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Yánez Benítez C, Lorente-Aznar T, Labaka I, Ribeiro MAF, Viteri Y, Morishita K, Baselga M, Güemes A. Tourniquet self-application assessment in cold weather conditions. BMC Emerg Med 2023; 23:101. [PMID: 37653492 PMCID: PMC10472695 DOI: 10.1186/s12873-023-00871-1] [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: 03/06/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Our study aimed to assess the ability of nonmedical civilians to self-apply extremity tourniquets in cold weather conditions while wearing insulating technical clothing after receiving basic training. METHODS A field study was conducted among 37 voluntary participants of an expedition party to the Spanish Antarctic base. The researchers assessed the participant's ability to self-apply five commercial extremity tourniquets (CAT, OMNA, RMT, SWAT-T, and RATS) over cold-weather clothing and their achieved effectiveness for vascular occlusion. Upper extremity self-application was performed with a single-handed technique (OHT), and lower extremity applying a two-handed technique (THT). Perceptions of self-application ease mean values ± standard deviation (SD) were compared by applying a 5% statistical significance threshold. Frequency count determined tourniquet preference. RESULTS All the tested ETs, except the SWAT-T, were properly self-applied with an OHT, resulting in effective vascular occlusion in the upper extremity. The five devices tested were self-applied correctly in the lower extremities using THT. The ratcheting marine-designed OMNA ranked the highest for application easiness on both the upper and lower extremities, and the windlass CAT model was the preferred device by most participants. CONCLUSIONS Civilian extremity tourniquet self-application on both upper and lower extremities can be accomplished in cold weather conditions despite using cold-weather gloves and technical clothing after receiving brief training. The ratcheting marine-designed OMNA ranked the highest for application ease, and the windlass CAT model was the preferred device.
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Affiliation(s)
- Carlos Yánez Benítez
- General and GI Surgery Department, San Jorge University Hospital, SALUD, Avenida Martínez de Velasco, 36, Huesca, 22004, Spain.
| | | | - Idurre Labaka
- Emergency Medicine, Donostia University Hospital, C/ Begiristain Doktorea Pasealekua, Donostia, Spain
| | - Marcelo A F Ribeiro
- Division of Trauma, Critical Care, and Acute Care Surgery, Sheikh Shakhbout Medical City, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Yosu Viteri
- Emergency Department, Torrelodones University Hospital, Avenida Castillo Olivares, s/n, Madrid, 28250, Spain
| | - Koji Morishita
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Marta Baselga
- Clinical and Experimental Research Group, Institute for Health Research of Aragón, C/ de San Juan Bosco, 13, Zaragoza, 50009, Spain
| | - Antonio Güemes
- Department of General Surgery, Lozano Blesa University Hospital, Avenida San Juan Bosco, 15, Zaragoza, 50009, Spain
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2
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Prosperi P, Verratti V, Taverna A, Rua R, Bonan S, Rapacchiale G, Bondi D, Di Giulio C, Lorkowski J, Spacone A. Ventilatory function and oxygen delivery at high altitude in the Himalayas. Respir Physiol Neurobiol 2023:104086. [PMID: 37257573 DOI: 10.1016/j.resp.2023.104086] [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: 04/30/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
This study aimed to evaluate changes in lung function assessed by spirometry and blood gas content in healthy high-altitude sojourners during a trek in the Himalayas. A group of 19 Italian adults (11 males and 8 females, mean age 43 ±15 years, and BMI 24.2 ±3.7kg/m2) were evaluated as part of a Mount Everest expedition in Nepal. Spirometry and arterial blood gas content were evaluated at baseline in Kathmandu (≈1400m), at the Pyramid Laboratory - Observatory (peak altitude of ≈5000m), and on return to Kathmandu 2-3 days after arrival at each site. All participants took 250mg of acetazolamide per os once daily during the ascent. We found that arterial hemoglobin saturation, O2 and CO2 partial pressures, and the bicarbonate level all decreased (in all cases, p<0.001 with R2=0.70-0.90), while pHa was maintained stable at the peak altitude. Forced vital capacity (FVC) remained stable, while forced expiratory volume in 1sec (FEV1) decreased (p=0.010, n2p=0.228), resulting in a lower FEV1/FVC ratio (p<0.001, n2p=0.380). The best predictor for acute mountain sickness was the O2 partial pressure at the peak altitude (p=0.004, R2=0.39). Finger pulse oximetry overestimated peripheral saturation relative to arterial saturation. We conclude that high-altitude hypoxia alters the respiratory function and the oxygen saturation of the arterial blood hemoglobin. Additionally, air rarefaction and temperature reduction, favoring hypoxic bronchoconstriction, could affect respiration. Pulse oximetry seems not enough to assist medical decisions at high altitudes.
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Affiliation(s)
- Pierpaolo Prosperi
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
| | - Vittore Verratti
- Department of Psychological, Health and Territorial Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Alberto Taverna
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy.
| | - Riccardo Rua
- Department of Anesthesia, Critical Care, and Emergency, University of Turin, 10126 Turin, Italy.
| | - Sofia Bonan
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Giorgia Rapacchiale
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
| | - Danilo Bondi
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Camillo Di Giulio
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Jacek Lorkowski
- Department of Orthopedics, Traumatology, and Sports Medicine, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, 02-507 Warsaw, Pol.
| | - Antonella Spacone
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
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3
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Li H, Wang C, Yu X, Luo Y, Wang H. Measurement of Cerebral Oxygen Extraction Fraction Using Quantitative BOLD Approach: A Review. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:101-118. [PMID: 36939794 PMCID: PMC9883382 DOI: 10.1007/s43657-022-00081-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
Quantification of brain oxygenation and metabolism, both of which are indicators of the level of brain activity, plays a vital role in understanding the cerebral perfusion and the pathophysiology of brain disorders. Magnetic resonance imaging (MRI), a widely used clinical imaging technique, which is very sensitive to magnetic susceptibility, has the possibility of substituting positron emission tomography (PET) in measuring oxygen metabolism. This review mainly focuses on the quantitative blood oxygenation level-dependent (qBOLD) method for the evaluation of oxygen extraction fraction (OEF) in the brain. Here, we review the theoretic basis of qBOLD, as well as existing acquisition and quantification methods. Some published clinical studies are also presented, and the pros and cons of qBOLD method are discussed as well.
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Affiliation(s)
- Hongwei Li
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433 China
| | - Chengyan Wang
- Human Phenome Institute, Fudan University, Shanghai, 201203 China
| | - Xuchen Yu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433 China
| | - Yu Luo
- Department of Radiology, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200434 China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433 China
- Human Phenome Institute, Fudan University, Shanghai, 201203 China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, (Fudan University), Ministry of Education, Shanghai, 200433 China
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4
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Mendez-Rebolledo G, Guzman-Muñoz E, Valdés-Badilla P, Ramirez-Campillo R, Cruz-Montecinos C, Núñez-Cortés R, Cabrera-Aguilera I, Calatayud J. Influence of lower limb muscle isometric strength and cardiovascular parameters on locomotor capacity in children and adolescents. J Back Musculoskelet Rehabil 2023; 36:1435-1446. [PMID: 37545211 DOI: 10.3233/bmr-230049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Although measures of exercise performance and physical activity are known to be related to 6-minute walk test (6mWT), the role of the strength of each muscle group of the lower limb in the locomotor capacity during the development period is unknown. OBJECTIVE To identify the role of the isometric strength of lower limb muscles and cardiovascular parameters on the locomotor capacity in children and adolescents, controlling for participants sex, age, and height. METHODS Participants (7 to 15 years old; female, n= 113; male, n= 128) were assessed for isometric strength (seven lower limb muscles), cardiovascular parameters (diastolic pressure, oxygen saturation, resting heart rate, respiratory rate), and 6mWT. Participants were split into nine age groups and separated by 1-year intervals. RESULTS Hip flexors-controlled for sex, age, and height-explained a meaningful percentage of the variance (R=2 0.45; p< 0.001) for 6mWT distance, and the resting heart rate explained a change in R2 of only 2% (p= 0.008). CONCLUSIONS Isometric strength of hip flexors explained ∼ 50% of the 6mWT distance, suggesting the importance of strength from an early age. Other factors, such as cardiovascular parameters, while relevant, may exert a secondary role on youth's capacity.
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Affiliation(s)
- Guillermo Mendez-Rebolledo
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Eduardo Guzman-Muñoz
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences Universidad Católica del Maule, Talca, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Valparaíso, Chile
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ignacio Cabrera-Aguilera
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Concepción, Chile
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
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Stell D, Noble JJ, Kay RH, Kwong MT, Jeffryes MJR, Johnston L, Glover G, Akinluyi E. Exploring the impact of pulse oximeter selection within the COVID-19 home-use pulse oximetry pathways. BMJ Open Respir Res 2022; 9:9/1/e001159. [PMID: 35140169 PMCID: PMC8830238 DOI: 10.1136/bmjresp-2021-001159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background During the COVID-19 pandemic, portable pulse oximeters were issued to some patients to permit home monitoring and alleviate pressure on inpatient wards. Concerns were raised about the accuracy of these devices in some patient groups. This study was conducted in response to these concerns. Objectives To evaluate the performance characteristics of five portable pulse oximeters and their suitability for deployment on home-use pulse oximetry pathways created during the COVID-19 pandemic. This study considered the effects of different device models and patient characteristics on pulse oximeter accuracy, false negative and false positive rate. Methods A total of 915 oxygen saturation (spO2) measurements, paired with measurements from a hospital-standard pulse oximeter, were taken from 50 patients recruited from respiratory wards and the intensive care unit at an acute hospital in London. The effects of device model and several patient characteristics on bias, false negative and false positive likelihood were evaluated using multiple regression analyses. Results and conclusions All five portable pulse oximeters appeared to outperform the standard to which they were manufactured. Device model, patient spO2 and patient skin colour were significant predictors of measurement bias, false positive and false negative rate, with some variation between models. The false positive and false negative rates were 11.2% and 24.5%, respectively, with substantial variation between models.
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Affiliation(s)
- David Stell
- Department of Medical Physics, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Jonathan James Noble
- One Small Step Gait Laboratory, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Rebecca Hazell Kay
- Department of Medical Physics, Guy's and St Thomas' Hospitals NHS Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Man Ting Kwong
- Department of Medical Physics, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Michael John Russell Jeffryes
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Medical Engineering and Physics, King's College Hospital NHS Foundation Trust, London, UK
| | - Liam Johnston
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Medical Engineering and Physics, King's College Hospital NHS Foundation Trust, London, UK
| | - Guy Glover
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Emmanuel Akinluyi
- Department of Medical Physics, Guy's and St Thomas' Hospitals NHS Trust, London, UK .,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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6
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Bock JM, Rodysill KJ, Calvin AD, Vungarala S, Sahakyan KR, Cha SS, Svatikova A, Lopez-Jimenez F, Somers VK. Waist-To-Hip Ratio Predicts Abnormal Overnight Oximetry in Men Independent of Body Mass Index. Front Cardiovasc Med 2021; 8:789860. [PMID: 34977196 PMCID: PMC8714785 DOI: 10.3389/fcvm.2021.789860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Ambulatory overnight oximetry (OXI) has emerged as a cost-effective initial test for sleep disordered breathing. Obesity is closely associated with obstructive sleep apnea (OSA); however, whether body mass index (BMI) or waist-to-hip ratio (WHR) predicts abnormal overnight OXI remains unknown. Methods: We performed a retrospective cross-sectional study of 393 men seen in the Executive Health Program at Mayo Clinic in Rochester, Minnesota who underwent ambulatory overnight OXI ordered by preventive medicine physicians between January 1, 2004 through December 31, 2010. We compared participant/spouse-reported symptoms (sleepiness, snoring), physician indications for OXI (obesity, fatigue), Epworth Sleepiness Scale scores, anthropomorphic measurements (WHR, BMI), and comorbid medical conditions (hypertension, diabetes) with OXI results. Results: 295 of the 393 men who completed OXI had abnormal results. During multivariate analysis, the strongest independent predictor of abnormal OXI for men was WHR (≥1.0, OR = 5.59) followed by BMI (≥30.0 kg/m2, OR = 2.75), age (≥55 yrs, OR = 2.06), and the presence of snoring (OR = 1.91, P < 0.05 for all). A strong association was observed between WHR and abnormal OXI in obese (BMI ≥ 30.0 kg/m2, OR = 6.28) and non-obese (BMI < 29.9 kg/m2, OR = 6.42, P < 0.01 for both) men. Furthermore, 88 men with abnormal OXI underwent polysomnography with 91% being subsequently diagnosed with OSA. Conclusions: In ambulatory, predominantly middle-aged men undergoing preventive services evaluation many physician indications for OXI were not predictors of abnormal results; however, WHR strongly predicted abnormal OXI in obese and non-obese men. As such, we suggest middle-aged men who snore and have a WHR ≥1.0 should be directly referred to a sleep clinic for polysomnography.
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Affiliation(s)
- Joshua M. Bock
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kirk J. Rodysill
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN, United States
- General Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Andrew D. Calvin
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, WI, United States
| | - Soumya Vungarala
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Karine R. Sahakyan
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stephen S. Cha
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Anna Svatikova
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Virend K. Somers
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
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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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8
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Dünnwald T, Kienast R, Niederseer D, Burtscher M. The Use of Pulse Oximetry in the Assessment of Acclimatization to High Altitude. SENSORS 2021; 21:s21041263. [PMID: 33578839 PMCID: PMC7916608 DOI: 10.3390/s21041263] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
Background: Finger pulse oximeters are widely used to monitor physiological responses to high-altitude exposure, the progress of acclimatization, and/or the potential development of high-altitude related diseases. Although there is increasing evidence for its invaluable support at high altitude, some controversy remains, largely due to differences in individual preconditions, evaluation purposes, measurement methods, the use of different devices, and the lacking ability to interpret data correctly. Therefore, this review is aimed at providing information on the functioning of pulse oximeters, appropriate measurement methods and published time courses of pulse oximetry data (peripheral oxygen saturation, (SpO2) and heart rate (HR), recorded at rest and submaximal exercise during exposure to various altitudes. Results: The presented findings from the literature review confirm rather large variations of pulse oximetry measures (SpO2 and HR) during acute exposure and acclimatization to high altitude, related to the varying conditions between studies mentioned above. It turned out that particularly SpO2 levels decrease with acute altitude/hypoxia exposure and partly recover during acclimatization, with an opposite trend of HR. Moreover, the development of acute mountain sickness (AMS) was consistently associated with lower SpO2 values compared to individuals free from AMS. Conclusions: The use of finger pulse oximetry at high altitude is considered as a valuable tool in the evaluation of individual acclimatization to high altitude but also to monitor AMS progression and treatment efficacy.
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Affiliation(s)
- Tobias Dünnwald
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT—Private University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
| | - Roland Kienast
- Department of Biomedical and Health Technology, Federal Higher Technical Institute for Education and Experimentation—HTL Anichstraße, 6020 Innsbruck, Austria;
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University Heart Center Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence:
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9
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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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10
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Luks AM, Swenson ER. Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance. Ann Am Thorac Soc 2020; 17:1040-1046. [PMID: 32521167 PMCID: PMC7462317 DOI: 10.1513/annalsats.202005-418fr] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/10/2020] [Indexed: 11/26/2022] Open
Abstract
During the ongoing coronavirus disease (COVID-19) pandemic, reports in social media and the lay press indicate that a subset of patients are presenting with severe hypoxemia in the absence of dyspnea, a problem unofficially referred to as "silent hypoxemia." To decrease the risk of complications in such patients, one proposed solution has been to have those diagnosed with COVID-19 but not sick enough to warrant admission monitor their arterial oxygenation by pulse oximetry at home and present for care when they show evidence of hypoxemia. Though the ease of use and low cost of pulse oximetry makes this an attractive option for identifying problems at an early stage, there are important considerations with pulse oximetry about which patients and providers may not be aware that can interfere with successful implementation of such monitoring programs. Only a few independent studies have examined the performance of pocket oximeters and smart phone-based systems, but the limited available data raise questions about their accuracy, particularly as saturation falls below 90%. There are also multiple sources of error in pulse oximetry that must be accounted for, including rapid fluctuations in measurements when the arterial oxygen pressure/tension falls on the steep portion of the dissociation curve, data acquisition problems when pulsatile blood flow is diminished, accuracy in the setting of severe hypoxemia, dyshemoglobinemias, and other problems. Recognition of these issues and careful counseling of patients about the proper means for measuring their oxygen saturation and when to seek assistance can help ensure successful implementation of needed monitoring programs.
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Affiliation(s)
- Andrew M. Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; and
| | - Erik R. Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; and
- Medical Service, VA Puget Sound Health Care System, Seattle, Washington
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11
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Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance. Ann Am Thorac Soc 2020. [PMID: 32521167 DOI: 10.1513/annalsats.202005‐418fr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During the ongoing coronavirus disease (COVID-19) pandemic, reports in social media and the lay press indicate that a subset of patients are presenting with severe hypoxemia in the absence of dyspnea, a problem unofficially referred to as "silent hypoxemia." To decrease the risk of complications in such patients, one proposed solution has been to have those diagnosed with COVID-19 but not sick enough to warrant admission monitor their arterial oxygenation by pulse oximetry at home and present for care when they show evidence of hypoxemia. Though the ease of use and low cost of pulse oximetry makes this an attractive option for identifying problems at an early stage, there are important considerations with pulse oximetry about which patients and providers may not be aware that can interfere with successful implementation of such monitoring programs. Only a few independent studies have examined the performance of pocket oximeters and smart phone-based systems, but the limited available data raise questions about their accuracy, particularly as saturation falls below 90%. There are also multiple sources of error in pulse oximetry that must be accounted for, including rapid fluctuations in measurements when the arterial oxygen pressure/tension falls on the steep portion of the dissociation curve, data acquisition problems when pulsatile blood flow is diminished, accuracy in the setting of severe hypoxemia, dyshemoglobinemias, and other problems. Recognition of these issues and careful counseling of patients about the proper means for measuring their oxygen saturation and when to seek assistance can help ensure successful implementation of needed monitoring programs.
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Investigation of Photoplethysmography Behind the Ear for Pulse Oximetry in Hypoxic Conditions with a Novel Device (SPYDR). BIOSENSORS-BASEL 2020; 10:bios10040034. [PMID: 32260393 PMCID: PMC7235881 DOI: 10.3390/bios10040034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
Photoplethysmography (PPG) is a valuable technique for noninvasively evaluating physiological parameters. However, traditional PPG devices have significant limitations in high-motion and low-perfusion environments. To overcome these limitations, we investigated the accuracy of a clinically novel PPG site using SPYDR®, a new PPG sensor suite, against arterial blood gas (ABG) measurements as well as other commercial PPG sensors at the finger and forehead in hypoxic environments. SPYDR utilizes a reflectance PPG sensor applied behind the ear, between the pinna and the hairline, on the mastoid process, above the sternocleidomastoid muscle, near the posterior auricular artery in a self-contained ear cup system. ABG revealed accuracy of SPYDR with a root mean square error of 2.61% at a 70–100% range, meeting FDA requirements for PPG sensor accuracy. Subjects were also instrumented with SPYDR, as well as finger and forehead PPG sensors, and pulse rate (PR) and oxygen saturation (SpO2) were measured and compared at various reduced oxygen profiles with a reduced oxygen breathing device (ROBD). SPYDR was shown to be as accurate as other sensors in reduced oxygen environments with a Pearson’s correlation >93% for PR and SpO2. In addition, SPYDR responded to changes in SpO2 up to 50 s faster than PPG measurements at the finger and forehead.
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Del Pozzi AT, Pandey A, Medow MS, Messer ZR, Stewart JM. Blunted cerebral blood flow velocity in response to a nitric oxide donor in postural tachycardia syndrome. Am J Physiol Heart Circ Physiol 2014; 307:H397-404. [PMID: 24878770 DOI: 10.1152/ajpheart.00194.2014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cognitive deficits are characteristic of postural tachycardia syndrome (POTS). Intact nitrergic nitric oxide (NO) is important to cerebral blood flow (CBF) regulation, neurovascular coupling, and cognitive efficacy. POTS patients often experience defective NO-mediated vasodilation caused by oxidative stress. We have previously shown dilation of the middle cerebral artery in response to a bolus administration of the NO donor sodium nitroprusside (SNP) in healthy volunteers. In the present study, we hypothesized a blunted middle cerebral artery response to SNP in POTS. We used combined transcranial Doppler-ultrasound to measure CBF velocity and near-infrared spectroscopy to measure cerebral hemoglobin oxygenation while subjects were in the supine position. The responses of 17 POTS patients were compared with 12 healthy control subjects (age: 14-28 yr). CBF velocity in POTS patients and control subjects were not different at baseline (75 ± 3 vs. 71 ± 2 cm/s, P = 0.31) and decreased to a lesser degree with SNP in POTS patients (to 71 ± 3 vs. 62 ± 2 cm/s, P = 0.02). Changes in total and oxygenated hemoglobin (8.83 ± 0.45 and 8.13 ± 0.48 μmol/kg tissue) were markedly reduced in POTS patients compared with control subjects (14.2 ± 1.4 and 13.6 ± 1.6 μmol/kg tissue), primarily due to increased venous efflux. The data indicate reduced cerebral oxygenation, blunting of cerebral arterial vasodilation, and heightened cerebral venodilation. We conclude, based on the present study outcomes, that decreased bioavailability of NO is apparent in the vascular beds, resulting in a downregulation of NO receptor sites, ultimately leading to blunted responses to exogenous NO.
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Affiliation(s)
- Andrew T Del Pozzi
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
| | - Akash Pandey
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
| | - Marvin S Medow
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
| | - Zachary R Messer
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
| | - Julian M Stewart
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
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Sightings edited by John W. Severinghaus. High Alt Med Biol 2013. [DOI: 10.1089/ham.2013.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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