and hyperoxic breathing. Retinal oximetry in severe chronic obstructive pulmonary disease: Eleven patients with severe chronic obstructive pulmonary disease participated in the study. Retinal oximetry measurements were made with and without their daily supplemental oxygen therapy. Retinal arteriolar oxyhaemoglobin saturation when inspiring ambient air was compared with blood samples from the radial artery and finger pulse oximetry and healthy controls. The healthy control group was assembled from our database for comparison of oxyhaemoglobin saturation of retinal arterioles and venules during the ambient air breathing. The retinal oximeter is based on a conventional fundus camera and a specialized software. A beam splitter coupled with two high-resolution digital cameras allows for simultaneous acquisition of retinal images at separative wavelengths for calculation of oxyhaemoglobin saturation. In addition, retinal images of 28 full-term healthy neonates were obtained with scanning laser ophthalmoscope combined with modified Oxymap analysis software for calculation of the optical density ratio and vessel diameter RESULTS: Retinal oximetry in central retinal vein occlusion: Mean retinal venous oxyhaemoglobin saturation was 31 ± 12% in CRVO eyes and 52 ± 11% in unaffected fellow eyes (mean ± SD, n = 14, p < 0.0001). The arteriovenous oxygen difference (AV-difference) was 63 ± 11% in CRVO eyes and 43 ± 7% in fellow eyes (p < 0.0001). The variability of retinal venous oxyhaemoglobin saturation was considerable within and between eyes affected by CRVO. There was no difference in oxyhaemoglobin saturation of retinal arterioles between the CRVO eyes and the unaffected eyes (p = 0.49). Retinal oximetry in healthy people under hyperoxia: During hyperoxic breathing, the oxyhaemoglobin saturation in retinal arterioles increased to 94.5 ± 3.8% as compared with 92.0 ± 3.7% at baseline (n = 30, p < 0.0001). In venules, the mean oxyhaemoglobin saturation increased to 76.2 ± 8.0% from 51.3 ± 5.6% (p < 0.0001) at baseline. The AV-difference was markedly lower during hyperoxic breathing as compared with the normoxic breathing (18.3 ± 9.0% versus 40.7 ± 5.7%, p < 0.0001). Retinal oximetry in severe chronic obstructive pulmonary disease: During ambient air breathing, chronic obstructive pulmonary disease subjects had significantly lower oxyhaemoglobin saturation than healthy controls in both retinal arterioles (87.2 ± 4.9% versus 93.4 ± 4.3%, p = 0.02, n = 11) and venules (45.0 ± 10.3% versus 55.2 ± 5.5%, p = 0.01) but the AV-difference was not markedly different (p = 0.17). Administration of their prescribed oxygen therapy significantly increased the oxyhaemoglobin saturation in retinal arterioles (87.2 ± 4.9% to 89.5 ± 6.0%, p = 0.02) but not in venules (45.0 ± 10.3% to 46.7 ± 12.8%, p = 0.3). Retinal oximetry values were slightly lower than finger pulse oximetry (mean percentage points difference = -3.1 ± 5.5) and radial artery blood values (-5.0 ± 5.4). Retinal oximetry study in neonates: The modified version of the retinal oximetry instrument estimated the optical density ratio in retinal arterioles to be 0.256 ± 0.041 that was significantly different from the 0.421 ± 0.089 in venules (n = 28, p < 0.001, paired t-test). The vascular diameter of retinal arterioles was markedly narrower than of venules (14.1 ± 2.7 and 19.7 ± 3.7 pixels, p < 0.001). CONCLUSION The results of this thesis indicate that spectrophotometric retinal oximetry is sensitive to both local and systemic changes in oxyhaemoglobin saturation. Retinal oxyhaemoglobin saturation values are slightly lower than radial artery blood sample and finger pulse oximetry values. The discrepancies between the different modalities are expected to derive from countercurrent exchange between central retinal artery and vein within the optic nerve but calibration issues cannot be excluded as contributing to this difference. Despite these differences, the findings indicate the potential of retinal oximetry for noninvasive real-time measurements of oxyhaemoglobin saturation in central nervous system vessels. Following calibration upgrade and technological improvement, verification retinal oximetry may potentially be applied to critically ill and anaesthesia care patients. The study on combined scanning laser ophthalmoscope and retinal oximetry supports the feasibility of the technique for oximetry analysis in newly born babies.
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