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Journal of Global Health Sep 2023Pulse oximetry has been used in medical care for decades. Its use quickly became standard of care in high resource settings, with delayed widespread availability and use...
BACKGROUND
Pulse oximetry has been used in medical care for decades. Its use quickly became standard of care in high resource settings, with delayed widespread availability and use in lower resource settings. Pulse oximetry training initiatives have been ongoing for years, but a map of the literature describing such initiatives among health care workers in low- and middle-income countries (LMICs) has not previously been conducted. Additionally, the coronavirus disease 2019 (COVID-19) pandemic further highlighted the inequitable distribution of pulse oximetry use and training. We aimed to characterise the landscape of pulse oximetry training for health care workers in LMICs prior to the COVID-19 pandemic as described in the literature.
METHODS
We systematically searched six databases to identify studies reporting pulse oximetry training among health care workers, broadly defined, in LMICs prior to the COVID-19 pandemic. Two reviewers independently assessed titles and abstracts and relevant full texts for eligibility. Data were charted by one author and reviewed for accuracy by a second. We synthesised the results using a narrative synthesis.
RESULTS
A total of 7423 studies were identified and 182 screened in full. A total of 55 training initiatives in 42 countries met inclusion criteria, as described in 66 studies since some included studies reported on different aspects of the same training initiative. Five overarching reasons for conducting pulse oximetry training were identified: 1) anaesthesia and perioperative care, 2) respiratory support programme expansion, 3) perinatal assessment and monitoring, 4) assessment and monitoring of children and 5) assessment and monitoring of adults. Educational programmes varied in their purpose with respect to the types of patients being targeted, the health care workers being instructed, and the depth of pulse oximetry specific training.
CONCLUSIONS
Pulse oximetry training initiatives have been ongoing for decades for a variety of purposes, utilising a multitude of approaches to equip health care workers with tools to improve patient care. It is important that these initiatives continue as pulse oximetry availability and knowledge gaps remain. Neither pulse oximetry provision nor training alone is enough to bolster patient care, but sustainable solutions for both must be considered to meet the needs of both health care workers and patients.
Topics: Adult; Child; Female; Pregnancy; Humans; Developing Countries; Pandemics; COVID-19; Educational Status; Health Personnel
PubMed: 37736848
DOI: 10.7189/jogh.13.04074 -
Pediatric Pulmonology Aug 2021To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes. (Review)
Review
OBJECTIVE
To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes.
METHODS
Five online databases were searched from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Data extracted included patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location, and length of observation period, and clinical outcomes were also collected. Descriptive statistical analyses were performed.
RESULTS
A total of 24 studies including 1395 children were reviewed. Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (35%), upper airway obstruction not at a well-defined site (12%) and need for long-term ventilation and pulmonary care (53%). Bronchoscopy was routinely used in 23 of 24 (96%) protocols. Tracheostomy tube modifications in the protocols included capping (n = 20, 83%), downsizing (n = 14, 58%), and fenestrations (n = 2, 8%). Measurements of gas exchange included polysomnography (n = 13/18, 72%), oximetry (n = 10/18, 56%), blood gases (n = 3,17%), and capnography (n = 3, 17%). After decannulation, children in 92% of protocols were transitioned to room air. Observation period of 48 h or less was used in 76% of children.
CONCLUSIONS
There exists large variability in pediatric decannulation protocols. Polysomnography plays an integral role in assessing most children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.
Topics: Bronchoscopy; Child; Clinical Protocols; Device Removal; Humans; Polysomnography; Retrospective Studies; Tracheostomy
PubMed: 34231976
DOI: 10.1002/ppul.25503 -
BMC Pediatrics Oct 2023Bath is an external stimulus for preterm infants. Currently, three methods are used for preterm infants to bath. It is important to choose the best way for them. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Bath is an external stimulus for preterm infants. Currently, three methods are used for preterm infants to bath. It is important to choose the best way for them. The objective of this meta-analysis is to evaluate the effectiveness of different bath methods on physiological indexes and behavioral status of preterm infants.
METHODS
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO(CRD42022377657). PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Sino Med, China National Knowledge Internet (CNKI) and Wan-Fang database were systematically searched for randomized controlled trials on the effects of different bath methods for preterm infants. The retrieval time was from the establishment of the database to February 2023. According to the inclusion and exclusion criteria, the literature was screened, quality evaluated and the data was extracted. Reman Version 5.4 was used for meta-analysis and Stata 16.0 software for publication bias Egger's test.
RESULTS
A total of 11 RCTs with 828 preterm infants were included. The results of meta-analysis showed that the body temperature and oxygen saturation of preterm infants in the sponge bath group were lower than those in conventional tub bath group (SMD = -0.34; 95%CI -0.56 to -0.12; I = 0; p < 0.01), (MD = -0.39; 95%CI -0.76 to -0.02; I = 39%; p = 0.04), while the heart rates were higher than those in conventional tub bath group(MD = 5.90; 95%CI 0.44 to 11.35; I = 61%; p = 0.03). Preterm infant's body temperature and blood oxygen saturation of in swaddle bath group were higher than those in conventional tub bath group (MD = 0.18; 95%CI 0.05 to 0.30; I = 88%; p < 0.01), (MD = 1.11; 95%CI 0.07 to 2.16; I = 86%; p = 0.04), respiratory rates were more stable compared with infants in conventional tub bath group (MD = -2.73; 95%CI -3.43 to -2.03; I = 0; p < 0.01). The crying duration, stress and pain scores of preterm infants in swaddle bath group were lower than those in conventional tub bath group (SMD = -1.64; 95CI -2.47 to -0.82; I = 91%; p < 0.01), (SMD = -2.34; 95%CI -2.78 to -1.91; I = 0; p < 0.01), (SMD = -1.01; 95%CI -1.40 to -0.62; I = 49%; p < 0.01). Egger's test showed no publication bias in body temperature, respiratory rate, oxygen saturation, and crying duration.
CONCLUSIONS
Swaddle bath is the best bathing method than conventional tub bath and sponge bath in maintaining the stability of preterm infant's body temperature, blood oxygen saturation and respiratory rate. In addition, swaddle bath also plays a role in reducing cry duration, stress scores, and pain levels of preterm infant compared with conventional tub bath and sponge bath. However, due to the important heterogeneity in some outcomes, future studies with larger sample size and more appropriately design are needed to conduct before recommendation.
TRIAL REGISTRATION
Prospero CRD42022377657.
Topics: Infant; Infant, Newborn; Humans; Infant, Premature; Body Temperature; Crying; Oximetry; Pain
PubMed: 37828460
DOI: 10.1186/s12887-023-04280-y -
BMJ Global Health Nov 2021Acute fever is a common presenting symptom in low/middle-income countries (LMICs) and is strongly associated with sepsis. Hypoxaemia predicts disease severity in such...
BACKGROUND
Acute fever is a common presenting symptom in low/middle-income countries (LMICs) and is strongly associated with sepsis. Hypoxaemia predicts disease severity in such patients but is poorly detected by clinical examination. Therefore, including pulse oximetry in the assessment of acutely febrile patients may improve clinical outcomes in LMIC settings.
METHODS
We systematically reviewed studies of any design comparing one group where pulse oximetry was used and at least one group where it was not. The target population was patients of any age presenting with acute febrile illness or associated syndromes in LMICs. Studies were obtained from searching PubMed, EMBASE, CABI Global Health, Global Index Medicus, CINAHL, Cochrane CENTRAL, Web of Science and DARE. Further studies were identified through searches of non-governmental organisation websites, snowballing and input from a Technical Advisory Panel. Outcomes of interest were diagnosis, management and patient outcomes. Study quality was assessed using the Cochrane Risk of Bias 2 tool for Cluster Randomised Trials and Risk of Bias in Non-randomized Studies of Interventions tools, as appropriate.
RESULTS
Ten of 4898 studies were eligible for inclusion. Their small number and heterogeneity prevented formal meta-analysis. All studies were in children, eight only recruited patients with pneumonia, and nine were conducted in Africa or Australasia. Six were at serious risk of bias. There was moderately strong evidence for the utility of pulse oximetry in diagnosing pneumonia and identifying severe disease requiring hospital referral. Pulse oximetry used as part of a quality-assured facility-wide package of interventions may reduce pneumonia mortality, but studies assessing this endpoint were at serious risk of bias.
CONCLUSIONS
Very few studies addressed this important question. In LMICs, pulse oximetry may assist clinicians in diagnosing and managing paediatric pneumonia, but for the greatest impact on patient outcomes should be implemented as part of a health systems approach. The evidence for these conclusions is not widely generalisable and is of poor quality.
Topics: Africa; Child; Developing Countries; Humans; Income; Oximetry
PubMed: 34824136
DOI: 10.1136/bmjgh-2021-007282 -
Translational Vision Science &... Aug 2020Hyperspectral imaging is gaining attention in the biomedical field because it generates additional spectral information to study physiological and clinical processes....
PURPOSE
Hyperspectral imaging is gaining attention in the biomedical field because it generates additional spectral information to study physiological and clinical processes. Several technologies have been described; however an independent, systematic literature overview is lacking, especially in the field of ophthalmology. This investigation is the first to systematically overview scientific literature specifically regarding retinal hyperspectral imaging.
METHODS
A systematic literature review was conducted, in accordance with PRISMA Statement 2009 criteria, in four bibliographic databases: Medline, Embase, Cochrane Database of Systematic Reviews, and Web of Science.
RESULTS
Fifty-six articles were found that meet the review criteria. A range of techniques was reported: Fourier analysis, liquid crystal tunable filters, tunable laser sources, dual-slit monochromators, dispersive prisms and gratings, computed tomography, fiber optics, and Fabry-Perrot cavity filter covered complementary metal oxide semiconductor. We present a narrative synthesis and summary tables of findings of the included articles, because methodologic heterogeneity and diverse research topics prevented a meta-analysis being conducted.
CONCLUSIONS
Application in ophthalmology is still in its infancy. Most previous experiments have been performed in the field of retinal oximetry, providing valuable information in the diagnosis and monitoring of various ocular diseases. To date, none of these applications have graduated to clinical practice owing to the lack of sufficiently large validation studies.
TRANSLATIONAL RELEVANCE
Given the promising results that smaller studies show for hyperspectral imaging (e.g., in Alzheimer's disease), advanced research in larger validation studies is warranted to determine its true clinical potential.
Topics: Alzheimer Disease; Humans; Hyperspectral Imaging; MEDLINE; Retina
PubMed: 32879765
DOI: 10.1167/tvst.9.9.9 -
Children (Basel, Switzerland) Apr 2021Continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) is the main method to guide respiratory and oxygen support in neonates during postnatal... (Review)
Review
Continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) is the main method to guide respiratory and oxygen support in neonates during postnatal stabilization and after admission to neonatal intensive care unit. The accuracy of these devices is therefore crucial. The presence of fetal hemoglobin (HbF) in neonatal blood might affect SpO2 readings. We performed a systematic qualitative review to investigate the impact of HbF on SpO2 accuracy in neonates. PubMed/Medline, Embase, Cumulative Index to Nursing & Allied Health database (CINAHL) and Cochrane library databases were searched from inception to January 2021 for human studies in the English language, which compared arterial oxygen saturations (SaO2) from neonatal blood with SpO2 readings and included HbF measurements in their reports. Ten observational studies were included. Eight studies reported SpO2-SaO2 bias that ranged from -3.6%, standard deviation (SD) 2.3%, to +4.2% (SD 2.4). However, it remains unclear to what extent this depends on HbF. Five studies showed that an increase in HbF changes the relation of partial oxygen pressure (paO2) to SpO2, which is physiologically explained by the leftward shift in oxygen dissociation curve. It is important to be aware of this shift when treating a neonate, especially for the lower SpO2 limits in preterm neonates to avoid undetected hypoxia.
PubMed: 33946236
DOI: 10.3390/children8050361 -
Cureus Feb 2023The purpose of this review is to summarize the research on the accuracy of oxygen saturation (spO) measurements using the Apple Watch (Apple Inc., Cupertino,... (Review)
Review
The purpose of this review is to summarize the research on the accuracy of oxygen saturation (spO) measurements using the Apple Watch (Apple Inc., Cupertino, California). The Medline and Google Scholar databases were searched for papers evaluating the spO measurements of the Apple Watch vs. any kind of ground truth and records were analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The five publications with 973 total patients that met the inclusion criteria all used the Apple Watch Series 6 and described 95% limits of agreement of +/- 2.7 to 5.9% spO. However, outliers of up to 15% spO were reported. Only one study had patient-level data uploaded to a public repository. The Apple Watch Series 6 does not show a strong systematic bias compared to conventional, medical-grade pulse oximeters. However, outliers do occur and should not cause concern in otherwise healthy individuals. The impact of race on measurement accuracy should be investigated.
PubMed: 36974257
DOI: 10.7759/cureus.35355 -
Journal of the Indian Society of... 2022This study aimed to determine the mean oxygen saturation values (SpO) in primary teeth using pulse oximetry. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This study aimed to determine the mean oxygen saturation values (SpO) in primary teeth using pulse oximetry.
MATERIALS AND METHODS
This comprehensive literature search on pulse oximeter used for primary teeth in determining pulp vitality using MeSH terms in four electronic databases, including PubMed, Scopus, Cochrane Library, and Ovid, from January 1990 to January 2022. Studies reported the sample size and the mean SpO values (with standard deviations) for each tooth group were included. The quality assessment of all the included studies was done using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa Scale. The meta-analysis included studies reporting means and standard deviations of SpO values. The I statistics were used to determine the degree of heterogeneity among the studies.
RESULTS
A total of 90 studies were identified, of which five met the eligibility criteria that were qualified for the systematic review, and among them, three were included in the meta-analysis. All five included studies were of low quality due to the high risk of bias related to the patient selection, index test, and uncertainties about outcome valuation. In the meta-analysis, the mean fixed-effect measure of oxygen saturation in the pulp of primary teeth was 88.45% (confidence interval: 83.97%-92.93%).
CONCLUSION
Though most of the available studies were of poor quality, the SpO in the healthy pulp can be established (minimum saturation, 83.48%) in primary teeth. Reference values established might help clinicians to assess changes in pulp status.
Topics: Humans; Oxygen Saturation; Dental Pulp; Oximetry; Health Status; Tooth, Deciduous
PubMed: 36861550
DOI: 10.4103/jisppd.jisppd_359_22 -
Cureus Oct 2023Hemodynamic monitoring of neonates is crucial because neonates are easily and acutely susceptible to hemodynamic disturbances. As such, non-invasive monitoring of... (Review)
Review
Hemodynamic monitoring of neonates is crucial because neonates are easily and acutely susceptible to hemodynamic disturbances. As such, non-invasive monitoring of hemodynamics is preferable. It has been postulated that non-invasive pulse oximetry determines the perfusion index and pulse variability index and provides accurate measurements to predict hemodynamic changes in preterm or term infants. Equally, numerous studies have investigated the efficacy of perfusion and pulse variability indices in monitoring neonatal hemodynamics. The aim of this study was to systematically review studies that have delved into the role of perfusion and pulse variability indices in the assessment of neonatal hemodynamics. The study collected data from 2010-2023 using the patient, intervention, comparison, outcome (PICO) search strategy using the databases PubMed, Scopus, and Excerpta Medica database (Embase). A total of 616 articles were evaluated based on their appropriateness and relevance; we included seven studies. As per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review. Our study concluded that these indices were effective in measuring hemodynamics.
PubMed: 38046508
DOI: 10.7759/cureus.48058 -
Sports Medicine (Auckland, N.Z.) Apr 2024In the last 5 years since our last systematic review, a significant number of articles have been published on the technical aspects of muscle near-infrared spectroscopy...
BACKGROUND
In the last 5 years since our last systematic review, a significant number of articles have been published on the technical aspects of muscle near-infrared spectroscopy (NIRS), the interpretation of the signals and the benefits of using the NIRS technique to measure the physiological status of muscles and to determine the workload of working muscles.
OBJECTIVES
Considering the consistent number of studies on the application of muscle oximetry in sports science published over the last 5 years, the objectives of this updated systematic review were to highlight the applications of muscle oximetry in the assessment of skeletal muscle oxidative performance in sports activities and to emphasize how this technology has been applied to exercise and training over the last 5 years. In addition, some recent instrumental developments will be briefly summarized.
METHODS
Preferred Reporting Items for Systematic Reviews guidelines were followed in a systematic fashion to search, appraise and synthesize existing literature on this topic. Electronic databases such as Scopus, MEDLINE/PubMed and SPORTDiscus were searched from March 2017 up to March 2023. Potential inclusions were screened against eligibility criteria relating to recreationally trained to elite athletes, with or without training programmes, who must have assessed physiological variables monitored by commercial oximeters or NIRS instrumentation.
RESULTS
Of the identified records, 191 studies regrouping 3435 participants, met the eligibility criteria. This systematic review highlighted a number of key findings in 37 domains of sport activities. Overall, NIRS information can be used as a meaningful marker of skeletal muscle oxidative capacity and can become one of the primary monitoring tools in practice in conjunction with, or in comparison with, heart rate or mechanical power indices in diverse exercise contexts and across different types of training and interventions.
CONCLUSIONS
Although the feasibility and success of the use of muscle oximetry in sports science is well documented, there is still a need for further instrumental development to overcome current instrumental limitations. Longitudinal studies are urgently needed to strengthen the benefits of using muscle oximetry in sports science.
Topics: Humans; Oximetry; Muscle, Skeletal; Spectroscopy, Near-Infrared; Oxygen Consumption; Sports Medicine
PubMed: 38345731
DOI: 10.1007/s40279-023-01987-x