scholarly journals Tracking Arteriovenous Fistula Maturation: A Novel Approach

2018 ◽  
Vol 47 (1-3) ◽  
pp. 240-245 ◽  
Author(s):  
Laura M. Rosales ◽  
Hanjie Zhang ◽  
Marilou Mateo ◽  
Brenda Chan ◽  
Israel Campos ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Arteriovenous Fistula ◽  
Arterial Oxygen Saturation ◽  
Central Venous Oxygen Saturation ◽  
The United States ◽  
Upper Body ◽  
Arterial Oxygen ◽  
Central Venous ◽  
Hemodynamic Changes ◽  
Improvement Project

Background: The time between the creation of an arteriovenous fistula (AVF) and its successful use is significantly longer in hemodialysis (HD) patients in the United States compared to those in other countries, and there is an urgent need to reduce the residence time of central-venous catheters (CVC). Methods: Successful AVF creation and maturation results in typical hemodynamic changes, such as an increase in cardiac output and upper body blood flow (UBBF). In patients with CVC as vascular access, we measured once per minute intradialytic central-venous oxygen saturation (ScvO2) and hemoglobin levels simultaneously using the Crit-Line Monitor. Under conditions of stable upper body oxygen consumption and arterial oxygen saturation, ScvO2 and hemoglobin concentration allows the calculation of estimated UBBF (eUBBF). In a quality improvement project, we used ScvO2 and eUBBF to track the hemodynamic changes accompanying AVF maturation. Results: Out of 11 patients (9 incident to HD, 1 female, age 61 ± 13 years), AVF maturation was successful in 9. In 1 patient, the AVF did not mature. One patient died from sudden cardiac death with a maturing AVF. In the 9 patients with successful AVF maturation, ScvO2 increased from 60.9 ± 2.7% prior to AVF creation to 73.4 ± 3.6% a week after AVF creation (19.6 ± 6.3% increase). eUBBF increased from 1.3 ± 0.3 to 2.2 ± 0.6 L/min (62.7 ± 37.5% increase); no material ScvO2 or eUBBF changes occurred in the other 2 patients. Conclusion: Our results indicate the potential utility of ScvO2 and eUBBF to track the hemodynamic response to AVF maturation. To what extent these insights translate into shortening of the time between AVF creation and successful cannulation warrants further investigations.

Investigating spectroscopic measurement of sublingual veins and tissue to estimate central venous oxygen saturation

2021 ◽  
pp. 1-9
Author(s):  
Aslinur Sircan-Kucuksayan ◽  
Oktay Eray ◽  
Murat Buyukaksu ◽  
Birce Gumus ◽  
Oguz Dursun ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Near Infrared ◽  
Arterial Oxygen Saturation ◽  
Central Venous Oxygen Saturation ◽  
Arterial Oxygen ◽  
Central Venous ◽  
Venous Oxygen Saturation ◽  
Oxygenation Status

BACKGROUND: Venous oxygen saturation reflects venous oxygenation status and can be used to assess treatment and prognosis in critically ill patients. A novel method that can measure central venous oxygen saturation (ScvO2) non-invasively may be beneficial and has the potential to change the management routine of critically ill patients. OBJECTIVE: The study aims to evaluate the potential of sublingual venous oxygen saturation (SsvO2) to be used in the estimation of ScvO2. METHODS: We have developed two different approaches to calculate SsvO2. In the first one, near-infrared spectroscopy (NIRS) measurements were performed directly on the sublingual veins. In the second approach, NIRS spectra were acquired from the sublingual tissue apart from the sublingual veins, and arterial oxygen saturation was measured using a pulse oximeter on the fingertip. RESULTS: Twenty-six healthy subjects were included in the study. In the first and second approaches, average SsvO2 values were 75.0% ± 1.8 and 75.8% ± 2.1, respectively. The results of the two different approaches were close to each other and similar to ScvO2 of healthy persons (> 70%). CONCLUSION: Oxygen saturation of sublingual veins has the potential to be used in intensive care units, non-invasively and in real-time, to estimate ScvO2.

scholarly journals Arterial oxygen saturation and hypoxemia in hemodialysis patients with COVID-19

2021 ◽  
Author(s):  
Priscila Preciado ◽  
Leticia M Tapia Silva ◽  
Xiaoling Ye ◽  
Hanjie Zhang ◽  
Yuedong Wang ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Time Course ◽  
Clinical Symptoms ◽  
Arterial Oxygen Saturation ◽  
Laboratory Data ◽  
Hemodialysis Patients ◽  
Arterial Oxygen ◽  
Maintenance Hemodialysis ◽  
Treatment Level ◽  
Improvement Project

Abstract Background Maintenance hemodialysis (MHD) patients are particularly vulnerable to COVID-19, a viral disease that may cause interstitial pneumonia, impaired alveolar gas exchange, and hypoxemia. We ascertained the time course of intradialytic arterial oxygen saturation (SaO2) in MHD patients between 4 weeks pre- and the week post-diagnosis of COVID-19. Methods We conducted a quality improvement project in confirmed COVID-19 in-center MHD patients from 11 dialysis facilities. In patients with an arterio-venous access SaO2 was measured 1x/minute during dialysis using the Crit-Line monitor (Fresenius Medical Care, Waltham, MA). We extracted demographic, clinical, treatment, and laboratory data and COVID-19 related symptoms from the patients’ electronic health records. Results Intradialytic SaO2 was available in 52 patients (29 males; age 66.5±15.7 years) contributing 338 hemodialysis treatments. Mean time between onset of symptoms indicative of COVID-19 and diagnosis was 1.1 days (median 0; range 0 to 9). Prior to COVID-19 diagnosis the rate of hemodialysis treatments with hypoxemia, defined as treatment-level average SaO2 < 90%, increased from 2.8% (2 to 4 weeks pre-diagnosis) to 12.2% (1 week) and 20.7% (3 days pre-diagnosis). Intradialytic oxygen supplementation increased sharply post-diagnosis. Eleven patients died from COVID-19 within 5 weeks. Compared to patients who recovered from COVID-19, demised patients showed a more pronounced decline in SaO2 prior to COVID-19 diagnosis. Conclusion In hemodialysis patients, hypoxemia may precede the onset of clinical symptoms and the diagnosis of COVID-19. A steep decline of SaO2 is associated with poor patient outcomes. Measurements of SaO2 may aid the pre-symptomatic identification of patients with COVID-19.

scholarly journals Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinshu Katayama ◽  
Jun Shima ◽  
Ken Tonai ◽  
Kansuke Koyama ◽  
Shin Nunomiya
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Prospective Observational Study ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Arterial Blood Gas ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Arterial Blood ◽  
Ventilated Patients

AbstractRecently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable.Trial registration UMIN000027671. Registered 7 June 2017.

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