scholarly journals Wearable pulse oximeters in the prompt detection of hypoxaemia and during movement: a diagnostic accuracy study (Preprint)

2021 ◽  
Author(s):  
Mauro Santos ◽  
Sarah Vollam ◽  
Marco A.F. Pimentel ◽  
Carlos Areia ◽  
Louise Young ◽  
...  
Keyword(s):  
Mean Squared Error ◽  
Characteristic Curve ◽  
Hospital Setting ◽  
Wireless Transmission ◽  
Transmission Mode ◽  
Peripheral Oxygen Saturation ◽  
Hypoxia Exposure ◽  
Arterial Blood ◽  
Patients At Risk ◽  
Pulse Oximeters

BACKGROUND Commercially available wearable (ambulatory) pulse oximeters have been recommended as a method for managing patients at risk of physiological deterioration, such as active patients with COVID-19 disease receiving care in hospital isolation rooms, however, their reliability is unclear to use in the hospital setting. OBJECTIVE We report the performance of wearable pulse oximeters in a simulated clinical setting when challenged by motion and low levels of arterial blood oxygen (SaO2). METHODS The performance of one wrist-worn (Wavelet) and three finger-worn (CheckMeTM O2+, AP-20 and WristOx2® 3150) wearable, wireless transmission-mode, pulse oximeters was evaluated. Seven motion tasks were performed: At rest, Sit-to-Stand, Tapping, Rubbing, Drinking, Turning Pages, and Using a Tablet. Hypoxia exposure followed, in which inspired gases were adjusted to achieve decreasing SaO2 levels at 100%, 95%, 90%, 87%, 85%, 83% and 80%. Peripheral oxygen saturation (SpO2) estimates were compared with simultaneous SaO2 samples to calculate the root mean squared error (RMSE). Area under the receiver-operating characteristic curve was used to analyse the detection of hypoxaemia, SaO2 < 90%. RESULTS SpO2 estimates matching 215 SaO2 samples in both study phases, from 33 participants, were analysed. Tapping, rubbing, turning pages and using a tablet degraded SpO2 estimation (RMSE > 4% for a least one device). All finger-worn pulse oximeters detected hypoxaemia, with an overall sensitivity ≥ 0.87 and specificity ≥ 0.80, comparable to that of the Philips MX450. CONCLUSIONS The SpO2 accuracy of wearable finger-worn pulse oximeters was within that required by the International Organization for Standardization guidelines. Performance was degraded by motion, but all were capable of detecting hypoxaemia. Our findings support the use of wearable, wireless transmission-mode, pulse oximeters to detect the onset of clinical deterioration in hospital settings. CLINICALTRIAL ISRCTN61535692; http://www.isrctn.com/ISRCTN61535692 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2019-034404

scholarly journals The Use of Pulse Oximetry in the Assessment of Acclimatization to High Altitude

Sensors ◽  
2021 ◽  
Vol 21 (4) ◽  
pp. 1263
Author(s):  
Tobias Dünnwald ◽  
Roland Kienast ◽  
David Niederseer ◽  
Martin Burtscher
Keyword(s):  
Pulse Oximetry ◽  
High Altitude ◽  
Acute Mountain Sickness ◽  
Measurement Methods ◽  
Peripheral Oxygen Saturation ◽  
Hypoxia Exposure ◽  
Lower Spo2 ◽  
Time Courses ◽  
Finger Pulse ◽  
Pulse Oximeters

Background: Finger pulse oximeters are widely used to monitor physiological responses to high-altitude exposure, the progress of acclimatization, and/or the potential development of high-altitude related diseases. Although there is increasing evidence for its invaluable support at high altitude, some controversy remains, largely due to differences in individual preconditions, evaluation purposes, measurement methods, the use of different devices, and the lacking ability to interpret data correctly. Therefore, this review is aimed at providing information on the functioning of pulse oximeters, appropriate measurement methods and published time courses of pulse oximetry data (peripheral oxygen saturation, (SpO2) and heart rate (HR), recorded at rest and submaximal exercise during exposure to various altitudes. Results: The presented findings from the literature review confirm rather large variations of pulse oximetry measures (SpO2 and HR) during acute exposure and acclimatization to high altitude, related to the varying conditions between studies mentioned above. It turned out that particularly SpO2 levels decrease with acute altitude/hypoxia exposure and partly recover during acclimatization, with an opposite trend of HR. Moreover, the development of acute mountain sickness (AMS) was consistently associated with lower SpO2 values compared to individuals free from AMS. Conclusions: The use of finger pulse oximetry at high altitude is considered as a valuable tool in the evaluation of individual acclimatization to high altitude but also to monitor AMS progression and treatment efficacy.

scholarly journals Development of an Automated, Real Time Surveillance Tool for Predicting Readmissions at a Community Hospital

2013 ◽  
Vol 04 (02) ◽  
pp. 153-169 ◽  
Author(s):  
R. Gildersleeve ◽  
P. Cooper
Keyword(s):  
Real Time ◽  
Community Hospital ◽  
Validation Cohort ◽  
Data Extraction ◽  
Characteristic Curve ◽  
Hospital Setting ◽  
Data Repository ◽  
Derivation Cohort ◽  
Effective Interventions ◽  
Patients At Risk

SummaryBackground: The Centers for Medicare and Medicaid Services’ Readmissions Reduction Program adjusts payments to hospitals based on 30-day readmission rates for patients with acute myocardial infarction, heart failure, and pneumonia. This holds hospitals accountable for a complex phenomenon about which there is little evidence regarding effective interventions. Further study may benefit from a method for efficiently and inexpensively identifying patients at risk of readmission. Several models have been developed to assess this risk, many of which may not translate to a U.S. community hospital setting.Objective: To develop a real-time, automated tool to stratify risk of 30-day readmission at a semi-rural community hospital.Methods: A derivation cohort was created by extracting demographic and clinical variables from the data repository for adult discharges from calendar year 2010. Multivariate logistic regression identified variables that were significantly associated with 30-day hospital readmission. Those variables were incorporated into a formula to produce a Risk of Readmission Score (RRS). A validation cohort from 2011 assessed the predictive value of the RRS. A SQL stored procedure was created to calculate the RRS for any patient and publish its value, along with an estimate of readmission risk and other factors, to a secure intranet site.Results: Eleven variables were significantly associated with readmission in the multivariate analysis of each cohort. The RRS had an area under the receiver operating characteristic curve (c-statistic) of 0.74 (95% CI 0.73-0.75) in the derivation cohort and 0.70 (95% CI 0.69-0.71) in the validation cohort.Conclusion: Clinical and administrative data available in a typical community hospital database can be used to create a validated, predictive scoring system that automatically assigns a probability of 30-day readmission to hospitalized patients. This does not require manual data extraction or manipulation and uses commonly available systems. Additional study is needed to refine and confirm the findings.Citation: Gildersleeve R, Cooper P. Development of an automated, real time surveillance tool for predicting readmissions at a community hospital. Appl Clin Inf 2013; 4: 153–169http://dx.doi.org/10.4338/ACI-2012-12-RA-0058

scholarly journals 112 Effects of experimentally-induced hypoxemia on hemodynamics and blood gases, and the performance of pulse oximeters in cattle

2019 ◽  
Vol 97 (Supplement_1) ◽  
pp. 41-41
Author(s):  
Lauren R Fontenot ◽  
Gordon E Carstens ◽  
Mauricio Lepiz ◽  
Kevin Washburn ◽  
Joanne Hardy
Keyword(s):  
Heart Rate ◽  
Mixed Model ◽  
Reference Method ◽  
Blood Gases ◽  
Peripheral Oxygen Saturation ◽  
Arterial Lactate ◽  
Non Invasive ◽  
Arterial Blood ◽  
Pulse Oximeters ◽  
Experimentally Induced

Abstract Arterial oxyhemoglobin saturation (SaO2) is considered to be the reference method for evaluating lung function. There is current interest in development of biosensors to measure SpO2 (peripheral oxygen saturation) using infrared technology as a non-invasive alternative for pre-clinical respiratory detection of disease in animals. Objectives of this study were to investigate effects of experimentally-induced hypoxemia on hemodynamics (heart rate, HR and blood pressure, BP) and SaO2, and to evaluate the ability of 2 SpO2 pulse oximeters (PowerLab, AD Instruments; Passport2, Datascope) to predict SaO2 in cattle. Further, arterial lactate concentrations were measured as an indicator of oxygen delivery to tissues. Graded levels of hypoxia in seven anesthetized Holstein steers (BW = 127 ± 7 kg) were achieved by step-wise reductions in inspired oxygen fraction (FiO2) from baseline (20–35%) to target levels of 14–15%, 16–17% and 18–19%. When the desired FiO2 levels were sustained for at least 3 min, arterial blood samples (n = 56) were collected and analyzed using a co-oximeter (pHOx-Ultra, Nova Biomedical) to determine SaO2 and lactate. Simultaneously, BP, HR, and SpO2 data from the 2 pulse oximeters were recorded. Data were analyzed with a mixed model that included level of FiO2 as fixed effect. As expected, SaO2 decreased (P < 0.001) as FiO2 was reduced. Heart rate increased (P < 0.001) as FiO2 was reduced, although BP was unaffected by hypoxia. While not significantly different (P = 0.15), arterial lactate concentrations were reduced with declining FiO2. Likewise, the SpO2 values recorded by both pulse oximeters decreased (P < 0.001) incrementally as FiO2 declined, although values were only moderately correlated (P < 0.01; r = 0.35 to 0.41) with SaO2. These results demonstrate that future efforts to develop biosensors to monitor SpO2 and HR may have utility for preclinical detection of respiratory disease in livestock.

scholarly journals 26 Effects of experimentally-induced hypoxemia on hemodynamics and blood gases, and the performance of pulse oximeters in cattle

2019 ◽  
Vol 97 (Supplement_1) ◽  
pp. 20-21
Author(s):  
Lauren R Fontenot ◽  
Gordon E Carstens ◽  
Mauricio Lepiz ◽  
Kevin Washburn ◽  
Joanne Hardy
Keyword(s):  
Heart Rate ◽  
Mixed Model ◽  
Reference Method ◽  
Blood Gases ◽  
Peripheral Oxygen Saturation ◽  
Arterial Lactate ◽  
Non Invasive ◽  
Arterial Blood ◽  
Pulse Oximeters ◽  
Experimentally Induced

Abstract Arterial oxyhemoglobin saturation (SaO2) is considered to be the reference method for evaluating lung function. There is current interest in development of biosensors to measure SpO2 (peripheral oxygen saturation) using infrared technology as a non-invasive alternative for pre-clinical respiratory detection of disease in animals. Objectives of this study were to investigate effects of experimentally-induced hypoxemia on hemodynamics (heart rate, HR and blood pressure, BP) and SaO2, and to evaluate the ability of 2 SpO2 pulse oximeters (PowerLab, AD Instruments; Passport2, Datascope) to predict SaO2 in cattle. Further, arterial lactate concentrations were measured as an indicator of oxygen delivery to tissues. Graded levels of hypoxia in seven anesthetized Holstein steers (BW = 127 ± 7 kg) were achieved by step-wise reductions in inspired oxygen fraction (FiO2) from baseline (20–35%) to target levels of 14–15%, 16–17%, and 18–19%. When the desired FiO2 levels were sustained for at least 3 min, arterial blood samples (n = 56) were collected and analyzed using a co-oximeter (pHOx-Ultra, Nova Biomedical) to determine SaO2 and lactate. Simultaneously, BP, HR and SpO2 data from the 2 pulse oximeters were recorded. Data were analyzed with a mixed model that included level of FiO2 as fixed effect. As expected, SaO2 decreased (P < 0.001) as FiO2 was reduced. Heart rate increased (P < 0.001) as FiO2 was reduced, although BP was unaffected by hypoxia. While not significantly different (P = 0.15), arterial lactate concentrations were reduced with declining FiO2. Likewise, the SpO2 values recorded by both pulse oximeters decreased (P < 0.001) incrementally as FiO2 declined, although values were only moderately correlated (P < 0.01; r = 0.35 to 0.41) with SaO2. These results demonstrate that future efforts to develop biosensors to monitor SpO2 and HR may have utility for preclinical detection of respiratory disease in livestock.

scholarly journals Prehospital Diagnosis of Shortness of Breath Caused by Profound Metformin-Associated Metabolic Acidosis

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 74
Author(s):  
Pietro Elias Fubini ◽  
Laurent Suppan
Keyword(s):  
Metabolic Acidosis ◽  
Hospital Setting ◽  
Blood Gases ◽  
Shortness Of Breath ◽  
Potential Harm ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Common Causes ◽  
Prehospital Diagnosis ◽  
Gas Measurement

Shortness of breath is a common complaint among patients in emergency medicine. While most common causes are usually promptly identified, less frequent aetiologies might be challenging to diagnose, especially in the pre-hospital setting. We report a case of prehospital dyspnoea initially ascribed to pulmonary oedema which turned out to be the result of profound metformin-associated metabolic acidosis. This diagnosis was already made during the prehospital phase by virtue of arterial blood gas measurement. Pre-hospital measurement of arterial blood gases is therefore feasible and can improve diagnostic accuracy in the field, thus avoiding unnecessary delay and potential harm to the patient before initiating the appropriate therapeutic actions.

Feasıbılıty of Transcutaneous Method for Carbon Dıoxıde Monıtorıng in an Intensive Care Unıt

2022 ◽  
Vol 18 ◽  
Author(s):  
Nazlıhan Boyacı ◽  
Sariyya Mammadova ◽  
Nurgül Naurizbay ◽  
Merve Güleryüz ◽  
Kamil İnci ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Partial Pressure ◽  
Blood Gas ◽  
Peripheral Oxygen Saturation ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Randomized Controlled Studies ◽  
Significant Difference

Background: Transcutaneous partial pressure of carbon dioxide (PtCO2) monitorization provides a continuous and non-invasive measurement of partial pressure of carbon dioxide (pCO2). In addition, peripheral oxygen saturation (SpO2) can also be measured and followed by this method. However, data regarding the correlation between PtCO2 and arterial pCO2 (PaCO2) measurements acquired from peripheric arterial blood gas is controversial. Objective: We aimed to determine the reliability of PtCO2 with PaCO2 based on its advantages, like non-invasiveness and continuous applicability. Methods: Thirty-five adult patients with hypercapnic respiratory failure admitted to our tertiary medical intensive care unit (ICU) were included. Then we compared PtCO2 and PaCO2 and both SpO2 measurements simultaneously. Thirty measurements from the deltoid zone and 26 measurements from the cheek zone were applied. Results: PtCO2 could not be measured from the deltoid region in 5 (14%) patients. SpO2 and pulse rate could not be detected at 8 (26.7%) of the deltoid zone measurements. Correlation coefficients between PtCO2 and PaCO2 from deltoid and the cheek region were r: 0,915 and r: 0,946 (p = 0,0001). In comparison with the Bland-Altman test, difference in deltoid measurements was -1,38 ± 1,18 mmHg (p = 0.252) and in cheek measurements it was -5,12 ± 0,92 mmHg (p = 0,0001). There was no statistically significant difference between SpO2 measurements in each region. Conclusion: Our results suggest that PtCO2 and SpO2 measurements from the deltoid region are reliable compared to the arterial blood gas analysis in hypercapnic ICU patients. More randomized controlled studies investigating the effects of different measurement areas, hemodynamic parameters, and hemoglobin levels are needed.

Repeatability and accuracy of fingertip pulse oximeters for measurement of hemoglobin oxygen saturation in arterial blood and pulse rate in anesthetized dogs breathing 100% oxygen

2021 ◽  
Vol 82 (4) ◽  
pp. 268-273
Author(s):  
Tamas D. Ambrisko ◽  
Stephanie C. Dantino ◽  
Stephanie C. J. Keating ◽  
Danielle E. Strahl-Heldreth ◽  
Adrianna M. Sage ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Pulse Rate ◽  
Hemoglobin Oxygen Saturation ◽  
Arterial Blood ◽  
Anesthetized Dogs ◽  
Pulse Oximeters

Validation of the Vertical Facial Growth Screening Test

2019 ◽  
Vol 58 (11-12) ◽  
pp. 1187-1193
Author(s):  
Christian Calvo-Henriquez ◽  
Silvia Martins-Neves ◽  
Gabriel Martinez-Capoccioni ◽  
Daniela Neves-Leal ◽  
Alberto Ruano-Ravina ◽  
...  
Keyword(s):  
Screening Test ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Ease Of Use ◽  
Facial Growth ◽  
The Face ◽  
Patients At Risk ◽  
Low Sensitivity ◽  
Dentofacial Orthopedics ◽  
Test Retest Reliability

Background. Vertical facial growth has a high prevalence. Nonspecialized professionals have shown low sensitivity to identify patients at risk. In the face of this difficulty, we designed and validated a screening checklist for vertical facial growth. Methods. A multidisciplinary team of 5 members developed the Vertical Facial Growth Screening Test. A sample of 160 evaluations was obtained. We consider as the gold standard the evaluation of 2 specialists in dentofacial orthopedics. Results. Consistency measured with Cronbach α was .675 for 10 items. Test-retest reliability was .956. The interobserver concordance was .886. The receiver operating characteristic curve has .987 area under the curve. Conclusion. This is the first study to design and validate a screening checklist for vertical facial growth for nonexpert evaluators. We think that given its good performance, ease of use, inexpensiveness, and availability, the test could be useful for nontrained professionals dealing with children.

scholarly journals A new approach to scoring systems to improve identification of acute medical admissions that will require critical care

2011 ◽  
Vol 56 (4) ◽  
pp. 195-202 ◽  
Author(s):  
H A Carmichael ◽  
E Robertson ◽  
J Austin ◽  
D Mccruden ◽  
C M Messow ◽  
...  
Keyword(s):  
Early Warning ◽  
Characteristic Curve ◽  
Medical Patient ◽  
Scoring Systems ◽  
Receiver Operator Characteristic Curve ◽  
Early Warning Score ◽  
Peripheral Oxygen Saturation ◽  
Logistic Regression Models ◽  
Prospective Application ◽  
Gas Measurements

Removal of the intensive care unit (ICU) at the Vale of Leven Hospital mandated the identification and transfer out of those acute medical admissions with a high risk of requiring ICU. The aim of the study was to develop triaging tools that identified such patients and compare them with other scoring systems. The methodology included a retrospective analysis of physiological and arterial gas measurements from 1976 acute medical admissions produced PREEMPT-1 (PRE-critical Emergency Medical Patient Triage). A simpler one for ambulance use (PREAMBLE-1 [PRE-Admission Medical Blue-Light Emergency]) was produced by the addition of peripheral oxygen saturation to a modification of MEWS (Modified Early Warning Score). Prospective application of these tools produced a larger database of 4447 acute admissions from which logistic regression models produced PREEMPT-2 and PREAMBLE-2, which were then compared with the original systems and seven other early warning scoring systems. Results showed that in patients with arterial gases, the area under the receiver operator characteristic curve was significantly higher in PREEMPT-2 (89·1%) and PREAMBLE-2 (84.4%) than all other scoring systems. Similarly, in all patients, it was higher in PREAMBLE-2 (92.4%) than PREAMBLE-1 (88.1%) and the other scoring systems. In conclusion, risk of requiring ICU can be more accurately predicted using PREEMPT-2 and PREAMBLE-2, as described here, than by other early warning scoring systems developed over recent years.

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