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Journal of Clinical Anesthesia Jun 2024The current standards of postoperative respiratory monitoring on medical-surgical floors involve spot-pulse oximetry checks every 4-8 h, which can miss the opportunity... (Meta-Analysis)
Meta-Analysis Review
Role of continuous pulse oximetry and capnography monitoring in the prevention of postoperative respiratory failure, postoperative opioid-induced respiratory depression and adverse outcomes on hospital wards: A systematic review and meta-analysis.
OBJECTIVE
The current standards of postoperative respiratory monitoring on medical-surgical floors involve spot-pulse oximetry checks every 4-8 h, which can miss the opportunity to detect prolonged hypoxia and acute hypercapnia. Continuous respiratory monitoring can recognize acute respiratory depression episodes; however, the existing evidence is limited. We sought to review the current evidence on the effectiveness of continuous pulse oximetry (CPOX) with and without capnography versus routine monitoring and their effectiveness for detecting postoperative respiratory failure, opioid-induced respiratory depression, and preventing downstream adverse events.
METHODS
We performed a systematic literature search on Ovid Medline, Embase, and Cochrane Library databases for articles published between 1990 and April 2023. The study protocol was registered in Prospero (ID: 439467), and PRISMA guidelines were followed. The NIH quality assessment tool was used to assess the quality of the studies. Pooled analysis was conducted using the software R version 4.1.1 and the package meta. The stability of the results was assessed using sensitivity analysis.
DESIGN
Systematic Review and Meta-Analysis.
SETTING
Postoperative recovery area.
PATIENTS
56,538 patients, ASA class II to IV, non-invasive respiratory monitoring, and post-operative respiratory depression.
INTERVENTIONS
Continuous pulse oximetry with or without capnography versus routine monitoring.
MEASUREMENTS
Respiratory rate, oxygen saturation, adverse events, and rescue events.
RESULTS
23 studies (17 examined CPOX without capnography and 5 examined CPOX with capnography) were included in this systematic review. CPOX was better at recognizing desaturation (SpO < 90%) OR: 11.94 (95% CI: 6.85, 20.82; p < 0.01) compared to standard monitoring. No significant differences were reported for ICU transfer, reintubation, and non-invasive ventilation between the two groups.
CONCLUSIONS
Oxygen desaturation was the only outcome better detected with CPOX in postoperative patients in hospital wards. These comparisons were limited by the small number of studies that could be pooled for each outcome and the heterogeneity between the studies.
Topics: Humans; Analgesics, Opioid; Respiratory Rate; Capnography; Monitoring, Physiologic; Respiratory Insufficiency; Oximetry; Postoperative Complications; Hospitals
PubMed: 38184918
DOI: 10.1016/j.jclinane.2024.111374 -
Sleep Medicine Reviews Jun 2016Overnight polysomnography is the gold standard tool for the diagnosis of obstructive sleep apnea syndrome (OSAS) in habitually snoring children, but it is expensive and... (Review)
Review
Overnight polysomnography is the gold standard tool for the diagnosis of obstructive sleep apnea syndrome (OSAS) in habitually snoring children, but it is expensive and not always available. Nocturnal oximetry has been proposed as an abbreviated and low-cost testing modality for the diagnosis of OSAS. In this systematic review, 25 original articles were evaluated to: (i) summarize reference values of nocturnal oximetry parameters in healthy children; (ii) identify abnormal oximetry patterns that predict OSAS in habitually snoring children; (iii) delineate abnormalities in oximetry that can predict responses to treatment interventions for OSAS and potential complications. Nocturnal SpO2 drops <90%, more than two clusters of desaturation events (≥4%) and oxyhemoglobin desaturation (≥4%) index (ODI4) >2.2 episodes/h are unusual in children without OSAS. At least three clusters of desaturation events, and at least three SpO2 drops below 90% in a nocturnal oximetry recording are indicative of moderate-to-severe OSAS. An ODI4 >2 episodes/h combined with OSAS symptoms also exhibits high positive predictive value for apnea-hypopnea index >1 episode/h. Children without clusters of desaturation events have low risk of major respiratory complications following adenotonsillectomy. Thus, nocturnal oximetry emerges as a valuable tool that can facilitate treatment decisions when polysomnography is not available.
Topics: Child; Humans; Hypoxia; Oximetry; Sleep Apnea, Obstructive; Snoring; Tonsillectomy
PubMed: 26146027
DOI: 10.1016/j.smrv.2015.05.008 -
Acta Ophthalmologica Mar 2017The retinal oximeter is a new tool for non-invasive measurement of retinal oxygen saturation in humans. Several studies have investigated the associations between... (Review)
Review
The retinal oximeter is a new tool for non-invasive measurement of retinal oxygen saturation in humans. Several studies have investigated the associations between retinal oxygen saturation and retinal diseases. In the present systematic review, we examine whether there are associations between retinal oxygen saturation and retinal ischaemic diseases. We used PubMed and Embase to search for retinal oxygen saturation and retinal ischaemic diseases. Three separate searches identified a total of 79 publications. After two levels of manual screening, 10 studies were included: six about diabetic retinopathy (DR) and four about retinal vein occlusion. No studies about retinal artery occlusion were included. In diabetes, all studies found that increases in retinal venous oxygen saturation (rvSatO ) were associated with present as well as increasing levels of DR. Four of six studies also found increased retinal arterial oxygen saturation (raSatO ) in patients with DR. In patients with central retinal vein occlusion (CRVO), all studies found that rvSatO was reduced, but raSatO remained unchanged. Branch retinal vein occlusion was not associated with changes in retinal oxygen saturation, but this was based on a single study. In conclusion, DR is associated with increased rvSatO and might also be related to increased raSatO . Central retinal vein occlusion (CRVO) is correlated with increased rvSatO but unrelated to raSatO . Prospective studies are needed to expand these findings. These would tell whether retinal oximetry could be a potential tool for screening or a biomarker of treatment outcome in patients with ischaemic retinal diseases.
Topics: Humans; Oximetry; Oxygen; Regional Blood Flow; Retinal Artery; Retinal Diseases; Retinal Vein
PubMed: 27585711
DOI: 10.1111/aos.13229 -
BMJ Open Jun 2017To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone.
DESIGN AND SETTING
Systematic literature review and random effects meta-analysis of randomised controlled trials (RCTs) reporting sedation-related adverse event incidence when adding capnography to visual assessment and pulse oximetry in patients undergoing PSA during ambulatory surgery in the hospital setting. Searches for eligible studies published between 1 January 1995 and 31 December 2016 (inclusive) were conducted in PubMed, the Cochrane Library and EMBASE without any language constraints. Searches were conducted in January 2017, screening and data extraction were conducted by two independent reviewers, and study quality was assessed using a modified Jadad scale.
INTERVENTIONS
Capnography monitoring relative to visual assessment and pulse oximetry alone.
PRIMARY AND SECONDARY OUTCOME MEASURES
Predefined endpoints of interest were desaturation/hypoxaemia (the primary endpoint), apnoea, aspiration, bradycardia, hypotension, premature procedure termination, respiratory failure, use of assisted/bag-mask ventilation and death during PSA.
RESULTS
The literature search identified 1006 unique articles, of which 13 were ultimately included in the meta-analysis. Addition of capnography to visual assessment and pulse oximetry was associated with a significant reduction in mild (risk ratio (RR) 0.77, 95% CI 0.67 to 0.89) and severe (RR 0.59, 95% CI 0.43 to 0.81) desaturation, as well as in the use of assisted ventilation (OR 0.47, 95% CI 0.23 to 0.95). No significant differences in other endpoints were identified.
CONCLUSIONS
Meta-analysis of 13 RCTs published between 2006 and 2016 showed a reduction in respiratory compromise (from respiratory insufficiency to failure) during PSA with the inclusion of capnography monitoring. In particular, use of capnography was associated with less mild and severe oxygen desaturation, which may have helped to avoid the need for assisted ventilation.
Topics: Bradycardia; Capnography; Conscious Sedation; Deep Sedation; Humans; Monitoring, Physiologic; Oximetry; Patient Safety; Randomized Controlled Trials as Topic; Respiration, Artificial; Respiratory Insufficiency
PubMed: 28667196
DOI: 10.1136/bmjopen-2016-013402 -
International Wound Journal Dec 2023Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this,... (Review)
Review
Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this, only around 15% of patients in the United Kingdom who require an ABPI measurement undergo the assessment. The Lanarkshire Oximetry Index (LOI) is a cheaper and arguably more accessible approach to vascular assessment and was initially proposed as an alternative to the ABPI in 2000. No synthesis of evidence related to the LOI has been performed since its introduction into the literature. Primary studies were sought to determine the clinimetric properties of the LOI and its level of agreement with ABPI assessments. Systematic searches of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, BNI, ProQuest Health and Medicine, Science Direct, Google Scholar and the British Library (online search) were conducted. Reference lists of identified studies were also reviewed to identify additional studies. Three primary studies met the inclusion criteria, reporting data from 307 patients and 584 limbs assessed using both the LOI and ABPI. All three studies reported fair to moderate kappa values for interrater reliability (κ = 0.290-0.747) and statistically significant positive correlation coefficients (r = 0.37, p < 0.001 in two studies) between the LOI and ABPI. The combined data from the three studies indicated a sensitivity of 52% (41.78-62.1, 95% confidence interval [CI]) and specificity of 96.08% (93.4-97.9, 95% CI) for the LOI using the ABPI as a reference. Additional data are required to indicate the safety of the LOI in practice. Data are also required to determine if the LOI is more acceptable to clinicians compared to the ABPI and whether there are any barriers/enablers to its implementation in practice. Given the relatively low specificity of the LOI, it may be beneficial to combine measurement of the LOI with a subjective clinical risk assessment tool to improve the sensitivity of this alternative approach to vascular assessment.
PubMed: 38050665
DOI: 10.1111/iwj.14519 -
Evidence-based Dentistry Dec 2022Data sources Medline, Web of Science and the Cochrane Central Register of Controlled Trials databases along with Google Scholar, Greylist and OpenGrey were... (Meta-Analysis)
Meta-Analysis Review
Data sources Medline, Web of Science and the Cochrane Central Register of Controlled Trials databases along with Google Scholar, Greylist and OpenGrey were systematically searched (up to December 2020).Study selection In vivo observational studies and clinical trials assessing the diagnostic accuracy of pulp vitality tests and sensibility tests in adult human teeth were screened. Exclusion criteria included non-English articles, deciduous teeth, case reports and in vitro studies.Data extraction and synthesis Data extracted included basic study location, sample size, age of participants, pathology of teeth, type of teeth and the vitality (pulse oximetry or Laser Doppler flowmetry) or sensibility test (cold, hot and electric pulp testing) used. Measures of diagnostic accuracy were synthesised (sensitivity, sensibility, predictive values, and likelihood ratios). Meta-analysis was performed using a bivariate random-effects model producing summary values for sensitivity and specificity. Results were presented as a ROC curve. Risk of bias and the quality of the studies were assessed using the QUADAS-2 tool.Results A total of ten studies were included in the review, of which five were included in the meta-analysis. Overall risk of bias was unclear. Pulse oximetry showed higher diagnostic accuracy than electric pulp testing and thermal testing. Insufficient data precluded quantitative analysis for Laser Doppler flowmetry.Conclusions Pulse oximetry demonstrates greater diagnostic accuracy when compared to sensibility testing. Limited sample size and heterogeneity among the included studies limits their applicability.
Topics: Adult; Humans; Dental Pulp; Dental Pulp Test; Dentition, Permanent; Laser-Doppler Flowmetry; Sensitivity and Specificity
PubMed: 36526833
DOI: 10.1038/s41432-022-0847-5 -
Respiratory Care Sep 2023The effect of application of fingernail polish on S measurement remains unclear. We conducted this systematic review to ascertain the impact of fingernail polish on S... (Review)
Review
BACKGROUND
The effect of application of fingernail polish on S measurement remains unclear. We conducted this systematic review to ascertain the impact of fingernail polish on S measurement.
METHODS
We queried PubMed, Embase, and CINAHL databases for publications indexed through December 2022. We included studies providing paired S data from fingertips without and after nail polish application or reporting the number of subjects whose S could not be measured due to fingernail polish. We used random effects modeling to summarize standardized mean differences (SMDs) and corresponding 95% CI for different nail polish colors from comparative studies.
RESULTS
We retrieved 122 studies and included 21 publications, mostly performed on healthy volunteers. Of these, 17 (81.0%) studies had a low risk of bias. We summarized mean SMD for 10 nail polish colors (black, blue, brown, green, orange, pink, purple, red, white, and yellow) from 25 paired data sets on S across 20 studies. We found small (likely clinically insignificant) but statistically significant differences in mean S when fingers were coated with black, blue, brown, or purple nail polish (SMD -0.57, -0.47, -0.33, and -0.25, respectively; 95% CI -0.86 to -0.29, -0.84 to -0.10, -0.59 to -0.07, and -0.48 to -0.02, respectively). Only one of 4 studies reported a high proportion of unsuccessful oximeter readings from fingers painted with black (88.0%) or brown (36.0%) nail polish.
CONCLUSIONS
Although fingernail polish of some colors can marginally reduce S reading or occasionally impede S measurement, the variability is clinically insignificant.
Topics: Humans; Color; Cosmetics; Nails; Oximetry; Oxygen
PubMed: 37185113
DOI: 10.4187/respcare.10399 -
Resuscitation Plus Sep 2024To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth. (Review)
Review
AIM
To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth.
METHODS
A search of Medline, SCOPUS, CINAHL and Cochrane was conducted between January 1, 1946, to until August 16, 2023. (CRD 42021283364) Study selection was based on predetermined criteria. Reviewers independently extracted data, appraised risk of bias and assessed certainty of evidence.
RESULTS
Pulse oximetry is slower and less precise than ECG for heart rate assessment. Both auscultation and palpation are imprecise for heart rate assessment. Other devices such as digital stethoscope, Doppler ultrasound, an ECG device using dry electrodes incorporated in a belt, photoplethysmography and electromyography are studied in small numbers of newborns and data are not available for extremely preterm or bradycardic newborns receiving resuscitation. Digital stethoscope is fast and accurate. Doppler ultrasound and dry electrode ECG in a belt are fast, accurate and precise when compared to conventional ECG with gel adhesive electrodes.
LIMITATIONS
Certainty of evidence was low or very low for most comparisons.
CONCLUSION
If resources permit, ECG should be used for fast and accurate heart rate assessment at birth. Pulse oximetry and auscultation may be reasonable alternatives but have limitations. Digital stethoscope, doppler ultrasound and dry electrode ECG show promise but need further study.
PubMed: 38912532
DOI: 10.1016/j.resplu.2024.100668 -
Acta Paediatrica (Oslo, Norway : 1992) May 2017Heart rate (HR) is a vital sign for assessing the need for resuscitation. We performed a systematic review of studies assessing novel methods of measuring HR in newborns... (Review)
Review
UNLABELLED
Heart rate (HR) is a vital sign for assessing the need for resuscitation. We performed a systematic review of studies assessing novel methods of measuring HR in newborns and infants in the neonatal unit. Two investigators completed independent literature searches. Identified papers were independently evaluated, and relevant data were extracted and analysed.
CONCLUSION
This systematic review identified seven new technologies, including camera-based photoplethysmography, reflectance pulse oximetry, laser Doppler methods, capacitive sensors, piezoelectric sensors, electromyography and a digital stethoscope. Clinicians should be aware of several of these, which may become available for clinical use in the near future.
Topics: Heart Rate; Humans; Infant, Newborn; Monitoring, Physiologic; Oximetry; Photoplethysmography
PubMed: 28199732
DOI: 10.1111/apa.13786 -
Archives of Disease in Childhood. Fetal... Dec 2023Measuring exhaled carbon dioxide (ECO) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee...
OBJECTIVE
Measuring exhaled carbon dioxide (ECO) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee on Resuscitation (ILCOR) only recommends ECO detection for confirming endotracheal tube placement. ILCOR has therefore prioritised a research question that needs to be urgently evaluated: 'In newborn infants receiving intermittent positive pressure ventilation by any non-invasive interface at birth, does the use of an ECO monitor in addition to clinical assessment, pulse oximetry and/or ECG, compared with clinical assessment, pulse oximetry and/or ECG only, decrease endotracheal intubation in the delivery room, improve response to resuscitation, improve survival or reduce morbidity?'.
DESIGN
Systematic review of randomised and non-randomised studies identified by Ovid MEDLINE, Embase and Cochrane CENTRAL search until 1 August 2022.
SETTING
Delivery room.
PATIENTS
Newborn infants receiving non-invasive ventilation at birth.
INTERVENTION
ECO measurement plus routine assessment compared with routine assessment alone.
MAIN OUTCOME MEASURES
Endotracheal intubation in the delivery room, response to resuscitation, survival and morbidity.
RESULTS
Among 2370 articles, 23 were included; however, none had a relevant control group. Although studies indicated that the absence of ECO may signify airway obstruction and ECO detection may precede a heart rate increase in adequately ventilated infants, they did not directly address the research question.
CONCLUSIONS
Evidence to support the use of an ECO monitor to guide non-invasive positive pressure ventilation at birth is lacking. More research on the effectiveness of ECO measurement in addition to routine assessment during non-invasive ventilation of newborn infants at birth is needed.
PROSPERO REGISTRATION NUMBER
CRD42022344849.
Topics: Infant, Newborn; Infant; Humans; Noninvasive Ventilation; Carbon Dioxide; Respiration, Artificial; Positive-Pressure Respiration; Resuscitation; Intermittent Positive-Pressure Ventilation
PubMed: 37558397
DOI: 10.1136/archdischild-2023-325698