Changes In Oxygen Saturation Research Articles

Correlation of Caesarean Section Rates to Maternal and Neonatal Mortality in the Eastern Mediterranean Region; A Population-Based Ecological Study

The physiological reaction of postocclusive local reactive hyperemia is regulated by neurovascular mechanisms and it reflects the function of microcirculation. Thermoregulatory changes occur first, in the form of increased skin surface temperature, which is usually followed by an increase in local blood flow. This study investigated a correlation between tourniquet duration on the upper arm, and the appearance of reactive hyperemia in the distal parts of the upper limb. Changes were registered with infrared thermometer and infrared thermography, which provided us a highly precise view of distribution of reactive hyperemia. Changes of oxygen saturation of peripheral arterial blood and blood pressure were also recorded. Our research has shown that longer duration of tourniquet leads to more intense and longer lasting reactive hyperemia in the palmar region, followed by higher temperatures of the skin surface, without any changes in postocclusive values of SpO2. Keywords: Infrared thermography, Microcirculation, Postocclusive hyperemia, Skin temperature, Tourniquet, Thermoregulatory changes.

Effect of Local Cold Therapy on Arterial Blood Oxygen Saturation and Temperature Changes in Patients Undergoing Surgery

Background: Postoperative complications can endanger the patient's life and disrupt the recovery process if not properly managed. Local cold therapy can be a safe non-pharmacologic method to manage these side effects; however, it has not been highly considered. Objectives: This study was done to determine the effect of local cold therapy on arterial blood oxygen saturation and temperature changes in patients undergoing surgery. Methods: This quasi-experimental study was performed at Shahrekord University of Medical Sciences in 2019 on 60 patients undergoing thoracic and abdominal surgery selected by convenience sampling, and they were randomly assigned to the intervention and control groups. The intervention (local cold therapy) was performed for 48 hours after full consciousness, three times a day for 20 minutes to the intervention group. Data were collected before and after the intervention using a demographic questionnaire, pulse oximetry device, and thermometer. The data were analyzed based on the independent samples t-test, paired-samples t-test, and chi-square and Fishers’ exact tests by SPSS version 20 software. Results: The mean arterial blood oxygen saturation percentage (O2Sat%) during the intervention significantly increased in both groups (P < 0.05), but the rate of increase was significantly higher in the local cold group (P < 0.05). The results of within-group research showed that the mean temperature had significant differences in the local cold therapy group (P < 0.05), but the mean body temperature did not show a significant difference between the two groups (P < 0.05). Conclusions: Local cold therapy can be effectively trained and used by nurses to improve the O2Sat%. It did not affect postoperative body temperature. Further studies must be conducted to investigate the effects of local cold therapy on postoperative body temperature changes.

Comparison of Chest-to-Back Skin-to-Skin Contact and Chest-to-Chest Skin-to-Skin Contact on the Risk of Oxygen Desaturation and Change in Heart Rate in Low Birth Weight and/or Premature Babies: A Randomized Controlled Clinical Trial.

Chest-to-chest (CC) skin-to-skin contact (SSC) is a widely used method of SSC to prevent low birth weight (LBW) and/or premature babies with the risk of hypothermia. However, very recently, a study has also shown that the chest-to-back (CB) SSC is also useful for such a purpose. It is also evident that CC SSC enhances the cardiorespiratory performance of LBW and/or premature babies from the risk of cold stress. However, whether babies kept in CB SSC have the risk of clinically relevant decreases of oxygen saturation or critical changes of the baby heart rate comparing the two SSC methods has been studied hardly. Thus, we assessed the risk of oxygen desaturation and changes in babies' heart rate among LBW and/or premature babies kept in CB SSC compared to the standard. In this study, we enrolled 46 LBW and/or premature babies born between 32 and 37 completed weeks of gestation. We used a parallel-group randomized controlled clinical trial. Peripheral arterial blood oxygen saturation (SpO2) and heart rate (HR) were measured using an OxiMaxN-600X Pulse Oximeter. We transformed these measurements into stability of the cardiorespiratory system in premature infant (SCRIP) scores. We applied a generalized estimating equation model to analyze the data. No statistically significant difference was observed between babies kept in CB SSC compared to babies kept in CC SSC in either blood oxygen saturation or heart rate (P > 0.05). Thus, the CB SSC can be used as one possible way to care for LBW and preterm babies in the kangaroo mother care. We suggest more studies before scaling up the approach in routine care.

Positive Expiratory Pressure Therapy on Oxygen Saturation and Ventilation After Abdominal Surgery: A Randomized Controlled Trial.

To evaluate the immediate effects of positive expiratory pressure therapy on oxygen saturation and ventilation after abdominal surgery. Positive expiratory pressure therapy to treat postoperative hypoxia is widespread, despite a lack of evidence of effect. This randomized, sham-controlled, crossover trial investigated adults 1-2 days after abdominal surgery at Umeå University Hospital, Sweden. The intervention was positive expiratory pressure of 10-15 cm H2O. The control was a sham device. The investigations were ended with deep-breathing maneuvers. Outcomes were the gradient of changes in peripheral oxygen saturation and transcutaneous carbon-dioxide partial pressure (PtcCO2). Eighty patients were included and randomized and 76 patients were analyzed. Oxygen saturation increased from a baseline mean of 92% to 95%, P < 0.001, during positive expiratory pressure breathing, while PtcCO2 decreased from a mean of 36 to 33 mm Hg, P < 0.001. This was followed by apnea, oxygen desaturations to a mean of 89%, P < 0.001, and increased PtcCO2 before returning to baseline values. The changes in oxygen saturation and PtcCO2 did not differ from sham breathing or deep-breathing maneuvers. Positive expiratory pressure breathing after abdominal surgery improves oxygen saturation during the maneuver because of hyperventilation, but it is followed by apnea, hypoventilation, and oxygen desaturation. The effect is not different from the expiration to a sham device or hyperventilation. It is time to stop positive expiratory pressure therapy after abdominal surgery, as there is no evidence of effect in previous trials, apart from the adverse effects reported here.

Predictors of changes in cerebral perfusion and oxygenation during obstructive sleep apnea

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder. Severe OSAS defined as apnea–hypopnea index (AHI) ≥ 30/h is a risk factor for developing cerebro-cardiovascular diseases. The mechanisms of how repetitive sleep apneas/hypopneas damage cerebral hemodynamics are still not well understood. In this study, changes in blood volume (BV) and oxygen saturation (StO2) in the left forehead of 29 newly diagnosed severe OSAS patients were measured by frequency-domain near-infrared spectroscopy during an incremental continuous positive airway pressure (CPAP) titration protocol together with polysomnography. The coefficients of variation of BV (CV-BV) and the decreases of StO2 (de-StO2) of more than 2000 respiratory events were predicted using linear mixed-effect models, respectively. We found that longer events and apneas rather than hypopneas induce larger changes in CV-BV and stronger cerebral desaturation. Respiratory events occurring during higher baseline StO2 before their onsets, during rapid-eye-movement sleep and those associated with higher heart rate induce smaller changes in CV-BV and de-StO2. The stepwise increased CPAP pressures can attenuate these changes. These results suggest that in severe OSAS the length and the type of respiratory event rather than widely used AHI may be better parameters to indicate the severity of cerebral hemodynamic changes.

Effect of Dexmedetomidine Combined with Ropivacaine on Cognitive Dysfunction and Inflammatory Response in Patients Undergoing Craniocerebral Surgery.

Objective To study the effects of dexmedetomidine in combination with ropivacaine in patients undergoing craniocerebral surgery and their efficiency on cognitive function and inflammatory response of patients. Methods 100 patients undergoing craniocerebral surgery in our hospital from November 2018 to September 2020 were randomly selected and divided into a control group and an experimental group by drawing lots, with 50 cases in each group. Patients in the control group received routine anesthesia, while those in the experimental group received 1 μg/kg of dexmedetomidine combined with 0.5% of ropivacaine for anesthesia to compare the anesthesia onset time, analgesic time, postoperative awake time, Social Disability Screening Schedule (SDSS) cognitive function score after waking, visual analogue scale (VAS) pain score, Ramsay sedation score, incidence of adverse reactions, postoperative inflammatory factor expression levels, and changes in heart rate, oxygen saturation, and blood pressure at T0, T1, T2, T3, and T4 between the two groups. Results The anesthesia onset time, SDSS cognitive function score after waking, VAS pain score, Ramsay sedation score, incidence of adverse reactions, and postoperative inflammatory factor expression levels in the experimental group were significantly lower than those in the control group (P < 0.05). The analgesic time and postoperative awake time in the experimental group were significantly longer than those in the control group, with statistical significance (P < 0.05). There were no statistically significant differences in the changes of heart rate, oxygen saturation, and blood pressure at T0, T1, T2, T3, and T4 between the two groups (P > 0.05). Conclusion Dexmedetomidine combined with ropivacaine has high application value in craniocerebral surgery.

Temperature and oxygen saturation in skilled nursing facility residents positive for SARS-CoV-2 prior to symptom onset.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spreads rapidly amongst residents of skilled nursing facilities (SNFs). The rapid transmission dynamics and high morbidity and mortality that occur in SNFs emphasize the need for early detection of cases. We hypothesized that residents of SNFs infected with SARS-CoV-2 would demonstrate an acute change in either temperature or oxygen saturation (SpO2 ) prior to symptom onset. The Minnesota Department of Health (MDH) conducted a retrospective analysis of both temperature and SpO2 at two separate SNFs to assess the utility of these quantitative markers to identify SARS-CoV-2 infection prior to the development of symptoms. A retrospective analysis was conducted of 165 individuals positive for SARS-CoV-2 who were residents of SNFs that experienced coronavirus disease 2019 (COVID-19) outbreaks during April-June 2020 in a metropolitan area of Minnesota. Age, sex, symptomology, temperature and SpO2 values, date of symptom onset, and date of positive SARS-CoV-2 test were analyzed. Temperature and SpO2 values for the period 14 days before and after the date of initial positive test were included. Descriptive analyses evaluated changes in temperature and SpO2 , defined as either exceeding a set threshold or demonstrating an acute change between consecutive measurements. Two (1%) residents had a temperature value ≥100°F, and 30 (18%) had at least one value ≥99°F within 14 days before symptom development. One hundred and sixteen residents (70%) had at least one SpO2 value ≤94%, while 131 (80%) had an acute decrease in SpO2 of ≥3% between consecutive values in the 14 days prior to symptom onset. Our results suggest that acute change in SpO2 might be useful in the identification of SARS-CoV-2 infection prior to the development of symptoms among residents living in SNFs. Facilities may consider adding SpO2 to daily temperature and symptom screening checklists to improve early detection of residents of SNFs infected with SARS-CoV-2.

A Reductive Metabolic Switch Protects Infants with Transposition of Great Arteries Undergoing Atrial Septostomy against Oxidative Stress

Transposition of the great arteries (TGA) is one of the most common cyanotic congenital heart diseases requiring neonatal surgical intervention. Parallel circulations that result in impaired cerebral oxygen delivery already in utero may lead to brain damage and long-term neurodevelopmental delay. Balloon atrial septostomy (BAS) is often employed to mix deoxygenated and oxygenated blood at the atrial level. However, BAS causes a sudden increase in arterial blood oxygenation and oxidative stress. We studied changes in oxygen saturation as well as metabolic profiles of plasma samples from nine newborn infants suffering from TGA before and until 48 h after undergoing BAS. The plasma metabolome clearly changed over time and alterations of four metabolic pathways, including the pentose phosphate pathway, were linked to changes in the cerebral tissue oxygen extraction. In contrast, no changes in levels of lipid peroxidation biomarkers over time were observed. These observations suggest that metabolic adaptations buffer the free radical burst triggered by re-oxygenation, thereby avoiding structural damage at the macromolecular level. This study enhances our understanding of the complex response of infants with TGA to changes in oxygenation induced by BAS.

Good news on masks

Although guidance is changing rapidly, it appears that the use of face masks will be an important component for the safe return of some children to school. Unfortunately, this guidance has been undermined by largely unfounded concerns about mask safety in children. An article in the current volume of The Journal addresses one aspect of mask safety in children, the use of N95s. Because current guidance calls for the use of cloth or surgical masks in most settings, the findings of the study by Lubrano et al should reassure us about the use of these more specialized masks for exceptional circumstances. Studying children wearing these masks (both with and without exhalation valves), the authors observed no changes in pulse rate or oxygen saturation. Although there were some marginally significant increases in respiratory rate and end tidal CO2 in children during mask wearing, neither of these were to levels of clinical importance. These findings are consistent with similar studies in adults. As the authors point out, no concerns about respiratory function have been raised with the use of less-restrictive masks (eg, cloth) in children. Discussions about the use of masks in children in school will likely continue for some time. Concern about safety probably does not need to be a part of these discussions. Article page 143 ▸ Effects of N95 Mask Use on Pulmonary Function in ChildrenThe Journal of PediatricsVol. 237PreviewTo assess whether use of an N95 mask by children is associated with episodes of desaturation or respiratory distress. Full-Text PDF

Changes in central venous-to-arterial carbon dioxide tension induced by fluid bolus in critically ill patients.

In this prospective observational study, we evaluated the effects of fluid bolus (FB) on venous-to-arterial carbon dioxide tension (PvaCO2) in 42 adult critically ill patients with pre-infusion PvaCO2 > 6 mmHg. FB caused a decrease in PvaCO2, from 8.7 [7.6-10.9] mmHg to 6.9 [5.8-8.6] mmHg (p < 0.01). PvaCO2 decreased independently of pre-infusion cardiac index and PvaCO2 changes during FB were not correlated with changes in central venous oxygen saturation (ScvO2) whatever pre-infusion CI. Pre-infusion levels of PvaCO2 were inversely correlated with decreases in PvaCO2 during FB and a pre-infusion PvaCO2 value < 7.7 mmHg could exclude a decrease in PvaCO2 during FB (AUC: 0.79, 95%CI 0.64-0.93; Sensitivity, 91%; Specificity, 55%; p < 0.01). Fluid bolus decreased abnormal PvaCO2 levels independently of pre-infusion CI. Low baseline PvaCO2 values suggest that a positive response to FB is unlikely.

Association of Ongoing Cerebral Oxygen Extraction During Deep Hypothermic Circulatory Arrest With Postoperative Brain Injury

Cardiac surgery utilizing circulatory arrest is most commonly performed under deep hypothermia (∼18°C) to suppress tissue oxygen demand and provide neuroprotection during operative circulatory arrest. Studies investigating the effects of deep hypothermic circulatory arrest (DHCA) on neurodevelopmental outcomes of patients with congenital heart disease give conflicting results. Here, we address these issues by quantifying changes in cerebral oxygen saturation, blood flow, and oxygen metabolism in neonates during DHCA and investigating the association of these changes with postoperative brain injury. Neonates with critical congenital heart disease undergoing DHCA were recruited for continuous intraoperative monitoring of cerebral oxygen saturation (ScO2) and an index of cerebral blood flow (CBFi) using 2 noninvasive optical techniques, diffuse optical spectroscopy (DOS) and diffuse correlation spectroscopy (DCS). Pre- and postoperative brain magnetic resonance imaging (MRI) was performed to detect white matter injury (WMI). Fifteen neonates were studied, and 11/15 underwent brain MRI. During DHCA, ScO2 decreased exponentially in time with a median decay rate of -0.04 min-1. This decay rate was highly variable between subjects. Subjects who had larger decreases in ScO2 during DHCA were more likely to have postoperative WMI (P=0.02). Cerebral oxygen extraction persists during DHCA and varies widely from patient-to-patient. Patients with a higher degree of oxygen extraction during DHCA were more likely to show new WMI in postoperative MRI. These findings suggest cerebral oxygen extraction should be monitored during DHCA to identify patients at risk for hypoxic-ischemic injury, and that current commercial cerebral oximeters may underestimate cerebral oxygen extraction.

A randomized pilot study using calcitriol in hospitalized COVID-19 patients.

The systemic illness associated with SARS-CoV-2 infection results in hospitalization rate of 380.3 hospitalizations per 100,000 population, overwhelming health care systems. Vitamin D regulates expression of approximately 11,000 genes spanning many physiologic functions that include regulation of both innate and adaptive immune function. We investigate potential benefit of calcitriol therapy given to patients hospitalized with COVID-19.This was an open label, randomized clinical trial of calcitriol or no treatment given to hospitalized adult patients with COVID-19. Subjects were randomly assigned treatment with calcitriol 0.5 μg daily for 14 days or hospital discharge; or no treatment (1:1) at time of enrollment.We enrolled 50 consecutive patients, 25 per trial arm. The change in peripheral arterial oxygen saturation to the inspired fraction of oxygen (SaO2/FIO2 ratio) was calculated on admission and discharge between the groups. The control group had an average increase of +13.2 (±127.7) on discharge and the calcitriol group had an increase of +91.04 (±119.08) (p = .0305), suggesting an improvement in oxygenation among subjects who received calcitriol. Additionally, 12 patients in the control group required oxygen supplementation on admission and 21 of them were discharged on room air. 14 subjects needed oxygen supplementation in the calcitriol group on admission while all 25 were discharged on room air.Other clinical markers showed the average length of stay was 9.24 (±9.4) in the control group compared to 5.5 (±3.9) days in the calcitriol group (p = .14). The need for ICU transfer was 8 in the control group and 5 in the calcitriol group. There were 3 deaths and 4 readmissions in the control group and 0 deaths and 2 readmissions in the calcitriol group.This pilot study illustrates improvement in oxygenation among hospitalized patients with COVID-19 treated with calcitriol and suggests the need for a larger randomized trial.

Ten-Year Trend of Retinopathy of Prematurity Among Extremely Preterm Infants in One Neonatal Intensive Care Unit in China.

Background: Extremely preterm (EP) infants are at the highest risk of retinopathy of prematurity (ROP). With more EP infants survived in China, recent data of ROP is lacking. The aim of the study is to report the trend of incidence of ROP among EP infants in a large neonatal intensive care unit in China over the past 10-year period, in relation with the overall survival rate and the change of oxygen saturation targets.Methods: This retrospective cohort study enrolled all EP infants born before 28 weeks' gestation and admitted to one of the largest tertiary neonatal intensive care units in China from 2010 to 2019. Data were compared between two time periods according to different oxygen saturation targets: 2010–2014 (P1) with low saturation target and 2015–2019 (P2) with higher target.Results: Of 630 EP infants admitted during the 10 years, 447 (71.0%) infants survived to discharge. The survival rate increased significantly from 61.6% in P1 to 75.8% in P2 (P < 0.05). Of the 472 infants who had ROP data, 318 (67.4%) developed ROP of any stage, 67 (14.2%) developed severe ROP, and 44 (9.3%) received treatment. The incidence of any ROP increased significantly from 51.7% in P1 to 74.3% in P2 (P < 0.05). The incidence of severe ROP increased from 11.0% in P1 to 15.6% in P2, and ROP treatment increased from 6.9% in P1 to 10.4% in P2, but neither reached statistical significance (both P > 0.05).Conclusions: We observed an increasing trend in the incidence of ROP across the 10-year period in one of the largest neonatal care units in China. The increased survival rate and the use of high-target oxygen saturation in the later period may partly explain this trend. Further investigations are needed to improve the care practices and to reduce the incidence of severe ROP.

Changes of retinal oxygen saturation during treatment of diabetic macular edema with a pre-defined regimen of aflibercept: a prospective study

PurposeTo study the effect of anti-VEGF therapy for diabetic macular edema (DME) on retinal oxygen saturation (O2S) and its correlation with functional and anatomical changes of retinal tissue.MethodsAn interventional prospective single group study. Included were 10 eyes of 10 patients with visually significant DME which received a fixed regimen of intravitreal aflibercept every 4 weeks for 5 months, followed by 3 injections every 8 weeks, and were controlled monthly. Visual acuity (VA), central retinal thickness (CRT), arterial (aO2S), venous (vO2S) and arterio-venous difference (AVdO2S) retinal oxygen saturation were noted monthly. Changes after 5th (V6) injection and on last follow-up (V12) were studied. Correlations of different parameters were analyzed.ResultsThe aO2S did not change whereas vO2S decreased (62.2 ± 9.4 pre-op to 57.2 ± 10.5 on V6, p = 0.03). This remained unchanged at 59.4 ± 13.2 on V12 (p = 0.2) and was accompanied by an increase of AVdO2S (40.8 ± 8.3 pre-op to 44.8 ± 10.6, p = 0.03 on V6) which was followed by a non-significant decrease to 41.8 ± 11.3 on V12 (p = 0.06). We found no correlation between BCVA and aO2S. However, mild correlation between BCVA and both vO2S and AVdO2S (r = −0.2 p = 0.035 and r = 0.185 p = 0.05 respectively) was found. No correlation was found between CRT and aO2S, vO2S, or AVdO2S.ConclusionsDuring DME treatment with fixed regimen of intravitreal aflibercept over 11 months, we observed a reduction of vO2S and increase of AVdO2S which correlated with BCVA but not CRT. This could be explained by increasing consumption of O2S in the central retina and, possibly, by re-perfusion process.

Low-dose whole-lung irradiation in severe COVID-19 pneumonia: a controlled clinical trial.

IntroductionThe COVID‐19 pandemic has caused significant morbidity and mortality thus far. Considering the historical uses of high‐voltage X‐ray beams for unresolvable pneumonia, we aimed to assess whether low‐dose whole‐lung irradiation (WLI) could provide any benefits for patients with refractory COVID‐19 pneumonia.MethodsEleven patients with refractory COVID‐19 pneumonia were treated with WLI to a total dose of 1 Gy and compared to 11 patients in a matched control group from June to November 2020. The study's primary endpoint was improvement of chest X‐ray severity score (CXRS), followed by changes in mean oxygen (O2) saturation and 28‐day mortality as secondary endpoints.ResultsThe final CXRS was significantly lower in the WLI group (8.7 ± 2.5) compared to the control group (12.3 ± 3.3) (P: 0.016). Change of CXRS from the first to the last chest X‐ray was −2.2 ± 3.1 for the WLI group and 0.7 ± 3.9 for the control group, which showed a trend for lower CXRS in the WLI group (U = 30, p: 0.085). Mean O2 saturation showed insignificant improvement in the first 24 hours after radiotherapy (mean difference: 2.5 ± 4.1, Z=−1.6, P value: 0.11). Overall survival after 28 days was 32% in the WLI group and 11% in the control group (P: 0.48). The reason for death in many patients was not merely respiratory failure, but also other adverse situations like pneumothorax, cardiogenic shock and pulmonary thromboembolism.ConclusionsLow‐dose WLI could improve the CXR severity score and O2 saturation in severely ill COVID‐19 patients, but larger studies are required to determine its impact on mortality.

Value of near-infrared spectroscopy in monitoring intestinal tissue oxygen saturation in preterm infants with hemodynamically significant patent ductus arteriosus: a prospective research.

To study the change in regional oxygen saturation (rSO2) of intestinal tissue in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA) by near-infrared spectroscopy, and the clinical significance of the change in intestinal oxygen level in preterm infants with hsPDA. The preterm infants with patent ductus arteriosus (PDA) who had gestational age <32 weeks and/or birth weight <1 500 g were prospectively enrolled, who were admitted to the Department of Neonatology, Shenzhen Longgang Central Hospital from October 2017 to October 2020.According to the diagnostic criteria for hsPDA, the preterm infants with patent ductus arteriosus (PDA) were divided into two groups: hsPDA and non-hsPDA. According to closure of the ductus arteriosus after oral administration of ibuprofen, the preterm infants in the hsPDA group were subdivided into two groups: hsPDA closure and hsPDA non-closure. Hemodynamic parameters were measured at diagnosis of PDA and after treatment, and the level of intestinal tissue rSO2 was monitored continuously to analyze its change. A total of 241 preterm infants with PDA were enrolled, with 55 infants (22.8%) in the hsPDA group and 186 infants (77.2%) in the non-hsPDA group. There were 36 infants (65%) in the hsPDA closure group and 19 infants (35%) in the hsPDA non-closure group. Compared with the non-hsPDA group, the hsPDA group had a significantly higher left atrial diameter/aortic root diameter ratio and significantly lower left ventricular ejection fraction and fractional shortening (P<0.05). At each time point within 6 hours after diagnosis (1, 2, 4, and 6 hours), the hsPDA group had significantly lower intestinal tissue rSO2 than the non-hsPDA group (P<0.05), and intestinal tissue rSO2 gradually decreased over time in the hsPDA group (P<0.05), with the lowest level of 0.448±0.014 at 6 hours. Compared with the hsPDA non-closure group, the hsPDA closure group had a significantly lower left atrial diameter/aortic root diameter ratio and significantly higher left ventricular ejection fraction and fractional shortening (P<0.05). At each time point within 48-96 hours after treatment (48, 72, and 96 hours), the hsPDA closure group had significantly higher intestinal tissue rSO2 than the hsPDA non-closure group (P<0.05), and intestinal tissue rSO2 gradually increased since 24 hours after treatment in the hsPDA closure group (P<0.05), with the highest level of 0.578±0.031 at 96 hours. hsPDA has an impact on intestinal tissue oxygenation in preterm infants, and continuous monitoring of intestinal tissue rSO2 by near-infrared spectroscopy can help to guide the clinical management of hsPDA in preterm infants.

Effects of simulated prolonged restrained sitting on physical and physiological states

Introduction: Advancement in aerospace technology, and resultant change in operational capabilities has posed unique challenges on the aircrew, who is required to operate for prolonged periods seated and restrained. Examination of the effects of prolonged restrained sitting on physical and physiological states was the desired objective of the study. Material and Methods: Longitudinal evaluation of subjective appreciation of physical discomfort and pain, and physiological parameters, namely, heart rate (HR), blood pressure (BP), oxygen saturation (SpO2), skin temperature, and calf girth changes across 6-h of simulated prolonged restrained sitting was undertaken among 15 healthy male non aircrew volunteers with mean age of 31.2 ± 3.63 years. Subjective discomfort was assessed by Category Partitioning Scale (CPS) and pain by Short-Form McGill Pain Questionnaire (SF-MPQ). Results: Prolonged restraint sitting of 6-h resulted in a significant increase in calf girth. Significant changes were also observed in CPS and SF-MPQ scores indicating an increase perception of discomfort and pain. Changes in HR, MAP, SpO2, and lower limb skin temperature were also observed even though these changes were lower in magnitude. Conclusion: The pain and discomfort following 6-h of prolonged restraint sitting were found to be appreciable by the subjects. This, along with a significant change in the calf circumference and other physiological parameters were possibly due to effects of venous pooling as a result of sitting for prolonged periods. The effects so observed could have potential flight safety implications and affect mission effectiveness. However, these findings need to be examined in actual cockpit conditions where the seat is more ergonomically designed; yet the aircrew is subjected to a wide spectrum of additional aeromedical stressors.

Effects of Temperature and Position Change on Neonatal Brain Regional Oxygen Saturation in Tub Bathing: A Prospective Study.

IntroductionA major goal in neonatal medicine is to reduce stress as much as possible in routine care. Bathing is one of the important routine cares for neonates, but it makes a big environmental change for them. We aimed to examine whether water temperature, room temperature, and position changes in tub bathing serve as noxious stimuli to neonates.MethodsThis prospective trial was performed in full-term and non-low-birth-weight neonates admitted to the hospital between July 2020 and March 2021. Those with underlying diseases, fetal distress, infection, and other medical conditions were excluded. Measurements were taken during the neonates’ first tub bath since birth, which was performed by a trained nurse. Changes in regional oxygen saturation (rSO2), determined using near-infrared spectroscopy, and water and room temperature, were examined at five different time points: upon entering the bath, head washing, position change, exiting the bath, and during the 3 min after bathing.ResultsIn total, 17 neonates were analyzed. No changes in rSO2 due to head washing or position change were observed; however, rSO2 significantly decreased upon entering (78.5 ± 4.1% vs. 75.7 ± 4.1%, p < 0.001) and exiting the bath (75.8 ± 5.7% vs. 74.4 ± 5.4%, p < 0.04). The rate change in rSO2 upon entering the bath showed a significant inverse correlation with water temperature (r = − 0.53, p < 0.03), and there were no significant correlations between rSO2 and water or room temperature upon exiting the bath. There was no change in body skin temperature before and after bathing, but rSO2 gradually decreased during the 3 min after bathing.ConclusionsNeonates may perceive certain temperatures during bathing as noxious stimuli. Therefore, methods to minimize stress associated with bathing should be implemented to reduce the difference between water temperature and room temperature during bathing.Trial registrationThis trial has been registered at UMIN repository with the trial number UMIN000041045 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046500). The date of the final dataset was April 01, 2021.

Pathogenetic Development Factors of Position-dependent Changes in Oxygen Saturation

It is known that the oxygen saturation of the peripheral blood is determined by the efficiency of the heart, the state of the microcirculatorybed, so position-dependent fluctuations in systolic blood pressure, pressure in the left renal and left adrenal veins,mediated bursts of hormones of the adrenal cortex can affect SO2. There is every reason to believe that SO2 will change in differentstatic positions. Aim. To study position-dependent changes in oxygen saturation based on the study of the pathogenetic effect of venous bloodflow in the “pool” of the left renal vein on the general hemodynamics and hormones of the adrenal cortex. Material and methods. A method for the polypositional assessment of oxygen saturation disturbances in six static states has beendeveloped: standing, sitting, on the back, on the abdomen, on your right side, on your left side. Statistical data processing was carriedout, which made it possible to determine the relationship between the indicators. Results. Polypositional studies of oxygen saturation hemodynamic parameters (SрO2) in six static states revealed the variability ofthe relationships of these groups when comparing them. The correlation was high, statistically significant between diastolic (DBP)and systolic (SBP) pressure, moderate between pulse (Ps) and SBP, pulse and DBP, weak between pulse and saturation. The groupsdivided by body positions relative to the pulse, SBP and DBP did not have a cluster structure. In the pron-position, SO2 had a minimalvalue, significantly different from the data in the other positions. Conclusion. Body position is one of the pathogenetically significant factors regulating blood oxygen saturation, which can helpin the treatment and rehabilitation of patients with respiratory failure (COVID-19). Polypositional saturation measurement in sixstatic states can determine a new, more effective algorithm for the management of patients with respiratory failure, both duringtreatment and during rehabilitation.

Tonsillectomy Outcomes for Children With Severe Obesity.

To determine the success of an adenotonsillectomy (T&A) in treating children with severe obesity utilizing a more accurate obesity scale. Retrospective cohort. A retrospective cohort of children with obesity between 5 and 10 years of age who underwent a T&A at Children's Hospital of Colorado (CHCO) was used. This study also utilized publicly available data from the Childhood Adenotonsillectomy Trial (CHAT) study. The cohort was divided into three obesity classes using age- and sex-specific body mass index (BMI) expressed as a percentage of the 95th percentile (%BMIp95) and compared for operative success differences. There were 132 patients included in our primary analysis, with obesity distribution as follows: Class 1 to 53 patients (40%), Class 2 to 45 patients (34%), and Class 3 to 34 patients (26%). Overall, 52 patients (35.9%) experienced a cure (obstructive apnea/hypopnea index [OAHI] <1), with 27 (52%) patients in Class 1 obesity, 18 (35%) in Class 2, and 7 (13%) in Class 3. Class 3 had a significantly lower obstructive sleep apnea cure rate compared with Class 1 patients (P=.013), but after adjusting for covariates, this difference was no longer present (P > .05). There was no significant difference in the preoperative to postoperative percent change in mean oxygen saturation (P=.82 CHCO, P=.43 CHAT), oxygen nadir (P=.20 CHCO, P=.49 CHAT), or OAHI (P=.12 CHCO, P=.26 CHAT) between the obesity classes. After adjusting for covariates, children with Class 3 obesity are as likely to be cured with a T&A as those with Class 1 obesity. A T&A should be considered a first line treatment for all children with obesity. 3 Laryngoscope, 132:461-469, 2022.