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Microsurgery Jan 2023Retrospective studies evaluating tissue oximetry in a more recent cohort have shown superiority in flap outcomes. This study compares the use of tissue oximetry in a...
BACKGROUND
Retrospective studies evaluating tissue oximetry in a more recent cohort have shown superiority in flap outcomes. This study compares the use of tissue oximetry in a historical cohort to clinical observation and handheld doppler in a more recent cohort. We hypothesize that there is no benefit to using tissue oximetry.
METHODS
A retrospective review was performed on patients who underwent abdominal-based autologous breast reconstruction by five microsurgeons at an academic institution from 2009 to 2020. Method of postoperative flap monitoring was determined then operative details and complications were analyzed.
RESULTS
1367 flaps were reviewed; 740 flaps in 460 patients were monitored with clinical observation and tissue oximetry, and 627 flaps in 391 patients were monitored with clinical observation and handheld doppler. There were no statistical differences in ischemic (p = .59) or congestive complications (p = .41), flap salvage rates when exploring for venous or arterial compromise (p = .52), or early flap loss (p = .56). Although not significant, acute flap-related return to the operating room was lower in the doppler group (4.6%) compared to the oximetry group (6.1%; p = .22). Flaps monitored with tissue oximetry had a statistical increase in length of stay (4.8 ± 1.4 days vs. 3.8 ± 1.6 days; p ≤ .001). The rates of late partial flap loss and fat necrosis were significantly higher in the oximetry group (2.6%, 19/740 vs. 0.3%, 2/740; p = .04) and (18.2%, 135/740 vs. 13.6%, 85/627; p = .02), respectively.
CONCLUSIONS
There is no statistical benefit to the use of tissue oximetry compared to handheld doppler in flap monitoring with regards to flap outcomes.
Topics: Humans; Free Tissue Flaps; Retrospective Studies; Mammaplasty; Breast; Oximetry; Postoperative Complications
PubMed: 35238069
DOI: 10.1002/micr.30873 -
Archives of Disease in Childhood Aug 2016Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters... (Review)
Review
OBJECTIVE
Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters are used to inform diagnosis and treatment (excluding surgical care) compared with health facilities where pulse oximeters are not used?
DESIGN
Studies were obtained for this systematic literature review by systematically searching the Database of Abstracts of Reviews of Effects, Cochrane, Medion, PubMed, Web of Science, Embase, Global Health, CINAHL, WHO Global Health Library, international health organisation and NGO websites, and study references.
PATIENTS
Children 0-19 years presenting for the first time to hospitals, emergency departments or primary care facilities.
INTERVENTIONS
Included studies compared outcomes where pulse oximeters were used for diagnosis and/or management, with outcomes where pulse oximeters were not used.
MAIN OUTCOME MEASURES
mortality, morbidity, length of stay, and treatment and management changes.
RESULTS
The evidence is low quality and hypoxaemia definitions varied across studies, but the evidence suggests pulse oximeter use with children can reduce mortality rates (when combined with improved oxygen administration) and length of emergency department stay, increase admission of children with previously unrecognised hypoxaemia, and change physicians' decisions on illness severity, diagnosis and treatment. Pulse oximeter use generally increased resource utilisation.
CONCLUSIONS
As international organisations are investing in programmes to increase pulse oximeter use in low-income settings, more research is needed on the optimal use of pulse oximeters (eg, appropriate oxygen saturation thresholds), and how pulse oximeter use affects referral and admission rates, length of stay, resource utilisation and health outcomes.
Topics: Adolescent; Child; Child, Preschool; Emergency Service, Hospital; Humans; Hypoxia; Infant; Infant, Newborn; Length of Stay; Oximetry; Primary Health Care; Treatment Outcome
PubMed: 26699537
DOI: 10.1136/archdischild-2015-309638 -
The Cochrane Database of Systematic... Oct 2014The use of conventional cardiotocographic (CTG) monitoring of fetal well-being during labour is associated with an increased caesarean section rate, compared with... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The use of conventional cardiotocographic (CTG) monitoring of fetal well-being during labour is associated with an increased caesarean section rate, compared with intermittent auscultation of the fetal heart rate, resulting in a reduction in neonatal seizures, although no differences in other neonatal outcomes. To improve the sensitivity of this test and therefore reduce the number of caesarean sections performed for nonreassuring fetal status, several additional measures of evaluating fetal well-being have been considered. These have demonstrated some effect on reducing caesarean section rates, for example, fetal scalp blood sampling for pH estimation/lactate measurement. The adaptation of pulse oximetry for use in the unborn fetus could potentially contribute to improved evaluation during labour and therefore lead to a reduction in caesarean sections for nonreassuring fetal status, without any change in neonatal outcomes.
OBJECTIVES
To compare the effectiveness and safety of fetal intrapartum pulse oximetry with other surveillance techniques.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2014), contacted experts in the field and searched reference lists of retrieved studies. In previous versions of this review, we performed additional searches of MEDLINE, Embase and Current Contents. These searches were discontinued for this review update, as they consistently failed to identify any trials that were not shown in the Cochrane Pregnancy and Childbirth Group's Trials Register.
SELECTION CRITERIA
All published and unpublished randomised controlled trials that compared maternal and fetal outcomes when fetal pulse oximetry was used in labour, (i) with or without concurrent use of conventional fetal surveillance, that is, cardiotocography (CTG), compared with using CTG alone or (ii) with or without concurrent use of both CTG and other method(s) of fetal surveillance, such as fetal electrocardiography (ECG) plus CTG.
DATA COLLECTION AND ANALYSIS
At least two independent review authors performed data extraction. We sought additional information from the investigators of three of the reported trials.
MAIN RESULTS
We included seven published trials: six comparing fetal pulse oximetry and CTG with CTG alone (or when fetal pulse oximetry values were blinded) and one comparing fetal pulse oximetry plus CTG with fetal ECG plus CTG. The published trials, with some unpublished data, were at high risk of bias in terms of the impractical nature of blinding participants and clinicians, as well as high risk or unclear risk of bias for outcome assessor for all but one report. Selection bias, attrition bias, reporting bias and other sources of bias were of low or unclear risk. The trials reported on a total of 8013 pregnancies. Differing entry criteria necessitated separate analyses, rather than meta-analysis of all trials.Systematic review of four trials from 34 weeks not requiring fetal blood sampling (FBS) prior to study entry showed no evidence of differences in the overall caesarean section rate between those monitored with fetal oximetry and those not monitored with fetal pulse oximetry or for whom the fetal pulse oximetry results were masked (average risk ratio (RR) 0.99 using random-effects, 95% confidence intervals (CI) 0.86 to 1.13, n = 4008, I² = 45%). There was evidence of a higher risk of caesarean section in the group with fetal oximetry plus CTG than in the group with fetal ECG plus CTG (one study, n = 180, RR 1.56, 95% CI 1.06 to 2.29). Neonatal seizures and neonatal encephalopathy were rare in both groups. No studies reported details of long-term disability.There was evidence of a decrease in caesarean section for nonreassuring fetal status in the fetal pulse oximetry plus CTG group compared to the CTG group, gestation from 34 weeks (average RR (random-effects) 0.65, 95% CI 0.46 to 0.90, n = 4008, I² = 63%). There was no evidence of differences between groups in caesarean section for dystocia, although the overall incidence rates varied between the trials.
AUTHORS' CONCLUSIONS
The addition of fetal pulse oximetry does not reduce overall caesarean section rates. One study found a higher caesarean section rate in the group monitored with fetal pulse oximetry plus CTG, compared with fetal ECG plus CTG. The data provide limited support for the use of fetal pulse oximetry when used in the presence of a nonreassuring CTG, to reduce caesarean section for nonreassuring fetal status. A better method than pulse oximetry is required to enhance the overall evaluation of fetal well-being in labour.
Topics: Cardiotocography; Cesarean Section; Delivery, Obstetric; Female; Fetal Monitoring; Humans; Oximetry; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 25287809
DOI: 10.1002/14651858.CD004075.pub4 -
AANA Journal Aug 2021In a series of commentaries in recent issues of the , potential bias in pulse oximetry has been questioned.
In a series of commentaries in recent issues of the , potential bias in pulse oximetry has been questioned.
Topics: Clinical Laboratory Techniques; Guidelines as Topic; Humans; Oximetry; Racism; United States
PubMed: 34342564
DOI: No ID Found -
Journal of Perianesthesia Nursing :... Apr 2022The objective of this review was to evaluate the effectiveness of capnography monitoring versus standard monitoring of pulse oximetry in detecting respiratory adverse... (Review)
Review
PURPOSE
The objective of this review was to evaluate the effectiveness of capnography monitoring versus standard monitoring of pulse oximetry in detecting respiratory adverse events in nonintubated pediatric and adult postanesthesia care unit (PACU) patients.
DESIGN
Experimental, quasi-experimental, and observational studies examining pulse oximetry and capnography in adult and pediatric patients in the PACU were included in this systematic review.
METHODS
An initial search of MEDLINE and CINAHL, PubMed, Web of Science, Prospero, Google Scholar, and Cochrane was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy in July 2019. Reference lists of studies included at critical appraisal stage were hand-searched. Studies published in English from 1978 onward were included.
FINDINGS
Meta-analysis was not possible due to variation in outcome measurements; therefore, results are presented in narrative form. Four studies were included in the review: 1 randomized controlled trial (RCT) and 3 observational cross-sectional studies. The RCT was considered of moderate to high quality, and the observational cross-sectional studies were of high quality. The main findings of this review suggest that there is limited high-quality evidence that capnography improves detection of respiratory adverse events in the PACU versus pulse oximetry.
CONCLUSIONS
The lack of RCTs and varied outcomes measures in the 4 studies reviewed meant that meta-analysis was not possible. Early detection of respiratory adverse events afforded by the addition of PETCO to SpO in the PACU was seen in these studies. More research is needed to determine if widespread implementation of capnography in addition to pulse oximetry would reduce severity of respiratory related adverse events in the PACU through more timely identification.
Topics: Adult; Capnography; Child; Cross-Sectional Studies; Hand; Humans; Monitoring, Physiologic; Oximetry
PubMed: 34974968
DOI: 10.1016/j.jopan.2021.03.013 -
JAMA Jun 2023
Topics: Oximetry; Oxygen; Social Discrimination; United States
PubMed: 37278816
DOI: 10.1001/jama.2023.6721 -
JAMA Jun 2023
Topics: Oximetry; Oxygen; Social Discrimination; United States
PubMed: 37278818
DOI: 10.1001/jama.2023.6718 -
Journal of Intensive Care Medicine Oct 2023Pulse oximetry is widely used in healthcare settings for both screening and continuous monitoring. In this article, it was aimed to review some aspects of pulse... (Review)
Review
Pulse oximetry is widely used in healthcare settings for both screening and continuous monitoring. In this article, it was aimed to review some aspects of pulse oximetry including clinical applications, portable devices, and recent advances in detail. The international and national reliable sources were used in the literature review for critical data analysis. A total of 31 articles including 19 prospective comparative clinical studies, 9 reviews, 1 meta-analysis, 1 retrospective study, and 1 experimental study were used for preparation of this part of the review. In this part of the article, clinical applications of pulse oximeters, portable/wearable pulse oximeters, remote patient monitoring, and recent advances were all reviewed in detail. Pulse oximetry is a widely used and reliable noninvasive technique that provides useful information about blood oxygenation in individuals. This technique can guide oxygen therapy, reduce the occurrence of hypoxemia, and decrease the frequency of admissions to the intensive care unit, as well as arterial blood gas sampling. New multiwaveform sensors and advanced signal processing techniques can differentiate between different types of hemoglobin and may be useful for continuous measurement of total hemoglobin, as well as for detecting and providing information on blood loss and cardiac output.
Topics: Humans; Monitoring, Physiologic; Oximetry; Oxygen; Prospective Studies; Retrospective Studies; Wearable Electronic Devices
PubMed: 37464772
DOI: 10.1177/08850666231189175 -
Physiological Measurement Nov 2022Sleep apnea (SA) is characterized by intermittent episodes of apnea or hypopnea paused or reduced breathing, respectively each lasting at least ten seconds that occur... (Review)
Review
Sleep apnea (SA) is characterized by intermittent episodes of apnea or hypopnea paused or reduced breathing, respectively each lasting at least ten seconds that occur during sleep. SA has an estimated global prevalence of 200 million and is associated with medical comorbidity, and sufferers are also more likely to sustain traffic- and work-related injury due to daytime somnolence. SA is amenable to treatment if detected early. Polysomnography (PSG) involving multi-channel signal acquisition is the reference standard for diagnosing SA but is onerous and costly. For home-based detection of SA, single-channelsignal acquisition using portable pulse oximeters is feasible. Machine (ML) and deep learning (DL) models have been developed for automated classification of SA versus no SA usingsignals alone. In this work, we review studies published between 2012 and 2022 on the use of ML and DL forsignal-based diagnosis of SA. A literature search based on PRISMA recommendations yielded 297 publications, of which 31 were selected after considering the inclusion and exclusion criteria. There were 20 ML and 11 DL models; their methods, differences, results, merits, and limitations were discussed. Many studies reported encouraging performance, which indicates the utility ofsignals in wearable devices for home-based SA detection.
Topics: Humans; Sleep Apnea Syndromes; Polysomnography; Oximetry; Heart Rate; Oxygen
PubMed: 36215979
DOI: 10.1088/1361-6579/ac98f0 -
Journal of Analytical Toxicology Mar 2023A comparative evaluation of two methods used for carboxyhemoglobin (COHb) determination in postmortem whole blood was performed: carbon monoxide (CO)-oximetry measuring...
Comparative Evaluation of Carboxyhemoglobin Quantification in Postmortem Whole Blood by CO-Oximetry and Headspace Gas Chromatography with Flame Ionization Detection and Atom Absorption Spectrophotometry.
A comparative evaluation of two methods used for carboxyhemoglobin (COHb) determination in postmortem whole blood was performed: carbon monoxide (CO)-oximetry measuring at 128 wavelengths and headspace gas chromatography with flame ionization detection (HS-GC--FID) where CO was determined after catalytic reduction of CO to CH4 and Fe was determined by atom absorption spectrophotometry (AAS, 248.3 nm). An aliquot of 100 µL whole blood was loaded into the CO-oximetry module. In the HS-GC--FID analysis, to 1.0 mL of whole blood, 3.0 mL of saponin solution was added, mixed and centrifuged. To 20 mL HS vials, 400 µL of the supernatant was added and the vials were immediately sealed. One milliliter of potassium hexacyanoferrat (III) solution was added through the HS septum and mixed. The samples were incubated at 70°C for 5 min. CO was separated using He as carrier gas and a CP-Molsieve 5 Å PLOT capillary column. Fe was determined using 400 µL of the saponin supernatant diluted to 10 mL by water. During a period of ∼3 years, 124 postmortem whole blood samples were analyzed. Bland-Altman method comparison showed satisfactory agreement and no significant bias between the methods for the whole saturation range (5 to 85% COHb). Five samples, all with %COHb >40, showed deviations of more than 10% COHb in absolute terms. One sample, in the lower COHb range <10%, was false negative on the CO-oximetry method. The between-assay accuracy, reported as bias, at 60% COHb was -0.8% and -9.0%, and precision, reported as relative standard deviation, was 1.6% and 7.7%, for the CO-oximetry and HS-GC--FID-AAS methods, respectively. Both methods obtained satisfactory results in proficiency testing rounds, with z-scores <±2 (n = 11). This study showed that the CO-oximetry method based on the 128-wavelength principle and the HS-GC--FID-AAS method are comparable and satisfactory for %COHb determination in postmortem whole blood.
Topics: Male; Humans; Carboxyhemoglobin; Flame Ionization; Oximetry; Chromatography, Gas; Spectrophotometry, Atomic
PubMed: 36495201
DOI: 10.1093/jat/bkac099