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Frontiers in Pediatrics 2024In neonatology, the accurate determination of vital parameters plays a pivotal role in monitoring critically ill newborns and premature infants, as well as aiding in...
INTRODUCTION
In neonatology, the accurate determination of vital parameters plays a pivotal role in monitoring critically ill newborns and premature infants, as well as aiding in disease diagnosis. In response to the limitations associated with contact-based measurement methods, substantial efforts have been directed toward developing contactless measurement techniques, particularly over the past decade.
METHODS
Building upon the insights gained from our pilot study, we realized a new investigation to assess the precision of our imaging photoplethysmography-based system within a clinical environment of the neonatal intermediate care unit. We conducted measurements in 20 preterm infants or newborns requiring therapeutic interventions. As a point of reference, we employed a conventional pulse oximeter. To analytically predict measurement artifacts, we analyzed the potential influence of confounding factors, such as motion artifacts, illumination fluctuations (under- and overexposure), and loss of region of interest prior to heart rate evaluation. This reduced the amount of data we evaluated for heart rate to 56.1% of its original volume.
RESULTS
In artifact-free time segments, the mean difference between the pulse oximetry and the imaging photoplethysmography-based system for 1 s sampling intervals resulted in -0.2 bpm (95% CI -0.8 to 0.4, LOA ± 12.2). For the clinical standard of 8 s averaging time, the mean difference resulted in -0.09 bpm (95% CI -0.7 to 0.6, LOA ± 10.1). These results match the medical standards.
DISCUSSION
While further research is needed to increase the range of measurable vital parameters and more diverse patient collectives need to be considered in the future, we could demonstrate very high accuracy for non-contact heart rate measurement in newborn infants in the clinical setting, provided artifacts are excluded. In particular, performing signal assessment helps make clinical measurements safer by identifying unreliable readings.
PubMed: 38681773
DOI: 10.3389/fped.2024.1383120 -
Journal of Medical Systems Apr 2024Preterm neonates are extensively monitored to require strict oxygen target attainment for optimal outcomes. In daily practice, detailed oxygenation data are hardly used...
BACKGROUND
Preterm neonates are extensively monitored to require strict oxygen target attainment for optimal outcomes. In daily practice, detailed oxygenation data are hardly used and crucial patterns may be missed due to the snapshot presentations and subjective observations. This study aimed to develop a web-based dashboard with both detailed and summarized oxygenation data in real-time and to test its feasibility to support clinical decision making.
METHODS
Data from pulse oximeters and ventilators were synchronized and stored to enable real-time and retrospective trend visualizations in a web-based viewer. The dashboard was designed based on interviews with clinicians. A preliminary version was evaluated during daily clinical rounds. The routine evaluation of the respiratory condition of neonates (gestational age < 32 weeks) with respiratory support at the NICU was compared to an assessment with the assistance of the dashboard.
RESULTS
The web-based dashboard included data on the oxygen saturation (SpO), fraction of inspired oxygen (FiO), SpO/FiO ratio, and area < 80% and > 95% SpO curve during time intervals that could be varied. The distribution of SpO values was visualized as histograms. In 65% of the patient evaluations (n = 86) the level of hypoxia was assessed differently with the use of the dashboard. In 75% of the patients the dashboard was judged to provide added value for the clinicians in supporting clinical decisions.
CONCLUSIONS
A web-based customized oxygenation dashboard for preterm neonates at the NICU was developed and found feasible during evaluation. More clear and objective information was found supportive for clinicians during the daily rounds in tailoring treatment strategies.
Topics: Humans; Infant, Newborn; Infant, Premature; Quality Improvement; Oximetry; Internet; Oxygen Saturation; Intensive Care Units, Neonatal; Monitoring, Physiologic
PubMed: 38656727
DOI: 10.1007/s10916-024-02064-0 -
Intensive Care Medicine Experimental Apr 2024The continuous exposure of blood to a non-biological surface during extracorporeal membrane oxygenation (ECMO) may lead to progressive thrombus formation in the...
BACKGROUND
The continuous exposure of blood to a non-biological surface during extracorporeal membrane oxygenation (ECMO) may lead to progressive thrombus formation in the oxygenator, hemolysis and consequently impaired gas exchange. In most centers oxygenator performance is monitored only on a once daily basis. Carboxyhemoglobin (COHb) is generated upon red cell lysis and is routinely measured with any co-oximetry performed to surveille gas exchange and acid-base homeostasis every couple of hours. This retrospective cohort study aims to evaluate COHb in the arterial blood gas as a novel marker of oxygenator dysfunction and its predictive value for imminent oxygenator change.
RESULTS
Out of the 484 screened patients on ECMO 89, cumulatively requiring 116 oxygenator changes within 1833 patient days, including 19,692 arterial COHb measurements were analyzed. Higher COHb levels were associated with lower post-oxygenator pO (estimate for log(COHb): - 2.176 [95% CI - 2.927, - 1.427], p < 0.0001) and with a shorter time to oxygenator change (estimate for log(COHb): - 67.895 [95% CI - 74.209, - 61.542] hours, p < 0.0001). COHb was predictive of oxygenator change within 6 h (estimate for log(COHb): 5.027 [95% CI 1.670, 15.126], p = 0.004).
CONCLUSION
COHb correlates with oxygenator performance and can be predictive of imminent oxygenator change. Therefore, longitudinal measurements of COHb in clinical routine might be a cheap and more granular candidate for ECMO surveillance that should be further analyzed in a controlled prospective trial design.
PubMed: 38656714
DOI: 10.1186/s40635-024-00626-7 -
Frontiers in Pharmacology 2024The benefits of low-dose esketamine for painless gastrointestinal endoscopy remain unclear. As such, the present study aimed to investigate the efficacy and safety of...
The benefits of low-dose esketamine for painless gastrointestinal endoscopy remain unclear. As such, the present study aimed to investigate the efficacy and safety of low-dose esketamine for this procedure. Seven common databases were searched for clinical studies investigating low-dose esketamine for painless gastrointestinal endoscopy. Subsequently, a meta-analysis was performed to synthesize and analyze the data extracted from studies fulfilling the inclusion criteria. Meta-analysis revealed that, compared with propofol, low-dose esketamine in combination with propofol significantly reduced recovery time by 0.56 min (mean difference [MD] -0.56%, 95% confidence interval (CI) -1.08 to -0.05, = 0.03), induction time by 9.84 s (MD -9.84, 95% CI -12.93 to -6.75, < 0.00001), propofol dosage by 51.05 mg (MD -51.05, 95% CI -81.53 to -20.57, = 0.01), and increased mean arterial pressure by 6.23 mmHg (MD 6.23, 95% CI 1.37 to 11.08, = 0.01). Meanwhile, low-dose esketamine reduced injection pain by 63% (relative risk [RR] 0.37, 95% CI 0.28 to 0.49, < 0.00001), involuntary movements by 40% (RR 0.60, 95% Cl 0.42 to 0.85, < 0.005), choking by 42% (RR 0.58, 95% Cl 0.38 to 0.88, = 0.01), bradycardia by 68% (RR 0.32, 95% Cl 0.18 to 0.58, = 0.0002), hypotension by 71% (RR 0.29, 95% Cl 0.21 to 0.40, < 0.00001), respiratory depression by 63% (RR 0.37, 95% 0.26 to 0.51, < 0.00001), additional cases of propofol by 53% (RR 0.47, 95% Cl 0.29 to 0.77, = 0.002), and increased hypertension by 1000% (RR 11.00, 95% Cl 1.45 to 83.28, = 0.02). There were no significant differences in mean heart rate, mean oximetry saturation, delirium, dizziness, vomiting, tachycardia, and hypoxemia. Subgroup analyses revealed that, compared with other dose groups, 0.25 mg/kg esketamine afforded additional benefits in recovery and induction time, mean arterial pressure, involuntary movements, hypoxemia, and respiratory depression. Low-dose esketamine was found to be safe and effective for providing anesthesia during gastrointestinal endoscopy, with 0.25 mg/kg identified as the optimal dose within the dosage ranges examined. However, caution should be exercised when administering this drug to patients with inadequate preoperative blood pressure control.
PubMed: 38645560
DOI: 10.3389/fphar.2024.1364546 -
Biomedical Optics Express Apr 2024Pulse oximetry represents a ubiquitous clinical application of optics in modern medicine. Recent studies have raised concerns regarding the potential impact of...
Pulse oximetry represents a ubiquitous clinical application of optics in modern medicine. Recent studies have raised concerns regarding the potential impact of confounders, such as variable skin pigmentation and perfusion, on blood oxygen saturation measurement accuracy in pulse oximeters. Tissue-mimicking phantom testing offers a low-cost, well-controlled solution for characterizing device performance and studying potential error sources, which may thus reduce the need for costly in vivo trials. The purpose of this study was to develop realistic phantom-based test methods for pulse oximetry. Material optical and mechanical properties were reviewed, selected, and tuned for optimal biological relevance, e.g., oxygenated tissue absorption and scattering, strength, elasticity, hardness, and other parameters representing the human finger's geometry and composition, such as blood vessel size and distribution, and perfusion. Relevant anatomical and physiological properties are summarized and implemented toward the creation of a preliminary finger phantom. To create a preliminary finger phantom, we synthesized a high-compliance silicone matrix with scatterers for embedding flexible tubing and investigated the addition of these scatterers to novel 3D printing resins for optical property control without altering mechanical stability, streamlining the production of phantoms with biologically relevant characteristics. Phantom utility was demonstrated by applying dynamic, pressure waveforms to produce tube volume change and resultant photoplethysmography (PPG) signals. 3D printed phantoms achieved more biologically relevant conditions compared to molded phantoms. These preliminary results indicate that the phantoms show strong potential to be developed into tools for evaluating pulse oximetry performance. Gaps, recommendations, and strategies are presented for continued phantom development.
PubMed: 38633081
DOI: 10.1364/BOE.518967 -
Research in Veterinary Science Jun 2024Pulse oximetry (SpO) identifies a decrease in the partial pressure of oxygen (PaO) when it falls below 80 mmHg, while oxygen reserve index (ORi), a dimensionless index...
Pulse oximetry (SpO) identifies a decrease in the partial pressure of oxygen (PaO) when it falls below 80 mmHg, while oxygen reserve index (ORi), a dimensionless index ranging from 0 to 1, detects PaO changes between 100 and 200 mmHg. This study investigates the usefulness of ORi in detecting impending deoxygenation before traditional SpO. Fifty-one dogs undergoing anesthesia were mechanically ventilated maintaining a fraction of inspired oxygen of 0.50 and an ORi of 1. Animals were classified according to their body condition score (BCS) as normal-fit (BCS 4-5/9), overweight (BCS 6-7/9), or obese (BCS 8-9/9). At the end of the procedure, dogs were placed in sternal recumbency, and after 10 min disconnected from the ventilator and maintained in apnea. ORi added warning time was determined at various ORi values as the time difference in reaching SpO of 95% from ORi of 0.9 and 0.5, compared to the SpO warning time from SpO of 98%. During apnea, ORi decreased before noticeable SpO changes. An ORi of 0.9 anticipated an SpO of 95% in normal-fit dogs by 87 (33-212) [median (range)] seconds or in those with a BCS ≥ 6/9 by 49 (7-161) seconds. Regardless of the BCS class, the median time from ORi of 0.5 to SpO of 95% was 30-35 s. ORi declined from 0.9 to 0.0 in 68 compared to 33 s between normal-fit and obese dogs (p < 0.05). In dogs, ORi added warning time could facilitate timely intervention, particularly in obese patients.
Topics: Dogs; Animals; Oximetry; Oxygen; Female; Male; Anesthesia; Respiration, Artificial; Dog Diseases
PubMed: 38631076
DOI: 10.1016/j.rvsc.2024.105268 -
HRB Open Research 2023Current methods of intrapartum fetal monitoring based on heart rate, increase the rates of operative delivery but do not prevent or accurately detect fetal hypoxic brain...
BACKGROUND
Current methods of intrapartum fetal monitoring based on heart rate, increase the rates of operative delivery but do not prevent or accurately detect fetal hypoxic brain injury. There is a need for more accurate methods of intrapartum fetal surveillance that will decrease the incidence of adverse perinatal and long-term neurodevelopmental outcomes while maintaining the lowest possible rate of obstetric intervention. Fetal pulse oximetry (FPO) is a technology that may contribute to improved intrapartum fetal wellbeing evaluation by providing a non-invasive measurement of fetal oxygenation status.
OBJECTIVE
This systematic review and meta-analysis aims to synthesise the evidence examining the association between intrapartum fetal oxygen saturation levels and adverse perinatal and long-term outcomes in the offspring.
METHODS
We will include randomised control trials (RCTs), cohort, cross-sectional and case-control studies which examine the use of FPO during labour as a means of measuring intrapartum fetal oxygen saturation and assess its effectiveness at detecting adverse perinatal and long-term outcomes compared to existing intrapartum surveillance methods. A detailed systematic search of PubMed, EMBASE, CINAHL, The Cochrane Library, Web of Science, ClinicalTrials.Gov and WHO ICTRP will be conducted following a detailed search strategy until February 2024. Three authors will independently review titles, abstracts and full text of articles. Two reviewers will independently extract data using a pre-defined data extraction form and assess the quality of included studies using the Risk of Bias tool for RCTs and Newcastle-Ottawa Scale for observational studies. The grading of recommendations, assessment, development, and evaluation (GRADE) approach will be used to evaluate the certainty of the evidence. We will use random-effects meta-analysis for each exposure-outcome association to calculate pooled estimates using the generic variance method. This systematic review will follow the Preferred Reporting Items for Systematic reviews and Meta-analyses and MOOSE guidelines.
PROSPERO REGISTRATION
CRD42023457368 (04/09/2023).
PubMed: 38628596
DOI: 10.12688/hrbopenres.13802.2 -
Respiratory Research Apr 2024Remote monitoring of patient-recorded spirometry and pulse oximetry offers an alternative approach to traditional hospital-based monitoring of interstitial lung disease... (Observational Study)
Observational Study
BACKGROUND
Remote monitoring of patient-recorded spirometry and pulse oximetry offers an alternative approach to traditional hospital-based monitoring of interstitial lung disease (ILD). Remote spirometry has been observed to reasonably reflect clinic spirometry in participants with ILD but remote monitoring has not been widely incorporated into clinical practice. We assessed the feasibility of remotely monitoring patients within a clinical ILD service.
METHODS
Prospective, single-arm, open-label observational multi-centre study (NCT04850521). Inclusion criteria included ILD diagnosis, age ≥ 18 years, FVC ≥ 50% predicted. 60 participants were asked to record a single spirometry and oximetry measurement at least once daily, monitored weekly by their local clinical team. Feasibility was defined as ≥ 68% of participants with ≥ 70% adherence to study measurements and recording measurements ≥ 3 times/week throughout.
RESULTS
A total of 60 participants were included in the analysis. 42/60 (70%) were male; mean age 67.8 years (± 11.2); 34/60 (56.7%) had idiopathic pulmonary fibrosis (IPF), Median ILD-GAP score was 3 (IQR 1-4.75). Spirometry adherence was achieved for ≥ 70% of study days in 46/60 participants (77%) and pulse oximetry adherence in 50/60 participants (83%). Recording ≥ 3 times/week every week was provided for spirometry in 41/60 participants (68%) and pulse oximetry in 43/60 participants (72%). Mean difference between recent clinic and baseline home spirometry was 0.31 L (± 0.72). 85.7% (IQR 63.9-92.6%) home spirometry attempts/patient were acceptable or usable according to ERS/ATS spirometry criteria. Positive correlation was observed between ILD-GAP score and adherence to spirometry and oximetry (rho 0.24 and 0.38 respectively). Adherence of weekly monitoring by clinical teams was 80.95% (IQR 64.19-95.79). All participants who responded to an experience questionnaire (n = 33) found remote measurements easy to perform and 75% wished to continue monitoring their spirometry at the conclusion of the study.
CONCLUSION
Feasibility of remote monitoring within an ILD clinical service was demonstrated over 3 months for both daily home spirometry and pulse oximetry of patients. Remote monitoring may be more acceptable to participants who are older or have more advanced disease.
TRIAL REGISTRATION
clinicaltrials.gov NCT04850521 registered 20 April 2021.
Topics: Humans; Male; Aged; Adolescent; Female; Prospective Studies; Feasibility Studies; Vital Capacity; Lung Diseases, Interstitial; Spirometry; Oximetry
PubMed: 38622608
DOI: 10.1186/s12931-024-02787-1 -
Health Policy and Technology Jun 2023Patients with suspected COVID-19 remain at risk for clinical deterioration after discharge and may benefit from home oxygen saturation (SpO) monitoring using portable...
OBJECTIVES
Patients with suspected COVID-19 remain at risk for clinical deterioration after discharge and may benefit from home oxygen saturation (SpO) monitoring using portable pulse oximeter devices. Our study aims to evaluate patient engagement and compliance with a home SpO monitoring program.
METHODS
This is a single center, prospective pilot study of patients being discharged from the ED or urgent care after evaluation of symptoms consistent with COVID-19. Subjects were given a portable pulse oximeter and instructed to obtain measurements at rest and with exertion twice daily for 14 days. Patients were contacted daily to collect recorded data. If attempts to contact the patient were unsuccessful for 3 consecutive days, patients were considered lost to follow up. The primary outcome of interest was patient engagement in the program which was defined as the percentage of patients that completed the 14-day study period, meaning they were not lost to follow up. Secondary outcomes included compliance with performing the SpO readings. Patient compliance was calculated as a percentage of completed readings out of the total expected readings.
RESULTS
Fifty patients were enrolled - 2 withdrew and 1 was a screen failure. Overall, engagement in the program was 46.8% with no significant difference between those who tested positive for SARS-CoV-2 versus those who tested negative (48.2% vs 45%, p = 0.831). Median compliance overall was 42.9% (IQR 22.22-78.57). Median compliance for the positive group was 50.0% (IQR 20-85.71) and 42.86% (IQR 22.92-76.44) for the negative group (p= 0.838).
CONCLUSION
Our study demonstrated that there was acceptable engagement and compliance in a 14-day home SpO monitoring program. These results support the use of home pulse oximetry monitoring in a select group of mildly ill patients with suspected COVID-19.
PubMed: 38620095
DOI: 10.1016/j.hlpt.2023.100776 -
Experimental Physiology Jun 2024Increasing placental perfusion (PP) could improve outcomes of growth-restricted fetuses. One way of increasing PP may be by using phosphodiesterase (PDE)-5 inhibitors,...
Increasing placental perfusion (PP) could improve outcomes of growth-restricted fetuses. One way of increasing PP may be by using phosphodiesterase (PDE)-5 inhibitors, which induce vasodilatation of vascular beds. We used a combination of clinically relevant magnetic resonance imaging (MRI) techniques to characterize the impact that tadalafil infusion has on maternal, placental and fetal circulations. At 116-117 days' gestational age (dGA; term, 150 days), pregnant ewes (n = 6) underwent fetal catheterization surgery. At 120-123 dGA ewes were anaesthetized and MRI scans were performed during three acquisition windows: a basal state and then ∼15-75 min (TAD 1) and ∼75-135 min (TAD 2) post maternal administration (24 mg; intravenous bolus) of tadalafil. Phase contrast MRI and T oximetry were used to measure blood flow and oxygen delivery. Placental diffusion and PP were assessed using the Diffusion-Relaxation Combined Imaging for Detailed Placental Evaluation-'DECIDE' technique. Uterine artery (UtA) blood flow when normalized to maternal left ventricular cardiac output (LVCO) was reduced in both TAD periods. DECIDE imaging found no impact of tadalafil on placental diffusivity or fetoplacental blood volume fraction. Maternal-placental blood volume fraction was increased in the TAD 2 period. Fetal and were not affected by maternal tadalafil administration. Maternal tadalafil administration did not increase UtA blood flow and thus may not be an effective vasodilator at the level of the UtAs. The increased maternal-placental blood volume fraction may indicate local vasodilatation of the maternal intervillous space, which may have compensated for the reduced proportion of UtA .
Topics: Animals; Female; Tadalafil; Pregnancy; Sheep; Uterine Artery; Placenta; Placental Circulation; Oxygen; Regional Blood Flow; Phosphodiesterase 5 Inhibitors; Magnetic Resonance Imaging; Fetus
PubMed: 38606906
DOI: 10.1113/EP091593