-
Frontiers in Pediatrics 2022Peripheral fractional oxygen extraction (pFOE) measured with near-infrared spectroscopy (NIRS) in combination with venous occlusion is of increasing interest in term and...
BACKGROUND
Peripheral fractional oxygen extraction (pFOE) measured with near-infrared spectroscopy (NIRS) in combination with venous occlusion is of increasing interest in term and preterm neonates.
OBJECTIVE
The aim was to perform a systematic qualitative review of literature on the clinical use of pFOE in term and preterm neonates and on the changes in pFOE values over time.
METHODS
A systematic search of PubMed, Embase and Medline was performed using following terms: newborn, infant, neonate, preterm, term, near-infrared spectroscopy, NIRS, oximetry, spectroscopy, tissue, muscle, peripheral, arm, calf, pFOE, OE, oxygen extraction, fractional oxygen extraction, peripheral perfusion and peripheral oxygenation. Additional articles were identified by manual search of cited references. Only studies in human neonates were included.
RESULTS
Nineteen studies were identified describing pFOE measured with NIRS in combination with venous occlusion. Nine studies described pFOE measured on the forearm and calf at different time points after birth, both in stable preterm and term neonates without medical/respiratory support or any pathological findings. Nine studies described pFOE measured at different time points in sick preterm and term neonates presenting with signs of infection/inflammation, anemia, arterial hypotension, patent ductus arteriosus, asphyxia or prenatal tobacco exposure. One study described pFOE both, in neonates with and without pathological findings.
CONCLUSION
This systematic review demonstrates that pFOE may provide additional insight into peripheral perfusion and oxygenation, as well as into disturbances of microcirculation caused by centralization in preterm and term neonates with different pathological findings.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021249235].
PubMed: 36081622
DOI: 10.3389/fped.2022.940915 -
Brazilian Oral Research 2023The main purpose of this study was to answer the question: "Can radiotherapy cause changes in the dental pulp condition of patients treated with irradiation in the head...
The main purpose of this study was to answer the question: "Can radiotherapy cause changes in the dental pulp condition of patients treated with irradiation in the head and neck region?" Clinical observational studies in adults with head and neck cancer undergoing treatment with ionizing radiation, longitudinal or cross-sectional follow-up to measure oxygen saturation (SpO2), and/or pulp sensitivity test to cold stimulation, were considered eligible. A systematic literature search was performed in six different databases, including the gray literature, and in article references. Two independent evaluators selected the studies, extracted the data, recorded the data on electronic spreadsheets, and then evaluated the methodological quality using the Checklist for Quasi-Experimental Studies tool devised by JBI. The data were assessed qualitatively using the Synthesis Without Metanalysis (SWiM) guidelines. After removing the duplicate articles, carefully analyzing the titles and abstracts, and reading the papers in full, seven studies were included. Four of the studies evaluated applied the cold sensitivity test, two associated pulse oximetry and cold sensitivity, and only one used just pulse oximetry. Evaluation using the cold sensitivity test and pulse oximetry in the initial periods before radiotherapy showed a decrease in the sensitive response and in SpO2 levels during a maximum period of 1 year. However, analyses thereafter indicated a normal response in both tests from 5 to 6 years after the end of radiotherapy treatment. Radiotherapy causes changes in pulp behavior patterns in the short term; however, recovery and return to average values occurs after long periods.
Topics: Adult; Humans; Cross-Sectional Studies; Head and Neck Neoplasms; Oximetry; Dental Pulp Diseases; Radiation, Ionizing; Dental Pulp
PubMed: 37531515
DOI: 10.1590/1807-3107bor-2023.vol37.0079 -
Neonatology 2023The noninvasive hemoglobin (NHb) devices are recently evaluated as an alternative to laboratory hemoglobin (LHb) in neonates. This systematic review explores the... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVE
The noninvasive hemoglobin (NHb) devices are recently evaluated as an alternative to laboratory hemoglobin (LHb) in neonates. This systematic review explores the diagnostic accuracy of NHb devices for neonatal hemoglobin measurement.
METHODS
Literature related to the comparison of NHb device with LHb in neonates was searched from Medline, PubMed Central, PubMed, Web of Science, Google Scholar, and Scopus databases after PROSPERO registration. The quality of included publications was assessed by QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). The pooled correlation coefficient and bias (precision) in Bland-Altman difference plots were used for summary statistics using MetaXL 5.0 software.
RESULTS
A total of 1,477 paired NHb-LHb observations were analyzed from 1,047 neonates in 10 studies. Massimo radical-pulse co-oximetry (8 studies) and Mediscan-2000 (2 studies) were used for NHb estimation. The pooled correlation coefficient between NHb and LHb was r = 0.94 (95% CI: 0.83-0.98, p < 0.001), and the pooled bias (precision) was -0.013 (1.4) gm/dL between NHb and LHb measurements in Bland-Altman analysis. NHb device had better precision in stable neonates (0.91gm/dL) over sick neonates (1.66 gm/dL).
CONCLUSIONS
Hemoglobin measurement by NHb is excellently correlated with LHb measurement with a minimal average difference. It may be used as a screening tool for hemoglobin measurement in neonates to avoid frequent phlebotomy.
Topics: Infant, Newborn; Humans; Hemoglobins; Oximetry; Data Collection
PubMed: 36450265
DOI: 10.1159/000526100 -
European Journal of Vascular and... Nov 2021Carotid endarterectomy is recommended for the prevention of ischaemic stroke due to carotid stenosis. However, the risk of stroke after carotid endarterectomy has been... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Carotid endarterectomy is recommended for the prevention of ischaemic stroke due to carotid stenosis. However, the risk of stroke after carotid endarterectomy has been estimated at 2% - 5%. Monitoring intra-operative cerebral oxygenation with near infrared spectroscopy (NIRS) has been assessed as a strategy to reduce intra- and post-operative complications. The aim was to summarise the diagnostic accuracy of NIRS to detect intra-operative ischaemic events, the values associated with ischaemic events, and the relative contribution of external carotid contamination to the NIRS signal in adults undergoing carotid endarterectomy.
DATA SOURCES
EMBASE, MEDLINE, Cochrane Centre Register of Controlled Trials, and reference lists through May 2019 were searched.
REVIEW METHODS
Non-randomised and randomised studies assessing NIRS as an intra-operative monitoring tool in carotid endarterectomy were included. Studies using NIRS as the reference were excluded. Risk of bias was assessed using the Newcastle Ottawa Scale, RoB-2, and QUADAS-2.
RESULTS
Seventy-six studies were included (n = 8 480), under local (n = 1 864) or general (n = 6 582) anaesthesia. Seven studies were eligible for meta-analysis (n = 524). As a tool for identifying intra-operative ischaemia, specificity increased with more stringent NIRS thresholds, while there was unpredictable variation in sensitivity across studies. A Δ20% threshold under local anaesthesia resulted in pooled estimates for sensitivity and specificity of 70.5% (95% confidence interval, CI, 54.1 - 82.9) and 92.4% (95% CI 85.5 - 96.1) compared with awake neurological monitoring. These studies had low or unclear risk of bias. NIRS signal consistently dropped across clamping and recovered to pre-clamp values upon de-clamp in most studies, and larger decreases were observed in patients with ischaemic events. The contribution of extracranial signal to change in signal across clamp varied from 3% to 50%.
CONCLUSION
NIRS has low sensitivity and high specificity to identify intra-operative ischaemia compared with awake monitoring. Extracranial signal contribution was highly variable. Ultimately, data from high quality studies are desperately needed to determine the utility of NIRS.
Topics: Carotid Stenosis; Endarterectomy, Carotid; Humans; Monitoring, Intraoperative; Sensitivity and Specificity; Spectroscopy, Near-Infrared
PubMed: 34627675
DOI: 10.1016/j.ejvs.2021.08.022 -
Medicina (Kaunas, Lithuania) Aug 2023Limited palatal muscle resection (PMR) is a surgical technique employed to alleviate respiratory disturbances in obstructive sleep apnea (OSA) patients with... (Meta-Analysis)
Meta-Analysis
Limited palatal muscle resection (PMR) is a surgical technique employed to alleviate respiratory disturbances in obstructive sleep apnea (OSA) patients with retropalatal narrowing by reducing soft palate volume and tightening the muscles. Although some previous publications have demonstrated the effectiveness of limited PMR, the overall efficacy and therapeutic role of limited PMR for the treatment of OSA remain uncertain. This study utilized meta-analysis and a systematic literature review to estimate the overall effectiveness of limited PMR in treating OSA. Multiple databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, were searched using specific keywords related to OSA and limited PMR. Original articles assessing respiratory disturbances before and after limited PMR in patients with OSA were included. Data from selected articles were collected using standardized forms, including clinicodemographic characteristics, apnea-hypopnea index (AHI), and lowest pulse oximetry values (minimum SpO). Random effect models were used for analyzing significant heterogeneity. Egger's test and funnel plot were used to identify publication bias. Four studies were included in this meta-analysis for AHI, and three studies were included for minimum SpO during sleep. A significant reduction in the AHI and an increase in the minimum SpO were shown following limited PMR as the standardized mean difference (95% confidence interval) was 2.591 (1.092-4.090) and 1.217 (0.248-2.186), respectively. No publication bias was found in either analysis. The results of the meta-analysis and systemic review add to the literature that limited PMR can result in a reduction in the AHI and an increase in min SaO. In OSA patients with suspected retropalatal obstruction, limited PMR may be efficiently performed.
Topics: Humans; Databases, Factual; Palatal Muscles; Sleep; Sleep Apnea, Obstructive
PubMed: 37629722
DOI: 10.3390/medicina59081432 -
Journal of Vascular Surgery May 2021No agreement has been reached regarding which bedside test is the most useful for the diagnosis of peripheral arterial disease (PAD) in patients with diabetes. The aim... (Meta-Analysis)
Meta-Analysis
A systematic review and meta-analysis of the diagnostic accuracy of point-of-care tests used to establish the presence of peripheral arterial disease in people with diabetes.
OBJECTIVE
No agreement has been reached regarding which bedside test is the most useful for the diagnosis of peripheral arterial disease (PAD) in patients with diabetes. The aim of the present systematic review and meta-analysis was to evaluate the performance of bedside tests for the detection of PAD in individuals with diabetes.
METHODS
MEDLINE and EMBASE databases were systematically searched for studies providing data on the diagnostic performance of bedside tests used for the detection of PAD in those with diabetes. A meta-analysis was performed to obtain pooled estimates of sensitivity and specificity for the diagnosis of PAD.
RESULTS
A total of 18 studies, reporting on a total of 3016 limbs of diabetic patients, were included in our qualitative review. Of these, 11 studies (1543 limbs) were included in the meta-analysis of diagnostic accuracy: ankle-brachial pressure index (9 studies and 1368 limbs; sensitivity, 63.5% [95% confidence interval (CI), 51.7%-73.9%]; specificity, 89.3% [95% CI, 81.1%-94.2%]); toe-brachial pressure index (3 studies and 221 limbs; sensitivity, 83.0% [95% CI, 59.1-94.3%]; specificity, 66.3% [95% CI, 41.3%-84.6%]); and tibial waveform assessment (4 studies and 397 limbs; sensitivity, 82.8% [95% CI, 73.3%-89.4%], specificity, 86.8% [95% CI, 75.5%-93.3%]). Overall, we found a high risk of bias across the studies, most frequently relating to patient selection and the lack of blinding.
CONCLUSIONS
The toe-brachial pressure index, pulse oximetry, and tibial arterial waveform assessment demonstrated some promise, warranting further investigation.
Topics: Ankle Brachial Index; Diabetic Foot; Female; Humans; Male; Oximetry; Peripheral Arterial Disease; Point-of-Care Testing; Predictive Value of Tests; Prognosis; Reproducibility of Results; Ultrasonography, Doppler
PubMed: 33278543
DOI: 10.1016/j.jvs.2020.11.030 -
Clinical Oral Investigations Nov 2020Currently, procedural sedation in the clinical setting relies heavily on the use of pulse oximetry to monitor hypoxemia. Different studies suggest that incidence of... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Currently, procedural sedation in the clinical setting relies heavily on the use of pulse oximetry to monitor hypoxemia. Different studies suggest that incidence of hypoxemia and incidence of arterial oxygen desaturation are reduced by early intervention via capnography monitoring. The aim of this article was to discuss the importance of implementing capnography monitoring during procedural sedations performed in a dental setting and determine whether additional capnographic monitoring reduces the incidence of arterial oxygen desaturation and the overall complications rate.
MATERIALS AND METHODS
Two independent reviewers conducted electronic (PubMed and EMBASE) and manual searches up to February 2020. Randomized clinical trials (RCTs), including both patients under procedural sedation monitored by capnography and oximetry, and reporting the incidence of hypoxemia or episodes of oxygen desaturation were included. Risk ratio was used to compare the outcomes (i.e., the incidence of hypoxemia, the episodes of oxygen desaturation, the detection of apnea, the reduction of events of bradycardia, and hypotension) between patients monitored by capnography and standard approach.
RESULTS
Fourteen randomized clinical trials fulfilling the inclusion criteria were selected. The analysis revealed that capnography monitoring group showed the lower incidence of hypoxemia (RR 0.76, 95%CI 0.70 to 0.83, p < 0.001) and the episodes of oxygen desaturation (RR 0.79, 95%CI 0.71 to 0.87, p < 0.001) compared with the oximetry monitoring group. Apnea was detected in capnography monitoring earlier than standard monitoring (RR 2.60, 95%CI 2.30 to 2.93, p < 0.001). No significant difference was found between capnography and standard monitoring groups in terms of reduction of events of bradycardia (RR 1.17, 95%CI 0.91 to 1.50, p = 0.225) and hypotension (RR 0.96, 95%CI 0.76 to 1.21, p = 0.746).
CONCLUSION
Capnography monitoring reduced incidence of hypoxemia during procedural sedations. Within the limitations of this review, we suggest that the application of capnography during procedural sedation would decrease the frequency of oxygen desaturation events and incidence of hypoxemia.
CLINICAL RELEVANCE
Training and instructing dental providers on using capnography monitoring would help in reducing adverse events during intravenous sedation.
Topics: Capnography; Conscious Sedation; Humans; Hypoxia; Incidence; Monitoring, Physiologic
PubMed: 32556657
DOI: 10.1007/s00784-020-03395-1 -
CMAJ : Canadian Medical Association... Apr 2021Cesarean delivery is the most common surgical procedure worldwide. Intrapartum fetal surveillance is routinely offered to improve neonatal outcomes, but the effects of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cesarean delivery is the most common surgical procedure worldwide. Intrapartum fetal surveillance is routinely offered to improve neonatal outcomes, but the effects of different methods on the risk of emergency cesarean deliveries remains uncertain. We conducted a systematic review and network meta-analysis to evaluate the effectiveness of different types of fetal surveillance.
METHODS
We searched MEDLINE, Embase and CENTRAL until June 1, 2020, for randomized trials evaluating any intrapartum fetal surveillance method. We performed a network meta-analysis within a frequentist framework. We assessed the quality and network inconsistency of trials. We reported primarily on intrapartum emergency cesarean deliveries and other secondary maternal and neonatal outcomes using risk ratios (RRs) and 95% confidence intervals (CIs).
RESULTS
We included 33 trials (118 863 patients) evaluating intermittent auscultation with Pinard stethoscope/handheld Doppler (IA), cardiotocography (CTG), computerized cardiotocography (cCTG), CTG with fetal scalp lactate (CTG-lactate), CTG with fetal scalp pH analysis (CTG-FBS), CTG with fetal pulse oximetry (FPO-CTG), CTG with fetal heart electrocardiogram (CTG-STAN) and their combinations. Intermittent auscultation reduced the risk of emergency cesarean deliveries compared with other types of surveillance (IA v. CTG: RR 0.83, 95% CI 0.72-0.97; IA v. CTG-FBS: RR 0.71, 95% CI 0.63-0.80; IA v.CTG-lactate: RR 0.77, 95% CI 0.64-0.92; IA v. FPO-CTG: RR 0.75, 95% CI 0.65-0.87; IA v.FPO-CTG-FBS: RR 0.81, 95% CI 0.67-0.99; cCTG-FBS v. IA: RR 1.21, 95% CI 1.04-1.42), except STAN-CTG-FBS (RR 1.17, 95% CI 0.98-1.40). There was a similar reduction observed for emergency cesarean deliveries for fetal distress. None of the evaluated methods was associated with a reduced risk of neonatal acidemia, neonatal unit admissions, Apgar scores or perinatal death.
INTERPRETATION
Compared with other types of fetal surveillance, intermittent auscultation seems to reduce emergency cesarean deliveries in labour without increasing adverse neonatal and maternal outcomes.
Topics: Cesarean Section; Female; Fetal Monitoring; Humans; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic
PubMed: 33824144
DOI: 10.1503/cmaj.202538 -
Journal of Clinical Monitoring and... Aug 2022One of the most significant limitations of oximeters is their performance under poor perfusion conditions. This systematic review examines pulse oximeter model accuracy... (Review)
Review
One of the most significant limitations of oximeters is their performance under poor perfusion conditions. This systematic review examines pulse oximeter model accuracy in adults under poor perfusion conditions. A multiple database search was conducted from inception to December 2020. The inclusion criteria were as follows: (1) adult participants (> 18 years) with explicitly stated conditions that cause poor peripheral perfusion (conditions localized at the oximeter placement site; or systemic conditions, including critical conditions such as hypothermia, hypotension, hypovolemia, and vasoconstricting agents use; or experimental conditions) (2) a comparison of arterial oxygen saturation and arterial blood gas values. A total of 22 studies were included and assessed for reliability and agreement using a modified Guidelines for Reporting Reliability and Agreement Studies tool. We calculated the accuracy root mean square error from bias and precision we extracted from the studies. Most oximeters (75%) were deemed accurate in patients with poor perfusion. Modern oximeters utilizing more complex algorithms were more likely to be accurate than older models. Earlobe placement of oximeters seemed more sensitive, with greater measurement accuracy, than on fingertip placement. Only one study controlled for skin pigmentation, and none strictly followed Food and Drug Association recommendations for experiments to determine oximeter accuracy. Oximeters are accurate in poorly perfused patients, especially newer oximeter models and those placed on earlobes. Further studies are needed that examine multiple oximeter models used on a diverse selection of patients while following FDA recommendations to examine oximeter accuracy.
Topics: Adult; Humans; Oximetry; Oxygen; Oxygen Saturation; Perfusion; Reproducibility of Results
PubMed: 35119597
DOI: 10.1007/s10877-021-00797-8 -
Biology Jul 2022Using muscle oxygenation to evaluate the therapeutic effects of physical exercise in pathologies through near-infrared spectroscopy (NIRS) is of great interest. The aim... (Review)
Review
Using muscle oxygenation to evaluate the therapeutic effects of physical exercise in pathologies through near-infrared spectroscopy (NIRS) is of great interest. The aim of this review was to highlight the use of muscle oxygenation in exercise interventions in clinical trials and to present the technological characteristics related to the equipment used in these studies. PubMed, WOS, and Scopus databases were reviewed up to December 2021. Scientific articles that evaluated muscle oxygenation after exercise interventions in the sick adult population were selected. The PEDro scale was used to analyze the risk of bias (internal validity). The results were presented grouped in tables considering the risk of bias scores, characteristics of the devices, and the effects of exercise on muscle oxygenation. All the stages were carried out using preferred reporting items for systematic reviews and meta-analyses (PRISMA). The search strategy yielded 820 clinical studies, of which 18 met the eligibility criteria. This review detailed the characteristics of 11 NIRS devices used in clinical trials that used physical exercise as an intervention. The use of this technology made it possible to observe changes in muscle oxygenation/deoxygenation parameters such as tissue saturation, oxyhemoglobin, total hemoglobin, and deoxyhemoglobin in clinical trials of patients with chronic disease. It was concluded that NIRS is a non-invasive method that can be used in clinical studies to detect the effects of physical exercise training on muscle oxygenation, hemodynamics, and metabolism. It will be necessary to unify criteria such as the measurement site, frequency, wavelength, and variables for analysis. This will make it possible to compare different models of exercise/training in terms of time, intensity, frequency, and type to obtain more precise conclusions about their benefits for patients.
PubMed: 36101451
DOI: 10.3390/biology11071073