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Veterinary Surgery : VS May 2024To evaluate the effect of continuous positive airway pressure (CPAP) on respiratory function in the early postoperative period of brachycephalic dogs.
OBJECTIVE
To evaluate the effect of continuous positive airway pressure (CPAP) on respiratory function in the early postoperative period of brachycephalic dogs.
STUDY DESIGN
Prospective, randomized clinical trial.
ANIMALS
A total of 32 dogs.
METHODS
Dogs were assigned to recover with or without CPAP (control) and assessed at specific time points over 1 h. Treatment was discontinued for dogs with a CPAP tolerance score of 3 or more (from a range of 0-4). The primary outcome was pulse oximetry (SpO). Secondary outcomes were arterial O pressure (PaO)/FiO ratio (PaO/FiO), arterial CO pressure (PaCO), and rectal temperature. For dogs that reached a CPAP tolerance score of 3 or more, only the data collected up to the time point before discontinuation were included in the analysis. The treatment effect (β) was analyzed using random effects models and the results were reported with 95% confidence intervals.
RESULTS
Dogs were assigned randomly to each protocol. Baseline characteristics in both groups were comparable. Arterial blood gases were obtained in seven control group dogs and nine CPAP group dogs. Treatment did not affect SpO (β = -0.1, -2.1 to 2.0) but affected the PaO/FiO ratio (β = 58.1, 2.6 to 113.6), with no effects on PaCO (β = -4.3, -10.5 to 1.9) or temperature (β = 0.4, -0.8 to 1.6).
CONCLUSION
In postoperative brachycephalic dogs, CPAP had no effect on SpO but improved the PaO/FiO ratio in brachycephalic dogs postoperatively.
CLINICAL SIGNIFICANCE
Continuous positive airway pressure offers a valuable solution to improve gas exchange efficiency, a prevalent concern in postoperative brachycephalic dogs, with the potential to enhance overall outcomes.
PubMed: 38803143
DOI: 10.1111/vsu.14111 -
Comparison of the vitality test with sensitivity tests in mature and immature teeth: clinical trial.BMC Oral Health May 2024One of the most important steps in deciding on the treatment of a tooth is to determine the vitality and health status of the pulp. Since immature teeth innervation is... (Comparative Study)
Comparative Study Clinical Trial
BACKGROUND
One of the most important steps in deciding on the treatment of a tooth is to determine the vitality and health status of the pulp. Since immature teeth innervation is not completed, the response to sensitivity tests may not yield definite results. Pulse oximetry (PO) which is considered as a vitality test, measures the arterial oxygen saturation (SpO). This study aims to compare PO, electric pulp test (EPT) and cold test in mature and immature permanent teeth.
METHODS
20 immature and 20 mature permanent incisors of 6-12-year-old ASA1 children who did not use any analgesics, were included in the study. Pulp vitality of the teeth was determined by EPT, cold test and PO. An infant probe of PO device (CMS60D, Contec Medical Systems Co. Ltd, China) was used to determine the SpO of the teeth. The SpO level is controlled on the patient's finger by a children's probe and an infant probe of PO. Shapiro-Wilk, Spearman rank correlation test and Kruskal-Wallis test/Dunn post-hoc analysis were used for statistical comparisons.
RESULTS
There was no significant correlation between finger SpO and the mature/immature teeth SpO (r=-0.026, r = 0.253). Arterial oxygen saturation values in the immature teeth were significantly higher than in the mature teeth (p = 0.002). There was a high correlation between the vitality response of the EPT, cold test and PO.
CONCLUSIONS
Pulse oximetry can be used as an effective vitality test compared to sensitivity tests in both immature and mature permanent incisors.
Topics: Humans; Oximetry; Child; Dental Pulp Test; Male; Female; Incisor; Dental Pulp; Cold Temperature; Oxygen Saturation
PubMed: 38802767
DOI: 10.1186/s12903-024-04317-3 -
Anesthesia and Analgesia May 2024
PubMed: 38801714
DOI: 10.1213/ANE.0000000000007086 -
Journal of Visualized Experiments : JoVE May 2024The detection of levels of impairment in microvascular oxygen consumption and reactive hyperemia is vital in critical care. However, there are no practical means for a...
The detection of levels of impairment in microvascular oxygen consumption and reactive hyperemia is vital in critical care. However, there are no practical means for a robust and quantitative evaluation. This paper describes a protocol to evaluate these impairments using a hybrid near-infrared diffuse optical device. The device contains modules for near-infrared time-resolved and diffuse correlation spectroscopies and pulse-oximetry. These modules allow the non-invasive, continuous, and real-time measurement of the absolute, microvascular blood/tissue oxygen saturation (StO2) and the blood flow index (BFI) along with the peripheral arterial oxygen saturation (SpO2). This device uses an integrated, computer-controlled tourniquet system to execute a standardized protocol with optical data acquisition from the brachioradialis muscle. The standardized vascular occlusion test (VOT) takes care of the variations in the occlusion duration and pressure reported in the literature, while the automation minimizes inter-operator differences. The protocol we describe focuses on a 3-min occlusion period but the details described in this paper can readily be adapted to other durations and cuff pressures, as well as other muscles. The inclusion of an extended baseline and post-occlusion recovery period measurement allows the quantification of the baseline values for all the parameters and the blood/tissue deoxygenation rate that corresponds to the metabolic rate of oxygen consumption. Once the cuff is released, we characterize the tissue reoxygenation rate, magnitude, and duration of the hyperemic response in BFI and StO2. These latter parameters correspond to the quantification of the reactive hyperemia, which provides information about the endothelial function. Furthermore, the above-mentioned measurements of the absolute concentration of oxygenated and deoxygenated hemoglobin, BFI, the derived metabolic rate of oxygen consumption, StO2, and SpO2 provide a yet-to-be-explored rich data set that can exhibit disease severity, personalized therapeutics, and management interventions.
Topics: Spectroscopy, Near-Infrared; Hyperemia; Humans; Critical Care; Oxygen; Oxygen Consumption; Oximetry; Muscle, Skeletal; Microcirculation; Microvessels; Oxygen Saturation
PubMed: 38801263
DOI: 10.3791/66062 -
The Western Journal of Emergency... May 2024Patients with coronavirus 2019 (COVID-19) are at high risk for respiratory dysfunction. The pulse oximetry/fraction of inspired oxygen (SpO/FiO) ratio is a non-invasive...
BACKGROUND
Patients with coronavirus 2019 (COVID-19) are at high risk for respiratory dysfunction. The pulse oximetry/fraction of inspired oxygen (SpO/FiO) ratio is a non-invasive assessment of respiratory dysfunction substituted for the PaO:FiO ratio in Sequential Organ Failure Assessment scoring. We hypothesized that emergency department (ED) SpO/FiO ratios correlate with requirement for mechanical ventilation in COVID-19 patients. Our objective was to identify COVID-19 patients at greatest risk of requiring mechanical ventilation, using SpO/FiO ratios.
METHODS
We performed a retrospective review of patients admitted with COVID-19 at two hospitals. Highest and lowest SpO/FiO ratios (percent saturation/fraction of inspired O) were calculated on admission. We performed chi-square, univariate, and multiple regression analysis to evaluate the relationship of admission SpO/FiO ratios with requirement for mechanical ventilation and intensive care unit (ICU) care.
RESULTS
A total of 539 patients (46% female; 84% White), with a mean age 67.6 ± 18.6 years, met inclusion criteria. Patients who required mechanical ventilation during their hospital stay were statistically younger in age ( = 0.001), had a higher body mass index ( < .001), and there was a higher percentage of patients who were obese ( = 0.03) and morbidly obese ( < .001). Shortness of breath, cough, and fever were the most common presenting symptoms with a median temperature of 99°F. Average white blood count was higher in patients who required ventilation ( = <0.001). A highest obtained ED SpO/FiO ratio of ≤300 was associated with a requirement for mechanical ventilation. A lowest obtained ED SpO/FiO ratio of ≤300 was associated with a requirement for intensive care unit care. There was no statistically significant correlation between ED SpO/FiO ratios >300 and mechanical ventilation or intensive care unit (ICU) requirement.
CONCLUSION
The ED SpO/FiO ratios correlated with mechanical ventilation and ICU requirements during hospitalization for COVID-19. These results support ED SpO/FiO as a possible triage tool and predictor of hospital resource requirements for patients admitted with COVID-19. Further investigation is warranted.
Topics: Humans; COVID-19; Female; Retrospective Studies; Male; Respiration, Artificial; Emergency Service, Hospital; Aged; Oximetry; Intensive Care Units; SARS-CoV-2; Middle Aged; Oxygen Saturation; Oxygen; Aged, 80 and over
PubMed: 38801037
DOI: 10.5811/westjem.17975 -
Chemistry (Weinheim An Der Bergstrasse,... May 2024Cationic Mn(III)-meso-tetraarylporphyrin derivatives, substituted in para position with different size alkyl chains, were investigated to function as antioxidants in...
Cationic Mn(III)-meso-tetraarylporphyrin derivatives, substituted in para position with different size alkyl chains, were investigated to function as antioxidants in free-radical degradation of high-molar-mass hyaluronan by the methods of rotational viscometry and oximetry. The results of rotational viscometry showed that MnTM-4-PyP5+, MnTE-4-PyP5+, MnTPr-4-PyP5+, MnTPen-4-PyP5+ and MnTHep-4-PyP5+ showed high efficiency in decomposing H2O2, and reducing of peroxidized hyaluronan. When using oxygen electrode, MnTE-4-PyP5+, MnTPr-4-PyP5+, MnTPen-4-PyP5+, and MnTHep-4-PyP5+ applied to function as protective antioxidants in hyaluronan degradation, the uptake of dissolved oxygen from the reaction milieu was rapid, followed by continual increase in oxygen concentration up to the end of the measurement. However, when especially MnTE-4-PyP5+, MnTPr-4-PyP5+, and MnTPen-4-PyP5+ were examined as hyaluronan chain-breaking antioxidants, after short-term dissolved oxygen uptake, almost no increase in oxygen concentration was shown.
PubMed: 38797703
DOI: 10.1002/chem.202401028 -
BMC Anesthesiology May 2024Oxygen delivery (DO) and its monitoring are highlighted to aid postoperative goal directed therapy (GDT) to improve perioperative outcomes such as acute kidney injury...
PURPOSE
Oxygen delivery (DO) and its monitoring are highlighted to aid postoperative goal directed therapy (GDT) to improve perioperative outcomes such as acute kidney injury (AKI) after high-risk cardiac surgeries associated with multiple morbidities and mortality. However, DO monitoring is neither routine nor done postoperatively, and current methods are invasive and only produce intermittent DO trends. Hence, we proposed a novel algorithm that simultaneously integrates cardiac output (CO), hemoglobin (Hb) and oxygen saturation (SpO) from the Edwards Life Sciences ClearSight System® and Masimo SET Pulse CO-Oximetry® to produce a continuous, real-time DO trend.
METHODS
Our algorithm was built systematically with 4 components - machine interface to draw data with PuTTY, data extraction with parsing, data synchronization, and real-time DO presentation using a graphic-user interface. Hb readings were validated.
RESULTS
Our algorithm was implemented successfully in 93% (n = 57 out of 61) of our recruited cardiac surgical patients. DO trends and AKI were studied.
CONCLUSION
We demonstrated a novel proof-of-concept and feasibility of continuous, real-time, non-invasive DO monitoring, with each patient serving as their own control. Our study also lays the foundation for future investigations aimed at identifying personalized critical DO thresholds and optimizing DO as an integral part of GDT to enhance outcomes in perioperative cardiac surgery.
Topics: Humans; Cardiac Surgical Procedures; Feasibility Studies; Algorithms; Male; Female; Oxygen; Oximetry; Aged; Middle Aged; Proof of Concept Study; Acute Kidney Injury; Monitoring, Physiologic; Cardiac Output; Hemoglobins; Oxygen Saturation
PubMed: 38796436
DOI: 10.1186/s12871-024-02561-2 -
Vascular May 2024There is a risk of distal embolization lower extremity endovascular interventions. Possibly a drug-coating embolism caused by coating detachment from intravascular... (Review)
Review
INTRODUCTION
There is a risk of distal embolization lower extremity endovascular interventions. Possibly a drug-coating embolism caused by coating detachment from intravascular devices.
METHODS
This review focuses on providing updated information on distal embolism in endovascular revascularization of lower extremity arteries, including the use of drug-coated balloons.
RESULTS
Drug-coating embolism is a special case of distal embolization during recanalization of the arteries of the lower extremities. Preclinical studies have demonstrated embolization of drug-coated balloons during angioplasty of lower extremity arteries. However, the clinical role of drug-coating embolism is not completely clear. A 2020 meta-analysis found an increased risk of major lower extremity amputation after drug-coated balloon angioplasty in patients with critical limb ischemia. But long-term research is emerging to support the safety of using these devices. Perhaps a more thorough assessment of the quality of life and the degree of compensation of lower limb ischemia with an intraoperative assessment of the frequency of peripheral embolizations using ultrasound emboli detection, as well as microcirculation with transcutaneous oximetry and laser Doppler flowmetry of the operated lower limb will allow a more detailed study of the phenomenon of drug-coating embolism and its impact on long-term clinical outcomes.
CONCLUSION
According to the results of preclinical studies, the use of paclitaxel-coated balloons leads to an increase in the concentration of paclitaxel in distal skeletal muscles. However, paclitaxel concentration in skeletal muscle was significantly higher in first-generation DCBs. The non-target effects of drug-coating balloon are not fully understood and require further study. Understanding the phenomenon of drug-coating embolism can help physicians to better assess the patient risk and to minimize complications.
PubMed: 38790137
DOI: 10.1177/17085381241256534 -
Journal of Perinatology : Official... May 2024We prospectively compared cerebral oxygen saturation (CrSO2) and pain score changes during procedures in late preterm (LPT) versus term infants.
OBJECTIVES
We prospectively compared cerebral oxygen saturation (CrSO2) and pain score changes during procedures in late preterm (LPT) versus term infants.
METHODS
Near-infrared spectroscopy, pulse oximetry, Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile-Revised (PIPP-R) scores were assessed and CrSO2 data analyzed.
RESULTS
Thirty infants in each group were evaluated. LPT infants displayed a milder significant drop in Minimum post-procedural CrSO2 and smaller Maximum-Minimum post-procedural CrSO2 disparity. CrSO2 minute changes between the groups were non-significant. Moderate correlations were observed in both groups between NIPS and Minimum post-procedural CrSO2, and a moderate correlation was found in the Maximum-Minimum post-procedural CrSO2 difference in LPT infants. No correlation between PIPP-R and CrSO2 values was noted.
CONCLUSION
LPT and term infants demonstrated decreased CrSO2 in response to painful procedures. Correlations between CrSO2 and PIPP-R or NIPS scores were poor to moderate, reflecting the complex nature of these associations relative to gestational age.
PubMed: 38789794
DOI: 10.1038/s41372-024-01978-4 -
Scientific Data May 2024Pulse oximeters measure peripheral arterial oxygen saturation (SpO) noninvasively, while the gold standard (SaO) involves arterial blood gas measurement. There are known...
Pulse oximeters measure peripheral arterial oxygen saturation (SpO) noninvasively, while the gold standard (SaO) involves arterial blood gas measurement. There are known racial and ethnic disparities in their performance. BOLD is a dataset that aims to underscore the importance of addressing biases in pulse oximetry accuracy, which disproportionately affect darker-skinned patients. The dataset was created by harmonizing three Electronic Health Record databases (MIMIC-III, MIMIC-IV, eICU-CRD) comprising Intensive Care Unit stays of US patients. Paired SpO and SaO measurements were time-aligned and combined with various other sociodemographic and parameters to provide a detailed representation of each patient. BOLD includes 49,099 paired measurements, within a 5-minute window and with oxygen saturation levels between 70-100%. Minority racial and ethnic groups account for ~25% of the data - a proportion seldom achieved in previous studies. The codebase is publicly available. Given the prevalent use of pulse oximeters in the hospital and at home, we hope that BOLD will be leveraged to develop debiasing algorithms that can result in more equitable healthcare solutions.
Topics: Humans; Oximetry; Blood Gas Analysis; Oxygen Saturation; Intensive Care Units; Ethnicity; Oxygen
PubMed: 38789452
DOI: 10.1038/s41597-024-03225-z