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Tufan TB, Rhein L, Guler U. Implementation Techniques for Transcutaneous Carbon Dioxide Monitoring: Approaches for Wearable Smart Health Applications. IEEE Trans Biomed Eng 2024; 71:929-943. [PMID: 37812542 DOI: 10.1109/tbme.2023.3322871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Wearable smart health applications aim to continuously monitor critical physiological parameters without disrupting patients' daily activities, such as giving a blood sample for lab analysis. For example, the partial pressure of arterial carbon dioxide, the critical indicator of ventilation efficacy reflecting the respiratory and acid-base status of the human body, is measured invasively from the arteries. Therefore, it can momentarily be monitored in a clinical setting when the arterial blood sample is taken. Although a noninvasive surrogate method for estimating the partial pressure of arterial carbon dioxide exists (i.e., transcutaneous carbon dioxide monitoring), it is primarily limited to intensive care units and comes in the form of a large bedside device. Nevertheless, recent advancements in the luminescence sensing field have enabled a promising technology that can be incorporated into a wearable device for the continuous and remote monitoring of ventilation efficacy. In this review, we examine existing and nascent techniques for sensing transcutaneous carbon dioxide and highlight novel wearable transcutaneous carbon dioxide monitors by comparing their performance with the traditional bedside counterparts. We also discuss future directions of transcutaneous carbon dioxide monitoring in next-generation smart health applications.
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Eley VA, Guy L, Woods C, Llewellyn S, Van Zundert AAJ. Transcutaneous carbon dioxide measurements in anesthetized apneic patients with BMI > 35 kg/m 2. J Anesth 2023; 37:971-975. [PMID: 37814088 PMCID: PMC10654171 DOI: 10.1007/s00540-023-03263-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
Transcutaneous carbon dioxide measurement (TcCO2) offers the ability to continuously and non-invasively monitor carbon dioxide (CO2) tensions when end-tidal monitoring is not possible. The accuracy of TcCO2 has not been established in anesthetized apneic patients with obesity. In this secondary publication, we present a methods comparison analysis of TcCO2 with the gold standard arterial PCO2, in adult patients with body mass index (BMI) > 35kg/m2 who were randomized to receive high flow or low flow nasal oxygenation during post-induction apnea. Agreement between PaCO2 and TcCO2 at baseline, the start of apnea and the end of apnea were assessed using a non-parametric difference plot. Forty-two participants had a median (IQR) BMI of 52 (40-58.5) kg/m2. The mean (SD) PaCO2 was 33.9 (4.0) mmHg at baseline and 51.4 (7.5) mmHg at the end of apnea. The bias was the greatest at the end of apnea median (95% CI, 95% limits of agreement) 1.90 mmHg (-2.64 to 6.44, -7.10 to 22.90). Findings did not suggest significant systematic differences between the PaCO2 and TcCO2 measures. For a short period of apnea, TcCO2 showed inadequate agreement with PaCO2 in patients with BMI > 35 kg/m2. These techniques require comparison in a larger population, with more frequent sampling and over a longer timeframe, before TcCO2 can be confidently recommended in this setting.
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Affiliation(s)
- Victoria A Eley
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia.
- Faculty of Medicine, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, 4006, Australia.
| | - Louis Guy
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia
- Faculty of Medicine, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
| | - Christine Woods
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia
| | - Stacey Llewellyn
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston Road, Herston, QLD, 4006, Australia
| | - Andre A J Van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia
- Faculty of Medicine, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
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Thy SA, Johansen AO, Thy A, Sørensen HH, Mølgaard J, Foss NB, Toft P, Meyhoff CS, Aasvang EK. Associations between clinical interventions and transcutaneous blood gas values in postoperative patients. J Clin Monit Comput 2023; 37:1255-1264. [PMID: 36808596 DOI: 10.1007/s10877-023-00982-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 07/15/2022] [Accepted: 01/29/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE Postoperative monitoring of circulation and respiration is pivotal to guide intervention strategies and ensure patient outcomes. Transcutaneous blood gas monitoring (TCM) may allow for noninvasive assessment of changes in cardiopulmonary function after surgery, including a more direct assessment of local micro-perfusion and metabolism. To form the basis for studies assessing the clinical impact of TCM complication detection and goal-directed-therapy, we examined the association between clinical interventions in the postoperative period and changes in transcutaneous blood gasses. METHODS Two-hundred adult patients who have had major surgery were enrolled prospectively and monitored with transcutaneous blood gas measurements (oxygen (TcPO2) and carbon dioxide (TcPCO2)) for 2 h in the post anaesthesia care unit, with recording of all clinical interventions. The primary outcome was changes in TcPO2, secondarily TcPCO2, from 5 min before a clinical intervention versus 5 min after, analysed with paired t-test. RESULTS Data from 190 patients with 686 interventions were analysed. During clinical interventions, a mean change in TcPO2 of 0.99 mmHg (95% CI-1.79-0.2, p = 0.015) and TcPCO2 of-0.67 mmHg (95% CI 0.36-0.98, p < 0.001) was detected. CONCLUSION Clinical interventions resulted in significant changes in transcutaneous oxygen and carbon dioxide. These findings suggest future studies to assess the clinical value of changes in transcutaneous PO2 and PCO2 in a postoperative setting. TRIAL REGISTRY Clinical trial number: NCT04735380. CLINICAL TRIAL REGISTRY https://clinicaltrials.gov/ct2/show/NCT04735380.
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Affiliation(s)
- Sandra A Thy
- Department of Anesthesiology, Center for Cancer and Organ Dysfunction, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Anesthesiology, Odense University Hospital and Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
| | - Andreas O Johansen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - André Thy
- Department of Anesthesiology, Center for Cancer and Organ Dysfunction, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Henrik H Sørensen
- Department of Anesthesiology, Center for Cancer and Organ Dysfunction, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jesper Mølgaard
- Department of Anesthesiology, Center for Cancer and Organ Dysfunction, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Nicolai B Foss
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Palle Toft
- Department of Anesthesiology, Odense University Hospital and Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eske K Aasvang
- Department of Anesthesiology, Center for Cancer and Organ Dysfunction, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Tufan TB, Guler U. A Transcutaneous Carbon Dioxide Monitor Based on Time-Domain Dual Lifetime Referencing. IEEE Trans Biomed Circuits Syst 2023; 17:795-807. [PMID: 37195846 DOI: 10.1109/tbcas.2023.3277398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The partial pressure of arterial carbon dioxide plays a critical role in assessing the acid-base and respiratory status of the human body. Typically, this measurement is invasive and can only be taken momentarily when an arterial blood sample is drawn. Transcutaneous monitoring is a noninvasive surrogate method that provides a continuous measure of arterial carbon dioxide. Unfortunately, current technology is limited to bedside instruments mainly used in intensive care units. We developed a first-of-its-kind miniaturized transcutaneous carbon dioxide monitor that utilizes a luminescence sensing film and a time-domain dual lifetime referencing method. Gas cell experiments confirmed the monitor's ability to accurately identify changes in the partial pressure of carbon dioxide within the clinically significant range. Compared to the luminescence intensity-based technique, the time-domain dual lifetime referencing method is less prone to measurement errors caused by changes in excitation strength, reducing the maximum error from ∼ 40% to ∼ 3% and resulting in more reliable readings. Additionally, we analyzed the sensing film by investigating its behavior under various confounding factors and its susceptibility to measurement drift. Finally, a human subject test demonstrated the effectiveness of the applied method in detecting even slight changes in transcutaneous carbon dioxide, as small as ∼ 0.7%, during hyperventilation. The prototype, which consumes 30.1 mW of power, is a wearable wristband with compact dimensions of 37 mm× 32 mm.
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Leonardi A, Murphy C, Hobson S, Rohera V, Vakhter V, Kahraman B, Bu G, Foroozan F, Rhein L, Guler U. Optimizing Transcutaneous Oxygen Measurement Sites on Humans. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083282 DOI: 10.1109/embc40787.2023.10340450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This study utilizes an optical method of transcutaneous oxygen sensing that has the potential to revolutionize at-home care. This technique is based on quenching the luminescence of a platinum porphyrin film. Since oxygen quenches luminescence, its lifetime is further measured to assess the partial pressure of transcutaneous oxygen diffusing through the skin. Unlike conventional transcutaneous oxygen monitors that use electrochemical sensors, the luminescence-based sensor allows the use of dry electrodes that do not require heating and reduce the risk of accidental skin irritations or burns. These properties not only improve patient safety but also allow the creation of miniature wearable transcutaneous oxygen sensors for continuous and accurate remote respiratory monitoring. To this end, it is critical to assess the efficiency of the wearable sensor by determining the optimal location for its placement on the body. Depending on the location on the body, physiological factors such as blood flow rate and skin thickness affect dermal perfusion of transcutaneous oxygen. In this work, four healthy volunteers participated in subject testing. We assessed each participant at the following locations: thumb, top of the wrist, forearm, thigh, and shin. All locations consistently reported accurate and reliable data. Among them, the thumb demonstrated shorter settling times and the most uniform luminescence lifetime values.
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Atherton P, Jungquist C, Spulecki C. An Educational Intervention to Improve Comfort with Applying and Interpreting Transcutaneous CO 2 and End-tidal CO 2 Monitoring in the PACU. J Perianesth Nurs 2022; 37:781-786. [PMID: 35691831 DOI: 10.1016/j.jopan.2022.03.001] [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] [Received: 01/03/2022] [Revised: 02/14/2022] [Accepted: 03/17/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to assess the effectiveness of an educational program about measuring ventilation using devices that assess carbon dioxide levels in patients recovering from a surgical procedure. DESIGN A pre-post survey of knowledge attainment from an educational intervention about measuring ventilation using end-tidal carbon dioxide (EtCO2) and transcutaneous carbon dioxide (tcPCO2) devices in the postanesthesia care unit (PACU) was distributed to current members of the American Society of PeriAnesthesia Nurses. METHODS Participants received a 12-question pre-intervention (five were related to demographics) and a five-question post-intervention survey. Non-demographic survey questions used a one to five Likert scale to assess comfortability or confidence. The intervention created was a voice-over presentation designed to improve PACU RN's comfort and confidence with using and interpreting tcPCO2 or EtCO2 in the PACU. FINDINGS PACU RNs (N = 108) reported they 'never' or 'rarely' used EtCO2 (n = 57, 52.7%) monitoring or tcPCO2 (n = 93, 86.1%) monitoring in the PACU. A paired t test revealed statistically significant differences in the PACU RN's pre-survey and posttest comfortability of applying and interpreting EtCO2 or tcPCO2 monitors (P < .05). CONCLUSIONS Capnography monitoring should be considered a standard of care for PACU patients. Education of registered nurses working in the PACU is critical before implementing EtCO2 or tcPCO2 monitoring.
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Affiliation(s)
| | - Carla Jungquist
- University at Buffalo (SUNY), School of Nursing, Buffalo, NY
| | - Cheryl Spulecki
- University at Buffalo (SUNY), School of Nursing, Buffalo, NY
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Strohleit D, Galetin T, Kosse N, Lopez-Pastorini A, Stoelben E. Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review. BMC Pulm Med 2021; 21:198. [PMID: 34112130 PMCID: PMC8193886 DOI: 10.1186/s12890-021-01532-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/10/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and gas exchange. The restitution of normal respiration takes place in the recovery room. Nonetheless, there is no evidence on the necessary observation time. We systematically reviewed current guidelines on bronchoscopy regarding sedation, monitoring and recovery. METHODS This review was registered at the PROSPERO database (CRD42020197476). MEDLINE and awmf.org were double-searched for official guidelines, recommendation or consensus statements on bronchoscopy from 2010 to 2020. The PICO-process focussed on adults (Patients), bronchoscopy with maintained spontaneous breathing (Interventions), and recommendations regarding the intra- and postprocedural monitoring and sedation (O). The guideline quality was graded. A catalogue of 54 questions was answered. Strength of recommendation and evidence levels were recorded for each recommendation. RESULTS Six guidelines on general bronchoscopy and three expert statements on special bronchoscopic procedures were identified. Four guidelines were evidence-based. Most guidelines recommend sedation to improve the patient's tolerance. Midazolam combined with an opioid is preferred. The standard monitoring consists of non-invasive blood pressure, and pulse oximetry, furthermore electrocardiogram in cardiac patients. Only one guideline discusses hypercapnia and capnometry, but without consensus. Two guidelines discuss a recovery time of two hours, but a recommendation was not given because of lack of evidence. CONCLUSION Evidence for most issues is low to moderate. Lung-diseased patients are not represented by current guidelines. Capnometry and recovery time lack evidence. More primary research in these fields is needed so that future guidelines may address these issues, too.
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Affiliation(s)
- Daniel Strohleit
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Thomas Galetin
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Nils Kosse
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Alberto Lopez-Pastorini
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Erich Stoelben
- Lung Clinic Cologne-Merheim, Thoracic Surgery, Hospital of Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
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Mycroft K, Nasiłowski J, Klimiuk J, Przybyłowski T. Complex home assessment of long-term non-invasive ventilation efficacy using transcutaneous monitoring of PCO 2 and polygraphy - A feasibility study. Adv Med Sci 2021; 66:105-112. [PMID: 33461098 DOI: 10.1016/j.advms.2021.01.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/21/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Home non-invasive ventilation (HNIV) during sleep is a standard treatment for chronic hypercapnic respiratory failure (CHRF). The aim of this study was to evaluate the feasibility of the complex overnight assessment of HNIV in adults performed at home and the efficacy of HNIV after one year of treatment. METHODS Stable patients with CHRF on HNIV for more than 12 months had unattended polygraphy (PG) with transcutaneous monitoring of PCO2 (tcPCO2) at home during one night. The recording quality was regarded as excellent when 100% and good if 80-99% of the analysis time was registered. The following efficacy criteria were approved: (1) SpO2<90% for <10% of analysis time, (2) increase in PtcCO2 ≤7.5 mmHg between baseline and average value at night, (3) apnea-hypopnea index (AHI) ≤5/h. RESULTS Eighteen patients with CHRF (median age 66 [60-74] years, 10 female) were included. The quality of the PG tracings was good to excellent in 16 (89%) patients and the quality of the tcPCO2 data was good to excellent in 14 (78%) patients. There was no difference in the quality of tcPCO2 between patients who lived alone and those who lived with family (100 [50-100]% vs. 100 [90-100]% of analysis time, respectively). Only 4 (22%) patients fulfilled all three efficacy criteria. CONCLUSIONS Home-based monitoring using PG and tcPCO2 is a feasible and adequate tool to assess the efficacy of HNIV. In most of the patients on HNIV for more than 12 months, the treatment was not effective based on the predefined efficacy criteria.
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Affiliation(s)
- Katarzyna Mycroft
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
| | - Jacek Nasiłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Klimiuk
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Tadeusz Przybyłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
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Fejfarová V, Matuška J, Jude E, Piťhová P, Flekač M, Roztočil K, Wosková V, Dubský M, Jirkovská A, Bém R, Husáková J, Lánská V. Stimulation TcPO2 Testing Improves Diagnosis of Peripheral Arterial Disease in Patients With Diabetic Foot. Front Endocrinol (Lausanne) 2021; 12:744195. [PMID: 34956078 PMCID: PMC8704582 DOI: 10.3389/fendo.2021.744195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND All diagnostic procedures of peripheral arterial disease (PAD) in diabetic foot (DF) are complicated due to diabetes mellitus and its late complications.The aim of our study is to enhance diagnosis of PAD using a novel transcutaneous oximetry (TcPO2) stimulation test. METHODS The study comprised patients with mild-to-moderate PAD(WIfI-I 1 or 2) and baseline TcPO2 values of 30-50 mmHg.TcPO2 was measured across 107 different angiosomes. Stimulation examination involved a modification of the Ratschow test. All patients underwent PAD assessment (systolic blood pressures (SBP), toe pressures (TP), the ankle-brachial indexes (ABI) and toe-brachial indexes (TBI), duplex ultrasound of circulation). Angiosomes were divided into two groups based on ultrasound findings: group M(n=60) with monophasic flow; group T(n=47) with triphasic flow. Large vessel parameters and TcPO2 at rest and after exercise (minimal TcPO2, changes in TcPO2 from baseline (Δ,%), TcPO2 recovery time) measured during the stimulation test were compared between study groups. RESULTS During the TcPO2 stimulation exercise test, group M exhibited significantly lower minimal TcPO2 (26.2 ± 11.1 vs. 31.4 ± 9.4 mmHg; p<0.01), greater Δ and percentage decreases from resting TcPO2 (p=0.014 and p=0.007, respectively) and longer TcPO2 recovery times (446 ± 134 vs. 370 ± 81ms;p=0.0005) compared to group T. SBPs, TPs and indexes were significantly lower in group M compared to group T. Sensitivity and specificity of TcPO2 stimulation parameters during PAD detection increased significantly to the level of SBP, ABI, TP and TBI. CONCLUSION Compared to resting TcPO2, TcPO2 measured during stimulation improves detection of latent forms of PAD and restenosis/obliterations of previously treated arteries in diabetic foot patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov [https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009V7W&selectaction=Edit&uid=U0005381&ts=2&cx=3j24u2], identifier NCT04404699.
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Affiliation(s)
- Vladimíra Fejfarová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- *Correspondence: Vladimíra Fejfarová,
| | - Jiří Matuška
- MATMED, Vascular Outpatient Clinic, Hodonín, Czechia
| | - Edward Jude
- Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, United Kingdom
| | - Pavlína Piťhová
- Diabetes Centre, Second Faculty of Medicine, Motol Teaching Hospital, Prague, Czechia
| | - Milan Flekač
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Karel Roztočil
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Veronika Wosková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Michal Dubský
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Alexandra Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Robert Bém
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Jitka Husáková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Věra Lánská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
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Golamari R, Gilchrist IC. Collateral Circulation Testing of the Hand- Is it Relevant Now? A Narrative Review. Am J Med Sci 2020; 361:702-710. [PMID: 33947584 DOI: 10.1016/j.amjms.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 03/30/2020] [Revised: 10/20/2020] [Accepted: 12/03/2020] [Indexed: 11/15/2022]
Abstract
Testing for collateral circulation of the hand before any radial artery procedure has been a subject of many controversies. Neither the Allen's test (AT) nor the plethysmography based Barbeau test, adequately and reliably test for collateral circulation. With growing interest in radial approaches for vascular procedures, its common use for arterial monitoring and blood gas sampling, there has been a growing interest in the relevance of assessing collateral hand circulation. Multiple studies now refute the utility of collateral testing, yet it continues to be propagated as an essential triaging assessment tool by educators. Allen's, or modified Allen tests (MAT) are operator dependent and often subjected to observational bias. Barbeau test is more objective, however, it fails to show added benefit in assessing pre-procedural patency. Despite studies questioning the validity of collateral circulation assessment, these tests continue to preclude radial approach. There is no standardization for being considered an abnormal test across literature and the significance of an abnormal test translating into a clinical outcome has not been investigated in prior studies. This may be attributed to the robust vascular supply of the hand, connections at the digital circulation level and vessel recruitment in an event of occlusion. We reviewed this topic extensively and make an argument that non-invasive collateral testing should be abandoned as a triage tool for radial artery procedures such as arterial punctures, arterial monitoring, and transradial vascular procedures.
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Affiliation(s)
- Reshma Golamari
- Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Ian C Gilchrist
- Department of Cardiovascular Diseases, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Jiang X, Shen Y, Fang Q, Zhang W, Cheng X. Platelet-to-lymphocyte ratio as a predictive index for delirium in critically ill patients: A retrospective observational study. Medicine (Baltimore) 2020; 99:e22884. [PMID: 33120832 PMCID: PMC7581125 DOI: 10.1097/md.0000000000022884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Delirium is a neuropsychiatric syndrome commonly encountered in critically ill patients, and systemic inflammation has been strongly implicated to underlie its pathophysiology. This study aimed to investigate the predictive value of the platelet-to-lymphocyte ratio (PLR) for delirium in the intensive care unit (ICU).In this retrospective observational study, we analyzed the clinical and laboratory data of 319 ICU patients from October 2016 to December 2017. Using the Locally Weighted Scatterplot Smoothing technique, a PLR knot was detected at a value of approximately 100. Logistic regression was used to investigate the association between the PLR and delirium.Of the 319 patients included in this study, 29 (9.1%) were diagnosed with delirium. In the delirium group, the duration of mechanical ventilation was significantly longer than that in the no-delirium group (40.2 ± 65.5 vs. 19.9 ± 26.5 hours, respectively; P < .001). A multiple logistic regression analysis showed that PLR > 100 (odds ratio [OR]: 1.003, 95% confidence interval [CI]: 1.001-1.005), age (OR: 2.76, 95% CI: 1.110-6.861), and the ratio of arterial oxygen partial pressure to the inspired oxygen fraction (OR: 0.996, 95% CI: 0.992-0.999) were independent predictors of delirium.In our study, a high PLR value on ICU admission was associated with a higher incidence of delirium. Owing to easy calculability, the PLR could be a useful delirium predictive index in ICUs, thereby enabling early interventions to be implemented.
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Affiliation(s)
- Xuandong Jiang
- Intensive Care Unit, Dongyang People's Hospital, Dongyang
| | | | - Qiang Fang
- Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Weimin Zhang
- Intensive Care Unit, Dongyang People's Hospital, Dongyang
| | - Xuping Cheng
- Intensive Care Unit, Dongyang People's Hospital, Dongyang
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Berli MC, Jundt-Ecker M, Meier MR, Hofer M, Schöni M, Götschi T, Uçkay I, Böni T, Waibel FWA. Resting TcPO2 levels decrease during liner wear in persons with a transtibial amputation. PLoS One 2020; 15:e0239930. [PMID: 32986780 PMCID: PMC7521692 DOI: 10.1371/journal.pone.0239930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background In our clinic, a substantial number of patients present with transtibial residual limb pain of no specific somatic origin. Silicone liner induced tissue compression may reduce blood flow, possibly causing residual limb pain. Thus, as a first step we investigated if the liner itself has an effect on transcutaneous oxygen pressure (TcPO2). Methods Persons with unilateral transtibial amputation and residual limb pain of unknown origin were included. Medical history, including residual limb pain, was recorded, and the SF-36 administered. Resting TcPO2 levels were measured in the supine position and without a liner at 0, 10, 20 and 30 minutes using two sensors: one placed in the Transverse plane over the tip of the Tibia End (= TTE), the other placed in the Sagittal plane, distally over the Peroneal Compartment (= SPC). Measurements were repeated with specially prepared liners avoiding additional pressure due to sensor placement. Statistical analyses were performed using SPSS. Results Twenty persons (9 women, 11 men) with a mean age of 68.65 years (range 47–86 years) participated. The transtibial amputation occurred on average 43 months prior to study entry (range 3–119 months). With liner wear, both sensors measured TcPO2 levels that were significantly lower than those measured without a liner (TTE: p < 0.001; SPC: p = 0.002) after 10, 20 and 30 minutes. No significant differences were found between TcPO2 levels over time between the sensors. There were no significant associations between TcPO2 levels and pain, smoking status, age, duration of daily liner use, mobility level, and revision history. Conclusion Resting TcPO2 levels decreased significantly while wearing a liner alone, without a prosthetic socket. Further studies are required to investigate the effect of liner wear on exercise TcPO2 levels.
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Affiliation(s)
- Martin C. Berli
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Michèle Jundt-Ecker
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | | | | | - Madlaina Schöni
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopaedic Surgery, Institute for Biomechanics, University of Zurich, ETH Zurich, Balgrist Campus, Zurich, Switzerland
| | - Ilker Uçkay
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Thomas Böni
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Felix W. A. Waibel
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
- * E-mail:
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Jo JY, Kim WJ, Ku S, Choi SS. Comparison of preoxygenation with a high-flow nasal cannula and a simple mask before intubation during induction of general anesthesia in patients undergoing head and neck surgery: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19525. [PMID: 32195955 PMCID: PMC7220443 DOI: 10.1097/md.0000000000019525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To assess the arterial oxygen partial pressure (PaO2) at defined time points during preoxygenation and to compare high-flow heated humidified nasal oxygenation with standard preoxygenation using oxygen insufflation via a facemask for at least 5 minutes, before intubation during induction of general anesthesia. METHODS This randomized, single-blinded, prospective study will be conducted in patients undergoing head and neck surgery. After standard monitoring, the artery catheter at the radial artery or dorsalis pedis artery will be placed and arterial blood gas analysis (ABGA) for baseline values will be performed simultaneously. Each group will be subjected to 1 of 2 preoxygenation methods (high-flow nasal cannula or simple facemask) for 5 minutes, and ABGA will be performed twice. After confirming intubation, we will start mechanical ventilation and check the vital signs and perform the final ABGA. DISCUSSION This trial aims to examine the trajectory of PaO2 levels during the whole preoxygenation procedure and after intubation. We hypothesize that preoxygenation with the high-flow nasal cannula will be superior to that with the face mask. STUDY REGISTRATION This trial was registered with the Clinical Trial Registry (NCT03896906; ClinicalTrials.gov).
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14
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Kanick SC, Schneider PA, Klitzman B, Wisniewski NA, Rebrin K. Continuous monitoring of interstitial tissue oxygen using subcutaneous oxygen microsensors: In vivo characterization in healthy volunteers. Microvasc Res 2019; 124:6-18. [PMID: 30742844 PMCID: PMC6570499 DOI: 10.1016/j.mvr.2019.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/19/2022]
Abstract
Measurements of regional tissue oxygen serve as a proxy to monitor local perfusion and have the potential to guide therapeutic decisions in multiple clinical disciplines. Transcutaneous oximetry (tcpO2) is a commercially available noninvasive technique that uses an electrode to warm underlying skin tissue and measure the resulting oxygen tension at the skin surface. A novel approach is to directly measure interstitial tissue oxygen using subcutaneous oxygen microsensors composed of a biocompatible hydrogel carrier platform with embedded oxygen sensing molecules. After initial injection of the hydrogel into subcutaneous tissue, noninvasive optical measurements of phosphorescence-based emissions at the skin surface are used to sense oxygen in the subcutaneous interstitial space. The object of the present study was to characterize the in vivo performance of subcutaneous microsensors and compare with transcutaneous oximetry (tcpO2). Vascular occlusion tests were performed on the arms of 7 healthy volunteers, with repeated tests occurring 1 to 10 weeks after sensor injection, yielding 95 total tests for analysis. Comparative analysis characterized the response of both devices to decreases in tissue oxygen during occlusion and to increases in tissue oxygen following release of the occlusion. Results indicated: (I) time traces returned by microsensors and tcpO2 were highly correlated, with the median (interquartile range) correlation coefficient of r = 0.93 (0.10); (II) both microsensors and tcpO2 sensed a statistically significant decrease in normalized oxygen during occlusion (p < 0.001 for each device); (III) microsensors detected faster rates change (p < 0.001) and detected overshoot during recovery more frequently (38% vs. 4% of tests); (IV) inter-measurement analysis showed no correlation of baseline values between microsensors and tcpO2 (r = 0.03), but comparison of integrated oxygen dynamics showed similar variation in the normalized response to occlusion between devices (p = 0.06), (V) intra-measurement analysis revealed that microsensors detect greater physiological fluctuations than tcpO2 (p < 0.001) and may provide enhanced sensitivity to processes such as vasomotion. Additionally, the functional response of microsensors was not significantly different across time groupings (per month) post-injection (p = 0.61). Although the compared devices have differences in the mechanisms used to sense oxygen, these findings demonstrate that subcutaneous oxygen microsensors measure changes in interstitial tissue oxygen in human subjects in vivo.
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Affiliation(s)
| | | | - Bruce Klitzman
- Kenan Plastic Surgery Research Labs and Biomedical Engineering, Duke University, Durham, NC, USA
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15
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Lim CJ, Lee S, Kim JH, Kil HJ, Kim YC, Park JW. Wearable, Luminescent Oxygen Sensor for Transcutaneous Oxygen Monitoring. ACS Appl Mater Interfaces 2018; 10:41026-41034. [PMID: 30404434 DOI: 10.1021/acsami.8b13276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We present a new concept for a wearable oxygen (O2) sensor for transcutaneous O2 pressure (tcpO2) monitoring by combining the technologies of luminescent gas sensing and wearable devices. O2 monitoring has been exhaustively studied given its central role in diagnosing various diseases. The ability to quantify the physiological distribution and real-time dynamics of O2 from the subcellular to the macroscopic level is required to fully understand mechanisms associated with both normal physiological and pathological conditions. Despite its profound biological and clinical importance, few effective methods exist for noninvasively quantifying O2 in a physiological setting. The wearable sensor developed here consists of three components: a luminescent sensing film attached onto skin by a carbon tape, an organic light-emitting diode (OLED) as a light source, and an organic photodiode (OPD) as a light detector. All the components are solution-processable and integrated on a plane in a bandage-like configuration. To verify the performance, tcpO2 variations by pressure-induced occlusion were measured in the lower arm and a thumb by the wearable sensor, and the results were comparable to those measured by a commercial instrument. In addition to its flexibility, other features of this sensor render it a potential low-cost solution for the simultaneous monitoring of tcpO2 in any part of a body.
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Affiliation(s)
- Chang-Jin Lim
- Department of Materials Science and Engineering , Yonsei University , Seoul 03722 , Korea
| | - Soyeon Lee
- Department of Materials Science and Engineering , Yonsei University , Seoul 03722 , Korea
| | - Jin-Hoon Kim
- Department of Materials Science and Engineering , Yonsei University , Seoul 03722 , Korea
| | - Hye-Jun Kil
- Biomedical Research Institute , Korea Institute of Science and Technology , Seoul 02792 , Korea
| | - Yu-Chan Kim
- Biomedical Research Institute , Korea Institute of Science and Technology , Seoul 02792 , Korea
| | - Jin-Woo Park
- Department of Materials Science and Engineering , Yonsei University , Seoul 03722 , Korea
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16
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Kawamoto S. [Latest Monitoring Systems for Vital Signs in Cardiothoracic Surgery]. Kyobu Geka 2018; 71:742-746. [PMID: 30310020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this review article, the latest monitoring systems for vital signs in cardiothoracic surgery, including a multi-wavelength pulse oximeter, a transcutaneous blood gas monitoring system, a modified pulmonary artery catheter, and modern less-invasive cardiac output measurement systems are introduced. These less-invasive and real-time/continuous monitoring technologies would provide useful information for perioperative care after cardiothoracic surgeries, and improve the outcomes of surgeries.
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Affiliation(s)
- Shunsuke Kawamoto
- Department of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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17
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Xue M, Wang D, Zhang Z, Cao Z, Luo Z, Zheng Y, Lu J, Zhao Q, Zhang XD. Demonstrating the Potential of Using Transcutaneous Oxygen and Carbon Dioxide Tensions to Assess the Risk of Pressure Injuries. Int J Biol Sci 2018; 14:1466-1471. [PMID: 30262998 PMCID: PMC6158733 DOI: 10.7150/ijbs.26987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/22/2018] [Indexed: 02/04/2023] Open
Abstract
Pressure injuries have a high incidence in elderly and critically ill patients, and can endanger lives in severe cases. The key to reducing the incidence of pressure injuries is to find an objective, noninvasive, automatic and consistent scientific method for assessing pressure injuries. To serve this need, we conducted a clinical study to investigate the potential of using transcutaneous oxygen tension (TcPO2) and transcutaneous carbon dioxide tension (TcPCO2) for assessing pressure injuries. From the results of the study we found that first, the values of TcPO2 and TcPCO2 are sensitive to the change of pressure imposed on the measured region and to the risk status of a pressure injury when a pressure is imposed. Second, the magnitude of change in TcPO2 and TcPCO2 is higher in patients with a high risk of a pressure injury compared with those who have a low risk. Third, TcPO2 and TcPCO2 are both significantly correlated with the Braden score, the widely used score for assessing the risk of a pressure injury. Therefore, TcPO2 and TcPCO2 have a potential to be an effective and convenient scientific tool for assessing the risk of pressure injuries.
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Affiliation(s)
- Mei Xue
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Dandan Wang
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau
| | - Zhaozhi Zhang
- Department of Statistical Science, Duke University, Durham, NC 27708, USA
| | - Zhixin Cao
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Zujin Luo
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Yingying Zheng
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Jingjing Lu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Qi Zhao
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau
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18
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Kantor DB, Petty CR, Phipatanakul W, Gaffin JM. Transcutaneous CO-oximetry differentiates asthma exacerbation and convalescence in children. J Allergy Clin Immunol 2018; 142:676-678.e5. [PMID: 29673798 PMCID: PMC6078811 DOI: 10.1016/j.jaci.2018.02.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/14/2018] [Accepted: 02/25/2018] [Indexed: 10/17/2022]
Affiliation(s)
- David B Kantor
- Department of Anesthesia, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Carter R Petty
- Clinical Research Center, Boston Children's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass.
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Heyboer M, Byrne J, Pons P, Wolner E, Seargent S, Wojcik SM. Use of in-chamber transcutaneous oxygen measurement to determine optimal treatment pressure in patients undergoing hyperbaric oxygen therapy. Undersea Hyperb Med 2018; 45:389-394. [PMID: 30241117] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Hyperbaric oxygen (HBO2) therapy is used to promote healing in select problem wounds. Transcutaneous oxygen measurement (TCOM) can be used to predict the response of these wounds to HBO2, with in-chamber TCOM values shown to be the most predictive. We evaluated the use of in-chamber TCOM values to determine optimal treatment pressure. METHODS A retrospective review was completed of patients undergoing HBO2 therapy for a lower-extremity wound and who had in-chamber TCOM. Data collected included TCOM values, treatment profile, and patient outcome. RESULTS A total of 142 patients were identified. The overall results demonstrated healing in 59%, minor amputation (below ankle) in 11.3%, and major amputation (above ankle) in 16.2% of patients. 79.3% of patients at 2 atmospheres absolute (ATA) and 86.6% of patients at 2.4 ATA had transcutaneous oxygen pressure (TcPO2) values ≥250 mmHg. Among those with TcPO2 ⟨250 mmHg at 2 ATA, 41% attained TcPO2 ⟩250 mmHg at 2.4 ATA. Among those treated at 2 ATA the healing rate was 70.6% if TcPO2 ⟩250 mmHg, and 11.8% if TcPO2 ⟨250 mmHg (P⟨0.001). Among those treated at 2.4 ATA the healing rate was 33.3% if TcPO2 ⟩250 mmHg and 14.3% if TcPO2 ⟨250 mmHg (P⟨0.001). DISCUSSION Determining optimal therapeutic pressure for patients undergoing HBO2 is important to maximize benefit and minimize risk. This study indicates that in-chamber TCOM can be used to select an individualized optimal treatment pressure in patients undergoing HBO2 for lower-extremity wounds, including diabetic foot ulcers. This may result in better utilization of HBO2 and better outcomes.
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Affiliation(s)
- Marvin Heyboer
- Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care, SUNY Upstate Medical University, Syracuse, New York U.S
| | - Joseph Byrne
- Center for Wound Care and Hyperbaric Medicine, St. Joseph's Hospital, Fayetteville, New York U.S
| | - Paula Pons
- Center for Wound Care and Hyperbaric Medicine, St. Joseph's Hospital, Fayetteville, New York U.S
| | - Elena Wolner
- SUNY Upstate Medical University, College of Medicine, Syracuse, New York U.S
| | - Sarah Seargent
- Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care, SUNY Upstate Medical University, Syracuse, New York U.S
| | - Susan M Wojcik
- SUNY Upstate Medical University, College of Medicine, Syracuse, New York U.S
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20
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Mitropoulos A, Gumber A, Crank H, Akil M, Klonizakis M. The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients. Arthritis Res Ther 2018; 20:112. [PMID: 29871697 PMCID: PMC5989435 DOI: 10.1186/s13075-018-1605-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/24/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aerobic exercise in general and high-intensity interval training (HIIT) specifically is known to improve vascular function in a range of clinical conditions. HIIT in particular has demonstrated improvements in clinical outcomes, in conditions that have a strong macroangiopathic component. Nevertheless, the effect of HIIT on microcirculation in systemic sclerosis (SSc) patients is yet to be investigated. Therefore, the purpose of the study was to compare the effects of two HIIT protocols (cycle and arm cranking) on the microcirculation of the digital area in SSc patients. METHODS Thirty-four limited cutaneous SSc patients (65.3 ± 11.6 years old) were randomly allocated in three groups (cycling, arm cranking and control group). The exercise groups underwent a 12- week exercise program twice per week. All patients performed the baseline and post-exercise intervention measurements where physical fitness, functional ability, transcutaneous oxygen tension (ΔTcpO2), body composition and quality of life were assessed. Endothelial-dependent as well as -independent vasodilation were assessed in the middle and index fingers using LDF and incremental doses of acetylcholine (ACh) and sodium nitroprusside (SNP). Cutaneous flux data were expressed as cutaneous vascular conductance (CVC). RESULTS Peak oxygen uptake increased in both exercise groups (p < 0.01, d = 1.36). ΔTcpO2 demonstrated an increase in the arm-cranking group only, with a large effect, but not found statistically significant,(p = 0.59, d = 0.93). Endothelial-dependent vasodilation improvement was greater in the arm-cranking (p < 0.05, d = 1.07) in comparison to other groups. Both exercise groups improved life satisfaction (p < 0.001) as well as reduced discomfort and pain due to Raynaud's phenomenon (p < 0.05). Arm cranking seems to be the preferred mode of exercise for study participants as compared to cycling (p < 0.05). No changes were observed in the body composition or the functional ability in both exercise groups. CONCLUSIONS Our results suggest that arm cranking has the potential to improve the microvascular endothelial function in SSc patients. Also notably, our recommended training dose (e.g., a 12-week HIIT program, twice per week), appeared to be sufficient and tolerable for this population. Future research should focus on exploring the feasibility of a combined exercise such as aerobic and resistance training by assessing individual's experience and the quality of life in SSc patients. TRIAL REGISTRATION ClinicalTrials.gov (NCT number): NCT03058887 , February 23, 2017.
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Affiliation(s)
- A. Mitropoulos
- Centre for Sport and Exercise Science, Collegiate Campus, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - A. Gumber
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - H. Crank
- Centre for Sport and Exercise Science, Collegiate Campus, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - M. Akil
- Rheumatology Department, Royal Hallamshire Hospital, Sheffield, UK
| | - M. Klonizakis
- Centre for Sport and Exercise Science, Collegiate Campus, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
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Ge X, Adangwa P, Lim JY, Kostov Y, Tolosa L, Pierson R, Herr D, Rao G. Development and characterization of a point-of care rate-based transcutaneous respiratory status monitor. Med Eng Phys 2018; 56:36-41. [PMID: 29628217 DOI: 10.1016/j.medengphy.2018.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 03/15/2018] [Accepted: 03/25/2018] [Indexed: 11/18/2022]
Abstract
Blood gas measurements provide vital clinical information in critical care. The current "gold standard" for blood gas measurements involves obtaining blood samples, which can be painful and can lead to bleeding, thrombus formation, or infection. Mass transfer equilibrium-based transcutaneous blood gas monitors have been used since the 1970s, but they require heating the skin to ≥42 °C to speed up the transcutaneous gas diffusion. Thus, these devices have a potential risk for skin burns. Here we report a new generation of noninvasive device for respiratory status assessment. Instead of waiting for mass transfer equilibrium, the blood gas levels are monitored by measuring the transcutaneous diffusion rate, which is proportional to blood gas concentration. The startup time of this device is almost independent of skin temperature, so the measurement can be made at any body temperature. The test results show that this device can track the blood gas levels quickly even at normal body temperature.
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Affiliation(s)
- Xudong Ge
- Center for Advanced Sensor Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA.
| | - Prosper Adangwa
- Center for Advanced Sensor Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
| | - Ja Young Lim
- Center for Advanced Sensor Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
| | - Yordan Kostov
- Center for Advanced Sensor Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
| | - Leah Tolosa
- Center for Advanced Sensor Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
| | - Richard Pierson
- Department of Surgery, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, Maryland 21201, USA
| | - Daniel Herr
- Department of Surgery, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, Maryland 21201, USA
| | - Govind Rao
- Center for Advanced Sensor Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA.
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Isosu T, Yoshida K, Oishi R, Imaizumi T, Iseki Y, Sanbe N, Ikegami Y, Obara S, Kurosawa S, Murakawa M. Effects of indigo carmine intravenous injection on oxygen reserve index (ORi™) measurement. J Clin Monit Comput 2017; 32:693-697. [PMID: 28975476 DOI: 10.1007/s10877-017-0064-5] [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] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/18/2017] [Indexed: 11/27/2022]
Abstract
To retrospectively investigate the effects of indigo carmine intravenous injection on oxygen reserve index (ORi™) in 20 patients who underwent elective gynecologic surgery under general anesthesia. The study subjects were patients who underwent elective gynecologic surgery under general anesthesia between April 2016 and January 2017, and were administered a 5-ml intravenous injection of 0.4% indigo carmine for clinical purposes during surgery with ORi monitoring. Changes in ORi within 20 min after indigo carmine injection were observed. A relevant decrease in ORi was defined as ≥ 10% reduction in ORi from pre-injection level. ORi rapidly decreased after indigo carmine intravenous injection in all patients. In 10 of 19 patients, ORi decreased to 0 after indigo carmine injection. The median lowest value of ORi was 0 (range 0-0.16) and the median time to reach the lowest value of ORi was 2 min (range 1-4 min) after injection. ORi values returned to pre-injection levels within 20 min in 13 of 19 patients, and the median time to return to pre-injection levels was 10 min (range 6-16 min) after injection. During ORi monitoring it is necessary to consider the rapid reduction in ORi after intravenous injection of indigo carmine.
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Affiliation(s)
- Tsuyoshi Isosu
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan.
| | - Keisuke Yoshida
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan
| | - Rieko Oishi
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan
| | - Tsuyoshi Imaizumi
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan
| | - Yuzo Iseki
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan
| | - Norie Sanbe
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan
| | - Yukihiro Ikegami
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan
| | - Shinju Obara
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan
| | - Shin Kurosawa
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan
| | - Masahiro Murakawa
- Department of Anesthesiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1297, Japan
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Chiang N, Jain JK, Sleigh J, Vasudevan T. Evaluation of hyperspectral imaging technology in patients with peripheral vascular disease. J Vasc Surg 2017; 66:1192-1201. [PMID: 28545710 DOI: 10.1016/j.jvs.2017.02.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/27/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hyperspectral imaging technology is a novel method of using transcutaneous measurement of oxyhemoglobin (HT-Oxy) and deoxyhemoglobin (HT-Deoxy) concentrations to create a two-dimensional, color-coded "oxygen map." The aims of this study were to compare the use of a hyperspectral imaging device with the transcutaneous oxygen measurement (TCOM), ankle-brachial index (ABI), and severity of peripheral vascular disease (PVD) and to assess their correlations. METHODS This prospective study recruited 294 participants divided into three distinct groups composed of healthy volunteers and patients with PVD. Patients underwent measurements of lower limbs at a standardized point over the head of the first metatarsal on the plantar aspect using the hyperspectral imaging device, generating four outputs including HT-Oxy, HT-Deoxy, oxygen saturation (HT-Sat), and skin temperature, and the TCOM system, generating transcutaneous partial pressure of oxygen (TcpO2) and carbon dioxide (TcpCO2). Demographic data, severity of PVD, ABI, and other pertinent information were obtained from both the participants and medical records. RESULTS Interoperator reliability ranged from 86% to 94% across the four hyperspectral imaging device outputs, whereas intraoperator reliability ranged from 92% to 94%. The HT-Oxy, HT-Sat, TcpCO2, and ABI of the diseased limb correlated significantly with the severity of PVD. HT-Sat significantly correlated with TcpO2 (R = 0.19), TcpCO2 (R = -0.26), ABI (R = 0.42), and skin temperature (R = 0.56). HT-Deoxy also correlated with TcpCO2 (R = 0.27). CONCLUSIONS This study demonstrates the reliability of hyperspectral imaging in comparison to TCOM, ABI, skin temperature, and severity of PVD in a series of patients. Its correlation to other established modalities and low interoperator and intraoperator variability could enable this modality to be a useful screening tool in PVD.
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Affiliation(s)
- Nathaniel Chiang
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Jitendra K Jain
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Jamie Sleigh
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Thodur Vasudevan
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Venermo M, Settembre N, Albäck A, Vikatmaa P, Aho PS, Lepäntalo M, Inoue Y, Terasaki H. Pilot Assessment of the Repeatability of Indocyanine Green Fluorescence Imaging and Correlation with Traditional Foot Perfusion Assessments. Eur J Vasc Endovasc Surg 2016; 52:527-533. [PMID: 27486005 DOI: 10.1016/j.ejvs.2016.06.018] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/28/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ankle brachial index (ABI), toe pressures (TP), and transcutaneous oxygen pressure (TcPO2) are traditionally used in the assessment of critical limb ischemia (CLI). Indocyanine green (ICG) fluorescence imaging can be used to evaluate local circulation in the foot and to evaluate the severity of ischemia. This prospective study analyzed the suitability of a fluorescence imaging system (photodynamic eye [PDE]) in CLI. MATERIAL AND METHODS Forty-one patients with CLI were included. Of the patients, 66% had diabetes and there was an ischemic tissue lesion in 70% of the limbs. ABI, toe pressures, TcPO2 and ICG-fluorescence imaging (ICG-FI) were measured in each leg. To study the repeatability of the ICG-FI, each patient underwent the study twice. After the procedure, foot circulation was measured using a time-intensity curve, where T1/2 (the time needed to achieve half of the maximum fluorescence intensity) and PDE10 (increase of the intensity during the first 10 s) were determined. A time-intensity curve was plotted using the same areas as for the TcPO2 probes (n=123). RESULTS The mean ABI was 0.43, TP 21 mmHg, TcPO2 23 mmHg, T1/2 38 s, and PDE10 19 AU. Time-intensity curves were repeatable. In a Bland-Altman scatter plot, the 95% limits of agreement of PDE10 was 9.9 AU and the corresponding value of T1/2 was 14 s. Correlation between ABI and TP was significant (R=.73, p<.001), and it was weaker in diabetic patients (R=.47, p=.048) compared with non-diabetic patients (R=.89, p=.002). Correlations between ABI and TcPO2 and TP and TcPO2 were weak (R=.37, p=.05 and R=.43, p=.037, respectively). Correlation between TcPO2 and PDE10 was strong in diabetic patients (R=.70, p=.003). CONCLUSIONS According to this pilot study, ICG-FI with PDE can be used in the assessment of blood supply in the ischemic foot.
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Affiliation(s)
- M Venermo
- Helsinki University Central Hospital, Helsinki, Finland.
| | - N Settembre
- Helsinki University Central Hospital, Helsinki, Finland
| | - A Albäck
- Helsinki University Central Hospital, Helsinki, Finland
| | - P Vikatmaa
- Helsinki University Central Hospital, Helsinki, Finland
| | - P-S Aho
- Helsinki University Central Hospital, Helsinki, Finland
| | - M Lepäntalo
- Helsinki University Central Hospital, Helsinki, Finland
| | - Y Inoue
- Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - H Terasaki
- Helsinki University Central Hospital, Helsinki, Finland; Tokyo Medical and Dental University Hospital, Tokyo, Japan
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Zhang J, Xiao Z, Chen L, Li L, Yang H, Luo B, Mai L, Yan L, Yang C. Cilostazol Can Increase Skin Oxygen Supply Assessed by Transcutaneous Oxygen Pressure Measurement in Type 2 Diabetes With Lower Limb Ischemic Disease: A Randomized Trial. J Wound Ostomy Continence Nurs 2016; 43:254-9. [PMID: 26938333 DOI: 10.1097/won.0000000000000214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to compare the efficacy and safety of cilostazol versus acetylsalicylic acid (ASA) for amelioration of lower limb ischemia in type 2 diabetes. DESIGN Prospective, randomized positive-controlled open clinical trial. SUBJECTS AND SETTING Eighty-nine patients with type 2 diabetes mellitus and symptoms of lower limb ischemia (perceptions of coldness of the lower limbs, numbness, intermittent claudication, or pain at rest) present for 6 months or more that had not significantly changed within the past 3 months participated in the study. All subjects had an initial transcutaneous oxygen pressure (TcpO2) of less than 40 mm Hg in the foot when measured in the supine position. Subjects included 46 males and 43 females; their ages ranged from 35 to 80 years. METHODS Participants were randomly allocated to 2 groups, one was treated with cilostazol 100 mg taken twice daily (n = 48), and a second group took 100 mg of ASA daily (n = 41) for 8 weeks. Clinical assessment included measurement of transcutaneous oxygenation, and symptoms associated with lower limb ischemia. Blood analyses included a full blood panel, coagulation screen, renal function tests, hepatic function tests, and lipid profiles. All tests were performed at baseline and repeated at 8 weeks. RESULTS Age, duration of diabetes, diabetic complications, lower limb ischemic symptoms, TcpO2, and smoking status did not differ between the 2 groups. In contrast, TcpO2 significantly improved from 37.1 ± 11.9 mm Hg to 42.0 ± 9.7 mm Hg in the cilostazol-treated group (P < .05), whereas no significant change was observed in the ASA-treated group (P > .05). Ischemic symptoms such as intermittent claudication (P = .009), perception of limb coldness (P = .008), and pain at rest (P = .017) showed greater improvement in the cilostazol-treated group when compared to subjects treated with ASA. Approximately 10% of patients treated with cilostazol experienced adverse side effects (palpitations, headache, diarrhea). Cilostazol was not found to have significant detrimental effects in hematologic or biochemical indices, including renal, hepatic, and blood coagulant function tests. CONCLUSIONS We found that 8 weeks of treatment with cilostazol 100 mg daily was safe and well tolerated for the treatment of type 2 diabetes with lower limb ischemic disease.
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Affiliation(s)
- Jinglu Zhang
- Jinglu Zhang, PhD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Zidong Xiao, MD, Department of Endocrinology of First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China. Lihong Chen, PhD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Li Li, MD, Emergency Department, the Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Haiyun Yang, MD, Department of Ultrasonic of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Baoming Luo, MD, Department of Ultrasonic of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Lifang Mai, MD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Li Yan, MD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Chuan Yang, PhD, Institution of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Bruschettini M, Romantsik O, Zappettini S, Ramenghi LA, Calevo MG. Transcutaneous carbon dioxide monitoring for the prevention of neonatal morbidity and mortality. Cochrane Database Syst Rev 2016; 2:CD011494. [PMID: 26874180 PMCID: PMC8720274 DOI: 10.1002/14651858.cd011494.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Carbon dioxide (CO2) measurement is a fundamental evaluation in a neonatal intensive care unit (NICU), as both low and high values of CO2 might have detrimental effects on neonatal morbidity and mortality. Though measurement of CO2 in the arterial blood gas is the most accurate way to assess the amount of CO2, it requires blood sampling and it does not provide a continuous monitoring of CO2. OBJECTIVES To assess whether the use of continuous transcutaneous CO2 (tcCO2) monitoring in newborn infants reduces mortality and improves short and long term respiratory and neurodevelopmental outcomes. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 11), MEDLINE via PubMed (1966 to November 1, 2015), EMBASE (1980 to November 1, 2015), and CINAHL (1982 to November 1, 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA Randomized, quasi-randomized and cluster randomized controlled trials comparing different strategies regarding tcCO2 monitoring in newborns. Three comparisons were considered, that is, continuous tcCO2 monitoring versus 1) any intermittent modalities to measure CO2; 2) other continuous CO2 monitoring; and 3) with or without intermittent CO2 monitoring. DATA COLLECTION AND ANALYSIS We used the standard methods of the Cochrane Neonatal Review Group. Two review authors independently assessed studies identified by the search strategy for inclusion. MAIN RESULTS Our search strategy yielded 106 references. Two review authors independently assessed all references for inclusion. We did not find any completed studies for inclusion, nor ongoing trials. AUTHORS' CONCLUSIONS There was no evidence to recommend or refute the use of transcutaneous CO2 monitoring in neonates. Well-designed, adequately powered randomized controlled studies are necessary to address efficacy and safety of transcutaneous CO2 monitoring in neonates.
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Affiliation(s)
- Matteo Bruschettini
- Institute for Clinical Sciences, Lund UniversityDepartment of PediatricsLundSweden21185
| | - Olga Romantsik
- Institute for Clinical Sciences, Lund UniversityDepartment of PediatricsLundSweden21185
| | | | | | - Maria Grazia Calevo
- Istituto Giannina GasliniEpidemiology, Biostatistics and Committees UnitGenoaItaly16147
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Abstract
A pulse oximeter is a common medical instrument used for noninvasively monitoring arterial oxygen saturation (SpO2). Currently, the fingertip-type pulse oximeter is the prevalent type of pulse oximeter used. However, it is inconvenient for long-term monitoring, such as that under motion. In this study, a wearable and wireless finger base-type pulse oximeter was designed and implemented using the tissue optical simulation technique and the Monte Carlo method. The results revealed that a design involving placing the light source at 135°-165° and placing the detector at 75°-90° or 90°-105° yields the optimal conditions for measuring SpO2. Finally, the wearable and wireless finger base-type pulse oximeter was implemented and compared with the commercial fingertip-type pulse oximeter. The experimental results showed that the proposed optimal finger base-type pulse oximeter design can facilitate precise SpO2 measurement.
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Affiliation(s)
- Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan
| | - Cheng-Yang Huang
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan
| | - Chien-Yue Chen
- Department of Electronics Engineering, National Yunlin University of Science and Technology, Yunlin 64002, Taiwan
| | - Jiun-Hung Lin
- Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan
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Kamenskaya OV, Klinkova AS, Karaskov AM. [Functional reserves of peripheral perfusion in patients with chronic lower limb ischaemia and the risk for restenosis development]. Angiol Sosud Khir 2016; 22:28-33. [PMID: 27336330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The authors studied the functional state of the peripheral microcirculatory blood flow (MCBF) by means of laser Doppler flowmetry and the level of partial pressure of oxygen (TcPO(2)) in a total of 82 patients presenting with stage IIB-IV chronic lower limb ischaemia (CLLI) prior to percutaneous transluminal balloon angioplasty (PTBA) with stenting of lower limb arteries and in the remote terms following revascularization (after 12 months). The study was aimed at assessing the functional reserves of peripheral perfusion in CLLI patients and the risk for the development of restenoses in the remote period after revascularization. Group One comprised 47 patients with the compensated functional state of the peripheral MCBF by the results of the orthostatic test (changing from the lying to standing position) and Group Two was composed of 35 patients with the decompensated state of MCBF. Decompensated disorders of functional reserves of the peripheral MCBF in CLLI patients, i.e., 1) no reaction of microcirculation to the orthostatic test and 2) a substantial decrease in the oxygen pressure in peripheral tissues (TcPO(2) less than 20 mm Hg) increase the chances of restenoses development in the remote period after revascularization 1.9- and 2.4-fold, respectively. Impairments of carbohydrate and lipid metabolism in CLLI patients promote a more than two-fold increase in the risk for the development of restenoses in the postoperative period. It is necessary to determine the functional reserve of the peripheral microcirculation in patients with CLLI at the preoperative stage in order to assess the prognosis of efficacy of revascularization and determine further goal-directed correction of the MCBF.
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Affiliation(s)
- O V Kamenskaya
- Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the RF Public Health Ministry, Novosibirsk, Russia
| | - A S Klinkova
- Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the RF Public Health Ministry, Novosibirsk, Russia
| | - A M Karaskov
- Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the RF Public Health Ministry, Novosibirsk, Russia
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29
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Torres Filho I, Nguyen NM, Jivani R, Terner J, Romfh P, Vakhshoori D, Ward KR. Oxygen saturation monitoring using resonance Raman spectroscopy. J Surg Res 2015; 201:425-31. [PMID: 27020828 DOI: 10.1016/j.jss.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Received: 09/28/2015] [Revised: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND The knowledge of hemoglobin oxygen saturation (SO2) and tissue oxygenation is critical to identify the presence of shock and therapeutic options. The resonance vibrational enhancement of hemoglobin allows measurement of oxy- and deoxy species of hemoglobin and resonance Raman spectroscopy (RRS-StO2) has been successfully used to measure aggregate microvascular oxygenation. We tested the hypothesis that noninvasive oxygen saturation measured by RRS-StO2 could serve as surrogate of systemic central venous SO2. METHODS In anesthetized rats, measurements of RRS-StO2 made in oral mucosa, skin, muscle, and liver were compared with measurements of central venous SO2 using traditional multi-wavelength oximetry. Various oxygenation levels were obtained using a stepwise hemorrhage while over 100 paired blood samples and Raman-based measurements were performed. The relationships between RRS-StO2 and clinically important systemic blood parameters were also evaluated. RRS-StO2 measurements were made in 3-mm diameter tissue areas using a microvascular oximeter and a handheld probe. RESULTS Significant correlations were found between venous SO2 and RRS-StO2 measurements made in the oral mucosa (r = 0.913, P < 0.001), skin (r = 0.499, P < 0.01), and liver (r = 0.611, P < 0.05). The mean difference between sublingual RRS-StO2 and blood sample SO2 values was 5.4 ± 1.6%. Sublingual RRS-StO2 also correlated with lactate (r = 0.909, P < 0.01), potassium (r = 0.757, P < 0.01), and pH (r = 0.703, P < 0.05). CONCLUSIONS Raman-based oxygen saturation is a promising technique for the noninvasive evaluation of oxygenation in skin, thin tissues, and solid organs. Under certain conditions, sublingual RRS-StO2 measurements correlate with central venous SO2.
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Affiliation(s)
- Ivo Torres Filho
- Department of Anesthesiology, Virginia Commonwealth University and the Virginia Commonwealth University Reanimation Engineering Science Center, Richmond, Virginia; Department of Emergency Medicine, Virginia Commonwealth University and the Virginia Commonwealth University Reanimation Engineering Science Center, Richmond, Virginia; Damage Control Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas.
| | - Nguyen M Nguyen
- Department of Anesthesiology, Virginia Commonwealth University and the Virginia Commonwealth University Reanimation Engineering Science Center, Richmond, Virginia
| | - Rizwan Jivani
- Department of Anesthesiology, Virginia Commonwealth University and the Virginia Commonwealth University Reanimation Engineering Science Center, Richmond, Virginia
| | - James Terner
- Department of Chemistry, Virginia Commonwealth University and the Virginia Commonwealth University Reanimation Engineering Science Center, Richmond, Virginia
| | | | | | - Kevin R Ward
- Department of Emergency Medicine and the Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, Michigan
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Spelten O, Fiedler F, Schier R, Wetsch WA, Hinkelbein J. Transcutaneous PTCCO 2 measurement in combination with arterial blood gas analysis provides superior accuracy and reliability in ICU patients. J Clin Monit Comput 2015; 31:153-158. [PMID: 26628269 DOI: 10.1007/s10877-015-9810-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Received: 07/29/2015] [Accepted: 11/24/2015] [Indexed: 11/25/2022]
Abstract
Hyper or hypoventilation may have serious clinical consequences in critically ill patients and should be generally avoided, especially in neurosurgical patients. Therefore, monitoring of carbon dioxide partial pressure by intermittent arterial blood gas analysis (PaCO2) has become standard in intensive care units (ICUs). However, several additional methods are available to determine PCO2 including end-tidal (PETCO2) and transcutaneous (PTCCO2) measurements. The aim of this study was to compare the accuracy and reliability of different methods to determine PCO2 in mechanically ventilated patients on ICU. After approval of the local ethics committee PCO2 was determined in n = 32 ICU consecutive patients requiring mechanical ventilation: (1) arterial PaCO2 blood gas analysis with Radiometer ABL 625 (ABL; gold standard), (2) arterial PaCO2 analysis with Immediate Response Mobile Analyzer (IRMA), (3) end-tidal PETCO2 by a Propaq 106 EL monitor and (4) transcutaneous PTCCO2 determination by a Tina TCM4. Bland-Altman method was used for statistical analysis; p < 0.05 was considered statistically significant. Statistical analysis revealed good correlation between PaCO2 by IRMA and ABL (R2 = 0.766; p < 0.01) as well as between PTCCO2 and ABL (R2 = 0.619; p < 0.01), whereas correlation between PETCO2 and ABL was weaker (R2 = 0.405; p < 0.01). Bland-Altman analysis revealed a bias and precision of 2.0 ± 3.7 mmHg for the IRMA, 2.2 ± 5.7 mmHg for transcutaneous, and -5.5 ± 5.6 mmHg for end-tidal measurement. Arterial CO2 partial pressure by IRMA (PaCO2) and PTCCO2 provided greater accuracy compared to the reference measurement (ABL) than the end-tidal CO2 measurements in critically ill in mechanically ventilated patients patients.
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Affiliation(s)
- Oliver Spelten
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50931, Cologne, Germany.
| | - Fritz Fiedler
- Department of Anaesthesiology and Intensive Care Medicine, St. Elisabeth-Hospital, Cologne, Germany
| | - Robert Schier
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Wolfgang A Wetsch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
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31
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Zhang H, Wang DX. Noninvasive Measurement of Carbon Dioxide during One-Lung Ventilation with Low Tidal Volume for Two Hours: End-Tidal versus Transcutaneous Techniques. PLoS One 2015; 10:e0138912. [PMID: 26466140 PMCID: PMC4605619 DOI: 10.1371/journal.pone.0138912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There may be significant difference between measurement of end-tidal carbon dioxide partial pressure (PetCO2) and arterial carbon dioxide partial pressure (PaCO2) during one-lung ventilation with low tidal volume for thoracic surgeries. Transcutaneous carbon dioxide partial pressure (PtcCO2) monitoring can be used continuously to evaluate PaCO2 in a noninvasive fashion. In this study, we compared the accuracy between PetCO2 and PtcCO2 in predicting PaCO2 during prolonged one-lung ventilation with low tidal volume for thoracic surgeries. METHODS Eighteen adult patients who underwent thoracic surgeries with one-lung ventilation longer than two hours were included in this study. Their PetCO2, PtcCO2, and PaCO2 values were collected at five time points before and during one-lung ventilation. Agreement among measures was evaluated by Bland-Altman analysis. RESULTS Ninety sample sets were obtained. The bias and precision when PtcCO2 and PaCO2 were compared were 4.1 ± 6.5 mmHg during two-lung ventilation and 2.9 ± 6.1 mmHg during one-lung ventilation. Those when PetCO2 and PaCO2 were compared were -11.8 ± 6.4 mmHg during two-lung ventilation and -11.8 ± 4.9 mmHg during one-lung ventilation. The differences between PtcCO2 and PaCO2 were significantly lower than those between PetCO2 and PaCO2 at all five time-points (p < 0.05). CONCLUSIONS PtcCO2 monitoring was more accurate for predicting PaCO2 levels during prolonged one-lung ventilation with low tidal volume for patients undergoing thoracic surgeries.
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Affiliation(s)
- Hong Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
- * E-mail:
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Blake DF, Naidoo P, Brown LH, Young D, Lippmann J. A comparison of the tissue oxygenation achieved using different oxygen delivery devices and flow rates. Diving Hyperb Med 2015; 45:79-83. [PMID: 26165528] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/08/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION High-concentration normobaric oxygen (O₂) administration is the first-aid priority in treating divers with suspected decompression illness. The best O₂ delivery device and flow rate are yet to be determined. AIM To determine whether administering O₂ with a non-rebreather mask (NRB) at a flow rate of 10 or 15 L·min ⁻¹ or with a demand valve with oronasal mask significantly affects the tissue partial pressure of O₂ (PtcO₂) in healthy volunteer scuba divers. METHODS Fifteen certified scuba divers had PtcO₂ measured at six positions on the arm and leg. Measurements were taken with subjects lying supine whilst breathing O₂ from a NRB at 10 or 15·L·min⁻¹, a demand valve with an adult Tru-Fit oronasal mask and, as a reference standard, an oxygen 'head hood'. End-tidal carbon dioxide was also measured. RESULTS While none of the emergency delivery devices performed as well as the head hood, limb tissue oxygenation was greatest when O₂ was delivered via the NRB at 15 L·min⁻¹. There were no clinically significant differences in end-tidal carbon dioxide regardless of the delivery device or flow rate. CONCLUSION Based on transcutaneous oximetry values, of the commonly available emergency O₂ delivery devices, the NRB at 15 L·min ⁻¹ is the device and flow rate that deliver the most O₂ to body tissues and, therefore, should be considered as a first-line pre-hospital treatment in divers with suspected decompression illness.
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Affiliation(s)
- Denise F Blake
- College of Marine and Environmental Sciences, James Cook University, Townsville, Emergency Department, The Townsville Hospital Townsville, Queensland, Australia 4814, E-mail:
| | - Philip Naidoo
- Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Lawrence H Brown
- Mount Isa Centre for Rural and Remote Health, James Cook University, Townsville
| | - Derelle Young
- Hyperbaric Medicine Unit, The Townsville Hospital, Townsville
| | - John Lippmann
- Divers Alert Network Asia-Pacific, Melbourne, Victoria, Australia
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Zulec M. [transcutaneous oximetry--between theory and practice]. Acta Med Croatica 2014; 68 Suppl 1:59-61. [PMID: 25326991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Transcutaneous oximetry is a procedure used to measure the pressure of oxygen in tissue and to determine oxygenation level. It is essential to determine the state of microcirculation and is used to assess the necessity and level of amputation and the effect of revascularization procedures, as a predictor of wound healing and hyperbaric oxygen therapy (HBOT) effectiveness tool. The measurement is done by the application electrode measuring point and the result is measured in mm Hg. Tissue with adequate oxygen level has a value greater than 50 mm Hg. Values between 20 and 40 mm Hg are considered hypoxic, while those below 20 mm Hg indicate extreme hypoxia. In Croatia, TcPO2 is commonly used for HBOT assessment but there is the need of broader application to objectify and facilitate procedures in the care of persons with impaired microcirculation.
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Dion JM, McKee C, Tobias JD, Herz D, Sohner P, Teich S, Michalsky M. Carbon dioxide monitoring during laparoscopic-assisted bariatric surgery in severely obese patients: transcutaneous versus end-tidal techniques. J Clin Monit Comput 2014; 29:183-6. [PMID: 24916514 DOI: 10.1007/s10877-014-9587-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/31/2014] [Indexed: 11/25/2022]
Abstract
Various factors including severe obesity or increases in intra-abdominal pressure during laparoscopy can lead to inaccuracies in end-tidal carbon dioxide (PETCO2) monitoring. The current study prospectively compares ET and transcutaneous (TC) CO2 monitoring in severely obese adolescents and young adults during laparoscopic-assisted bariatric surgery. Carbon dioxide was measured with both ET and TC devices during insufflation and laparoscopic bariatric surgery. The differences between each measure (PETCO2 and TC-CO2) and the PaCO2 were compared using a non-paired t test, Fisher's exact test, and a Bland-Altman analysis. The study cohort included 25 adolescents with a mean body mass index of 50.2 kg/m2 undergoing laparoscopic bariatric surgery. There was no difference in the absolute difference between the TC-CO2 and PaCO2 (3.2±3.0 mmHg) and the absolute difference between the PETCO2 and PaCO2 (3.7±2.5 mmHg). The bias and precision were 0.3 and 4.3 mmHg for TC monitoring versus PaCO2 and 3.2 and 3.2 mmHg for ET monitoring versus PaCO2. In the young severely obese population both TC and PETCO2 monitoring can be used to effectively estimate PaCO2. The correlation of PaCO2 to TC-CO2 is good, and similar to the correlation of PaCO2 to PETCO2. In this population, both of these non-invasive measures of PaCO2 can be used to monitor ventilation and minimize arterial blood gas sampling.
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Affiliation(s)
- Joanna M Dion
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA,
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Liu S, Sun J, Chen X, Yu Y, Liu X, Liu C. The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery. PLoS One 2014; 9:e91563. [PMID: 24699267 PMCID: PMC3974655 DOI: 10.1371/journal.pone.0091563] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 02/12/2014] [Indexed: 11/18/2022] Open
Abstract
To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2) were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2) and. (PTCCO2-PaCO2) were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2), mean 42.1,SD 5.4 kg/m(2)) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD). And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD). The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2) = 0.64, P<0.01), whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60 + 0.97 × PaCO2 (r(2) = 0.89). The LOA (limits of agreement) of 95% average PaCO2-PetCO2 difference is 10.3 ± 4.6 mmHg (mean ± 1.96 SD), while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9 ± 2.6 mmHg (mean ± 1.96 SD). In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery.
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Affiliation(s)
- Shijiang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Sun
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xing Chen
- Department of Project Management, Jiangsu New Energy Development Company, Jiangsu Guoxin Investment Group, Nanjing, China
| | - Yingying Yu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Liu
- Department of Anesthesiology, General Hospital of TISCO, TaiYuan, China
| | - Cunming Liu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail:
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Karlen W, Lim J, Ansermino JM, Dumont GA, Scheffer C. Recognition of correct finger placement for photoplethysmographic imaging. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:7480-3. [PMID: 24111475 DOI: 10.1109/embc.2013.6611288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In mobile health applications, non-expert users often perform the required medical measurements without supervision. Therefore, it is important that the mobile device guides them through the correct measurement process and automatically detects potential errors that could impact the readings. Camera oximetry provides a non-invasive measurement of heart rate and blood oxygen saturation using the camera of a mobile phone. We describe a novel method to automatically detect the correct finger placement on the camera lens for camera oximetry. Incorrect placement can cause optical shunt and if ignored, lead to low quality oximetry readings. The presented algorithm uses the spectral properties of the pixels to discriminate between correct and incorrect placements. Experimental results demonstrate high mean accuracy (99.06%), sensitivity (98.06%) and specificity (99.30%) with low variability. By sub-sampling pixels, the computational cost of classifying a frame has been reduced by more than three orders of magnitude. The algorithm has been integrated in a newly developed application called OxiCam where it provides real-time user feedback.
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Marano M. [Pulse oximetry in the dialysis room]. G Ital Nefrol 2013; 30:gin/00075.15. [PMID: 23832478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of pulse oximetry can improve the management of critical events and daily clinical problems in a haemodialysis unit. Blood oxygen saturation using pulse oximetry (SpO2), the so-called 'fifth vital sign', can be determined together with noninvasive blood pressure measurement, before haemodialysis treatment or when, during treatment, a patient's condition suddenly worsens. The pulse oximeter provides useful information on pulse rate and on heart rhythm. It can be considered a diagnostic first step for dyspnoea because normal-high values rule out interstitial pulmonary fluid. It is also a useful screening for blood gas analysis, providing confirmation of arterial blood from an arteriovenous fistula sample. It can indicate when oxygen therapy should be initiated and provides monitoring. Finally, it can be used to explore pulse blood flow distal to the arteriovenous fistula.
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Aksel'rod BA, Tolstova IA, Gus'kov DA. [Tissue oxygenation monitoring during cardiac surgery]. Anesteziol Reanimatol 2013:19-24. [PMID: 24000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED The aim of this study was to evaluate tissue oxymetry dynamics in patients with different initial tissue oxygenation levels and to analyze the relation of these data with the perioperative period flow peculiarities. PATIENTS AND METHODS 92 patients undergoing on-pump myocardium revascularization or valve replacement were included in the study. Regional oxygenation in all patients was monitored with FORE-SIGHT Laser Tissue Oximeter. Sensors were located in the right hemisphere projection and on right forearm. Tissue (StO2) and cerebral (SctO2) oxygenation data were analyzed before anaesthesia start, before CBP on 45th -minute of CPB and in the end of the operation. At these stages also was performed standardized time (3 minutes) vessel occlusion test (VOT). RESULTS None patients had episodes of StO2, decrease below the critical level during the operation, that allows to talk about central haemodynamics stability during the study. 1st group - patients with initial StO2, below 70% (n=19). In this group StO2, remain low throughout the operation. 2nd group- patients with initial StO2, over 70%, but before CPB decreased below 70% (n=49). 3rd group - patients with high StO2, throughout anaesthesia. VOT data confirmed tissue oxygenation disturbances in Ist and 2nd groups. In st group oxygen reserve (OR) was lower than in other groups and at the end of the surgery - lower than initial one. In 2nd group OR decreased significantly before CPB and during CPB didn't differ from 1st group. In 3rd group OR during anaesthesia was higher, than in 1st and 2nd group, but decreased by the end of the surgery. Lactate level after CPB doesn't exceed the upper limit, however, it's level was higher in the 1st and 2nd group than in the 3rd group. Central vein saturation in 3rd group was higher than in the Ist and 2nd group at all stages, except for operation start. Lower StO2, levels in 1st and 2nd group were accompanied with extension of ALV ICU length-of-stay and hospitalization. RESUME: Tissue oxymetry may be useful for regional oxygenation assessment during anesthesia. There is a decrease in tissue oxygenation and oxygen reserve of peripheral tissues during on-pump cardiosurgery The low tissue oxygenation level during preperfusion period may be a predictor for early postoperative complications.
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Abstract
OBJECTIVES To compare the agreement, precision and repeatability of end tidal carbon dioxide (EtCO2 ) and transcutaneous carbon dioxide (TcCO2 ) with partial pressure of arterial CO(2) ( PaCO2) in postoperative neonates. PATIENTS Fifty mechanically ventilated neonates without lung disease, and with no contraindications for either TcCO2 or EtCO2 monitoring. INTERVENTIONS Paired TcCO2 and EtCO2 values were recorded with three consecutive measurements within the first 48 h of surgery. MAIN OUTCOME MEASURES EtCO2, TcCO2 and PaCO2 triplets were compared using Bland-Altman plots. RESULTS One hundred thirty-two triplet measures of CO(2) were recorded with mean PaCO2 43.5 (7.3) mm Hg, EtCO2 38.8 (6.4) mm Hg and 43.8 (8.8) mm Hg (p<0.0001 for EtCO2 against PaCO2; paired t test). The PaCO2 - EtCO2 bias±2SD was 4.1±9.0 mm Hg and -0.8±13.0 mm Hg for PaCO2 - TcCO2. 56.1% of EtCO2, and 60.6% of TcCO2 values were within ±5 mm Hg of paired PaCO2. CONCLUSIONS In postoperative neonates, EtCO2 and TcCO2 demonstrated a clinically acceptable agreement with PaCO2.
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Affiliation(s)
- David Gerald Tingay
- Department of Neonatology, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia.
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Bjerregård A, Jansen E. Monitoring carbon dioxide in mechanically ventilated patients during hyperbaric treatment. Diving Hyperb Med 2012; 42:134-136. [PMID: 22987459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 06/20/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Measurement of the arterial carbon dioxide (P(a)CO(2)) is an established part of the monitoring of mechanically ventilated patients. Other ways to get information about carbon dioxide in the patient are measurement of end-tidal carbon dioxide (P(ET)CO(2)) and transcutaneous carbon dioxide (PTCCO2). Carbon dioxide in the blood and cerebral tissue has great influence on vasoactivity and thereby blood volume of the brain. We have found no studies on the correlation between P(ET)CO(2) or P(TC)CO(2), and P(a)CO(2) during hyperbaric oxygen therapy (HBOT). METHOD We studied 10 intubated and ventilatory stable patients during HBOT. End-tidal and transcutaneous measurements provided continuous data. Arterial blood samples were collected after reaching the operational pressure of 284 kPa (2.8 ATA) and analysed outside the chamber. A total of 17 paired samples of P(ET)CO(2), P(TC)CO(2) and P(a)CO(2) were obtained. RESULTS There was a good correlation between P(ET)CO(2) and P(a)CO(2) using linear regression (r(2) = 0.83). Bland-Altman analysis showed that P(ET)CO(2) on average was 2.22 kPa higher than P(a)CO(2) with limits of agreement (LoA) at ± 2.4 kPa. P(TC)CO(2), on average, was 2.16 kPa lower than P(a)CO(2) and the correlation using linear regression was poor (r(2) = 0.24). Bland-Altman analysis revealed LoA at ± 3.2 kPa. CONCLUSION During hyperbaric conditions we found that P(ET)CO(2) as opposed to P(TC)CO(2) offered the greater precision, but there was great variability among patients. Care must be taken when using P(ET)CO(2) or P(TC)CO(2) as an estimate of P(a)CO(2).
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Affiliation(s)
- Asger Bjerregård
- Department of Anaesthesia, Centre for Head and Orthopaedics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
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Warriner RA, Hopf HW. The effect of hyperbaric oxygen in the enhancement of healing in selected problem wounds. Undersea Hyperb Med 2012; 39:923-935. [PMID: 23045921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Problem wounds represent a significant and growing challenge to our healthcare system. The incidence and prevalence of these wounds are increasing in the population, resulting in growing utilization of healthcare resources and dollars expended. Venous leg ulcers represent the most common lower-extremity wound seen in ambulatory wound care centers, with recurrences frequent and outcomes often less than satisfactory. Pressure ulcers are common in patients in long-term institutional care settings adding significant increases in cost, disability and liability. Foot ulcers in patients with diabetes contribute to more than half of lower-extremity amputations in the United States in a group at risk, representing only 3 percent of the population. In response to this challenge, specialized programs have emerged designed to identify and manage these patients, using standardized protocols and a variety of new technologies to improve outcomes. Hyperbaric oxygen treatment (HBO2T) has been increasingly utilized in an adjunctive role in the care of many of these patients, coinciding with optimized patient and local wound care.
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Rubortone SA, De Carolis MP, Lacerenza S, Bersani I, Occhipinti F, Romagnoli C. Use of a combined SpO₂/PtcCO₂ sensor in the delivery room. Sensors (Basel) 2012; 12:10980-9. [PMID: 23112642 PMCID: PMC3472870 DOI: 10.3390/s120810980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 06/12/2012] [Revised: 07/16/2012] [Accepted: 07/31/2012] [Indexed: 11/16/2022]
Abstract
Arterial oxygen saturation (SaO2) and partial arterial pressure of carbon dioxide (PaCO2) are important respiratory parameters in critically ill neonates. A sensor combining a pulse oximeter with the Stow-Severinghaus electrode, required for the measurement of peripheral oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (PtcCO2), respectively, has been recently used in neonatal clinical practice (TOSCA500ÒRadiometer). We evaluated TOSCA usability and reliability in the delivery room (DR), throughout three different periods, on term, late-preterm, and preterm neonates. During the first period (period A), 30 healthy term neonates were simultaneously monitored with both TOSCA and a MASIMO pulse oximeter. During the second period (period B), 10 healthy late-preterm neonates were monitored with both TOSCA and a transcutaneous device measuring PtcCO2 (TINAÒ TCM3, Radiometer). During the third period (period C), 15 preterm neonates were monitored with TOSCA and MASIMO after birth, during stabilization, and during transport to the neonatal intensive care unit (NICU). Blood gas analyses were performed to compare transcutaneous and blood gas values. TOSCA resulted easily and safely usable in the DR, allowing reliable noninvasive SaO2 estimation. Since PtcCO2 measurements with TOSCA required at least 10 min to be stable and reliable, this parameter was not useful during the early resuscitation immediately after birth. Moreover, PtcCO2 levels were less precise if compared to the conventional transcutaneous monitoring. However, PtcCO2 measurement by TOSCA was useful as trend-monitoring after stabilization and during transport to NICU.
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Affiliation(s)
- Serena Antonia Rubortone
- Division of Neonatology, Department of Paediatrics, Catholic University of Sacred Heart, Largo Gemelli 8, I-00168 Rome, Italy.
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Lu HZ, Wu TH, Zhao P, Zheng JW. [The application of tissue partial pressure of carbon dioxide in monitoring hemorrhagic shock]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2012; 24:59-62. [PMID: 22248755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Heng-zhi Lu
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China
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Benhamou Y, Edet S, Begarin L, Cailleux N, Hanoy M, Bessin C, Godin M, Levesque H. Transcutaneous oxymetry as predictive test of peripheral vascular revascularization in haemodialysis population. Nephrol Dial Transplant 2011; 27:2066-9. [PMID: 22025120 DOI: 10.1093/ndt/gfr564] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) occurs frequently among haemodialysis patients but it is underestimated. Vascular treatment and amputations are more frequent in end stage renal disease (ESRD) population compared to the general population possibly because of a diagnosis of PAD delayed. Transcutaneous oxymetry (TcPO2) is commonly used in vascular medicine to reflect local arterial blood flow and skin oxygenation.The aim of this study was to assess the accuracy of the TcPO2 measurements to screen PAD and to predict vascular outcomes in haemodialysis population. METHODS In a 1-year prospective study, the value of TcPO2 was assessed in a cohort of 48 patients when starting haemodialysis. RESULTS Twenty one patients had at least one vascular stenosis (42%) on Doppler examination and were considered as affected by PAD. At inclusion a pathologic resting TcPO2 (<40mmHg) was found in 13 patients (29%). A severe ischemia (TcPO2 <30mmHg) was noted in 8 patients (16.7%) and a critical limb ischemia (TcPO2 <10mmHg) in 3 patients.(6%). Eleven (25.5%) and 6 patients (15%) had a TcPO2 <40mmHg at 6 and 12 months respectively. During the follow-up, death was seven times more frequent in patients with abnormal TcPO2 at T0 compared to patients with normal TcPO2 (38% vs 5.7%; p = 0.04). Revascularization (n = 6) or amputation (n = 5) were required for 5 patients. TcPO2 was pathologic in all patients and legs requiring a vascular treatment. The sensitivity, specificity, positive predictive value and negative predictive value were 100%, 85.2%, 38% and 100% respectively. CONCLUSIONS This study confirms the underestimated PAD diagnosis and the severity of PAD in haemodialysis population. A TcPO2 less than 40mmHg at the onset of the haemodialysis could identify patients at high risk of death and patients requiring vascular treatment. Moreover, since haemodialysis seems to be an accelerating factor of atherosclerosis, TcPO2 might be perform as a complement to traditional vascular explorations to assess the distal vascular conditions of limbs of haemodialysis patients.
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Affiliation(s)
- Ygal Benhamou
- Department of Internal Medicine, Rouen University Hospital, Rouen, France.
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Hickey M, Samuels N, Randive N, Langford RM, Kyriacou PA. Investigation of photoplethysmographic signals and blood oxygen saturation values obtained from human splanchnic organs using a fiber optic sensor. J Clin Monit Comput 2011; 25:245-55. [PMID: 21953382 DOI: 10.1007/s10877-011-9302-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 09/08/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A reliable, continuous method of monitoring splanchnic organ oxygen saturation could allow for the early detection of malperfusion, and may prevent the onset of multiple organ failure. Current monitoring techniques have not been widely accepted in critical care monitoring. As a preliminary to developing a continuous indwelling device, this study evaluates a new handheld fiber optic photoplethysmographic (PPG) sensor for estimating the blood oxygen saturation (SpO(2)) of splanchnic organs during surgery. METHODS A fiber optic splanchnic PPG sensor, instrumentation system and virtual instrument were developed to facilitate PPG and SpO(2) measurement from splanchnic organs. Following Local Research Ethics Committee approval, the sensor was evaluated on seventeen ASA 1 and 2 patients undergoing open laparotomy. PPG signals were obtained from the large bowel, small bowel, liver and stomach. Simultaneous PPG signals from the finger were also obtained using an identical fiber optic sensor. RESULTS Good quality PPG signals with high signal-to-noise (SNR) ratios were obtained from all splanchnic sites under investigation. Analysis of the ac and dc amplitudes of the red and infrared PPG signals showed there to be a statistically significant difference between PPG signals obtained from splanchnic organs with those obtained from the finger (using fiber optic sensors). Estimated SpO(2) values from the splanchnic organs show good agreement with those obtained from the finger using both a fiber optic sensor and a commercial device. Furthermore, the results of a Bland and Altman analysis indicate that fiber optic splanchnic pulse oximetry, particularly of the bowel, may provide a suitable method for monitoring splanchnic organ perfusion. CONCLUSION The evaluation of a new fiber optic sensor on anaesthetized patients undergoing laparotomy demonstrated that good quality PPG signals and SpO(2) estimates can be obtained from splanchnic organs. Such a sensor may provide a useful tool for the intraoperative assessment of splanchnic perfusion.
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Affiliation(s)
- Michelle Hickey
- School of Engineering and Mathematical Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
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Abstract
AIM To evaluate the accuracy in transcutaneous (Tc) blood gas monitoring in newborn infants, including extremely low birth weight infants, during neonatal intensive care. METHODS Tc PO(2) /PCO(2) was monitored in the neonatal intensive care unit (NICU) during stable infant conditions. In comparison, simultaneous arterial PO(2) and PCO(2) was measured. Sixty measurements were taken in 46 infants with median (range) birth weight of 0.93 (0.53-4.7) kg and at median (range) age of 8.5 (1-44) days. Comparison of measurements was performed using Bland-Altman plots, and the mean (95% CI) of the difference was calculated. Comparison was also performed in relation to body weight, postnatal age and oxygen requirement. RESULTS The mean (95% CI) difference in PO(2) (TcPO(2)-aPO(2)) was 0.3 (-0.2-0.9) kPa, and the corresponding difference in PCO(2) (TcPCO(2)-aPCO(2)) was 0.4 (0.03-0.8, p < 0.05) kPa. Some differences were related to body weight, age and oxygen requirement, but these differences were small. CONCLUSION There was good agreement between TcPO(2)/TcPCO(2) and corresponding arterial measurements. The mean difference between the methods was small and clinically acceptable in a current NICU. Tc blood gas monitoring could be recommended as a valuable complement for blood gas monitoring also in extremely low birth weight infants.
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Affiliation(s)
- Kenneth L Sandberg
- Department of Paediatrics, Sahlgrenska Academy at University of Gothenburg, Sweden.
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Löndahl M, Katzman P, Hammarlund C, Nilsson A, Landin-Olsson M. Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle-brachial index in patients with diabetes and chronic foot ulcers. Diabetologia 2011; 54:65-8. [PMID: 20957342 DOI: 10.1007/s00125-010-1946-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Accepted: 09/01/2010] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS The randomised, double-blind, placebo-controlled Hyperbaric Oxygen Therapy (HBOT) in Diabetic Patients with Chronic Foot Ulcers (HODFU) study showed beneficial effect of HBOT. As this treatment is expensive and time-consuming, being able to select patients for therapy would be very useful. The aim of this study was to evaluate whether circulatory variables could help in predicting outcome of HBOT. METHODS All HODFU study participants who completed therapy, predefined as receiving at least 36 out of 40 scheduled HBOT/placebo sessions, were included in this study (n = 75). Baseline transcutaneous oximetry (TcPO₂), toe blood pressure (TBP) and ankle-brachial index (ABI) were measured. Ulcer healing rate was registered at the 9-month follow-up visit. An ulcer was considered healed when it was completely epithelialised and remained so at the 12-month follow-up. RESULTS In the HBOT group TcPO₂ were significantly lower for patients whose ulcer did not heal as compared with those whose ulcers healed. A significantly increased healing frequency was seen with increasing TcPO(2) levels in the HBOT group (TcPO₂/healing rate: <25 mmHg/0%; 26-50 mmHg/50%; 51-75 mmHg/73%; and >75 mmHg/100%). No statistically significant relation between the level of TBP or ABI and healing frequency was seen. CONCLUSIONS/INTERPRETATION Our results indicate that TcPO₂ in contrast to ABI and TBP correlates to ulcer healing following HBOT. We suggest HBOT as a feasible adjunctive treatment modality in diabetic patients with chronic non-healing foot ulcers when basal TcPO₂ at the dorsum of the foot is above 25 mmHg. TRIAL REGISTRATION NCT00953186 FUNDING Mrs Thelma Zoegas Foundation and Faculty of Medicine, Lund University.
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Affiliation(s)
- M Löndahl
- Institution for Clinical Sciences in Lund, Lund University, Sweden.
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Abstract
Diabetic foot ulceration is a major complication of diabetes and afflicts as many as 15 to 25% of type 1 and 2 diabetes patients during their lifetime. If untreated, diabetic foot ulcers may become infected and require total or partial amputation of the affected limb. Early identification of tissue at risk of ulcerating could enable proper preventive care, thereby reducing the incidence of foot ulceration. Furthermore, noninvasive assessment of tissue viability around already formed ulcers could inform the diabetes caregiver about the severity of the wound and help assess the need for amputation. This article reviews how hyperspectral imaging between 450 and 700 nm can be used to assess the risk of diabetic foot ulcer development and to predict the likelihood of healing noninvasively. Two methods are described to analyze the in vivo hyperspectral measurements. The first method is based on the modified Beer-Lambert law and produces a map of oxyhemoglobin and deoxyhemoglobin concentrations in the dermis of the foot. The second is based on a two-layer optical model of skin and can retrieve not only oxyhemoglobin and deoxyhemoglobin concentrations but also epidermal thickness and melanin concentration along with skin scattering properties. It can detect changes in the diabetic foot and help predict and understand ulceration mechanisms.
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Affiliation(s)
- Dmitry Yudovsky
- Henry Samueli School of Engineering and Applied Science, University of CaliforniaLos Angeles, CA
| | - Aksone Nouvong
- Department of Surgery, UCLA/Olive View Medical CenterSylmar, CA
| | - Laurent Pilon
- Biomedical Inter-Department Program, Henry Samueli School of Engineering and Applied Science, University of CaliforniaLos Angeles, CA
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Abstract
Rigorous glucose control is essential for prevention of diabetes-related complications in diabetes patients. Even without diabetes, tight glucose control is beneficial in hospitalized, critically ill patients. Actually, three different glucose measurement methods are used: (1) hand held devices, (2) blood-gas analyzers, and (3) laboratory analyzers in core laboratories. Each method is subject to specific challenges and limitations that can affect the overall system performance. In this article, we aim to demonstrate that even glucose measurement results from core laboratories (professional laboratory systems) do not necessarily reflect the absolute "true" glucose level of a patient.
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Affiliation(s)
- Christian Weber
- Institute for Medical Informatics and Biostatistics, Basel, Switzerland
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Cooper AA. New tools 2009. Diabetes Self Manag 2009; 26:32-40. [PMID: 20058719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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