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Mitchell JM, Walsh S, O'Byrne LJ, Conrick V, Burke R, Khashan AS, Higgins J, Greene R, Maher GM, McCarthy FP. Association between intrapartum fetal pulse oximetry and adverse perinatal and long-term outcomes: a systematic review and meta-analysis protocol. HRB Open Res 2024; 6:63. [PMID: 38628596 PMCID: PMC11019289 DOI: 10.12688/hrbopenres.13802.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
Background Current methods of intrapartum fetal monitoring based on heart rate, increase the rates of operative delivery but do not prevent or accurately detect fetal hypoxic brain injury. There is a need for more accurate methods of intrapartum fetal surveillance that will decrease the incidence of adverse perinatal and long-term neurodevelopmental outcomes while maintaining the lowest possible rate of obstetric intervention. Fetal pulse oximetry (FPO) is a technology that may contribute to improved intrapartum fetal wellbeing evaluation by providing a non-invasive measurement of fetal oxygenation status. Objective This systematic review and meta-analysis aims to synthesise the evidence examining the association between intrapartum fetal oxygen saturation levels and adverse perinatal and long-term outcomes in the offspring. Methods We will include randomised control trials (RCTs), cohort, cross-sectional and case-control studies which examine the use of FPO during labour as a means of measuring intrapartum fetal oxygen saturation and assess its effectiveness at detecting adverse perinatal and long-term outcomes compared to existing intrapartum surveillance methods. A detailed systematic search of PubMed, EMBASE, CINAHL, The Cochrane Library, Web of Science, ClinicalTrials.Gov and WHO ICTRP will be conducted following a detailed search strategy until February 2024. Three authors will independently review titles, abstracts and full text of articles. Two reviewers will independently extract data using a pre-defined data extraction form and assess the quality of included studies using the Risk of Bias tool for RCTs and Newcastle-Ottawa Scale for observational studies. The grading of recommendations, assessment, development, and evaluation (GRADE) approach will be used to evaluate the certainty of the evidence. We will use random-effects meta-analysis for each exposure-outcome association to calculate pooled estimates using the generic variance method. This systematic review will follow the Preferred Reporting Items for Systematic reviews and Meta-analyses and MOOSE guidelines. PROSPERO registration CRD42023457368 (04/09/2023).
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Affiliation(s)
- Jill M. Mitchell
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
| | - Siobhan Walsh
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
| | - Laura J. O'Byrne
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
| | - Virginia Conrick
- UCC Library, University College Cork, Cork, County Cork, Ireland
| | - Ray Burke
- Tyndall National Institute, University College Cork, Cork, County Cork, Ireland
| | - Ali S. Khashan
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- School of Public Health, University College Cork, Cork, County Cork, Ireland
| | - John Higgins
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
| | - Richard Greene
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
- National Perinatal Epidemiology Centre, University College Cork, Cork, County Cork, Ireland
| | - Gillian M. Maher
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- School of Public Health, University College Cork, Cork, County Cork, Ireland
| | - Fergus P. McCarthy
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
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Garlapati P, Vali P, Lakshminrusimha S, Smith BJ, Zavorsky GS. The Precision Between Transcutaneous Carbon Dioxide Versus P aCO2 in Infants Undergoing Therapeutic Hypothermia. Respir Care 2024; 69:339-344. [PMID: 37253608 PMCID: PMC10984588 DOI: 10.4187/respcare.10696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Infants with hypoxic-ischemic encephalopathy are often treated with therapeutic hypothermia and high-frequency ventilation. Fluctuations in PaCO2 during therapeutic hypothermia are associated with poor neurodevelopmental outcomes. Transcutaneous CO2 monitors offer a noninvasive estimate of PaCO2 represented by transcutaneously measured partial pressure of carbon dioxide (PtcCO2 ). We aimed to assess the precision between PtcCO2 and PaCO2 values in neonates undergoing therapeutic hypothermia. METHODS This was a retrospective chart review of 10 neonates who underwent therapeutic hypothermia requiring respiratory support over 2 y. A range of 2-27 simultaneous PtcCO2 and PaCO2 pairs of measurements per neonate were analyzed via linear mixed models and a Bland-Altman plot for multiple observations per neonate. RESULTS A linear mixed-effect model demonstrated that PtcCO2 and PaCO2 (controlling for sex) were similar. The 95% CI of the mean difference ranged from -2.3 to 5.7 mm Hg (P = .41). However, precision was poor as the PtcCO2 ranged from > 18 mm Hg to < 13 mm Hg than PaCO2 values for 95% of observations. CONCLUSIONS The neonates' PtcCO2 was as much as 18 mm Hg higher to 13 mm Hg lower than the PaCO2 95% of the time. Transcutaneous CO2 monitoring may not be a good trending tool, nor is it appropriate for estimating PaCO2 in patients undergoing therapeutic hypothermia.
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Affiliation(s)
- Pranav Garlapati
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California
| | - Payam Vali
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California
| | - Satyan Lakshminrusimha
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California
| | - Brian J Smith
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California
| | - Gerald S Zavorsky
- Dr Garlapati is affiliated with Newborn Specialists of Tulsa, Tulsa, Oklahoma. Drs Vali and Lakshminrusimha are affiliated with Department of Pediatrics, UC Davis Medical Center, Sacramento, California. Mr Smith is affiliated with Department of Respiratory Care, UC Davis Medical Center, Sacramento, California. Dr Zavorsky is affiliated with Department of Physiology and Membrane Biology, University of California, Davis, Sacramento, California.
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Ikuta K, Fukuoka K, Suyama Y, Morita M, Kimura Y, Umeda R, Kanayama H, Ohga M, Nakagaki M, Yagi S. Comparison of Antera 3D® and TcPO2 for Evaluation of Blood Flow in Skin. Yonago Acta Med 2023; 66:146-152. [PMID: 36820288 PMCID: PMC9937973 DOI: 10.33160/yam.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
Background There is a need for quick skin blood flow tests that can be performed in the wound healing field. Antera 3D® is a compact scanner using multispectral imaging. It can perform quick assessment of skin conditions. The purpose of the present study was to investigate the ability of the Antera 3D® to assess skin blood flow in comparison with transcutaneous partial pressure of oxygen (TcPO2) measurements. Methods This study was conducted on 13 patients with a history of lower extremity ulcers. Measurements of hemoglobin average level (hereafter, Hb score) measured by Antera 3D® and TcPO2 measured by a transcutaneous blood gas monitor were obtained at the same sites on the dorsal foot and lower leg. Differences in Hb score and TcPO2 were analyzed by t-test for each measurement site and for the presence of peripheral arterial disease (PAD). The correlation between TcPO2 and Hb score was analyzed by Pearson's correlation coefficient. Results Twenty-four limbs were tested. Hb score was higher (P < 0.001) and TcPO2 was lower (P = 0.056) in the dorsal foot compared to the lower leg. In the dorsal foot, Hb score was higher (P = 0.023) and TcPO2 was lower (P = 0.046) in patients with PAD compared to those without PAD. A significant negative correlation (r = -0.68; 95% confidence interval -0.85 to -0.38, P < 0.001) between TcPO2 and Hb score was observed in the dorsal foot. Conclusion The negative correlation between TcPO2 and Hb score may reflect compensatory peripheral vasodilation due to occlusion or stenosis of central arteries. This study showed that Hb score measured by Antera 3D® may be related to skin blood flow.
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Affiliation(s)
- Kento Ikuta
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and
| | - Kohei Fukuoka
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and
| | - Yoshiko Suyama
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and
| | - Maki Morita
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and
| | - Yuka Kimura
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and
| | - Ryunosuke Umeda
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and
| | - Haruka Kanayama
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and,Department of Plastic and Reconstructive Surgery, Nagoya
University, Graduate School of Medicine, Nagoya 466-8560, Japan
| | - Makoto Ohga
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and
| | - Makoto Nakagaki
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and
| | - Shunjiro Yagi
- Department of Plastic and Reconstructive Surgery, Tottori
University Hospital, Yonago 683-8504, Japan and
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Tazón-Varela MA, Padilla-Mielgo Á, Villaverde-Plazas R, Espinoza-Cuba F, Gallo-Salazar N, Muñoz-Cacho P. Methemoglobinemia Secondary to Inhalation of Automobile Emissions with Suicide Motivations. J Clin Med 2023; 12. [PMID: 36769383 DOI: 10.3390/jcm12030734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Methemoglobinemia (MetHb) is a rare and potentially severe dyshemoglobinemia that can be induced by exposure to oxidizing agents, decreasing the functional capacity of the hemoglobin molecule to transport and release oxygen into the tissues. MetHb can originate from gases with oxidizing capacity generated by internal combustion engines, although since the universalization of catalyst converters in automobiles, a tiny proportion of MetHb poisoning is due to exposure to engine gases and fumes. Within this group, only two cases due to suicidal motivations have been reported in the last 30 years. CASE PRESENTATION Here, we expose the case of a patient with MetHb levels of 25.2% (normal 0-1.5%) who with suicidal motivations had attached and locked a hose to the exhaust pipe of her vehicle with electrical tape, becoming exposed to a sustained concentration of the vehicle's exhaust. Upon her arrival at the emergency department, the presence of generalized greyish cyanosis with alterations of the sensorium, dissociation between saturation measured by arterial blood gas analysis and pulse oximetry (98% vs. 85%), no response to high-flow oxygen therapy, and an excellent response to intravenous methylene blue treatment were highlighted. CONCLUSIONS This report illustrates an original case of acute toxic acquired MetHb due to inhalation of oxidizing substances originating from the bad ignition of an internal combustion engine. When evaluating a patient with suspected gas intoxication, we usually consider poisoning by the most common toxins, such as carbon monoxide or cyanide. In this context, we propose an algorithm to assist in the suspicion of this entity in patients with cyanosis in the emergency department. MetHb poisoning should be suspected, and urgent co-oximetry should be requested when there is no congruence between cyanosis intensity and oxygen saturation measured by pulse oximetry, if there is discordance between the results of oxygen saturation measured by arterial blood gas and pulse oximeter, and if there is no response to oxygen treatment. This algorithm could be useful to not delay diagnosis, improve prognosis, and limit potential sequelae.
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Martín-Escudero P, Cabanas AM, Fuentes-Ferrer M, Galindo-Canales M. Oxygen Saturation Behavior by Pulse Oximetry in Female Athletes: Breaking Myths. Biosensors (Basel) 2021; 11:bios11100391. [PMID: 34677347 PMCID: PMC8534025 DOI: 10.3390/bios11100391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 12/18/2022]
Abstract
The myths surrounding women’s participation in sport have been reflected in respiratory physiology. This study aims to demonstrate that continuous monitoring of blood oxygen saturation during a maximal exercise test in female athletes is highly correlated with the determination of the second ventilatory threshold (VT2) or anaerobic threshold (AnT). The measurements were performed using a pulse oximeter during a maximum effort test on a treadmill on a population of 27 healthy female athletes. A common behavior of the oxygen saturation evolution during the incremental exercise test characterized by a decrease in saturation before the aerobic threshold (AeT) followed by a second significant drop was observed. Decreases in peripheral oxygen saturation during physical exertion have been related to the athlete’s physical fitness condition. However, this drop should not be a limiting factor in women’s physical performance. We found statistically significant correlations between the maximum oxygen uptake and the appearance of the ventilatory thresholds (VT1 and VT2), the desaturation time, the total test time, and between the desaturation time and the VT2. We observed a relationship between the desaturation time and the VT2 appearance. Indeed, a linear regression model between the desaturation time and the VT2 appearance can predict 80% of the values in our sample. Besides, we suggest that pulse oximetry is a simple, fairly accurate, and non-invasive technique for studying the physical condition of athletes who perform physical exertion.
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Affiliation(s)
- Pilar Martín-Escudero
- Professional Medical School of Physical Education and Sport, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-E.); (M.G.-C.)
| | - Ana María Cabanas
- Departamento de Física, Universidad de Tarapacá, Arica 1010064, Chile
- Correspondence:
| | - Manuel Fuentes-Ferrer
- Unit of Clinical Management (UGC), Department of Preventive Medicine, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Mercedes Galindo-Canales
- Professional Medical School of Physical Education and Sport, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-E.); (M.G.-C.)
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Oda T, Kato H, Nakamura M, Morita A. Analysis of biomonitoring data after full-thickness skin grafting. J Dermatol 2021; 48:1035-1043. [PMID: 33811395 DOI: 10.1111/1346-8138.15873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/28/2022]
Abstract
Skin graft vascularization is investigated mainly by histological evaluation. Immunohistochemical analysis has been conducted only in mice. Transcutaneous oxygen tension (TcPO2 ), which is an index of blood flow, has not been evaluated in skin grafts and only a few studies have reported biologic monitoring data using color tone evaluation and surface temperature. In humans, these tests can be performed non-invasively. To evaluate human skin graft vascularization, we analyzed biomonitoring data after skin grafting. We evaluated 14 patients who underwent skin grafting surgery at Nagoya City University Hospital. The TcPO2 , color tone, surface temperature, and dermoscopic observations at recipient sites were measured at postoperative day (POD) 4, 6, and 11. Mean TcPO2 levels at POD4, 6, and 11 were 12.7, 15.2, and 33.5 mmHg, respectively, and significantly higher at POD11 than at POD4 (p = 0.003, Steel-Dwass test). Dermoscopic observation revealed gradually increasing redness and yellowness. Color tone evaluation measured by spectrophotometry supported the appearance. The a*(redness) value at POD4, 6, and 11 was 6.19, 9.20, and 11.27, respectively, and significantly higher at POD11 than at POD4 (p < 0.001, Steel-Dwass test). The b*(yellowness) value at POD4, 6, and 11 was 8.83, 9.24, and 13.02, respectively, and significantly higher at POD11 than at POD4 (p = 0.020, Steel-Dwass test). The surface temperature did not significantly differ between graft and control sites. These findings suggest that skin graft vascularization started by POD6 and stabilized by POD11. Because TcPO2 increases after POD4, skin grafts should remain undisturbed until at least POD11.
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Affiliation(s)
- Takao Oda
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Jakubowicz JF, Bai S, Matlock DN, Jones ML, Hu Z, Proffitt B, Courtney SE. Effect of Transcutaneous Electrode Temperature on Accuracy and Precision of Carbon Dioxide and Oxygen Measurements in the Preterm Infants. Respir Care 2018; 63:900-906. [PMID: 29717098 DOI: 10.4187/respcare.05887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High electrode temperature during transcutaneous monitoring is associated with skin burns in extremely premature infants. We evaluated the accuracy and precision of CO2 and O2 measurements using lower transcutaneous electrode temperatures below 42°C. METHODS We enrolled 20 neonates. Two transcutaneous monitors were placed simultaneously on each neonate, with one electrode maintained at 42°C and the other randomized to temperatures of 38, 39, 40, 41, and 42°C. Arterial blood was collected twice at each temperature. RESULTS At the time of arterial blood sampling, values for transcutaneously measured partial pressure of CO2 (PtcCO2 ) were not significantly different among test temperatures. There was no evidence of skin burning at any temperature. For PtcCO2 , Bland-Altman analyses of all test temperatures versus 42°C showed good precision and low bias. Transcutaneously measured partial pressure of O2 (PtcO2 ) values trended arterial values but had large negative bias. CONCLUSION Transcutaneous electrode temperatures as low as 38°C allow an assessment of PtcCO2 as accurate as that with electrodes at 42°C.
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Affiliation(s)
- Jessica F Jakubowicz
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Shasha Bai
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - David N Matlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Michelle L Jones
- St. John Medical Center and Hillcrest Medical Center, Tulsa, OK.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Zhuopei Hu
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Betty Proffitt
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sherry E Courtney
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
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Jin Z, Yang M, Lin R, Huang W, Wang J, Hu Z, Shu Q. Application of end-tidal carbon dioxide monitoring via distal gas samples in ventilated neonates. Pediatr Neonatol 2017; 58:370-375. [PMID: 28511794 DOI: 10.1016/j.pedneo.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous research has suggested correlations between the end-tidal partial pressure of carbon dioxide (PETCO2) and the partial pressure of arterial carbon dioxide (PaCO2) in mechanically ventilated patients, but both the relationship between PETCO2 and PaCO2 and whether PETCO2 accurately reflects PaCO2 in neonates and infants are still controversial. This study evaluated remote sampling of PETCO2 via an epidural catheter within an endotracheal tube to determine the procedure's clinical safety and efficacy in the perioperative management of neonates. METHODS Abdominal surgery was performed under general anesthesia in 86 full-term newborns (age 1-30 days, weight 2.55-4.0 kg, American Society of Anesthesiologists class I or II). The infants were divided into 2 groups (n = 43 each), and carbon dioxide (CO2) gas samples were collected either from the conventional position (the proximal end) or a modified position (the distal end) of the epidural catheter. RESULTS The PETCO2 measured with the new method was significantly higher than that measured with the traditional method, and the difference between PETCO2 and PaCO2 was also reduced. The accuracy of PETCO2 measured increased from 78.7% to 91.5% when the modified sampling method was used. The moderate correlation between PETCO2 and PaCO2 by traditional measurement was 0.596, which significantly increased to 0.960 in the modified sampling group. Thus, the PETCO2 value was closer to that of PaCO2. CONCLUSION PETCO2 detected via modified carbon dioxide monitoring had a better accuracy and correlation with PaCO2 in neonates.
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Affiliation(s)
- Ziying Jin
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
| | - Maoying Yang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Binjiang District, Hangzhou, Zhejiang Province, China
| | - Ru Lin
- Department of Thoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Wenfang Huang
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jiangmei Wang
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Zhiyong Hu
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qiang Shu
- Department of Thoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Storm-Versloot MN, Verweij L, Lucas C, Ludikhuize J, Goslings JC, Legemate DA, Vermeulen H. Clinical relevance of routinely measured vital signs in hospitalized patients: a systematic review. J Nurs Scholarsh 2013; 46:39-49. [PMID: 24124656 DOI: 10.1111/jnu.12048] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conflicting evidence exists on the effectiveness of routinely measured vital signs on the early detection of increased probability of adverse events. PURPOSE To assess the clinical relevance of routinely measured vital signs in medically and surgically hospitalized patients through a systematic review. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature, and Meta-analysen van diagnostisch onderzoek (in Dutch; MEDION) were searched to January 2013. STUDY SELECTION Prospective studies evaluating routine vital sign measurements of hospitalized patients, in relation to mortality, septic or circulatory shock, intensive care unit admission, bleeding, reoperation, or infection. DATA EXTRACTION Two reviewers independently assessed potential bias and extracted data to calculate likelihood ratios (LRs) and predictive values. DATA SYNTHESIS Fifteen studies were performed in medical (n = 7), surgical (n = 4), or combined patient populations (n = 4; totaling 42,565 participants). Only three studies were relatively free from potential bias. For temperature, the positive LR (LR+) ranged from 0 to 9.88 (median 1.78; n = 9 studies); heart rate 0.82 to 6.79 (median 1.51; n = 5 studies); blood pressure 0.72 to 4.7 (median 2.97; n = 4 studies); oxygen saturation 0.65 to 6.35 (median 1.74; n = 2 studies); and respiratory rate 1.27 to 1.89 (n = 3 studies). Overall, three studies reported area under the Receiver Operator Characteristic (ROC) curve (AUC) data, ranging from 0.59 to 0.76. Two studies reported on combined vital signs, in which one study found an LR+ of 47.0, but in the other the AUC was not influenced. CONCLUSIONS Some discriminative LR+ were found, suggesting the clinical relevance of routine vital sign measurements. However, the subject is poorly studied, and many studies have methodological flaws. Further rigorous research is needed specifically intended to investigate the clinical relevance of routinely measured vital signs. CLINICAL RELEVANCE The results of this research are important for clinical nurses to underpin daily routine practices and clinical decision making.
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Affiliation(s)
- Marja N Storm-Versloot
- Department of Surgery, Academic Medical Centre at the University of Amsterdam, The Netherlands
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