Mean Respiratory Rate Research Articles

Investigation of the prognostic role of systemic immunoinflammatory index in patients with acute pancreatitis.

The aim of this study was to examine the effect of systemic immunoinflammatory index (SII), calculated on presentation to the emergency department (ED), on the prediction of clinical outcomes of patients who were diagnosed with acute pancreatitis (AP). This research was designed as a single-center, cross-sectional, and retrospective study. Adult patients who were diag-nosed with AP in the ED between October 2021 and October 2022 in the tertiary care hospital, whose diagnostic and therapeutic procedures were complete in the data recording system, have been included in the study. Mean age, respiratory rate, and length of stay of the non-survivors were significantly higher than the mean of the survivors (t-test, p=0.042, p=0.001, and p=0.001, respectively). Mean SII score of the patients with fatal outcome was higher than the survivors (t-test, p=0.001). ROC analysis of the SII score to predict mortality revealed that the area under the curve was found to be 0.842 (95%CI 0.772-0.898), and the Youden index was 0.614, (p=0.001). When the cutoff value of the SII score in determining mortality is 1243, the sensitivity of the score was found to be 85.0%, specificity 76.4%, positive predictive value 37.0%, and negative predictive value 96.9%. SII score was statistically significant in estimating mortality. SII calculated on presentation to the ED can be a useful scoring system to predict the clinical outcomes of patients who were admitted to the ED and were diagnosed with AP.

Comparative Study of the Effect of Oral Chloral Hydrate and Intranasal Fentanyl on Sedation in Children for Electroencephalography.

Sedation and stability during electroencephalography (EEG) in pediatrics have high clinical importance. This study compares the sedative properties of oral chloral hydrate (OCH) and intranasal fentanyl (INF). This study was a randomized clinical trial conducted in 2020 in Isfahan City on sixty-two pediatric candidates for EEG. Patients were randomized into two groups receiving 50 mg/kg OCH and 2 μg/kg INF thirty minutes before the process. The heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), and oxygen saturation (O2 sat) of patients, sedation, and physician's satisfaction were measured and compared between groups. The HR of patients decreased significantly in both groups (P< 0.001), and the patients that received INF had significantly lower HR 15, 30, 45, and 60 minutes after drug administrations (P< 0.05). RR evaluation indicated significantly decreased RR in both groups (P< 0.001), and patients receiving INF had lower RR 30, 45, and 60 per minutes after drug administrations (P< 0.001). Both groups showed significantly increased sedation levels during the study (P< 0.001), and patients treated with INF had higher sedation levels 15, 30, and 45 minutes after drug administration. Satisfaction rates were higher among the group that received INF (P= 0.020). The use of INF had significant analgesic and sedative effects on pediatrics undergoing EEG.

Dairy Cow Thermal Balance Model During Heat Stress: Part 2. Model Assessment

Highlights The thermal balance model body temperature and respiration rate results compared well with published data. Model results were commonly within one standard deviation of reported averages. Research that measures more model inputs, coefficients, and results is needed. The thermal balance model can be used to identify heat stress factors and assess mitigation practices. Abstract. A steady-state process-based lactating cow thermal balance spreadsheet model developed by Nelson and Janni (in press) was compared to mean measured body temperatures, respiration rates, and skin temperatures from two published studies (Gebremedhin et al., 2010; Chen et al., 2015). Model body temperatures were also compared with reticular temperatures from cows standing in unshaded paddocks that were part of a solar shade study (Sharpe et al., 2021). Gebremedhin et al. (2010) reported measured mean rectal temperatures, 39.4 ± 0.5 C and 40.6 ± 0.4 C for hot and dry conditions with and without a solar load; model body temperatures for similar hot and dry conditions were 39.7 C and 40.6 C with and without a solar load, respectively. Model respiration rates were within one standard deviation of measured mean respiration rates (Gebremedhin et al., 2010). The model body temperature for a baseline condition was 39.1°C, which was within 0.1°C of the mean baseline temperature of 39.2 ± 0.6°C (Chen et al., 2015). The model respiration rate was 63 breaths per minute (bpm); much lower than the reported baseline respiration rate of 88 bpm (Chen et al., 2015). Model body temperatures were 0.1°C to 0.7°C lower than the measured mean reticular temperatures of standing cows in non-shaded paddocks with solar loads when ambient temperatures ranged from 24.4°C to 26.5°C. Model results compared well with mean measured parameters from three studies. The model can be used to assess the impact of factors affecting heat exchange (e.g., body mass, milk yield, solar load, air dry-bulb temperature, dew-point temperature, and air velocity) on heat exchange flux, cow respiration rate, and body temperature. Keywords: Body temperature, Dairy, Heat stress, Lactating cow, Respiration rate, Thermal balance model.

Prediction and risk assessment of sepsis-associated encephalopathy in ICU based on interpretable machine learning

Sepsis-associated encephalopathy (SAE) is a major complication of sepsis and is associated with high mortality and poor long-term prognosis. The purpose of this study is to develop interpretable machine learning models to predict the occurrence of SAE after ICU admission and implement the individual prediction and analysis. Patients with sepsis admitted to ICU were included. SAE was diagnosed as glasgow coma score (GCS) less than 15. Statistical analysis at baseline was performed between SAE and non-SAE. Six machine learning classifiers were employed to predict the occurrence of SAE, and the adjustment of model super parameters was performed by using Bayesian optimization method. Finally, the optimal algorithm was selected according to the prediction efficiency. In addition, professional physicians were invited to evaluate our model prediction results for further quantitative assessment of the model interpretability. The preliminary analysis of variance showed significant differences in the incidence of SAE among patients with pathogen infection. There were significant differences in physical indicators like respiratory rate, temperature, SpO2 and mean arterial pressure (P < 0.001). In addition, the laboratory results were also significantly different. The optimal classification model (XGBoost) indicated that the best risk factors (cut-off points) were creatinine (1.1 mg/dl), mean respiratory rate (18), pH (7.38), age (72), chlorine (101 mmol/L), sodium (138.5 k/ul), SAPSII score (23), platelet count (160), and phosphorus (2.4 and 5.0 mg/dL). The ranked features derived from the best model (AUC is 0.8837) were mechanical ventilation, duration of mechanical ventilation, phosphorus, SOFA score, and vasopressin usage. The SAE risk prediction model based on XGBoost created here can make very accurate predictions using simple indicators and support the visual explanation. The interpretable model was effectively evaluated by professional physicians and can help them predict the occurrence of SAE more intuitively.

Immediate skin-to-skin contact for low birth weight infants is safe in terms of cardiorespiratory stability in limited-resource settings

AimTo investigate the safety of skin-to-skin contact initiated immediately after birth on cardiorespiratory parameters in unstable low birth weight infants. MethodsA randomized clinical trial was conducted in tertiary newborn units in Ghana, India, Malawi, Nigeria and Tanzania in 2017–2020, in infants with birth weight 1.0–1.799 kg. The intervention was Kangaroo mother care initiated immediately after birth and continued until discharge compared to conventional care with Kangaroo mother care initiated after meeting stability criteria. The results of the primary study showed that immediate Kangaroo mother care reduced neonatal mortality by 25% and the results have been published previously. The post-hoc outcomes of this study were mean heart rate, respiratory rate, oxygen saturation during the first four days and the need of respiratory support. Results1,602 infants were allocated to control and 1,609 to intervention. Mean birth weight was 1.5 kg (SD 0.2) and mean gestational age was 32.6 weeks (SD 2.9). Infants in the control group had a mean heart rate 1.4 beats per minute higher (95% CI -0.3–3.1, p = 0.097), a mean respiratory rate 0.4 breaths per minute higher (-0.7–1.5, p = 0.48) and a mean oxygen saturation 0.3% higher (95% CI -0.1–0.7, p = 0.14) than infants in the intervention group. ConclusionThere were no significant differences in cardiorespiratory parameters during the first four postnatal days. Skin-to-skin contact starting immediately after birth is safe in low birth weight infants in limited-resource settings.

Effects of Seawater Immersion on Lethal Triad and Organ Function in Healthy and Hemorrhagic Shock Rats

IntroductionMarine casualties are increasing, and mortality from trauma associated with immersion in seawater is high. However, the associated pathophysiological characteristics remain unclear, limiting research into the early emergency treatment strategy. MethodsHealthy and 50% hemorrhagic shock rats were soaked in 15°C and 21°C seawater for 2 h, 4 h and 6 h, respectively, and the effects on vital signs, internal environment, tissue metabolism, lethal triad, vital organ functions and survival were observed. ResultsImmersion in seawater can cause death in healthy rats. Rats with hemorrhagic shock in 15°C seawater showed a lower survival rate than the corresponding groups in 21°C seawater. Moreover, compared with 21°C seawater, 15°C seawater played a more remarkable role in decreasing mean arterial pressure, heart rate, and respiration rate, increasing water content and decreasing Na+/K+-ATPase activity in the brain and lung; increase in plasma osmolality, Na+, K+, Cl−, and the occurrence of the lethal triad manifested by a decrease in core body temperature, pH, lactate, and an increase in coagulation parameters, as well as damage to cardiac, intestinal, hepatic, and renal functions in rats with hemorrhagic shock. ConclusionsImmersion in seawater at low temperatures could be lethal to healthy rats, causing the occurrence of a lethal triad and damage to vital organs. Furthermore, 15°C-seawater had a more significant effect than 21°C-seawater on aggravating the imbalance of internal environment and tissue metabolism, resulting in a higher incidence of the lethal triad and thus aggravating the dysfunctions of vital organs, which eventually resulted in higher mortality in rats with hemorrhagic shock.

798 CARDIOVASCULAR EFFECTS OF WHOLE-BODY CRYOTHERAPY IN NON-PROFESSIONAL ATHLETES

Abstract Whole-body cryotherapy (WBC) is a method of cold therapy widely applied for muscle recovery after injury to counteract the inflammatory response due to specific diseases, characterized by high levels of inflammation. WBC consists of short exposure, of about 2-3 minutes, to dry air at cryogenic temperatures (up to -190°C) in a special chamber. Our study aimed to investigate changes in respiratory rate, oxygen saturation, blood pressure, heart rate and body temperature induced by WBC sessions in athletes. Ten volunteer middle-distance non-professional runners (age: 38±12 years) received 3 once-a-day sessions of WBC. Subjects underwent blood pressure measurements and ECG recorded before and immediately after the daily session. During WBC we recorded a single lead trace (D1) for heart rhythm control. Moreover, we monitored the 5 vital signs, such as blood pressure, heart rate, respiratory rate, oxygen saturation and body temperature, during, and after all WBC session. We did not report significant changes in ECG main intervals (PR, QT, and QTc) and in the mean systolic blood pressure during and after WBC [baseline: 118 ± 5 mmHg, changed to 120 ± 3 mmHg during WBC, and to 121 ± 2 mmHg after session]. Mean respiratory rate did not change significantly during WBC as well as oxygen saturation (98 vs. 99%). Mean heart rate changed from 50.98 ± 4.43 bpm (before) to 56.83 ± 4.26 bpm after WBC session (p &amp;lt; 0.05) and body temperature was slightly increased after WBC, however it remains within physiological values. In non-professional athletes WBC did not affect cardiovascular response and can be safely used. However, further studies are required to confirm these promising results of safety in elderly non-athlete subjects.

Relationship between Vital Signs and Asthma Attack Levels of Patients having Asthmatic Episodes

Objective: To analysis the relationship of vital signs of patients experiencing acute asthmatic episodes presenting in the emergency room.Methods: A cross-sectional study was conducted at the emergency department of provincial hospital, in Banjarmasin, Indonesia between July-August 2019. Subjects were studied during an acute asthmatic episode. The patient's vital signs, such as respiratory rate, temperature, blood pressure, and heart rate were continuously and in real time monitored using observation sheets kept by nurses providing emergency care.Results: Of 220 patients with acute asthmatic attack, the mean age was 30.6 ± 9.7 years. There were 92 (41.8%) males and 128 (58.2%) females. According to the different levels of asthmatic episodes, majority 109 (49.5%) of patients had moderate level of asthmatic attack, while 66 (30.0%) patients had mild and 45 (20.5%) patients had severe asthmatic attack. Mean respiratory rate and heart rate significantly increased according to the levels of an asthma attack (mild to severe) (p-values &lt; 0.001) respectively. Conclusion: During an acute asthmatic episode, vital signs (such as heart rate and respiratory rate) alter abnormally, indicating the need for an immediate intervention. Appropriate asthma medications, as well as diligent vital sign monitoring by nursing staff, are essential for patients with altered vital signs.

Effect of different low doses of intrathecal morphine (0.1 and 0.2 mg) on pain and vital functions in patients undergoing total hip arthroplasty: a randomised controlled study

BackgroundOrthopaedic surgeries are among the most painful procedures. By adding low-dose morphine to intrathecal bupivacaine for spinal anaesthesia, the analgesic effect can be improved. The objeсtive of the study was tо compare the efficacy and safety of lоw-dоse (0.1 mg аnd 0.2 mg) intrаtheсаl mоrphine (ITM).MethodsА prоspeсtive rаndоmised study was соnduсted at the Hоspitаl оf Trаumаtоlоgy аnd Оrthоpaediсs, Riga, Latvia (February 2020 tо May 2021) and enrolled 90 patients undergoing primary hip arthroplasty. All subjects were randomised intо three study grоups, using the online tool оn www.randomiser.org. Treatment groups were allocated to intrathecal morphine (0.1 mg and 0.2 mg) in addition to bupivacaine (15 to 18 mg). The primary outcome was postoperative pain intensity among the three study groups within 24 hours by NRS. The secondary outcomes: pain at rest 4 h, 7 h, 12 h, 24 h postoperatively, respiratory rate, SpО2, morphine соnsumptiоn, оxygen supply, opioid-related аdverse reасtiоns within 24 hours postoperatively. Dаtа were аnаlysed using R version 4.2.0, applying the Mann-Whitney test, Pearson’s chi-squared test, Fisher’s exact test, Friedman test, Wilcoxon test.ResultsThe primary outcome in the control, ITM 0.1 mg, ITM 0.2 mg groups, respectively: 2.56, 0.87, 0.28 (p < 0.001). The secondary outcomes in the control, ITM 0.1 mg, ITM 0.2 mg group, respectively: pain scores 4h – 1.21, 0.48, 0.17 (p = 0.068); 7 h – 2.62, 1.00, 0.17 (p < 0.001); 12 h – 3.08, 0.65, 0.37 (p < 0.001); 24 h – 2.50, 1.20, 0.41 (p < 0.001); rescue medication requests (incidence, %): 77%, 16.7%, 13.3% (p < 0.001); mean respiratory rate (breath/min) – 15.2; 15.2 (p > 0.05); mean SpO2 (%): 96.7%; 95.7%; 96.07%. Significant adverse effects: pruritus in ITM 0.2 mg group (23% of subjects, p < 0.001).ConclusionsAdult patients undergoing THA under spinal anaesthesia with bupivacaine and 0.2 mg morphine had superior analgesia to patients who received spinal analgesia with bupivacaine or bupivacaine and 0.1 mg morphine.Trial registrationStudy ID ISRCTN37212222; 20/04/2022 (registered retrospectively)

Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Rural Area: Why, How, and What Next?

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to fall in lung function, quality of life, and ultimately disease progression. The present study is an effort to study in detail about COPD exacerbation in a rural tertiary hospital. Aim: To study demographic, clinical, and laboratory profile of hospitalized patients of AECOPD. Methodology: Retrospective data of 170 consecutive patients of AECOPD were collected from records, were divided into two groups based on severity, and were analyzed: Group 1 for admission in the wards and Group 2 for intensive care unit (ICU) admissions. Results: A total of 141 (82.9%) patients were hospitalized in the wards, whereas 29 (17.1%) were admitted in the ICU. The mean age was 62.36 years in the wards and 64.89 years in the ICU. Nearly 89.4% of patients were smokers. Dyspnea (100%) was the most common symptom followed by cough (99%) and expectoration (98%). The mean respiratory rate at the time of presentation was 26/min in the wards and 31.56/min in the ICU. The mean oxygen saturation was 93% in the wards and 88.62% in the ICU. The mean post forced expiratory volume in 1 s (FEV1) was 43.98% in ward patients and 29.28% among ICU patients. Arterial blood gas revealed mean PaCO2 of 44.25 mmHg in the wards and 63.24 mmHg in the ICU. The mean pH in the ward was 7.48 compared to 7.34 in the ICU. The mean pulmonary arterial pressure (PAP) was higher in the ICU (53.74 mmHg) than in the ward (38.87 mmHg). Conclusion: The ratio of hospitalization in ICU to ward was 1:5. The site of treatment depends on respiratory rate, oxygen saturation, post-FEV1%, PAP, pH, and PaCO2.

Effects of maternal choline supplementation on performance and immunity of progeny from birth to weaning.

The objectives were to investigate whether supplementation with rumen-protected choline (RPC) during late pregnancy in Holstein cows affects offspring immunity and growth, and whether effects are utero-placental, colostrum dependent, or both. A total of 105 multiparous Holstein cows were assigned randomly to a prepartum diet (1.54 Mcal of NEL/kg of DM, and 15.8% CP) without (control) or with added RPC (12.9 g/d of choline ion). Calves (n = 111) were blocked by sex and assigned randomly to colostrum from control cows or colostrum from RPC cows, resulting in 4 treatments in a 2 × 2 factorial arrangement: (1) calves born and fed colostrum from non-supplemented dams (NN; n = 33); (2) calves from non-supplemented dams and fed colostrum from RPC-fed cows (NC; n = 25); (3) calves from RPC-supplemented dams and colostrum from non-supplemented cows (CN; n = 28); and (4) calves from RPC-supplemented dams and colostrum from RPC-fed cows (CC; n = 25). Growth, intakes, and immunity of females were evaluated up to 56 d of age. Growth and intake of male calves was evaluated up to 35 d of age, and physiological and immune responses to intravenous LPS challenge were evaluated from 21 to 35 d of age. Effects of prenatal and colostrum treatments and interactions between treatments were analyzed using mixed models. Calves fed colostrum from RPC-supplemented dams had a 17.4% increase in apparent efficiency of absorption of IgG compared with calves fed colostrum from control dams (27.4 vs. 23.3%). Incidence of fever in the first 21 d of age tended to be less in females born from RPC-supplemented dams compared with females born from control dams (31 vs. 58%). Prenatal RPC females had increased hematocrit and concentrations of red blood cells, leukocytes, neutrophils, and lymphocytes in blood compared with prenatal females born from control dams. Compared with prenatal control females, prenatal RPC females had greater intake of milk replacer (704 vs. 748 ± 9.9 g/d) and starter (45.4 vs. 60.2 ± 5.9 g/d) during the first 21 d of age. In male calves, mean intake of DM was greater (1,074 vs. 976 ± 45 g/d) after the LPS challenge (0 to 8 d) by calves born from dams fed RPC compared with males born from control dams. Calves born from RPC-fed dams also had lower mean rectal temperature (39.0 vs. 39.2°C) and mean respiration rate (35.6 vs. 39.3 breaths/min) compared with males born from control dams. Moreover, serum concentrations of metabolites (i.e., β-hydroxybutyric acid, fatty acids, and glucose), cytokines (i.e., tumor necrosis factor-α) and acute phase proteins (i.e., serum amyloid A) were consistent with less-severe inflammatory response to LPS in males born from dams fed RPC compared with control. Source of colostrum and interaction between prenatal and colostrum treatments had minimal effects on calf responses to LPS. Overall, maternal RPC supplementation during late gestation suggests a positive effect on immunity, in that colostrum from RPC-fed dams increased efficiency of IgG absorption and maternal supplementation with RPC during late gestation, regardless of colostrum source, attenuated responses to LPS.

A COMPARISON OF EFFECTS OF DEXMEDETOMIDINE VERSUS MIDAZOLAM-FENTANYL ON POST-OPERATIVE RECOVERY, SEDATION, ANALGESIA AND HEMODYNAMIC PARAMETERS IN PATIENTS UNDERGOING MIDDLE EAR SURGERY UNDER LOCAL ANESTHESIA

Objective: The objective of the study was to compare the effects of dexmedetomidine versus midazolam-fentanyl on post-operative recovery, sedation, analgesia, and hemodynamic parameters in patients undergoing middle ear surgery under local anesthesia. Methods: Seventy-two patients were randomly divided into two equal groups - Group D (dexmedetomidine) and Group MF (midazolam and fentanyl). Intra operative heart rate, mean blood pressure, respiratory rate (RR), and SPO2 were recorded every 15 min for the 1st 30 min and then at every 30 min interval till the end of the surgery. In post-operative period, hemodynamic parameters, Aldrete score and pain were assessed at every 30 min till the patient was discharged from post anesthesia care unit (PACU). Post-operative sedation of the patient was checked at 1 h, 2 h, 4 h, and 8 h. Observations: Midazolam and fentanyl combination caused more fall in Aldrete scores as compared to dexmedetomidine initially, but readiness to discharge from PACU was similar in both the groups. Patients of MF group had significantly higher sedation scores at post op 2 h, but overall duration of sedation was similar in both the groups. Post-op pain was significantly more in MF group patients, as compared to dexmedetomidine patients at 1.5 h. More number of patients of MF group demanded rescue analgesia in PACU. Both group of drugs caused similar changes in hemodynamic parameters during surgery but in post-operative period, dexmedetomidine produced less decline in RR and oxygen saturation as compared to midazolam and fentanyl combination. Conclusion: The present study concluded that dexmedetomidine seems to be a better alternative to the combination of midazolam plus fentanyl sedation for patients undergoing middle ear surgeries done under local anesthesia due to better analgesia and lesser derangement of hemodynamic parameters in post-operative period.

UTILIZATION OF CONTINUOUS REMOTE MONITORING FOR A HIGH-RISK PATIENT REQUIRING INTERVAL TUMOR DEBULKING PALLIATIVE THERAPY

UTILIZATION OF CONTINUOUS REMOTE MONITORING FOR A HIGH-RISK PATIENT REQUIRING INTERVAL TUMOR DEBULKING PALLIATIVE THERAPY

Association between the Korean Triage and Acuity Scale level and severity of children with dyspnea in the emergency department

Purpose: Triage tools play a vital role in classifying the severity of children in emergency departments (EDs). We investigated the association between the Korean Triage and Acuity Scale (KTAS) and severity of dyspnea in the ED.Methods: We conducted a retrospective study of children aged 3-14 years with dyspnea who visited the ED from January 2015 through December 2021. They were divided into severe (KTAS level 1-3) and non-severe (KTAS level 4-5) groups. Between the groups, we compared the clinical characteristics, including age, sex, associated symptoms, vital signs, route of visit, treatment at ED, and outcomes. Results: Among a total of 468 children with dyspnea, 267 and 201 were assigned to the severe and non-severe groups, respectively. The severe group had higher frequencies of fever (21.7% vs. 13.9%; P = 0.031), cough (53.2% vs. 43.3%; P = 0.034), systemic steroids (42.3% vs. 25.9%; P &lt; 0.001), intravenous fluids (47.6% vs. 25.4%; P &lt; 0.001), oxygen therapy (16.5% vs. 6.5%; P = 0.001), inotropics (4.1% vs. 1.0%; P = 0.042), and hospitalization (24.7% vs. 11.9%; P = 0.002). The severe group also showed a higher mean heart rate, respiratory rate, and temperature, and lower mean oxygen saturation (all Ps &lt; 0.001). Among these findings, fever, heart rate, respiratory rate, temperature, intravenous fluids, oxygen therapy, inotropics, and hospitalization remained significantly different between the groups after defining the severe group as a KTAS level 1-2.Conclusion: This study shows the association between KTAS and severity of dyspnea in the ED. Therefore, KTAS may reflect not only the initial clinical conditions but also emergency measures and outcomes in children with dyspnea who visit EDs.

PSI-16 Effects of Melatonin on Physiological Parameters, Chute and Exit Scores in Beef Calves Exposed to Summer Heat Stress

Abstract This study was designed to evaluate the effects of melatonin on rectal temperature (RT), respiratory rate (RR), heat shock protein 70 (HSP 70), growth hormone (GH), chute (CS) and exit scores (ES) in beef calves exposed to heat stress during the summer. A total of twenty (20) eight months old calves divided into 2 groups were used for the study: melatonin group (MEL, n = 10) received 24mg of melatonin, once every 28 days, and control group (CON, n = 10) did not receive any subcutaneous melatonin implant. The effect of melatonin on RT, RR, HSP 70, GH, chute (CS) and ES were evaluated biweekly (Day 0, 14, 28, 42, 56, 70). The mean ambient temperature (AT) 24.00 ± 0.21°C, relative humidity (RH) 81.60 ± 0.76 % and temperature-humidity index (THI) 89.97 ± 0.70 recorded during the study were above the normal range reported for calves. The biweekly fluctuation of weight gain (WG) in MEL were higher than the CON. The mean RT (39.40 ± 0.06°C), RR (62.57 ± 1.15 cpm), CS (1.13 ± 0.04) and ES (1.5 ± 0.09) in the MEL group were lower (P &amp;lt; 0.05) than the corresponding values of 40.10 ± 0.06°C, 71.53 ± 1.59 cpm, 1.40 ± 0.07 and 1.80 ± 0.10 in the CON group. The biweekly variations in RT, RR, CS, ES, HSP 70 were lower (P &amp;lt; 0.05) in the MEL than the CON. Growth hormone concentrations were higher at D56 and 70 in MEL compared to the CON. Our results demonstrated that MEL ameliorates heat stress during the summer by lowering RT, RR, CS, and ES of beef heifers during the study period. In addition, melatonin influenced the biweekly variation in WG, RT, RR, CS, ES, HSP 70 and GH of heifers during the study period.

Differential pulse oximetry readings between ethnic groups and delayed transfer to intensive care units.

Pulse oximeters are widely used to monitor blood oxygen saturations, although concerns exist that they are less accurate in individuals with pigmented skin. This study aimed to determine if patients with pigmented skin were more severely unwell at the period of transfer to intensive care units (ICUs) than individuals with White skin. Using data from a large teaching hospital, measures of clinical severity at the time of transfer of patients with COVID-19 infection to ICUs were assessed, and how this varied by ethnic group. Data were available on 748 adults. Median pulse oximetry demonstrated similar oxygen saturations at the time of transfer to ICUs (Kruskal-Wallis test, P = 0.51), although median oxygen saturation measurements from arterial blood gases at this time demonstrated lower oxygen saturations in patients classified as Indian/Pakistani ethnicity (91.6%) and Black/Mixed ethnicity (93.0%), compared to those classified as a White ethnicity (94.4%, Kruskal-Wallis test, P = 0.005). There were significant differences in mean respiratory rates in these patients (P < 0.0001), ranging from 26 breaths/min in individuals with White ethnicity to 30 breaths/min for those classified as Indian/Pakistani ethnicity and 31 for those who were classified as Black/Mixed ethnicity. These data are consistent with the hypothesis that differential measurement error for pulse oximeter readings negatively impact on the escalation of clinical care in individuals from other than White ethnic groups. This has implications for healthcare in Africa and South-East Asia and may contribute to differences in health outcomes across ethnic groups globally.

The association between temperature, heart rate, and respiratory rate in children aged under 16 years attending urgent and emergency care settings.

Background and importanceBody temperature is considered an independent determinant of respiratory rate and heart rate; however, there is limited scientific evidence regarding the association. This study aimed to assess the association between temperature, and heart rate and respiratory rate in children.ObjectiveThe objective of this study was to validate earlier findings that body temperature causes an increase of approximately 10 bpm rise in heart rate per 1 °C rise in temperature, in children aged under 16 years old.DesignA prospective study using anonymised prospectively collected patient data of 188 635 attendances, retrospectively extracted from electronic patient records.Settings and participantsFour Emergency or Urgent Care Departments in the North West of England. Participants were children and young people aged 0–16 years old who attended one of the four sites over a period of 3 years.Outcome measures and analysisMultiple linear regression models, adjusted for prespecified confounders (including oxygen saturation, heart rate, respiratory rate, site of attendance, age), were used to examine the influence of various variables on heart rate and respiratory rate.Main resultsAmong the 235 909 patient visits (median age 5) included, the mean temperature was 37.0 (SD, 0.8). Mean heart rate and respiratory rate were 115.6 (SD, 29.0) and 26.9 (SD, 8.3), respectively. For every 1 °C increase in temperature, heart rate will on average be 12.3 bpm higher (95% CI, 12.2–12.4), after accounting for oxygen saturation, location of attendance, and age. For every 1 °C increase in temperature, there is on average a 0.3% decrease (95% CI, 0.2–0.4%) in respiratory rate.ConclusionIn this study on children attending urgent and emergency care settings, there was an independent association between temperature and heart rate but not between temperature and respiratory rate.

Moderate sedation by total intravenous remimazolam-alfentanil vs. propofol-alfentanil for third molar extraction: A prospective randomized controlled trial.

BackgroundOral dental treatment cause anxiety, fear, and physical stress. This study aimed to investigate the efficacy and safety of moderate sedation by remimazolam with alfentanil vs. propofol with alfentanil in third molar extraction.MethodsThis single-center, randomized, single-blind clinical trial included 100 adults who underwent third molar ambulatory extraction. All patients had continuous infusion of Alfentanil 0.2 μg/kg/min. Group remimazolam with alfentanil (group RA) had an induction dose of 80 μg/kg and maintenance dosage of 5 μg/kg/min. In group propofol with alfentanil (PA group), propofol was infused at an initial concentration of 1.8 μg/mL under target controlled infusion (TCI) mode and a maintenance concentration of 1.5 μg/mL. The incidence rates of adverse effects were recorded and compared. Depth of sedation was assessed using the modified observer alertness/sedation assessment (MOAA/S) and entropy index. Recovery characteristics were recorded and complications observed for next 24 h.ResultsThe incident of adverse events 6 (12%) in the group RA was lower than the group PA 25 (50%) [Mean difference 0.136 (95%CI, 0.049–0.377); P < 0.05], with no serious adverse events during the sedation procedure. The incidence of injection pain in group RA was significantly lower than that in group PA [4 vs. 26%, mean difference 0.119 (95%CI, 0.025–0.558); P = 0.004]. Before starting local anesthesia, the mean arterial pressure, heart rate, and respiratory rate of the PA group were lower than those of the RA group. None of the patients required further treatments for a decreased heart rate, blood pressure, or low SpO2. The rate of moderate sedation success was 100% in both groups. The MOAA/S score was similar between the groups indicating that the depth of sedation was effective. Group RA had significantly shorter recovery and discharge times than those of group PA.ConclusionsRemimazolam with alfentanil is a safer and more effective alternative for ambulatory sedation and can reduce recovery and discharge time and the incidence of perioperative adverse events compare with propofol.Clinical trial registrationhttp://www.chictr.org.cn/index.aspx, identifier: ChiCTR2200058106.

Comparison of the effect of incentive spirometry and deep breathing exercises on hemodynamic parameters of patients undergoing coronary artery bypass graft surgery: A Clinical Trial

Background and ObjectiveHemodynamic changes are among the common complications after coronary artery bypass graft (CABG) surgery. Incentive spirometry (IS) and deep breathing exercises (DBEs) are widely used in patients undergoing CABG surgery. The aim of the present study was to compare the effect of IS and DBEs on hemodynamic and oxygenation parameters of patients undergoing CABG surgery. MethodsThis is a clinical trial that was performed on 40 patients with heart disease who were candidates for coronary artery bypass graft surgery. Participants were selected using convenience sampling and then randomly divided into two groups. One day before surgery, one group was taught how to perform DBE and the other group was taught how to use IS in practice. Hemodynamic and oxygenation indices were measured and recorded before the intervention, the first, second, and the third day after the intervention. Data analysis was carried out using SPSS ver.16 and descriptive and inferential statistical tests. ResultsThe mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the first day after the intervention in patients undergoing the IS group was significantly higher than the DBE group (p<0.05). On the third day after the intervention, the mean arterial oxygen saturation (SaO2) in patients of the IS group was significantly higher than the DBE group and the mean respiratory rate (RR) in patients in the IS group was significantly lower than the DBE group (p <0.05). However, there was no significant difference between the two groups in terms of other indices (p> 0.05). ConclusionThe results showed that IS has a greater effect on hemodynamic and oxygenation indices of patients undergoing CABG compared to DBE, so, it is recommended to use IS to improve hemodynamic and oxygenation indices in these patients.

Monitoring driver stress during highway driving using wearable bio-signal sensors

Various functions for improving automobile seat comfort have been developed to reduce driver stress. However, how drivers respond to the seat comfort functions in real driving has not yet been studied. This experiment evaluated the effect of a seat air-conditioning system (ACS) on driver stress by tracking changes in various bio-signals during 60-min highway driving. Heart rate, heart rate variability, skin conductance, and respiration rates were quantified using non-invasive sensors from 13 drivers while varying the seat ACS condition in hot weather. Study results show that the high-frequency power of the heart rate variability, mean skin conductance level, and mean respiration rate detected the changes in the seat ACS over 60%, implying the possibility of seat comfort monitoring using the bio-signals. Further research should be conducted with various environmental or driver conditions to improve detection performance.