1
|
Kupke A, Shachar C, Robertson C. Pulse Oximeters and Violation of Federal Antidiscrimination Law. JAMA 2023; 329:365-366. [PMID: 36622690 DOI: 10.1001/jama.2022.24976] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This Viewpoint discusses how some pulse oximeters can provide incorrect oxygen saturation data for dark-skinned patients compared with light-skinned patients, describes the reasons that biased oximeters remained in use, and highlights why a rule recently proposed by the US Department of Health and Human Services may bring about needed change in the use of pulse oximetry for patients with dark skin.
Collapse
Affiliation(s)
- Annabel Kupke
- Boston University School of Law, Boston, Massachusetts
| | - Carmel Shachar
- The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Cambridge, Massachusetts
| | | |
Collapse
|
2
|
Lauterbach CJ, Romano PA, Greisler LA, Brindle RA, Ford KR, Kuennen MR. Accuracy and Reliability of Commercial Wrist-Worn Pulse Oximeter During Normobaric Hypoxia Exposure Under Resting Conditions. Res Q Exerc Sport 2021; 92:549-558. [PMID: 32633688 DOI: 10.1080/02701367.2020.1759768] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
Purpose: The present study analyzed peripheral blood oxygen saturation (SpO2) and heart rate (HR) measurements taken on the Garmin fēnix® 5X Plus watch, comparing them to measurements taken on a standard medical-grade pulse oximeter during normobaric hypoxia exposure under resting conditions. Methods: Thirteen women (mean ± SD: Age 20 ± 1 years, height 165 ± 5 cm, mass, 67 ± 9 kg) and ten men (mean ± SD: Age 21 ± 3 years, height 177 ± 6 cm, mass 78 ± 11 kg) sat inside a customized environmental chamber while the fraction of inspired oxygen (FIO2) was adjusted to simulate altitudes of 12,000; 10,000; 8,000; 6,000; and 900 ft. The novel commercial device (Garmin fēnix®) and a medical-grade pulse oximeter (Nonin® 7500) were used to measure SpO2 and HR in triplicate at each simulated altitude. Bland-Altman analyses were used to assess differences between methods. Results: Bland-Altman analysis indicated 3.3% bias for SpO2 measurements taken on the Garmin fēnix® at 12,000 ft of simulated altitude (limits of agreement: -1.9-8.6%). Mean differences in SpO2 measurements were smaller at the remaining simulated altitudes, where bias measurements ranged from 0.7% to 0.8%. The Garmin fēnix® also underestimated heart rate, but those discrepancies were minimal (bias measurements at all simulated altitude exposures were < 1.0 bpm). Conclusions: With the exception of readings taken at 12,000 ft of simulated altitude, the Garmin fēnix® exhibits minimal overestimation of SpO2 and minimal underestimation of HR during simulated altitude exposure. These data suggest the Garmin fēnix® watch may be a viable method to monitor SpO2 and HR under most ambient environmental conditions.
Collapse
Affiliation(s)
| | | | | | - Richard A Brindle
- High Point University
- Baylor University - Keller Army Community Hospital
| | | | | |
Collapse
|
3
|
Biddle C. The Editor's Desk: Science and Clinical Potpourri for Your Life and Your Practice. AANA J 2021; 89:281-282. [PMID: 34342564] [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: 06/13/2023]
Abstract
In a series of commentaries in recent issues of the New England Journal of Medicine, potential bias in pulse oximetry has been questioned.
Collapse
|
4
|
Kang MH, Lee GJ, Lee JH, Kim MS, Yan Z, Jeong J, Jang K, Song YM. Outdoor-Useable, Wireless/Battery-Free Patch-Type Tissue Oximeter with Radiative Cooling. Adv Sci (Weinh) 2021; 8:2004885. [PMID: 34026462 PMCID: PMC8132059 DOI: 10.1002/advs.202004885] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 05/23/2023]
Abstract
For wearable electronics/optoelectronics, thermal management should be provided for accurate signal acquisition as well as thermal comfort. However, outdoor solar energy gain has restricted the efficiency of some wearable devices like oximeters. Herein, wireless/battery-free and thermally regulated patch-type tissue oximeter (PTO) with radiative cooling structures are presented, which can measure tissue oxygenation under sunlight in reliable manner and will benefit athlete training. To maximize the radiative cooling performance, a nano/microvoids polymer (NMVP) is introduced by combining two perforated polymers to both reduce sunlight absorption and maximize thermal radiation. The optimized NMVP exhibits sub-ambient cooling of 6 °C in daytime under various conditions such as scattered/overcast clouds, high humidity, and clear weather. The NMVP-integrated PTO enables maintaining temperature within ≈1 °C on the skin under sunlight relative to indoor measurement, whereas the normally used, black encapsulated PTO shows over 40 °C owing to solar absorption. The heated PTO exhibits an inaccurate tissue oxygen saturation (StO2) value of ≈67% compared with StO2 in a normal state (i.e., ≈80%). However, the thermally protected PTO presents reliable StO2 of ≈80%. This successful demonstration provides a feasible strategy of thermal management in wearable devices for outdoor applications.
Collapse
Affiliation(s)
- Min Hyung Kang
- School of Electrical Engineering and Computer Science (EECS)Gwangju Institute of Science and Technology (GIST)123, Cheomdangwagi‐ro, BukguGwangju61005Republic of Korea
| | - Gil Ju Lee
- School of Electrical Engineering and Computer Science (EECS)Gwangju Institute of Science and Technology (GIST)123, Cheomdangwagi‐ro, BukguGwangju61005Republic of Korea
| | - Joong Hoon Lee
- School of Electrical Engineering and Computer Science (EECS)Gwangju Institute of Science and Technology (GIST)123, Cheomdangwagi‐ro, BukguGwangju61005Republic of Korea
| | - Min Seok Kim
- School of Electrical Engineering and Computer Science (EECS)Gwangju Institute of Science and Technology (GIST)123, Cheomdangwagi‐ro, BukguGwangju61005Republic of Korea
| | - Zheng Yan
- Department of BiomedicalBiological and Chemical EngineeringUniversity of MissouriColumbiaMO65211USA
- Department of Mechanical and Aerospace EngineeringUniversity of MissouriColumbiaMO65211USA
| | - Jae‐Woong Jeong
- School of Electrical EngineeringKorea Advanced Institute of Science and Technology (KAIST)291 Daehak‐ro, Yuseong‐guDaejeon34141Republic of Korea
| | - Kyung‐In Jang
- Department of Robotics EngineeringDaegu Gyeongbuk Institute of Science and Technology (DGIST)Daegu42988Republic of Korea
| | - Young Min Song
- School of Electrical Engineering and Computer Science (EECS)Gwangju Institute of Science and Technology (GIST)123, Cheomdangwagi‐ro, BukguGwangju61005Republic of Korea
- Anti‐Viral Research CenterGwangju Institute of Science and Technology (GIST)123, Cheomdangwagi‐ro, BukguGwangju61005Republic of Korea
- AI Graduate SchoolGwangju Institute of Science and Technology (GIST)123, Cheomdangwagi‐ro, BukguGwangju61005Republic of Korea
| |
Collapse
|
5
|
Kirszenblat R, Edouard P. Validation of the Withings ScanWatch as a Wrist-Worn Reflective Pulse Oximeter: Prospective Interventional Clinical Study. J Med Internet Res 2021; 23:e27503. [PMID: 33857011 PMCID: PMC8078374 DOI: 10.2196/27503] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/17/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A decrease in the level of pulse oxygen saturation as measured by pulse oximetry (SpO2) is an indicator of hypoxemia that may occur in various respiratory diseases, such as chronic obstructive pulmonary disease (COPD), sleep apnea syndrome, and COVID-19. Currently, no mass-market wrist-worn SpO2 monitor meets the medical standards for pulse oximeters. OBJECTIVE The main objective of this monocentric and prospective clinical study with single-blind analysis was to test and validate the accuracy of the reflective pulse oximeter function of the Withings ScanWatch to measure SpO2 levels at different stages of hypoxia. The secondary objective was to confirm the safety of this device when used as intended. METHODS To achieve these objectives, we included 14 healthy participants aged 23-39 years in the study, and we induced several stable plateaus of arterial oxygen saturation (SaO2) ranging from 100%-70% to mimic nonhypoxic conditions and then mild, moderate, and severe hypoxic conditions. We measured the SpO2 level with a Withings ScanWatch on each participant's wrist and the SaO2 from blood samples with a co-oximeter, the ABL90 hemoximeter (Radiometer Medical ApS). RESULTS After removal of the inconclusive measurements, we obtained 275 and 244 conclusive measurements with the two ScanWatches on the participants' right and left wrists, respectively, evenly distributed among the 3 predetermined SpO2 groups: SpO2≤80%, 80% CONCLUSIONS In conclusion, the Withings ScanWatch is able to measure SpO2 levels with adequate accuracy at a clinical grade. No undesirable effects or adverse events were reported during the study. TRIAL REGISTRATION ClinicalTrials.gov NCT04380389; http://clinicaltrials.gov/ct2/show/NCT04380389.
Collapse
|
6
|
Luks AM, Swenson ER. Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance. Ann Am Thorac Soc 2020; 17:1040-1046. [PMID: 32521167 PMCID: PMC7462317 DOI: 10.1513/annalsats.202005-418fr] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [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: 05/04/2020] [Accepted: 06/10/2020] [Indexed: 11/26/2022] Open
Abstract
During the ongoing coronavirus disease (COVID-19) pandemic, reports in social media and the lay press indicate that a subset of patients are presenting with severe hypoxemia in the absence of dyspnea, a problem unofficially referred to as "silent hypoxemia." To decrease the risk of complications in such patients, one proposed solution has been to have those diagnosed with COVID-19 but not sick enough to warrant admission monitor their arterial oxygenation by pulse oximetry at home and present for care when they show evidence of hypoxemia. Though the ease of use and low cost of pulse oximetry makes this an attractive option for identifying problems at an early stage, there are important considerations with pulse oximetry about which patients and providers may not be aware that can interfere with successful implementation of such monitoring programs. Only a few independent studies have examined the performance of pocket oximeters and smart phone-based systems, but the limited available data raise questions about their accuracy, particularly as saturation falls below 90%. There are also multiple sources of error in pulse oximetry that must be accounted for, including rapid fluctuations in measurements when the arterial oxygen pressure/tension falls on the steep portion of the dissociation curve, data acquisition problems when pulsatile blood flow is diminished, accuracy in the setting of severe hypoxemia, dyshemoglobinemias, and other problems. Recognition of these issues and careful counseling of patients about the proper means for measuring their oxygen saturation and when to seek assistance can help ensure successful implementation of needed monitoring programs.
Collapse
Affiliation(s)
- Andrew M. Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; and
| | - Erik R. Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; and
- Medical Service, VA Puget Sound Health Care System, Seattle, Washington
| |
Collapse
|
7
|
Mantha S, Tripuraneni SL, Roizen MF, Fleisher LA. Proposed Modifications in the 6-Minute Walk Test for Potential Application in Patients With Mild COVID-19: A Step to Optimize Triage Guidelines. Anesth Analg 2020; 131:398-402. [PMID: 32433249 PMCID: PMC7258841 DOI: 10.1213/ane.0000000000004986] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 12/31/2022]
Abstract
Supplemental Digital Content is available in the text.
Collapse
Affiliation(s)
| | | | - Michael F. Roizen
- Cleveland Clinic Learn College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | - Lee A. Fleisher
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| |
Collapse
|
8
|
Ozawa J, Watanabe T, Ito M, Miyake F, Nagano N, Ogawa R, Matsumura S, Araki R, Tamura M, Namba F. Defining the reference range of regional cerebral tissue oxygen saturation using a new portable near-infrared spectroscopy device for term infants. Early Hum Dev 2020; 141:104941. [PMID: 31883487 DOI: 10.1016/j.earlhumdev.2019.104941] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/14/2019] [Accepted: 12/15/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The arterial oxygen saturation of infants requiring resuscitation can be monitored using a pulse oximeter. However, the device cannot provide information about cerebral oxygenation. Thus, we used a new portable near-infrared spectroscopy (NIRS) device that can monitor regional cerebral tissue oxygen saturation (crSO2) with a probe attached to the examiner's finger. AIM To identify the reference ranges for crSO2 within the first 10 min after birth in term infants who did not receive any medical intervention in the delivery room. RESULTS crSO2 in the left frontoparietal area of the forebrain was measured within the first 10 min of life in 127 healthy term infants. The median gestational age and birth weight were 37.6 weeks and 2742 g, respectively, and 85% of the infants were delivered via a scheduled cesarean section. The 3rd-97th percentile values for crSO2 ranged from 33.1% to 56.7% at 1 min, from 33.2% to 59.5% at 2 min, and from 38.7% to 66.6% at 5 min after birth. A median of 3.5 min was required to achieve a crSO2 > 50%. CONCLUSIONS This study showed the reference ranges for crSO2 measured with the new portable NIRS device within the first 10 min after birth in term infants.
Collapse
Affiliation(s)
- Junichi Ozawa
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Takaaki Watanabe
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Masato Ito
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Fuyu Miyake
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Nobuhiko Nagano
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Ryo Ogawa
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Shun Matsumura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Ryuichiro Araki
- Community Health Science Center, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan.
| | - Masanori Tamura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan.
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan.
| |
Collapse
|
9
|
Collett R, Salisbury I, Loeb RG, Sanderson PM. Smooth or Stepped? Laboratory Comparison of Enhanced Sonifications for Monitoring Patient Oxygen Saturation. Hum Factors 2020; 62:124-137. [PMID: 31180734 DOI: 10.1177/0018720819845742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/09/2023]
Abstract
BACKGROUND The pulse oximeter (PO) provides anesthesiologists with continuous visual and auditory information about a patient's oxygen saturation (SpO2). However, anesthesiologists' attention is often diverted from visual displays, and clinicians may inaccurately judge SpO2 values when relying on conventional PO auditory tones. We tested whether participants could identify SpO2 value (e.g., "97%") better with acoustic enhancements that identified three discrete clinical ranges by either changing abruptly at two threshold values (stepped-effects) or changing incrementally with each percentage value of SpO2 (smooth-effects). METHOD In all, 79 nonclinicians participated in a between-subjects experiment that compared performance of participants using the stepped-effects display with those who used the smooth-effects display. In both conditions, participants heard sequences of 72 tones whose pitch directly correlated to SpO2 value, and whose value could change incrementally. Primary outcome was percentage of responses that correctly identified the absolute SpO2 percentage, ±1, of the last pulse tone in each sequence. RESULTS Participants using the stepped-effects auditory tones identified absolute SpO2 percentage more accurately (M = 53.7%) than participants using the smooth-effects tones (M = 47.9%, p = .038). Identification of range and detection of transitions between ranges showed even stronger advantages for the stepped-effects display (p < .005). CONCLUSION The stepped-effects display has more pronounced auditory cues at SpO2 range transitions, from which participants can better infer absolute SpO2 values. Further development of a smooth-effects display for this purpose is not necessary.
Collapse
|
10
|
Cloete E, Gentles TL, Bloomfield FH. introduce nationwide pulse oximetry screening for the detection of critical congenital heart disease and other hypoxaemic conditions in the newborn. N Z Med J 2020; 133:111-117. [PMID: 31945047] [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: 06/10/2023]
Abstract
The mortality risk for infants with critical congenital heart disease (CCHD) unrecognised at the time of birth is high. Pulse oximetry has been utilised as a screening tool for the detection of these anomalies in the newborn as the majority will have a degree of hypoxaemia. This screening strategy has a moderate sensitivity and excellent specificity for the detection of CCHD, and a low false-positive rate. Respiratory and infective diseases are responsible for a large number of positive test results. The early recognition of these diseases can also improve health outcomes. Different approaches have been taken to introduce screening, ranging from hospital-led initiatives to mandatory state-wide policies. A study conducted in New Zealand demonstrated that sector-led screening initiatives are unlikely to result in equitable outcomes. In this midwifery-led maternity setting a nationwide pulse oximetry screening programme with adequate human and material resources should be introduced.
Collapse
Affiliation(s)
- Elza Cloete
- Senior Research Fellow, Liggins Institute, University of Auckland, Auckland
| | - Thomas L Gentles
- Paediatric Cardiologist, Director Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland
| | | |
Collapse
|
11
|
Lazzeroni M, Toma-Dasu I, Ureba A, Schiavo F, Wiedenmann N, Bunea H, Thomann B, Baltas D, Mix M, Stoykow C, Sörensen A, Grosu AL. Quantification of Tumor Oxygenation Based on FMISO PET: Influence of Location and Oxygen Level of the Well-Oxygenated Reference Region. Adv Exp Med Biol 2020; 1232:177-182. [PMID: 31893408 DOI: 10.1007/978-3-030-34461-0_22] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Tumor hypoxia may play a fundamental role in determining the radiotherapy outcome for several cancer types. Functional imaging with hypoxia specific radiotracers offers a way to visualize and quantify regions of increased radioresistance, which may benefit from dose escalation strategies. Conversion of the uptake in positron emission tomography (PET) images into oxygenation maps offers a way to quantitatively characterize the microenvironment. However, normalization of the uptake with respect to a well-oxygenated reference volume (WOV), which should be properly selected, is necessary when using conversion functions. This study aims at assessing the sensitivity of quantifying tumor oxygenation based on 18F-fluoromisonidazole (FMISO) PET with respect to the choice of the location and the oxygenation level of the WOV in head and neck cancer patients. WOVs varying not only in shape and location but also with respect to the assigned pO2 level were considered. pO2 values other than the standard 60 mmHg were selected according to the specific tissue type included in the volume. For comparison, the volume which would be considered as hypoxic based on a tissue-to-muscle ratio equal to 1.4 was also delineated, as conventionally done in clinical practice. Hypoxia mapping strategies are found highly sensitive to selection of the location of well-oxygenated region, but also on its assigned oxygenation level, which is crucial for hypoxia-guided adaptive dose escalation strategies.
Collapse
Affiliation(s)
- M Lazzeroni
- Department of Physics, Stockholm University, Stockholm, Sweden.
| | - I Toma-Dasu
- Department of Physics, Stockholm University, Stockholm, Sweden
| | - A Ureba
- Department of Physics, Stockholm University, Stockholm, Sweden
| | - F Schiavo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - N Wiedenmann
- Department of Radiation Oncology, Medical Center, Medical Faculty Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany
| | - H Bunea
- Department of Radiation Oncology, Medical Center, Medical Faculty Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany
| | - B Thomann
- Department of Radiation Oncology, Medical Center, Medical Faculty Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany
| | - D Baltas
- Department of Radiation Oncology, Medical Center, Medical Faculty Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany
| | - M Mix
- Department of Nuclear Medicine, University Medical Center, Freiburg, Germany
| | - C Stoykow
- Department of Nuclear Medicine, University Medical Center, Freiburg, Germany
| | - A Sörensen
- Department of Nuclear Medicine, University Medical Center, Freiburg, Germany
| | - A L Grosu
- Department of Radiation Oncology, Medical Center, Medical Faculty Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany
| |
Collapse
|
12
|
Ostojic D, Guglielmini S, Moser V, Fauchère JC, Bucher HU, Bassler D, Wolf M, Kleiser S, Scholkmann F, Karen T. Reducing False Alarm Rates in Neonatal Intensive Care: A New Machine Learning Approach. Adv Exp Med Biol 2020; 1232:285-290. [PMID: 31893422 DOI: 10.1007/978-3-030-34461-0_36] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED In neonatal intensive care units (NICUs), 87.5% of alarms by the monitoring system are false alarms, often caused by the movements of the neonates. Such false alarms are not only stressful for the neonates as well as for their parents and caregivers, but may also lead to longer response times in real critical situations. The aim of this project was to reduce the rates of false alarms by employing machine learning algorithms (MLA), which intelligently analyze data stemming from standard physiological monitoring in combination with cerebral oximetry data (in-house built, OxyPrem). MATERIALS & METHODS Four popular MLAs were selected to categorize the alarms as false or real: (i) decision tree (DT), (ii) 5-nearest neighbors (5-NN), (iii) naïve Bayes (NB) and (iv) support vector machine (SVM). We acquired and processed monitoring data (median duration (SD): 54.6 (± 6.9) min) of 14 preterm infants (gestational age: 26 6/7 (± 2 5/7) weeks). A hybrid method of filter and wrapper feature selection generated the candidate subset for training these four MLAs. RESULTS A high specificity of >99% was achieved by all four approaches. DT showed the highest sensitivity (87%). The cerebral oximetry data improved the classification accuracy. DISCUSSION & CONCLUSION Despite a (as yet) low amount of data for training, the four MLAs achieved an excellent specificity and a promising sensitivity. Presently, the current sensitivity is insufficient since, in the NICU, it is crucial that no real alarms are missed. This will most likely be improved by including more subjects and data in the training of the MLAs, which makes pursuing this approach worthwhile.
Collapse
Affiliation(s)
- D Ostojic
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland.
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - S Guglielmini
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - V Moser
- CSEM, Neuchâtel, Switzerland
| | - J C Fauchère
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - H U Bucher
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Wolf
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - S Kleiser
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - F Scholkmann
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - T Karen
- Biomedical Optics Research Laboratory (BORL), University of Zurich, Zurich, Switzerland
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
13
|
Reiners JK, Hellmann N, Schmidt J, Kästner SBR. Odd haemoglobins in odd-toed ungulates: Impact of selected haemoglobin characteristics of the white rhinoceros (Ceratotherium simum) on the monitoring of the arterial oxygen saturation of haemoglobin. PLoS One 2019; 14:e0226851. [PMID: 31887165 PMCID: PMC6936770 DOI: 10.1371/journal.pone.0226851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/16/2019] [Accepted: 12/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Due to the current poaching crisis in Africa, increasing numbers of white rhinoceroses (Ceratotherium simum) require opioid immobilisation for medical interventions or management procedures. Alarmingly, the results of both blood gas analysis and pulse oximetry regularly indicate severe hypoxaemia. Yet, the recovery of the animals is uneventful. Thus, neither of the techniques seems to represent the real oxygenation level. We hypothesized that unusual haemoglobin characteristics of this species interfere with the techniques developed and calibrated for the use in human patients. METHODS Haemoglobin was isolated from blood samples of four adult, white rhinoceroses. Oxygen dissociation curves at pH 7.2 and 7.4 (37°C) were determined based on the absorbance change of haemoglobin in the Soret-region (around 420 nm). Absorbance spectra of oxy- and deoxyhaemoglobin extending into the infrared region were measured. RESULTS Oxygen dissociation curves of rhinoceros haemoglobin showed the typical high oxygen affinity (p50 of 2.75 ± 0.07 and 2.00 ± 0.04 kPa for pH 7.2 and 7.4, respectively) under near-physiological conditions with respect to pH, temperature and DPG. The infrared absorbance spectra of oxy- and deoxyhaemoglobin showed only marginal deviations from standard human spectra, possibly due to the presence of a few percent of methaemoglobin in vitro. CONCLUSIONS Our data enables the development of a rhinoceros-specific blood gas analysis algorithm, which allows for species-specific calculation of SaO2 levels in anaesthetized animals. The inconspicuous absorbance spectra do not contribute to the systematic underestimation of SpO2 by pulse-oximetry.
Collapse
Affiliation(s)
- Julia K. Reiners
- Department of Anaesthesiology, University of Veterinary Medicine Hanover, Foundation, Hanover, Germany
- * E-mail:
| | - Nadja Hellmann
- Institute for Molecular Biophysics, University of Mainz, Mainz, Germany
| | - Juliane Schmidt
- Institute for Molecular Biophysics, University of Mainz, Mainz, Germany
| | - Sabine B. R. Kästner
- Department of Anaesthesiology, University of Veterinary Medicine Hanover, Foundation, Hanover, Germany
| |
Collapse
|
14
|
Ferrés-Padró V, Solà Muñoz S, Jacob Rodríguez J, Membrado-Ibáñez S, Amigó Tadín M, Jiménez Fàbrega FX. Health care quality indicators and improvements to make in the prehospital care of adults exposed to carbon monoxide. Emergencias 2019; 31:304-310. [PMID: 31625301] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe health care quality indicators in cases of carbon monoxide (CO) exposure attended by prehospital services and to explore factors associated with the use of pulse CO-oximetry (SpCO) for the noninvasive estimation of CO saturation of arterial blood. MATERIAL AND METHODS Cohort study of patients exposed to CO and transported by advanced life support units of the Emergency Medical Services of Catalonia between January 2015 and December 2017. We selected 11 applicable quality indicators and used multivariate analysis to explore factors associated with the recording of SpCO. RESULTS We studied 1676 cases of CO exposure. SpCO was recorded in 1108 cases (66.1%). CO saturation exceeded 10% in 358 patients (32.3%). Adherence was deficient in 5 of the 11 applicable quality indicators. Multivariate analysis showed less use of pulse CO-oximetry when another toxic exposure was present (odds ratio [OR], 0.34; 95% CI, 0.11- 1.00) and when the first responder was from the advanced life support service (OR, 0.43; 95% CI, 0.31-0.59). SpCO was used more in the presence of a history of mental health problems (OR, 3.01; 95% CI,1.27-7.17), headache (OR, 2.13; 95% CI, 1.2-3.72), and along with use of oxygen therapy (OR, 10.33; 95% CI, 5.46-19.53). CONCLUSION Prehospital attendance of episodes of CO exposure is marked by failure to comply with some health care quality indicators. We detected factors associated with under use of SpCO as well as areas to target for improvement.
Collapse
|
15
|
Buekers J, Theunis J, De Boever P, Vaes AW, Koopman M, Janssen EV, Wouters EF, Spruit MA, Aerts JM. Wearable Finger Pulse Oximetry for Continuous Oxygen Saturation Measurements During Daily Home Routines of Patients With Chronic Obstructive Pulmonary Disease (COPD) Over One Week: Observational Study. JMIR Mhealth Uhealth 2019; 7:e12866. [PMID: 31199331 PMCID: PMC6594211 DOI: 10.2196/12866] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/16/2019] [Accepted: 04/27/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients can suffer from low blood oxygen concentrations. Peripheral blood oxygen saturation (SpO2), as assessed by pulse oximetry, is commonly measured during the day using a spot check, or continuously during one or two nights to estimate nocturnal desaturation. Sampling at this frequency may overlook natural fluctuations in SpO2. OBJECTIVE This study used wearable finger pulse oximeters to continuously measure SpO2 during daily home routines of COPD patients and assess natural SpO2 fluctuations. METHODS A total of 20 COPD patients wore a WristOx2 pulse oximeter for 1 week to collect continuous SpO2 measurements. A SenseWear Armband simultaneously collected actigraphy measurements to provide contextual information. SpO2 time series were preprocessed and data quality was assessed afterward. Mean SpO2, SpO2 SD, and cumulative time spent with SpO2 below 90% (CT90) were calculated for every (1) day, (2) day in rest, and (3) night to assess SpO2 fluctuations. RESULTS A high percentage of valid SpO2 data (daytime: 93.27%; nocturnal: 99.31%) could be obtained during a 7-day monitoring period, except during moderate-to-vigorous physical activity (MVPA) (67.86%). Mean nocturnal SpO2 (89.9%, SD 3.4) was lower than mean daytime SpO2 in rest (92.1%, SD 2.9; P<.001). On average, SpO2 in rest ranged over 10.8% (SD 4.4) within one day. Highly varying CT90 values between different nights led to 50% (10/20) of the included patients changing categories between desaturator and nondesaturator over the course of 1 week. CONCLUSIONS Continuous SpO2 measurements with wearable finger pulse oximeters identified significant SpO2 fluctuations between and within multiple days and nights of patients with COPD. Continuous SpO2 measurements during daily home routines of patients with COPD generally had high amounts of valid data, except for motion artifacts during MVPA. The identified fluctuations can have implications for telemonitoring applications that are based on daily SpO2 spot checks. CT90 values can vary greatly from night to night in patients with a nocturnal mean SpO2 around 90%, indicating that these patients cannot be consistently categorized as desaturators or nondesaturators. We recommend using wearable sensors for continuous SpO2 measurements over longer time periods to determine the clinical relevance of the identified SpO2 fluctuations.
Collapse
Affiliation(s)
- Joren Buekers
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Measure, Model & Manage Bioresponses, Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Jan Theunis
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Anouk W Vaes
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
| | - Maud Koopman
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
| | - Eefje Vm Janssen
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
| | - Emiel Fm Wouters
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jean-Marie Aerts
- Measure, Model & Manage Bioresponses, Department of Biosystems, KU Leuven, Leuven, Belgium
| |
Collapse
|
16
|
Peyrony O, Dumas G, Legay L, Principe A, Franchitti J, Simonetta M, Verrat A, Amami J, Milacic H, Bragança A, Gillet A, Resche-Rigon M, Fontaine JP, Azoulay E. Central venous oxygen saturation is not predictive of early complications in cancer patients presenting to the emergency department. Intern Emerg Med 2019; 14:281-289. [PMID: 30306323 DOI: 10.1007/s11739-018-1966-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/06/2018] [Indexed: 12/14/2022]
Abstract
Central venous oxygen saturation (ScvO2) is easily observable in oncology patients with long-term central venous catheters (CVC), and has been studied as a prognostic factor in patients with sepsis. We sought to investigate the association between ScvO2 and early complications in cancer patients presenting to the ED. We prospectively enrolled adult cancer patients with pre-existing CVC who presented to the ED. ScvO2 was measured on their CVC. The outcome was admission to the intensive care unit (ICU) or mortality by day 7. ScvO2 was first studied as a continuous variable (%) with a ROC analysis and as a categorical variable (cut-off at < 70%) with a multivariate analysis. A total of 210 cancer patients were enrolled. At baseline, ScvO2 showed no significant difference between patients who were admitted to the ICU or died before day 7, and patients who did not (67%; IQR 62-68% vs. 71%; IQR 65-78% respectively, P = 0.3). The ROC analysis showed the absence of discrimination accuracy for ScvO2 to predict the outcome (AUC = 0.56). By multivariate analysis, ScvO2 < 70% was not associated with the outcome (OR 1.67; 95% CI 0.64-4.36). Variables that were associated with ICU admission or death by day 7 included a shock-index (heart rate/systolic blood pressure) > 1 and a performance status > 2 (OR 4.76; 95% CI 1.81-12.52 and OR 6.23, 95% CI 2.40-16.17, respectively). This study does not support the use of ScvO2 to risk stratify cancer patients presenting to the ED.
Collapse
Affiliation(s)
- Olivier Peyrony
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Guillaume Dumas
- Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Léa Legay
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alessandra Principe
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jessica Franchitti
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marie Simonetta
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Verrat
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jihed Amami
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Hélène Milacic
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Adélia Bragança
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Ariane Gillet
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Matthieu Resche-Rigon
- Biostatistics and Medical Information Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS-INSERM-UMR1153), ECSTRRA Team, Paris, France
- Paris Diderot University, Paris, France
| | - Jean-Paul Fontaine
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elie Azoulay
- Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS-INSERM-UMR1153), ECSTRRA Team, Paris, France
- Paris Diderot University, Paris, France
| |
Collapse
|
17
|
Rimbi M, Nakitende I, Namujwiga T, Kellett J. How well are heart rates measured by pulse oximeters and electronic sphygmomanometers? Practice-based evidence from an observational study of acutely ill medical patients during hospital admission. Acute Med 2019; 18:144-147. [PMID: 31536051] [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: 06/10/2023]
Abstract
BACKGROUND heart rates generated by pulse oximeters and electronic sphygmomanometers in acutely ill patients may not be the same as those recorded by ECG. METHODS heart rates recorded by an oximeter and an electronic sphygmomanometer were compared with electrocardiogram (ECG) heart rates measured on acutely ill medical patients. RESULTS 1010 ECGs were performed on 217 patients while they were in the hospital. The bias between the oximeter and the ECG measured heart rate was -1.37 beats per minute (limits of agreement -22.6 to 19.9 beats per minute), and the bias between the sphygmomanometer and the ECG measured heart rate was -0.14 beats per minute (limits of agreement -22.2 to 21.9 beats per minute). Both devices failed to identify more than half the ECG recordings that awarded 3 NEWS points for heart rate. CONCLUSION Heart rates of acutely ill patients are not reliably measured by pulse oximeter or electronic sphygmomanometers.
Collapse
Affiliation(s)
- M Rimbi
- Medical Officer, Department of Medicine, Kitovu Hospital, Masaka, Uganda
| | - I Nakitende
- Department of Medicine, Enrolled Nurse, Department of Medicine, Kitovu Hospital, Masaka, Uganda
| | - T Namujwiga
- Department of Medicine, Enrolled Midwife, Department of Medicine, Kitovu Hospital, Masaka, Uganda
| | - J Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| |
Collapse
|
18
|
Burge A, Green M, Russell-Jones D. Patient power - Kidd Gloves. Clin Med (Lond) 2018; 18:437. [PMID: 30287446 PMCID: PMC6334117 DOI: 10.7861/clinmedicine.18-5-437] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anneka Burge
- Royal Surrey County Hospital, Guildford, Surrey, UK
| | - Malcolm Green
- head of NHLI and founder of British Lung Foundation, Retired
| | | |
Collapse
|
19
|
|
20
|
Crossle B. Pulse Oximeters: Overview and Common Maintenance Issues. Biomed Instrum Technol 2018; 52:160-161. [PMID: 29558180 DOI: 10.2345/0899-8205-52.2.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
21
|
den Boogert WJ, van Elteren HA, Goos TG, Reiss IKM, de Jonge RCJ, van den Berg VJ. Reproducibility of the Pleth Variability Index in premature infants. J Clin Monit Comput 2017; 32:457-464. [PMID: 28861669 PMCID: PMC5943392 DOI: 10.1007/s10877-017-0058-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022]
Abstract
The aim was to assess the reproducibility of the Pleth Variability Index (PVI), developed for non-invasive monitoring of peripheral perfusion, in preterm neonates below 32 weeks of gestational age. Three PVI measurements were consecutively performed in stable, comfortable preterm neonates in the first 48 h of life. On each occasion, pulse oximeter sensors were attached to two different limbs for 5 min. Reproducibility was assessed with the intra-class correlation coefficient (ICC) and Bland–Altman analysis. A total of 25 preterm neonates were included. Inter-limb comparison showed fair to moderate ICC’s with 95%-confidence intervals (95%-CI). Left hand–right hand ICC = 0.498, 95%-CI (0.119–0.753); right foot–right hand ICC = 0.314 (−0.088–0.644); right foot–left foot ICC = 0.315 (−0.089–0.628). Intra-limb comparison showed fair to moderate ICC for right foot–right foot ICC = 0.380 (−0.014–0.677); and good ICC for right hand–right hand ICC = 0.646 (0.194–0.852). Bland–Altman plots showed moderate reproducibility of measurements between different limbs and of the same limb in consecutive time periods, with large biases and wide limits of agreement. The findings from this study indicate that PVI measurement is poorly reproducible when measured on different limbs and on the same limb in stable and comfortable preterm neonates.
Collapse
Affiliation(s)
- Wilhelmina J. den Boogert
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Room Sp-3434, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Hugo A. van Elteren
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Room Sp-3434, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Tom G. Goos
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Room Sp-3434, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Irwin K. M. Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Room Sp-3434, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Rogier C. J. de Jonge
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Room Sp-3434, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Victor J. van den Berg
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Room Sp-3434, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| |
Collapse
|
22
|
Abstract
In recent years, pulse oximetry screening for critical congenital heart disease (CCHD) in newborns has been added to the list of recommended uniform screening panels and recommended by several health care organizations. Most states use pulse oximetry to screen for CCHD. Studies have identified problems with compliance and higher failure rate at moderate altitudes than at sea level, suggesting the need for alternate algorithms. Altitude, time, health status of newborns and type of cardiac defect appear to affect results. Early detection of CCHD improves health outcomes and reduces morbidity and mortality. Barriers to screening include out-of-hospital births, cost and knowledge deficits among health care professionals.
Collapse
|
23
|
Abstract
BACKGROUND Health care professionals typically use resting metabolic rate (RMR) via indirect calorimetry to determine a person's energy expenditure. Traditional indirect calorimetry measurements involve an expensive, cumbersome piece of equipment that requires careful calibration. The recent development of a handheld indirect calorimeter makes it easier to measure RMR. The purpose of this study was to compare simultaneous measurements of RMR with handheld and traditional indirect calorimeters. METHODS Healthy, free-living subjects (n = 50) age 18 years and older were tested simultaneously with both indirect calorimeters. All subjects breathed through the handheld device using a mouthpiece while wearing noseclips to prevent leaks. The handheld indirect calorimetry device was placed inside a canopy. The exhaled gas from the handheld was positioned directly over the inlet to the port delivering gases to the traditional device's mixing chamber. The canopy facilitated the simultaneous collection of all expired gases into the traditional device. During the measurement, oxygen consumption and RMR were continuously recorded on a personal computer. RESULTS Mean oxygen consumption and RMR did not significantly differ between the two devices, with a mean difference of 0.58 +/- 15.33 mL/min (p = .790) and 4.66 +/- 113.39 kcal/day (p = .773) and an absolute difference of 12.3 +/- 8.99 mL/min and 86.58 +/- 72.32 kcal/day, respectively. Correlation coefficients for oxygen consumption and RMR were 0.945 and 0.941, respectively. CONCLUSIONS No significant difference was found between the measurements of indirect calorimetry with the MedGem (HealtheTech, Golden, CO) device compared with the DeltaTrac device (Datex-Ohmeda, Madison, WI). These findings suggest that the handheld indirect calorimeter may provide an accurate measure of oxygen consumption and RMR measurements for spontaneously breathing subjects.
Collapse
Affiliation(s)
- Christina L Stewart
- University of Cincinnati Medical Center, 3202 Eden Avenue, Cincinnati, OH 45267, USA
| | | | | |
Collapse
|
24
|
Huizing MJ, Villamor-Martínez E, Vento M, Villamor E. Pulse oximeter saturation target limits for preterm infants: a survey among European neonatal intensive care units. Eur J Pediatr 2017; 176:51-56. [PMID: 27853941 PMCID: PMC5219014 DOI: 10.1007/s00431-016-2804-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED The optimum range of pulse oximeter oxygen saturation (SpO2) for preterm infants remains controversial. Between November 2015 and February 2016, we conducted a web-based survey aimed to investigate the current and former practices on SpO2 targets in European neonatal intensive care units (NICUs). We obtained valid responses from 193 NICUs, treating 8590 newborns ≤28 weeks per year, across 27 countries. Forty different saturation ranges were reported, ranging from 82-93 to 94-99%. The most frequently utilized SpO2 ranges were 90-95% (28%), 88-95% (12%), 90-94% (5%), and 91-95% (5%). A total of 156 NICUs (81%) changed their SpO2 limits over the last 10 years. The most frequently reported former limits were 88-92% (18%), 85-95% (9%), 88-93 (7%), and 85-92% (6%). The NICUs that increased their SpO2 ranges expected to obtain a reduction in mortality. A 54% of the NICUs found the scientific evidence supporting their SpO2 targeting policy strong or very strong. CONCLUSION We detected a high degree of heterogeneity in pulse oximeter SpO2 target limits across European NICUs. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned. What is Known: • For preterm infants requiring supplemental oxygen, the optimum range of pulse oximeter oxygen saturation (SpO 2 ) to minimize organ damage, without causing hypoxic injury, remains controversial. What is New: • This survey highlights the lack of consensus regarding SpO 2 target limits for preterm infants among European neonatal intensive care units (NICUs). We detected 40 different SpO 2 ranges, and even the most frequently reported range (i.e., 90-95%) was used in only 28% of the 193 respondent NICUs. • A total of 156 NICUs (81%) changed their SpO 2 limits over the last 10 years. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned.
Collapse
Affiliation(s)
- Maurice J. Huizing
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Eduardo Villamor-Martínez
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Máximo Vento
- Division of Neonatology, University & Polytechnic Hospital La Fe, Valencia, Spain
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| |
Collapse
|
25
|
Cournoyer A, Denault A, Cossette S, Fortier A, Daoust R, Iseppon M, Chauny JM, Notebaert E. Reproducibility, interchangeability of measures, time to measure stabilization, and reference values of two tissue oximeters in healthy volunteers. J Biomed Opt 2016; 21:97003. [PMID: 27637007 DOI: 10.1117/1.jbo.21.9.097003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/30/2016] [Indexed: 06/06/2023]
Abstract
This study aimed to compare two tissue oximeters, the INVOS 5100c and the Equanox 7600, in terms of their reproducibility and the interchangeability of their measures. In a randomized order, three measurements were taken at six different sites on both sides of the body in 53 healthy volunteers. Intraclass correlation coefficients (ICC) and within-subject standard deviation (Sw) were calculated for each device. The ICCs were compared using Fisher r-to-z transformation and the Sw were compared using paired-sample t-tests. We found no difference between the reproducibility of the INVOS {ICC=0.92 [95% confidence interval (CI) 0.90 to 0.93]} and Equanox [ICC=0.90 (95% CI 0.88 to 0.93)] in terms of ICCs (p=0.06). However, the Equanox [Sw=1.96 (95% CI 1.91 to 2.02)] showed a better Sw than the INVOS [Sw=2.11 (95% CI 2.05 to 2.17)] (p=0.019). Also, when compared directly to stable condition, the readings produced by the two oximeters varied considerably [ICC 0.43 (95% CI 0.36 to 0.49)]. When taken individually, both tissue oximeters displayed good reproducibility, the Equanox being slightly better than the INVOS in terms of absolute reproducibility. However, when compared, the oximeters showed poor interdevices agreement. Reference values were also described.
Collapse
Affiliation(s)
- Alexis Cournoyer
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
| | - André Denault
- Université de Montréal, Faculty of Medicine, Department of Anesthesia and Critical Care Division, 5000 Bélanger, Montréal H1T 1C8, Canada
| | - Sylvie Cossette
- Université de Montréal, Faculty of Nursing, 2375 Côte-Ste-Catherine, Montréal H3T 1A8, Canada
| | - Annik Fortier
- Montréal Health Innovations Coordinating Center, 4100 Molson #400, Montréal H1Y 3N1, Canada
| | - Raoul Daoust
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
| | - Massimiliano Iseppon
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
| | - Jean-Marc Chauny
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
| | - Eric Notebaert
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
| |
Collapse
|
26
|
Cortés-Puch I, Wesley RA, Carome MA, Danner RL, Wolfe SM, Natanson C. Usual Care and Informed Consent in Clinical Trials of Oxygen Management in Extremely Premature Infants. PLoS One 2016; 11:e0155005. [PMID: 27191961 PMCID: PMC4871545 DOI: 10.1371/journal.pone.0155005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 09/09/2015] [Accepted: 04/22/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The adequacy of informed consent in the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial (SUPPORT) has been questioned. SUPPORT investigators and publishing editors, heads of government study funding agencies, and many ethicists have argued that informed consent was adequate because the two oxygen saturation target ranges studied fell within a range commonly recommended in guidelines. We sought to determine whether each oxygen target as studied in SUPPORT and four similar randomized controlled trials (RCTs) was consistent with usual care. DESIGN/PARTICIPANTS/SETTING PubMed, EMBASE, Web of Science, and Scopus were searched for English articles back to 1990 providing information on usual care oxygen management in extremely premature infants. Data were extracted on intended and achieved oxygen saturation levels as determined by pulse oximetry. Twenty-two SUPPORT consent forms were examined for statements about oxygen interventions. RESULTS While the high oxygen saturation target range (91 to 95%) was consistent with usual care, the low range (85 to 89%) was not used outside of the SUPPORT trial according to surveys and clinical studies of usual care. During usual care, similar lower limits (< 88%) were universally paired with higher upper limits (≥ 92%) and providers skewed achieved oxygen saturations toward the upper-end of these intended ranges. Blinded targeting of a low narrow range resulted in significantly lower achieved oxygen saturations and a doubling of time spent below the lower limit of the intended range compared to usual care practices. The SUPPORT consent forms suggested that the low oxygen saturation arm was a widely practiced subset of usual care. CONCLUSIONS SUPPORT does not exemplify comparative effectiveness research studying practices or therapies in common use. Descriptions of major differences between the interventions studied and commonly practiced usual care, as well as potential risks associated with these differences, are essential elements of adequate informed consent.
Collapse
Affiliation(s)
- Irene Cortés-Puch
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bldg. 10, Room 2C145, Bethesda, Maryland 20892, United States of America
- * E-mail: (ICP); (CN)
| | - Robert A. Wesley
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bldg. 10, Room 2C145, Bethesda, Maryland 20892, United States of America
| | - Michael A. Carome
- Health Research Group, Public Citizen, 1600 20th Street NW, Washington, D.C. 20009, United States of America
| | - Robert L. Danner
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bldg. 10, Room 2C145, Bethesda, Maryland 20892, United States of America
| | - Sidney M. Wolfe
- Health Research Group, Public Citizen, 1600 20th Street NW, Washington, D.C. 20009, United States of America
| | - Charles Natanson
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bldg. 10, Room 2C145, Bethesda, Maryland 20892, United States of America
- * E-mail: (ICP); (CN)
| |
Collapse
|
27
|
O'Driscoll BR, Grant K, Green D, Edeghere S, Bakerly ND, Murphy P, Edwards V, Turkington PM. The national early warning score gives misleading scores for oxygen saturation in patients at risk of hypercapnia. Clin Med (Lond) 2014; 14:695-6. [PMID: 25468871 PMCID: PMC4954158 DOI: 10.7861/clinmedicine.14-6-695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | | | | | - Val Edwards
- Salford Royal Foundation NHS Trust Salford, UK
| | | |
Collapse
|
28
|
Abd Sukor J, Mohktar MS, Redmond SJ, Lovell NH. Signal quality measures on pulse oximetry and blood pressure signals acquired from self-measurement in a home environment. IEEE J Biomed Health Inform 2014; 19:102-8. [PMID: 25312963 DOI: 10.1109/jbhi.2014.2361654] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recently, decision support system (DSSs) have become more widely accepted as a support tool for use with telehealth systems, helping clinicians to summarize and digest what would otherwise be an unmanageable volume of data. One of the pillars of a home telehealth system is the performance of unsupervised physiological self-measurement by patients in their own homes. Such measurements are prone to error and noise artifact, often due to poor measurement technique and ignorance of the measurement and transduction principles at work. These errors can degrade the quality of the recorded signals and ultimately degrade the performance of the DSS system, which is aiding the clinician in their management of the patient. Developed algorithms for automated quality assessment for pulse oximetry and blood pressure (BP) signals were tested retrospectively with data acquired from a trial that recorded signals in a home environment. The trial involved four aged subjects who performed pulse oximetry and BP measurements by themselves at their home for ten days, three times per day. This trial was set up to mimic the unsupervised physiological self-measurement as in a telehealth system. A manually annotated "gold standard" (GS) was used as the reference against which the developed algorithms were evaluated after analyzing the recordings. The assessment of pulse oximetry signals shows 95% of good sections and 67% of noisy sections were correctly detected by the developed algorithm, and a Cohen's Kappa coefficient (κ) of 0.58 was obtained in 120 pooled signals. The BP measurement evaluation demonstrates that 75% of the actual noisy sections were correctly classified in 120 pooled signals, with 97% and 91% of the signals correctly identified as worthy of attempting systolic and/or diastolic pressure estimation, respectively, with a mean error and standard deviation of 2.53±4.20 mmHg and 1.46±5.29 mmHg when compared to a manually annotated GS. These results demonstrate the feasibility, and highlight the potential benefit, of incorporating automated signal quality assessment algorithms for pulse oximetry and BP recording within a DSS for telehealth patient management.
Collapse
|
29
|
Affiliation(s)
- Robert Vinci
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | | |
Collapse
|
30
|
Schuh S, Freedman S, Coates A, Allen U, Parkin PC, Stephens D, Ungar W, DaSilva Z, Willan AR. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA 2014; 312:712-8. [PMID: 25138332 DOI: 10.1001/jama.2014.8637] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [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: 11/14/2022]
Abstract
IMPORTANCE Routine use of pulse oximetry has been associated with changes in bronchiolitis management and may have lowered the hospitalization threshold for patients with bronchiolitis. OBJECTIVE To examine if infants with bronchiolitis whose displayed oximetry measurements have been artificially elevated 3 percentage points above true values experience hospitalization rates at least 15% lower compared with infants with true values displayed. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, parallel-group trial conducted from 2008 to 2013 in a tertiary-care pediatric emergency department in Toronto, Ontario, Canada. Participants were 213 otherwise healthy infants aged 4 weeks to 12 months with mild to moderate bronchiolitis and true oxygen saturations of 88% or higher. INTERVENTIONS Pulse oximetry measurements with true saturation values displayed or with altered saturation values displayed that have been increased 3 percentage points above true values. MAIN OUTCOMES AND MEASURES The primary outcome was hospitalization within 72 hours, defined as inpatient admission within this interval or active hospital care for greater than 6 hours. Secondary outcomes included the use of supplemental oxygen in the emergency department, level of physician agreement with discharge from the emergency department, length of emergency department stay, and unscheduled visits for bronchiolitis within 72 hours. RESULTS Forty-four of 108 patients (41%) in the true oximetry group and 26 of 105 (25%) in the altered oximetry group were hospitalized within 72 hours (difference, 16% [95% CI for the difference, 3.6% to 28.4%]; P = .005). Using the emergency department physician as a random effect, the primary treatment effect remained significant (adjusted odds ratio, 4.0 [95% CI, 1.6 to 10.5]; P = .009). None of the secondary outcomes were significantly different between the groups. There were 23 of 108 (21.3%) subsequent unscheduled medical visits for bronchiolitis in the true oximetry group and 15 of 105 (14.3%) in the altered oximetry group (difference, 7% [95% CI, -0.3% to 0.2%]; P = .18). CONCLUSIONS AND RELEVANCE Among infants presenting to an emergency department with mild to moderate bronchiolitis, those with an artificially elevated pulse oximetry reading were less likely to be hospitalized within 72 hours or to receive active hospital care for more than 6 hours than those with unaltered oximetry readings. This suggests that oxygen saturation should not be the only factor in the decision to admit, and its use may need to be reevaluated. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00673946.
Collapse
Affiliation(s)
- Suzanne Schuh
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen Freedman
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Allan Coates
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Derek Stephens
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy Ungar
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zelia DaSilva
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew R Willan
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Losa-Iglesias ME, Becerro-de-Bengoa-Vallejo R, Becerro-de-Bengoa-Losa KR. Reliability and concurrent validity of a peripheral pulse oximeter and health-app system for the quantification of heart rate in healthy adults. Health Informatics J 2014; 22:151-9. [PMID: 25038201 DOI: 10.1177/1460458214540909] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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] [Indexed: 11/15/2022]
Abstract
There are downloadable applications (Apps) for cell phones that can measure heart rate in a simple and painless manner. The aim of this study was to assess the reliability of this type of App for a Smartphone using an Android system, compared to the radial pulse and a portable pulse oximeter. We performed a pilot observational study of diagnostic accuracy, randomized in 46 healthy volunteers. The patients' demographic data and cardiac pulse were collected. Radial pulse was measured by palpation of the radial artery with three fingers at the wrist over the radius; a low-cost portable, liquid crystal display finger pulse oximeter; and a Heart Rate Plus for Samsung Galaxy Note®. This study demonstrated high reliability and consistency between systems with respect to the heart rate parameter of healthy adults using three systems. For all parameters, ICC was > 0.93, indicating excellent reliability. Moreover, CVME values for all parameters were between 1.66-4.06 %. We found significant correlation coefficients and no systematic differences between radial pulse palpation and pulse oximeter and a high precision. Low-cost pulse oximeter and App systems can serve as valid instruments for the assessment of heart rate in healthy adults.
Collapse
|
32
|
Dawson JA, Bastrenta P, Cavigioli F, Thio M, Ong T, Siew ML, Hooper SB, Davis PG. The precision and accuracy of Nellcor and Masimo oximeters at low oxygen saturations (70%) in newborn lambs. Arch Dis Child Fetal Neonatal Ed 2014; 99:F278-81. [PMID: 24596406 DOI: 10.1136/archdischild-2013-305091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Administration of oxygen in the delivery room is informed by oxygen saturation (SpO₂). An oxygen saturation range of 60%-70% is the threshold for administering oxygen in the first minutes after birth. The accuracy of newer generation oximeters to measure SpO₂ has not been compared against the 'gold standard', direct arterial blood oxygen saturation (SaO₂) when SaO₂ is low. The aim of this study was to determine the accuracy and precision of Nellcor and Masimo oximeters to measure SpO₂ when SaO₂ <70%. METHOD Prospective observational study in ventilated anaesthetised newborn lambs with an indwelling carotid artery catheter. Ventilation was adjusted to achieve hypoxaemia. Nellcor (Oxi-Max 600 with Max-N sensor) and Masimo (Rad 4 with low noise optical probe (LNOP) sensor) sensors were applied to the right forelimb (preductal). An arterial blood sample was collected at 1-5 min intervals when the animal was hypoxic. The displayed SpO₂ was recorded. We used Bland-Altman analysis to determine precision and accuracy of each oximeter when SaO₂ <70%. RESULTS 17 lambs were studied, 165 measurements were obtained, 123 were SaO₂ <70%. The mean difference (±1.96 SD) Nellcor SpO₂-SaO₂ when SaO₂ <70% was 17% (-12% to 46%). The mean difference (±1.96 SD) Masimo SpO₂-SaO₂ when SaO2 <70% was 13% (-19% to 45%). CONCLUSIONS At SaO₂<70%, both monitors overestimated oxygen saturation (SpO₂) compared with the gold standard. Both oximeters were equally inaccurate when SaO₂ was low.
Collapse
|
33
|
Madsen PH, Laursen CB. [Pulsoximetri]. Ugeskr Laeger 2014; 176:V07130429. [PMID: 25096464] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Poul Henning Madsen
- Medicinsk Afdeling, Lungemedicin, -Sygehus Lillebælt, Fredericia og Vejle Sygehuse, Dronningensgade 97, 7000 Fredericia.
| | | |
Collapse
|
34
|
|
35
|
Jenny C, Biallas M, Trajkovic I, Fauchère JC, Bucher HU, Wolf M. Reproducibility of cerebral tissue oxygen saturation measurements by near-infrared spectroscopy in newborn infants. J Biomed Opt 2011; 16:097004. [PMID: 21950939 DOI: 10.1117/1.3622756] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Early detection of cerebral hypoxemia is an important aim in neonatology. A relevant parameter to assess brain oxygenation may be the cerebral tissue oxygen saturation (StO(2)) measured by near-infrared spectroscopy (NIRS). So far the reproducibility of StO(2) measurements was too low for clinical application, probably due to inhomogeneities. The aim of this study was to test a novel sensor geometry which reduces the influence of inhomogeneities. Thirty clinically stable newborn infants, with a gestational age of median 33.9 (range 26.9 to 41.9) weeks, birth weight of 2220 (820 to 4230) g, postnatal age of 5 (1 to 71) days were studied. At least four StO(2) measurements of 1 min duration were carried out using NIRS on the lateral head. The sensor was repositioned between measurements. Reproducibility was calculated by a linear mixed effects model. The mean StO(2) was 79.99 ± 4.47% with a reproducibility of 2.76% and a between-infant variability of 4.20%. Thus, the error of measurement only accounts for 30.1% of the variability. The novel sensor geometry leads to considerably more precise measurements compared to previous studies with, e.g., ∼5% reproducibility for the NIRO 300. The novel StO(2) values hence have a higher clinical relevance.
Collapse
Affiliation(s)
- Carmen Jenny
- University Hospital Zurich, Biomedical Optics Research Laboratory, Division of Neonatology, Department of Obstetrics and Gynecology, 8091 Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
36
|
Arri SJ, Muehlemann T, Biallas M, Bucher HU, Wolf M. Precision of cerebral oxygenation and hemoglobin concentration measurements in neonates measured by near-infrared spectroscopy. J Biomed Opt 2011; 16:047005. [PMID: 21529095 DOI: 10.1117/1.3570303] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND AIM One source of error with near-infrared spectroscopy (NIRS) is the assumption that the measured tissue is optically homogeneous. This is not always the case. Our aim is to assess the impact of tissue homogeneity (TH) on the precision of NIRS measurements in neonates. METHODS On 36 term and 27 preterm neonates at least five 1-min measurements are performed on each subject using the OxiplexTS. The sensor position is slightly changed before each measurement while assessing TH. The precision for cerebral tissue oxygenation saturation (StO(2)) and total hemoglobin concentration (tHb) are calculated by repeated measures analysis of variance. RESULTS The mean StO(2) is not significantly different between term and preterm infants. The mean tHb is significantly lower in preterm infants (p < 0.01). With increasing TH, the precision of StO(2) increase from 5.6 to 4.6% for preterm and from 11.0 to 2.0% for term infants; the precision of tHb increases from 10.1 to 7.5μM for preterm and from 16.4 to 3.5 μM for term infants. The precision for StO(2) is higher in term than in preterm infants. The precision for tHb shows no significant difference between the two groups. CONCLUSIONS The precision of NIRS measurements correlates with tissue homogeneity.
Collapse
Affiliation(s)
- Sandra Jasminder Arri
- Department of Obstetrics and Gynecology, University Hospital Zurich, Clinic of Neonatology, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | | | | | | | | |
Collapse
|
37
|
|
38
|
|
39
|
|
40
|
D'Angelo R. All parturients receiving neuraxial morphine should be monitored with continuous pulse oximetry. Int J Obstet Anesth 2010; 19:202-4. [PMID: 20202817 DOI: 10.1016/j.ijoa.2009.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 08/02/2009] [Indexed: 11/19/2022]
Affiliation(s)
- R D'Angelo
- Department of Obstetric Anesthesia, Wake Forest University, Winston-Salem, NC 27103, USA.
| |
Collapse
|
41
|
Bilan N, Behbahan AG, Abdinia B, Mahallei M. Validity of pulse oximetry in detection of hypoxaemia in children: comparison of ear, thumb and toe probe placements. East Mediterr Health J 2010; 16:218-222. [PMID: 20799578] [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: 05/29/2023]
Abstract
This study of paediatric intensive care patients aimed to determine where pulse oximetry probes shouid be placed to obtain the most accurate and reliable readings of peripheral oxygen saturation (SpO2). Using arterial blood gas analysis (SaO2) as the gold standard and SpO2 92% and SaO2 < 90% as indicators of hypoxaemia, negative predictive values of SpO2 were 96%, 98% and 98% at the ear, thumb and big toe respectively in 110 children, and 93% at all 3 sites in 90 neonates. The highest clinical agreement between SaG, and SpO2 was for ear probes in children (kappa = 0.70) and the lowest was for big toe probes (kappa = 0.57 and 0.28 in children and neonates respectively).
Collapse
Affiliation(s)
- N Bilan
- Tuberculosis and Lung Diseases Research Centre, Tabriz Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
| | | | | | | |
Collapse
|
42
|
Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, Gidding SS, Beekman RH, Grosse SD. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation 2009; 120:447-58. [PMID: 19581492 DOI: 10.1161/circulationaha.109.192576] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this statement is to address the state of evidence on the routine use of pulse oximetry in newborns to detect critical congenital heart disease (CCHD). METHODS AND RESULTS A writing group appointed by the American Heart Association and the American Academy of Pediatrics reviewed the available literature addressing current detection methods for CCHD, burden of missed and/or delayed diagnosis of CCHD, rationale of oximetry screening, and clinical studies of oximetry in otherwise asymptomatic newborns. MEDLINE database searches from 1966 to 2008 were done for English-language papers using the following search terms: congenital heart disease, pulse oximetry, physical examination, murmur, echocardiography, fetal echocardiography, and newborn screening. The reference lists of identified papers were also searched. Published abstracts from major pediatric scientific meetings in 2006 to 2008 were also reviewed. The American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. In an analysis of pooled studies of oximetry assessment performed after 24 hours of life, the estimated sensitivity for detecting CCHD was 69.6%, and the positive predictive value was 47.0%; however, sensitivity varied dramatically among studies from 0% to 100%. False-positive screens that required further evaluation occurred in only 0.035% of infants screened after 24 hours. CONCLUSIONS Currently, CCHD is not detected in some newborns until after their hospital discharge, which results in significant morbidity and occasional mortality. Furthermore, routine pulse oximetry performed on asymptomatic newborns after 24 hours of life, but before hospital discharge, may detect CCHD. Routine pulse oximetry performed after 24 hours in hospitals that have on-site pediatric cardiovascular services incurs very low cost and risk of harm. Future studies in larger populations and across a broad range of newborn delivery systems are needed to determine whether this practice should become standard of care in the routine assessment of the neonate.
Collapse
|
43
|
Smith SMS, Roberts SB, Duggan-Brennan M, Powrie KE, Haffenden R. Emergency oxygen delivery in adults 1: updating nursing practice. Nurs Times 2009; 105:16-18. [PMID: 19400337] [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: 05/27/2023]
Abstract
The first in this two-part unit discusses new British Thoracic Society guidance on using emergency oxygen in adults. This is the first national guidance on this area and the implications for possible changes to practice are highlighted here. This part outlines the philosophy behind the guideline, the differences between hypoxaemic and hypercapnic patients and essential assessments for critically ill patients who need emergency oxygen. It also discusses using this therapy for patients with lung cancer in acute situations.
Collapse
Affiliation(s)
- Sheree M S Smith
- St Mary's Hospital, London, Imperial College Healthcare NHS Trust
| | | | | | | | | |
Collapse
|
44
|
Abstract
Calibration of fluorescent optical sensors for accurate, quantitative intracellular measurements in vivo suffers from lack of a representative medium that appropriately simulates the molecular complexity of the cytosol. We present a novel protocol for accurate intracellular oxygen sensing via fluorescence lifetime imaging microscopy (FLIM) using cell lysate-FLIM measurements to correct the in vitro calibration of a fluorescent oxygen sensor, and we describe electron paramagnetic resonance (EPR) validation studies. Lysate-FLIM studies provided biochemical information, while EPR provided a "gold standard" for intracellular oxygen estimation. Oxygen levels were evaluated in living human normal squamous and adenocarcinoma esophageal epithelial cells, and good agreement was observed between oxygen levels derived from the optical protocol and EPR. The proposed protocol introduces the concept of a living cell line as a reference for estimating unknown oxygen levels in other cell lines and accounts for high degrees of variability between different cell lines.
Collapse
|
45
|
Riches A. First guidance on emergency oxygen. Nurs Times 2008; 104:81. [PMID: 19068897] [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: 05/27/2023]
|
46
|
Hammer M, Vilser W, Riemer T, Schweitzer D. Retinal vessel oximetry-calibration, compensation for vessel diameter and fundus pigmentation, and reproducibility. J Biomed Opt 2008; 13:054015. [PMID: 19021395 DOI: 10.1117/1.2976032] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The purpose of this study was to measure the hemoglobin oxygenation in retinal vessels and to evaluate the sensitivity and reproducibility of the measurement. Using a fundus camera equipped with a special dual wavelength transmission filter and a color charge-coupled device camera, two monochromatic fundus images at 548 and 610 nm were recorded simultaneously. The optical densities of retinal vessels for both wavelengths and their ratio, which is known to be proportional to the oxygen saturation, were calculated. From 50-deg images, the used semiautomatic vessel recognition and tracking algorithm recognized and measured vessels of 100 microm or more in diameter. On average, arterial and venous oxygen saturations were measured at 98+/-10.1% and 65+/-11.7%, respectively. For measurements in the same vessel segments from the five images per subject, standard deviations of 2.52% and 3.25% oxygen saturation were found in arteries and veins, respectively. Respiration of 100% oxygen increased the mean arterial and venous oxygen saturation by 2% and 7% respectively. A simple system for noninvasive optical oximetry, consisting of a special filter in a fundus camera and software, was introduced. It is able to measure the oxygen saturation in retinal branch vessels with reproducibility and sensitivity suitable for clinical investigations.
Collapse
Affiliation(s)
- Martin Hammer
- University of Jena, Department of Ophthalmology, Jena, Germany.
| | | | | | | |
Collapse
|
47
|
Reich JD, Connolly B, Bradley G, Littman S, Koeppel W, Lewycky P, Liske M. The reliability of a single pulse oximetry reading as a screening test for congenital heart disease in otherwise asymptomatic newborn infants. Pediatr Cardiol 2008; 29:885-9. [PMID: 18347842 DOI: 10.1007/s00246-008-9214-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 11/29/2022]
Abstract
Routine pulse oximetry has been studied to detect children with otherwise undiagnosed congenital heart disease prior to nursery discharge. The reported sensitivities in asymptomatic patients have been less than expected and vary widely, bringing into question the reliability of the test. The purpose of this study was to assess whether routine pulse oximetry contributes to identifying patients with critical congenital heart disease and to determine the reliability of a single pulse oximeter reading in screening asymptomatic newborn infants. Between December 26, 2003, and December 31, 2005, three hospitals in west central Florida performed a pulse oximetry routinely on all newborns at the time of discharge. Patients diagnosed with critical congenital heart disease during the study period were identified to assess whether the pulse oximetry reading initiated their diagnosis. In one hospital, the pulse oximeter data were evaluated for reliability. Downloaded data were compared to a log compiled by the nursery personnel, first without (phase 1) and then with (phase 2) their knowledge and additional training. Results were characterized as reliable, probe placed but reading not verifiable, or no evidence of probe placement. Of the 7962 infants who received oximetry testing, there were 12 postnatal diagnoses of critical congenital heart disease. None was initially identified by routine pulse oximetry. Pulse oximetry reliability improved substantially between phase 1 and phase 2 (38 v. 60%, p < 0.0001). Optimal reliability (>95%) was obtained by a nurse with a degree of LPN or higher performing an assessment of at least 360 seconds. Routine pulse oximetry was neither reliable nor an important diagnostic tool in our cohort. Important human factors (probe placement time, oximetry training, and nursing degree) impact single determination pulse oximetry reliability. With routine surveillance and quality improvement, the reliability of this test can be increased. Future studies to determine the effectiveness of pulse oximetry screening for the diagnosis of congenital heart disease in the asymptomatic newborn population must address these factors. Until such a study demonstrates acceptable sensitivity and clinical value, universal screening should not be instituted.
Collapse
Affiliation(s)
- J D Reich
- The Watson Clinic LLP, The Watson Clinic Center for Research, 1600 Lakeland Hills Boulevard, Lakeland, FL 33805, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Häggblad E, Lindbergh T, Karlsson MGD, Casimir-Ahn H, Salerud EG, Strömberg T. Myocardial tissue oxygenation estimated with calibrated diffuse reflectance spectroscopy during coronary artery bypass grafting. J Biomed Opt 2008; 13:054030. [PMID: 19021410 DOI: 10.1117/1.2976433] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We present a study using a method able to assess tissue oxygenation, taking into account the absorption and the level of scattering in myocardial tissue using a calibrated fiber optic probe. With this method, interindividual comparisons of oxygenation can be made despite varying tissue optical properties during coronary artery bypass grafting (CABG). During CABG, there are needs for methods allowing continuous monitoring and prediction of the metabolism in the myocardial tissue. 14 patients undergoing CABG are investigated for tissue oxygenation during different surgical phases using a handheld fiber optic spectroscopic probe with a source-detector distance of less than 1 mm. The probe is calibrated using a light transport model, relating the absorption and reduced scattering coefficients (mu(a) and mu(s)') to the measured spectra. By solving the inverse problem, absolute measures of tissue oxygenation are evaluated by the sum of oxygenized hemoglobin and myoglobin. Agreement between the model and measurements is obtained with an average correlation coefficient R2 of 0.96. Oxygenation is found to be significantly elevated after aorta cross-clamping and cardioplegic infusion, as well as after reperfusion, compared to a baseline (p<0.05). Tissue oxygenation decreases during cardiac arrest and increases after reperfusion.
Collapse
Affiliation(s)
- Erik Häggblad
- Linköping University, Department of Biomedical Engineering, Linköping Biomedical Optics Group, Linköping, Sweden.
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
A pulse oximeter clipped to a drip chamber seemed to conjure up life for Andreas Kopka
Collapse
Affiliation(s)
- Andreas Kopka
- Greater Glasgow University Hospitals, Southern General Hospital, Glasgow G51 4TF.
| |
Collapse
|
50
|
Abstract
OBJECTIVE Congenital cardiovascular malformations (CCVMs) are relatively common with a prevalence of 5-10 per 1000 live births. Pulse oximetry screening is proposed to identify newborns with critical CCVMs which are missed by routine prenatal ultrasound and by pre-discharge physical examinations. The purpose of this study was to identify the number of infants with a delayed diagnosis of critical CCVMs potentially detectable by pre-discharge pulse oximetry screening. PATIENTS AND METHODS Hospital Discharge records in New Jersey from 199-2004 for infants with critical CCVMs were identified using ICD-9 codes. These records were matched to the Electronic Birth Certificate records to identify newborns who were discharged as normal newborns and were later admitted with a diagnosis of critical CCVMs. Chart review was completed on these cases to confirm a delay in diagnosis. RESULTS Chart reviews confirmed delayed diagnosis of critical CCVM in 47 infants out of 670,245 births. Coarctation of the Aorta was the most common delayed diagnosis. The age at final diagnosis varied from 3 days to 6.5 months. CONCLUSIONS Further examination of pulse oximetry as a routine newborn screening service is warranted. Implementation of pre-discharge pulse oximetry screening for newborns may improve the timely detection of asymptomatic critical CCVMs.
Collapse
Affiliation(s)
- Tajwar Aamir
- New Jersey Department of Health and Senior Services, Division of Family Health Services, Trenton, New Jersey 08625, USA.
| | | | | |
Collapse
|