Oxygen Saturation Monitoring Research Articles

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.

Load tests in the diagnosis of dust pathology of the respiratory system

The influence of aerosols of fibrogenic action on the state of the cardiorespiratory system in dust-hazardous industries does not lose its significance over the years since the pathology of the respiratory organs gradually develops in working-age workers. Continuous medical monitoring of the health status of the working population, improvement of diagnostic research methods and their application at the early stages of exposure to harmful industrial factors will help prevent the development of occupational diseases and preserve the ability to work professional aptitude. Objective. To study the relationship between the state of the cardiorespiratory system and exercise tolerance based on the results of a 6-minute walk test in patients with dust pathology of the respiratory organs. Material and methods. 193 men with confirmed pneumoconiosis (79 people), occupational chronic obstructive pulmonary disease (58 people) and those in contact with the dust factor at work without respiratory pathology (56 people) were examined using echocardiography, spirometry, bodyplethysmography, a 6-minute walking load test with simultaneous monitoring of blood oxygen saturation (saturation) and pulse. Results. The correlation of the results of the 6-minute test with the functional state of the cardiorespiratory system of the subjects was revealed. The oxygen saturation of the blood during the exercise test was confirmed to show a different relationship with the indices of bodyplethysmography and spirometry, characterizing the central pathogenetic moments of the formation of respiratory failure. Conclusion. characteristic changes in saturation during the test with a 6-minute walk make an accessible and at the same time significant contribution to the diagnosis of respiratory organs in workers of dust-hazardous occupations.

The impact of routine pulse oximetry use on outcomes in COVID-19-infected patients at increased risk of severe disease: A retrospective cohort analysis.

The phenomenon of silent hypoxaemia has been described in patients with COVID-19 pneumonia, which is characterised by low oxygen saturation levels of <90% in those who appear clinically well and do not show signs of significant respiratory distress. To assess the impact on clinical outcomes for high-risk COVID-19 patients using a pulse oximeter to monitor oxygen saturation levels in a home setting. We performed a retrospective cohort analysis using data from a large South African insurance administrator. Patients were categorised as high risk, based on age and specific underlying clinical conditions, or from predictive models derived from medical scheme administrative claims data. The impact of pulse oximetry home monitoring on COVID-19 clinical outcomes was investigated by the use of Cox proportional hazard models. Between 2 March 2020 and 31 October 2020, of 38 660 patients analysed, 8 115 were in the intervention group. The 60-day mortality rate for the evaluated high-risk population was 1.35%. After adjusting for age and comorbidity differences, the intervention group was found to have an adjusted hazard ratio of 0.52 (p<0.0001). No statistical significance was found between the intervened and control groups for admission to hospital, admission to intensive care unit (ICU) and use of mechanical ventilation. The intervention group had a lower median C-reactive protein (CRP) level on admission (p=0.03). After adjustment for admission CRP levels, elevated CRP was associated with an increased mortality (p<0.0001), while the statistical significance in mortality between the intervention and the control group was lost. High-risk COVID-19 patients who used a pulse oximeter to monitor oxygen saturation levels had significantly lower mortality rates compared with other high-risk patients. The mortality benefit may be explained by earlier presentation to hospital, as suggested by lower initial CRP levels.

A Review of Monitoring Methods for Cerebral Blood Oxygen Saturation.

In recent years, cerebral blood oxygen saturation has become a key indicator during the perioperative period. Cerebral blood oxygen saturation monitoring is conducive to the early diagnosis and treatment of cerebral ischemia and hypoxia. The present study discusses the three most extensively used clinical methods for cerebral blood oxygen saturation monitoring from different aspects: working principles, relevant parameters, current situations of research, commonly used equipment, and relative advantages of different methods. Furthermore, through comprehensive comparisons of the methods, we find that near-infrared spectroscopy (NIRS) technology has significant potentials and broad applications prospects in terms of cerebral oxygen saturation monitoring. Despite the current NIRS technology, the only bedside non-invasive cerebral oxygen saturation monitoring technology, still has many defects, it is more in line with the future development trend in the field of medical and health, and will become the main method gradually.

Tissue Oxygen Saturation during Gastric Tube Reconstruction with Cervical Anastomosis for Esophagectomy: A Case Series

Background One cause of anastomotic leakage after radical esophagectomy is blood flow insufficiency at the cervical anastomosis site. . Methods Eighteen patients, who underwent radical esophagectomy with gastric tube reconstruction, were studied. The regional tissue oxygen saturation (rSO2) was measured at the tip (point pre 0) and 2, 4, and 6 cm on the distal side of the tip (point pre 1, pre 2, and pre 3, respectively) before the gastric tube was raised to the cervical site through the retrosternal route. After that, rSO2 was measured at the tip, 2 and 4 cm on the distal side of the tip (points post 0, post 1, and post 2), the actual anastomotic site (point AN), and the chest skin as an indicator of whole-body oxygenation. The relationship between rSO2 scores and the rate of anastomotic leakage was determined. Results The mean rSO2 at pre 0, pre 1, pre 2, and pre 3 were 48.9%, 52.3%, 54.8%, and 56.9%, respectively (p < 0.05). The mean rSO2 at post 0, post 1, and post 2 were 47.8%, 50.5%, and 52.3%, respectively, and the rSO2 at point AN was 52.1%. Anastomotic leakage was found in 6 patients. The rSO2 at points pre 0, pre 1, and pre 2, post 0 and point AN were significantly lower in patients with anastomosis leakage than those without (p < 0.05). Conclusion Tissue oxygen saturation monitoring was a useful indicator of blood flow insufficiency in the gastric tube during radical esophagectomy.

Internet of Things Framework for Oxygen Saturation Monitoring in COVID-19 Environment.

The pandemic/epidemic of COVID-19 has affected people worldwide. A huge number of lives succumbed to death due to the sudden outbreak of this corona virus infection. The specified symptoms of COVID-19 detection are very common like normal flu; asymptomatic version of COVID-19 has become a critical issue. Therefore, as a precautionary measurement, the oxygen level needs to be monitored by every individual if no other critical condition is found. It is not the only parameter for COVID-19 detection but, as per the suggestions by different medical organizations such as the World Health Organization, it is better to use oximeter to monitor the oxygen level in probable patients as a precaution. People are using the oximeters personally; however, not having any clue or guidance regarding the measurements obtained. Therefore, in this article, we have shown a framework of oxygen level monitoring and severity calculation and probabilistic decision of being a COVID-19 patient. This framework is also able to maintain the privacy of patient information and uses probabilistic classification to measure the severity. Results are measured based on latency of blockchain creation and overall response, throughput, detection, and severity accuracy. The analysis finds the solution efficient and significant in the Internet of Things framework for the present health hazard in our world.

Limited resources restrict the provision of adequate neonatal respiratory care in the countries of Africa.

Over two thirds of newborn deaths occur in Africa and South Asia, and respiratory failure is a major contributor of these deaths. The exact availability of continuous positive airway pressure (CPAP) and surfactant in Africa is unknown. The aim of this study was to describe the availability of newborn respiratory care treatments in the countries of Africa. Surveys, in English, French and Portuguese, were sent to neonatal leaders in all 48 continental countries and the two islands with populations over 1million. Forty-nine (98%) countries responded. Twenty-one countries reported less than 50 paediatricians, and 12 countries had no neonatologists. Speciality neonatal nursing was recognised in 57% of countries. Most units were able to provide supplemental oxygen. CPAP was available in 63% and 67% of the most well-equipped government and private hospitals. Surfactant was available in 33% and 39% of the most well-equipped public and private hospitals, respectively. Availability of CPAP and surfactant was greatly reduced in smaller cities. Continuous oxygen saturation monitoring was only available in 33% of countries. The availability of proven life-saving interventions in Africa is inadequate. There is a need to sustainably improve availability and use of these interventions.

Clinical effects and safety of ferric carboxymaltose in pregnancy: An Indian real-life experience.

There is limited clinical evidence of ferric carboxymaltose injection (FCM) usage in Indian pregnant women. We assessed the efficacy and safety of FCM in Indian pregnant women with moderate-to-severe anemia. Single-center, retrospective, observational data collection was conducted at a tertiary care research institute. Data of pregnant women with anemia who received FCM in their second and third trimester was retrieved and analyzed for hematological parameters at baseline and at 4 ± 2 weeks. Neonatal outcomes were also assessed. Adverse events and other safety parameters were noted. Data of 271 patients was retrieved and analyzed for safety and data for 168 patients analyzed for efficacy. A significant increase in hemoglobin was noted with FCM in 4 weeks (1.25 g/dL; p < 0.001). Patients with severe anemia reported an increase in hemoglobin of 4.23 g/dL (p=0.01). Patients receiving FCM in the second trimester noted a significant increase in hemoglobin of 1.74 g/dL (p < 0.001). A significant increase in hemoglobin was noted as early as 20 days (p < 0.001) and also in patients receiving FCM after 34 weeks (p=0.002). No adverse fetal or neonatal outcomes were observed. Adverse events noted in 4% of patients with itching and rash being most common. Continuous monitoring of blood pressure, heart rate, and oxygen saturation for 40 min during and after FCM administration reported no deterioration or negative safety signal. FCM corrects anemia in all subsets of Indian pregnant women and supports evidence of efficacy and safety. Continuous monitoring of vital parameters during FCM infusions supports its excellent safety.

Dynamical Analysis of Biological Signals with the 0–1 Test: A Case Study of the PhotoPlethysmoGraphic (PPG) Signal

The 0–1 test distinguishes between regular and chaotic dynamics for a deterministic system using a time series as a starting point without appealing to any state space reconstruction method. A modification of the 0–1 test allows for the determination of a more comprehensive range of signal dynamic behaviors, particularly in the field of biological signals. We report the results of applying the test and study with more details the PhotoPlethysmoGraphic (PPG) signal behavior from different healthy young subjects, although its use is extensible to other biological signals. While mainly used for heart rate and blood oxygen saturation monitoring, the PPG signal contains extensive physiological dynamics information. We show that the PPG signal, on a healthy young individual, is predominantly quasi-periodic on small timescales (short span of time concerning the dominant frequency). However, on large timescales, PPG signals yield an aperiodic behavior that can be firmly chaotic or a prior transition via an SNA (Strange Nonchaotic Attractor). The results are based on the behavior of well-known time series that are random, chaotic, aperiodic, periodic, and quasi-periodic.

Balloon Test Occlusion of Internal Carotid Artery in Recurrent Nasopharyngeal Carcinoma Before Endoscopic Nasopharyngectomy: A Single Center Experience.

ObjectivesEndoscopic nasopharyngectomy (ENPG) is a promising way in treating recurrent nasopharyngeal carcinoma (rNPC), but sometimes may require therapeutic internal carotid artery (ICA) occlusion beforehand. Balloon test occlusion (BTO) is performed to evaluate cerebral ischemic tolerance for ICA sacrifice. However, absence of neurological deficits during BTO does not preclude occur of delayed cerebral ischemia after permanent ICA occlusion. In this study, we evaluate the utility of near-infrared spectroscopy (NIRS) regional cerebral oxygen saturation (rSO2) monitoring during ICA BTO to quantify cerebral ischemic tolerance and to identify the valid cut-off values for safe carotid artery occlusion. This study also aims to find out angiographic findings of cerebral collateral circulation to predict ICA BTO results simultaneously.Material and Methods87 BTO of ICA were performed from November 2018 to November 2020 at authors’ institution. 79 angiographies of collateral flow were performed in time during BTO and classified into several Subgroups and Types according to their anatomic and collateral flow configurations. 62 of 87 cases accepted monitoring of cerebral rSO2. Categorical variables were compared by using Fisher exact tests and Mann–Whitney U tests. Receiver operating characteristic curve analysis was used to determine the most suitable cut-off value.ResultsThe most suitable cut-off △rSO2 value for detecting BTO-positive group obtained through ROC curve analysis was 5% (sensitivity: 100%, specificity: 86%). NIRS rSO2 monitoring wasn’t able to detect BTO false‐negative results (p = 0.310). The anterior Circle was functionally much more important than the posterior Circle among the primary collateral pathways. The presence of secondary collateral pathways was considered as a sign of deteriorated cerebral hemodynamic condition during ICA BTO. In Types 5 and 6, reverse blood flow to the ICA during BTO protected patients from delayed cerebral ischemia after therapeutic ICA occlusion (p = 0.0357). In Subgroup IV, absence of the posterior Circle was significantly associated with BTO-positive results (p = 0.0426).ConclusionAngiography of cerebral collateral circulation during ICA BTO is significantly correlated with ICA BTO results. Angiographic ICA BTO can be performed in conjunction with NIRS cerebral oximeter for its advantage of being noninvasive, real-time, cost-effective, simple for operation and most importantly for its correct prediction of most rSO2 outcomes of ICA sacrifice. However, in order to ensure a safe carotid artery occlusion, more quantitative adjunctive blood flow measurements are recommended when angiography of cerebral collateral circulation doesn’t fully support rSO2 outcome among clinically ICA BTO-negative cases.

Effect of Changing Selected body Positions on Oxygen Saturation among Patients with Acute Stroke

Background: Body position generally effect on respiratory and stroke disease. Stroke morbidity increased by inappropriate position during the early recovery phase. Aim: To evaluate the effect of changing selected body positions on oxygen saturation among patients with acute stroke. Research design: Quasi-experiment research design applied in this study. Sitting: the study carried out at the stroke intensive care unit of the Neurological Department of Aswan University Hospitals. Sample: 60 patients with acute stroke within 24- 48 hours following mild to moderate and severe stroke allocated a randomized sequence of four positions. One hour spent in each position. SaO2 was recorded each15 minutes by pulse oximetry with a finger probe. Tools of data collection: structured interview questionnaire sheet, Glasgow Coma Scale, the Scandinavian stroke scale, and oxygen saturation monitoring record. Results: mean score of SaO2 at 2nd 15 min, 3rd 15 min, 4th min, and mean SaO2 of one hour at the semi-sitting position was higher than different positions (Supine position, Right side position, and Left side position) with statistically significant differences with p-value .008, .05, .002, and .019 respectively, the semi-sitting position was the best position of all position. Conclusion: the study finding concluded that the semi-sitting position is the best position than other positions in improving oxygen saturation after one hour from positioning among stroke patients. Recommendation: use a semi-sitting position and implicate this positioning strategy in the future to improve arterial oxygen saturation in acute stroke patients.

Newborn care technology investments for LMIC settings: a CPAP approach

Globally, it is estimated that 15 million babies are born prematurely each year. Approximately one million of these newborns die due to complications of preterm birth, and these deaths occur...

IMPACT OF AGE ON OUTCOME OF COVID-19 PATIENTS AT A TERTIARY CARE HOSPITAL

Objective: To assess the impact of age on outcome of COVID-19 patients at a tertiary care hospital.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Combined Military Hospital Malir, Karachi, from Apr to Jun 2020.&#x0D; Methodology: This was a retrospective cross sectional study conducted at Combined Military Hospital Malir Karachi. About 120 positive cases of SARS COV-2 were studied, including males and females. Age range was 21-85 years. Patients were divided into groups according to age, group A (21-40 years), group B (41-55 years), group C (56-85 years). Presenting complaints and associated co morbidities were also analyzed. Mild cases were managed conservatively. Moderate to severe oxygen dependent cases were managed in intensive care units.&#x0D; Results: The mean age of patients was 40.24 years with 16.25 ± SD. Co- morbidities were noted in 67 (55.83%) patients, highest in group C, hypertension being the most common. Ten patients could not survive, due respiratory failure complicated by adult respiratory distress syndrome (ARDS). Bilateral infiltrates &gt;50% observed in (14%) out of (n=120) patients. One hundred and ten patients were discharged with uneventful recovery.&#x0D; Conclusion: Mortality was highest among elderly patients with comorbidities. Therefore, international standing operative measures (SOPs) to be followed. Meticulous monitoring of vital signs and oxygen saturation in mild cases is the bare minimum requirement and timely appropriate treatment escalation of moderate to severe cases in intensive care units is the key to success.

Photoacoustic imaging for the monitoring of local changes in oxygen saturation following an adrenaline injection in human forearm skin.

Clinical monitoring of blood oxygen saturation (sO2) is traditionally performed using optical techniques, such as pulse oximetry and diffuse reflectance spectroscopy (DRS), which lack spatial resolution. Photoacoustic imaging (PAI) is a rapidly developing biomedical imaging technique that is superior to previous techniques in that it combines optical excitation and acoustic detection, providing a map of chromophore distribution in the tissue. Hitherto, PAI has primarily been used in preclinical studies, and only a few studies have been performed in patients. Its ability to measure sO2 with spatial resolution during local vasoconstriction after adrenaline injection has not yet been investigated. Using PAI and spectral unmixing we characterize the heterogeneous change in sO2 after injecting a local anesthetic containing adrenaline into the dermis on the forearm of seven healthy subjects. In comparison to results obtained using DRS, we highlight contrasting results obtained between the two methods arising due to the so-called 'window effect' caused by a reduced blood flow in the superficial vascular plexus. The results demonstrate the importance of spatially resolving sO2 and the ability of PAI to assess the tissue composition in different layers of the skin.

Effectiveness of application of a manual for improvement of alarms management by nurses in Intensive Care Units.

Objective.To evaluate the effects of application of a manual on the improvement of alarms management in Intensive Care Units (ICU).Methods.This quasi-experimental study evaluated the effectiveness of the introduction into of a manual for alarm management and control in the ICU of a hospital in southeastern Iran. The intervention was a 4-hour workshop was on topics related to the adverse effects of alarms, standardization of ECG, oxygen saturation and blood pressure monitoring systems, and the use of ventilators and infusion pumps. Data were collected thorough 200 hours of observation of 60 ICU nurses (100 hours’ pre-intervention and 100 hours’ post-intervention). Response time, type of response, customization of alarm settings for each patient, the person responding to an alarm, and the cause of the alarm were analyzed. Alarms were classified into three types: false, true and technical.Results.The results showed a statistically significant difference between the pre- and post-intervention frequency of alarm types, frequency of monitoring parameters, customized monitoring settings for patients, and individuals who responded to alarms. The percentage of effective interventions was significantly higher for all parameters after the intervention (46.9%) than before the intervention (38.9%).Conclusion.The employment of a manual for management of alarms from electronic equipment in ICUs can increase the frequency of appropriate responses to alarms in these units.

Comparison of Intermittent versus Continuous Superior Venal Caval Oxygen Saturation Monitoring in Early Goal Directed Therapy in Septic Shock: A Systematic Review.

Early goal directed therapy (EGDT) is a bundle of care (monitoring ScvO 2 and lactate along with clinical parameters and instituting therapy) that has shown to improve outcomes in patients with septic shock. We conducted a systematic review of clinical trials and observational studies to compare intermittent versus continuous monitoring of ScvO 2 . We did major database searches till August 2020. Hospitalized children (>2 months age) and adults with septic shock were included. The intervention was "intermittent ScvO 2 monitoring," and the comparator was "continuous ScvO 2 monitoring." The primary outcome is "all-cause mortality." Of 564 citations, 3 studies ( n = 541) including both children and adults were included in the analysis. There was no significant difference in the "overall/all-cause mortality" (two randomized controlled trials; 258 participants) between the "intermittent" and "continuous" ScvO 2 monitoring groups (relative risk [RR]: 1.00; 95% confidence interval [CI]: 0.8-1.24). However, a single observational study (283 participants) showed a significant increase in mortality in the intermittent group (RR: 1.46; 95% CI: 1.03-2.05). The GRADE evidence generated for "overall/all-cause mortality" was of "moderate certainty." To conclude, the present meta-analysis did not find any significant difference between "intermittent" and "continuous" ScvO 2 monitoring in patients with septic shock.

Relationship between laryngomalacia and sleep-related breathing disorders in infants with brief resolved unexplained events

Introduction: Brief resolved unexplained events (BRUE) occur during infancy. It is characterized by one or more symptoms, including skin color change, shortness of breath and unresponsiveness. Laryngomalacia is the most frequent cause of stridor in infants and results in the collapse of the supraglottic structures during inspiration and intermittent obstruction of the upper airways. To our knowledge, the relationship between BRUE and laryngomalacia has been little investigated. Methods: The medical records of 448 children (age < 12 months) treated for BRUE between July 2011 and March 2018 and followed up until March 2020 were retrospectively reviewed. Endoscopic evaluation was performed using a flexible fibrolaryngoscope. All patients underwent a brief polysomnography and 24-h cardiorespiratory monitoring. Cardiorespiratory and oxygen saturation monitoring was continued at home; 94% of patients underwent follow-up. Results: Laryngeal fiberoptic endoscopy revealed laryngomalacia in 11% of children with a clinical history of BRUE. Laryngomalacia was associated with obstructive/mixed apnea in 67%. Home cardiorespiratory monitoring showed a gradual reduction in the number of respiratory events during follow-up and complete resolution of laryngomalacia in 88% of patients. Conclusions: This is the first report that showed follow-up data from cases of BRUE with laryngomalacia. The improvement in laryngomalacia alone, although not complete, was sufficient to improve obstructive events.

Effect of hemoglobin content on cerebral oxygen saturation during surgery for scoliosis in pediatric patients

BackgroundAlthough regional cerebral oxygen saturation (rScO2) monitoring has been widely used in clinical practice, the relationship between hemoglobin (dHB) content and rScO2 is incompletely understood. The aim of this study was to analyze the effect of hemoglobin content on rScO2 in pediatric patients undergoing general anesthesia for correction of scoliosis.MethodsNinety-two pediatric patients aged 3 to 14 years undergoing scoliosis correction surgery were enrolled. Continuous monitoring of bilateral regional cerebral oxygen saturation by near-infrared spectroscopy (NIRS, CASMED, USA) was performed after entering the operation room. rScO2 was recorded when the patients entered the operating room (T0, baseline), after anesthesia induced intubation (T1), and after radial artery puncture (T2). The lowest value of rScO2 during surgery was also recorded. The arterial blood pressure (ABP), heart rate (HR), pulse oxygen saturation (SpO2), end tidal carbon dioxide partial pressure (PetCO2) were continuously recorded. Patients were classified as low rScO2 or high rScO2 group according to whether the lowest intraoperative rScO2 was 15% lower than the baseline value. An analysis and comparison of differences in hemoglobin content in these two groups was carried out.ResultsThe preoperative hemoglobin-postoperative hemoglobin of patients in the high rScO2 group was significantly lower than that in the low rScO2 group (t = − 7.86, p < 0.01), the amount of bleeding during the operation was also less than that in the low rScO2 group (t = − 6.05, p < 0.01), and the systolic pressure of patients was higher than that in the low rScO2 group (t = 4.27, p < 0.01).ConclusionsThe decrease in hemoglobin level which occurs during surgery leads to a decrease in cerebral oxygen saturation. In order to ensure patient safety during surgery, it is necessary to carry out volume management and appropriate transfusion and fluid replacement in a timely manner.Trial registrationChinese Clinical Trial Registry, ChiCTR1800016359. Registered 28 May 2018.

Flexible Hybrid Electronics for Monitoring Hypoxia.

Hypoxia refers to insufficient oxygen amounts at the tissue level unable to maintain adequate homeostasis. Severe hypoxia may occur in the absence of subjective breathlessness due to respiratory failure. Precise monitoring of low blood oxygen saturation is crucially desired, catering to the clinical requirements. However, current pulse oximeters cannot function well in monitoring peripheral oxygen saturation limited by the weak peripheral blood circulation at a low oxygen level. In this work, we propose a flexible hybrid electronic (FHE) with a compact structure and high sensitivity for conveniently monitoring hypoxia. This FHE is composed of 10-µm thickness semiconductors with different materials, functionalities, and sizes. Its performance is demonstrated by monitoring arterial blood oxygen saturation (SaO2) at the body's different arteries. The absolute error is less than 2% within a SaO2 ranging from 99% to 63%. The efficient techniques presented in this work may bring light to the next-generation flexible hybrid electronics and provide potential widespread use in research and clinical applications, especially for emergency treatment.

Early Goal-Directed Therapy With and Without Intermittent Superior Vena Cava Oxygen Saturation Monitoring in Pediatric Septic Shock: A Randomized Controlled Trial

To compare early goal-directed therapy (EGDT) 'With' and 'Without' intermittent superior vena cava oxygen saturation (ScvO2) monitoring in pediatric septic shock. Open label randomized controlled trial. Pediatric intensive care unit in a tertiary care center. Children aged 1 month to 12-year with septic shock. Patients not responding to fluid resuscitation (up to 40 ml/kg) were randomized to EGDT 'With' (n=59) and 'Without' (n=61) ScvO2 groups. Resuscitation was guided by ScvO2 monitoring at 1-hour, 3-hour, and later on six-hourly in the '' ScvO2 group and by clinical variables in the 'Without' ScvO2 group. Primary outcome was all-cause 28-day mortality. Secondary outcomes were time to and proportion of patient achieved therapeutic endpoints (at 6 hours and PICU stay), need for organ supports, new organ dysfunction (at 24 hours and PICU stay), and length of PICU and hospital stay. The study was stopped after interim analysis due to lower mortality in the intervention group. There was significantly lower all-cause 28-day mortality in EDGT with ScvO2 than without ScvO2 group [37.3% vs. 57.5%, adjusted hazard ratio 0.57, 95%CI 0.33 to 0.97, P=0.04]. Therapeutic endpoints were achieved early in 'With' ScvO2 group [mean (SD) 3.6 (1.6) vs. 4.2 (1.6) h, P=0.03]. Organ dysfunction by sequential organ assessment score during PICU stay was lower in with ScvO2 group [median (IQR) 5 (2,11) vs. 8 (3,13); P=0.03]. There was no significant difference in other secondary outcomes. EGDT with intermittent ScvO2 monitoring was associated with reduced mortality and improved organ dysfunction in pediatric septic shock.