Oximeter Readings Research Articles

The Relative Indirect Effects of Technology Bias and Implicit Bias on Racial Disparity in Service Delivery and Sepsis Mortality

Racism at the individual and societal levels has been identified as a cause of disparity in healthcare outcomes in the United States but reducing disparity has been slow. This study disentangles the relative effects of two types of racism on inpatient service delivery and hospital mortality: technology bias and implicit bias. Drawing on clinical data from intensive care unit (ICU) patients with sepsis, we use propensity score matching to balance groups of White and nonwhite patients and run a causal mediation analysis to test our model, which links patient race to hospital mortality through two mediating variables related to service delivery: (1) discrepancies in blood oxygen saturation measurements due to technology bias embedded in the medical device (i.e., pulse oximeter) and (2) administration of supplemental oxygen, which could be impacted by clinicians’ implicit bias. We first replicate prior findings that (a) higher discrepancies between oximeter readings and laboratory tests for nonwhite patients compared to Whites and (b) a higher discrepancy lowers the likelihood of patients receiving supplemental oxygen during the ICU stay. We make a unique contribution by finding that nonwhite patients with sepsis have a 79% higher risk of hospital mortality in the ICU compared to Whites, with nearly half of the racial disparity in mortality stemming from technology bias and less than a fifth from clinicians’ implicit bias. Eliminating these two biases would help save thousands of lives annually among racial/ethnic minorities with sepsis in the United States. Our findings indicate that technology bias exerts a greater negative impact on mortality than does implicit bias, highlighting the importance of device approval standards and clinicians' ability to customize decision criteria for supplemental oxygen.

The Impact of Mean Arterial Pressure during Cardiopulmonary Bypass on Postoperative Outcomes in Coronary Artery Bypass Graft Surgery

Background: Maintaining an optimal mean arterial pressure (MAP) is vital for cerebral blood flow and the overall health of patients undergoing coronary artery bypass graft (CABG) surgery. This study investigated the impact of low MAP on cerebral blood flow and in-hospital clinical outcomes in CABG candidates at our hospital. Methods: We compared a convenience sample of 55 patients with a low MAP (55 mmHg) and 54 patients with a high MAP (75 mmHg) who underwent CABG at Tehran Heart Center in 2023. We recorded the patients' demographic and clinical characteristics by measuring cerebral oximeter readings and lactate levels pre- and post-operation. We then compared the baseline and postoperative characteristics between the 2 groups and determined the impact of MAP on their postoperative changes. Results: The groups were statistically similar at baseline, except for a lower pH in the low MAP group (55 mmHg) (P=0.016). The preoperative and postoperative measurements (including lactate levels and cerebral oximeter readings) did not differ between the groups. However, heart rate was significantly higher in the high MAP group (75 mmHg) (P=0.034). The adjusted effect of baseline MAP on selected postoperative characteristics showed that it could significantly but inversely influence heart rate (β coefficient=-5.952; P=0.017) and had a borderline effect on troponin (β coefficient=1.734; P=0.051) and HCO3 (β coefficient=0.785; P=0.062). Conclusion: MAP did not significantly influence clinical outcomes in our study. Nonetheless, maintaining an optimal MAP is essential for preventing cerebral injury and ensuring adequate cerebral oxygenation in CABG patients.

Effect of positive end expiratory pressure on non-hypoxic apnea time and atelectasis during induction of anesthesia in infant: A randomized controlled trial.

This study aimed to assess the impact of positive-end-expiratory pressure (PEEP) on the non-hypoxic apnea time in infants during anesthesia induction with an inspired oxygen fraction of 0.8. This age stratified randomized controlled trial included patients under 1 year of age. Preoxygenation was performed using an inspired oxygen fraction of 0.8 for 2 min. Inspired oxygen fraction of 0.8 was administered via a face mask with volume-controlled ventilation at a tidal volume of 6 mL.kg-1, with or without 7 cmH2O of PEEP. Tracheal intubation was performed after 3 min of ventilation; however, it was disconnected from the breathing circuit. Ventilation was resumed once the pulse oximetry readings reached 95%. The primary outcome was the non-hypoxic apnea time, defined as the time from the cessation of ventilation to achieving a pulse oximeter reading of 95%. The secondary outcome measures included the degree of atelectasis assessed by ultrasonography and the presence of gastric air insufflation. Eighty-four patients were included in the final analysis. In the positive end-expiratory pressure group, the atelectasis score decreased (17.0 vs. 31.5, p < .001; mean difference and 95% CI of 11.6, 7.5-15.6), while the non-hypoxic apnea time increased (80.1 s vs. 70.6 s, p = .005; mean difference and 95% CI of -9.4, -16.0 to -2.9), compared to the zero end-expiratory pressure group, among infants who are 6 months old or younger, not in those aged older than 6 months. The application of positive end-expiratory pressure reduced the incidence of atelectasis and extended the non-hypoxic apnea time in infants who are 6 months old or younger. However, it did not affect the incidence of atelectasis nor the non-hypoxic apnea time in patients aged older than 6 months.

Randomised crossover study on pulse oximeter readings from different sensors in very preterm infants

ObjectiveIn extremely preterm infants, different target ranges for pulse oximeter saturation (SpO2) may affect mortality and morbidity. Thus, the impact of technical changes potentially affecting measurements should be assessed. We...

Comparison of human smartwatch and transmittance pulse oximetry for evaluating peripheral oxygen saturation in anesthetized dogs.

Pulse oximetry is a valuable tool for monitoring animals during anesthesia and assessing the adequacy of administered oxygen therapy. To compare the pulse oximeter readings obtained by the Garmin Fenix 5X plus (GF5Xp) smartwatch and transmittance pulse oximetry (TPO) in anesthetized dogs. Twelve clinical canine patients requiring anesthesia for castration were prospectively enrolled in this study. The animals were premedicated with intramuscular dexmedetomidine at a dose of 5 µg/kg. Anesthesia was induced through intravenous administration of propofol and maintained using sevoflurane. The arterial hemoglobin oxygen saturation (SpO2) readings obtained from the tongue using TPO (238 readings) were compared with measurements taken over the lateral side of the tibia using a GF5Xp smart wearable device (238 readings). This comparison was performed using a Bland-Altman plot, where the differences (%) between the methods were plotted against their mean SpO2 (Gold standard - Device), and the limits of agreement were represented as the mean ± 1.96 times the standard deviation. The SpO2 levels in dogs were overestimated by the GF5Xp relative to the readings obtained by the TPO, with the bias of -0.3% (95% CI: -3.1%-2.5%). GF5Xp may be interchangeable with TPO in dogs. Further studies are required to validate the accuracy of the GF5Xp in non-anesthetized dogs or dogs outside the physiological range.

Low Perfusion and Missed Diagnosis of Hypoxemia by Pulse Oximetry in Darkly Pigmented Skin: A Prospective Study.

Retrospective clinical trials of pulse oximeter accuracy report more frequent missed diagnoses of hypoxemia in hospitalized Black patients than White patients, differences that may contribute to racial disparities in health and health care. Retrospective studies have limitations including mistiming of blood samples and oximeter readings, inconsistent use of functional versus fractional saturation, and self-reported race used as a surrogate for skin color. Our objective was to prospectively measure the contributions of skin pigmentation, perfusion index (PI), sex, and age on pulse oximeter errors in a laboratory setting. We enrolled 146 healthy subjects, including 25 with light skin (Fitzpatrick class I and II), 78 with medium (class III and IV), and 43 with dark (class V and VI) skin. We studied 2 pulse oximeters (Nellcor N-595 and Masimo Radical 7) in prevalent clinical use. We analyzed 9763 matched pulse oximeter readings (pulse oximeter measured functional saturation [Sp o2 ]) and arterial oxygen saturation (hemoximetry arterial functional oxygen saturation [Sa o2 ]) during stable hypoxemia (Sa o2 68%-100%). PI was measured as percent infrared light modulation by the pulse detected by the pulse oximeter probe, with low perfusion categorized as PI < 1%. The primary analysis was to assess the relationship between pulse oximeter bias (difference between Sa o2 and Sp o2 ) by skin pigment category in a multivariable mixed-effects model incorporating repeated-measures and different levels of Sa o2 and perfusion. Skin pigment, PI, and degree of hypoxemia significantly contributed to errors (bias) in both pulse oximeters. For PI values of 1.0% to 1.5%, 0.5% to 1.0%, and <0.5%, the P value of the relationship to mean bias or median absolute bias was <.00001. In lightly pigmented subjects, only PI was associated with positive bias, whereas in medium and dark subjects bias increased with both low perfusion and degree of hypoxemia. Sex and age was not related to pulse oximeter bias. The combined frequency of missed diagnosis of hypoxemia (pulse oximeter readings 92%-96% when arterial oxygen saturation was <88%) in low perfusion conditions was 1.1% for light, 8.2% for medium, and 21.1% for dark skin. Low peripheral perfusion combined with darker skin pigmentation leads to clinically significant high-reading pulse oximeter errors and missed diagnoses of hypoxemia. Darkly pigmented skin and low perfusion states are likely the cause of racial differences in pulse oximeter performance in retrospective studies.

Impacts of Skin Color and Hypoxemia on Noninvasive Assessment of Peripheral Blood Oxygen Saturation: A Scoping Review.

Standard pulse oximeters estimate arterial blood saturation (SaO2) non-invasively by emitting and detecting light of a specific wavelength through a cutaneous vascular bed, such as a digit or the ear lobe. The quantity measured at these peripheral sites is designated as oxygen saturation (SpO2). Most reliable pulse oximeters are calibrated from measurements of healthy volunteers using some form of oxygen desaturation method. As the degree of inducible hypoxemia is limited, the calibration below achievable desaturation levels is usually extrapolated, leading to potential measurement error at low SaO2 values, especially in highly pigmented skin. Such skin color-related errors (SCRE) are the topic of this scoping review. Specifically, this study aimed to identify the combined impact of skin color and reduced SaO2 on the non-invasive assessment of SpO2 and report the consequences of potential inaccuracies. Three databases were searched (Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Web of Science) for peer-reviewed prospective and retrospective studies published in English between 2000 and 2022 involving human patients with hypoxemia that included a measure of skin color (Fitzpatrick scale or race/ethnicity). Ten studies met the criteria and were included in the final review. Eight of these studies reported statistically significant higher pulse oximeter readingsin darker-skinned patients with hypoxia compared to their arterial blood gas measurements. Occult hypoxia was more prevalent in Black and Hispanic patients than in White patients. Minority patients overall (Black, Asian, and American Indian) were more likely to have a SaO2 < 88% that was not detected by pulse oximetry (occult hypoxemia) during hospitalization. With greater levels of hypoxemia, the differences between SpO2 and SaO2 were greater. If SaO2 was < 90%, then SpO2 was overestimated in all ethnicities but worse in minorities. In conclusion, the bias found in pulse oximeter readings in the skin of color broadly impacts patients with hypoxemia. The failure of SpO2 measuring devices to detect occult hypoxemia can delay the delivery of life-saving treatment to critically ill patients requiring respiratory rehabilitation and supplemental oxygen therapy. This may lead to adverse health outcomes, increased in-hospital mortality, and complications such as organ dysfunction. An improvement in pulse oximeter detection mechanisms that would include all skin pigmentations is therefore much desired to optimize individual healthcare status and minimize disparities in treatment.

COVID-19 Proactive Disease Management Using COVID Virtual Hospital in a Rural Community.

A community teaching hospital serving a rural population established an intensive "hospital at home" program for patients with COVID-19 utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician contact. Herein, we report patient outcomes and provider experiences resulting from this "virtual" approach to triaging pandemic care. COVID-19-positive patients appropriate for outpatient management were enrolled in our COVID Virtual Hospital (CVH). Patients received pulse oximeters and instructions for home monitoring of vital signs. CVH nurses contacted the patient within 12-48 hours. The primary care provider was alerted of the patient's diagnosis and held a virtual visit with patient within 2-3 days. Nurses completed a triage form during each patient call; the resulting risk score determined timing of subsequent calls. CVH-relevant patient outcomes included emergency department (ED) visits, mortality, and disease-related hospitalization. Additionally, a survey of providers was conducted to assess CVH experience. From April 22, 2020, to December 21, 2020, 1916 patients were enrolled in the CVH, of which 195 (10.2%) had subsequent visits to the ED. Among those 195 ED visits, 102 (52.3%) were nurse-directed while 93 (47.7%) were patient self-directed; 88 (86.3%) nurse-directed ED visits were subsequently admitted to inpatient care and 14 were discharged home. Of the 93 self-directed ED visits, 3 (3.2%) were admitted. A total of 91 CVH patients (4.7%) were ultimately admitted to inpatient care. Seven deaths occurred among CVH patients, 5 of whom had been admitted for inpatient care. Among 71 providers (23%) who responded to the survey, 94% and 93% agreed that the CVH was beneficial to providers and patients, respectively. Proactive in-home triage of patients with COVID-19 utilizing a virtual hospital model minimized unnecessary presentations to ED and likely prevented our rural hospital from becoming overwhelmed during year one of the pandemic.

Efficacy of benzocaine and lidocaine bioadhesive patches in various minor oral surgical procedures in children - An evaluative study.

The key to successful management of a child in the dental clinic depends greatly on providing painless anaesthesia. Topical anaesthesia using bioadhesive patches may be a breakthrough in this field. The purpose of the study was to compare the efficacy of Benzocaine and Lidocaine bioadhesive patches in reducing pain associated with various minor oral surgical procedures in children. Hundred subjects, aged 6-9 years, requiring various minor oral surgical procedures such as extractions of primary teeth, nerve blocks, mucocele excision or drainage of abscesses were divided equally into Groups 1 and 2. In Group 1, custom fabricated Benzocaine patches were placed for 5 minutes at the target site prior to the procedure, and in Group 2, Lidocaine patches were used in the same manner. Each subject completed a visual analogue scale (VAS) and Wong-Baker Faces pain scale (FPS) after each procedure. Pulse rate and saturation of peripheral oxygen were assessed using pulse oximeter. The duration of the study was from September 2014 to September 2015. The statistical analysis was done using paired t test, ANOVA and Bonferroni post hoc analysis. P value less than 0.05 were considered as statistically significant. A significant difference in pain scores was observed favouring the use of Benzocaine over Lidocaine patches (P < 0.05). However, no significant differences in pulse oximeter readings were observed. A statistically significant reduction in pain rating scores was observed in the Benzocaine group after a five-minute application of the patch.

Development of a Flexible Smart Wearable Oximeter Insole for Monitoring SpO2 Levels of Diabetics’ Foot Ulcer

This work presents the development of a fully functional prototype of a wearable smart shoe insole that can monitor arterial oxygen saturation (SpO <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> ) levels at the foot of a diabetic patient using photoplethysmography (PPG) signals. Continuous monitoring of SpO <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> levels at foot in patients with diabetic foot ulcer (DFU) can provide critical information on the severity of the ulcer, the wound healing process, and alerting clinicians for critical limb ischemia. The developed oximetry system seamlessly integrates the Internet of things (IoT) via a custom-developed Android mobile application, thus enabling “at-home” monitoring. Twenty healthy subjects were tested, and the insole oximeter was able to successfully estimate SpO <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> levels at the toe. An average error of ≈ 2.6% was calculated for the measured/estimated SpO <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> levels at the subjects’ toe when compared to a reference oximeter attached to the finger. Perfusion Index (PI) - which represents the blood flow/supply in tissues - was used as a method for validating the oximeter readings. It was observed that fingers (index fingers) generally have larger PI values when compared to the toe, while PI results of both monitoring sites were in the acceptable range. In addition, a dataset was formed for the twenty test subjects, and machine learning (ML) techniques were applied to predict the SpO <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> level and the site of measurement (Finger or Toe), using multiple linear regression and classification methods. The ML results show that AC components of the PPG signals have a more significant contribution to the SpO <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> estimations when compared to the DC components. In addition, KNN (K=1) classifier, was able to successfully predict the monitoring sites, with a test accuracy of 96.86%.

Invited Commentary: Undiagnosed and Undertreated-the Suffocating Consequences ofthe Use of Racially Biased Medical Devices During the COVID-19 Pandemic.

While medical technology is typically considered neutral, many devices rely upon racially biased algorithms that prioritize care for White patients over Black patients, who may require more urgent medical attention. In their accompanying article, Sudat et al. (Am J Epidemiol. 2023;XXX(XX):XXX-XXX) document striking inaccuracies in pulse oximeter readings among Black patients, with significant clinical implications. Their findings suggest that this resulted in racial differences in delivery of evidence-based care during the coronavirus disease 2019 (COVID-19) pandemic, affecting admissions and treatment protocols. Despite the medical community's growing awareness of the pulse oximeter's significant design flaw, the device is still in use. In this article, I contextualize Sudat et al.'s study results within the larger history of racial bias in medical devices by highlighting the consequences of the continued underrepresentation of diverse populations in clinical trials. I probe the implications of racially biased assessments within clinical practice and research and illustrate the disproportionate impact on patients of color by examining 2 medical tools, the pulse oximeter and pulmonary function tests. Both cases result in the undertreatment and underdiagnosis of Black patients. I also demonstrate how the social underpinnings of racial bias in medical technology contribute to poor health outcomes and reproduce health disparities, and propose several recommendations for the field to rectify the harms of racial bias in medical technology.

Effects of positive end-expiratory pressure and oxygen concentration on non-hypoxemic apnea time during face mask ventilation of anesthesia induction: A randomized controlled trial.

Background: The optimal ventilatory strategy for the face mask ventilation during anesthesia induction is still unknow. Methods: We evaluated the effect of two positive end-expiratory pressure (PEEP) levels (0cmH2O and 6cmH2O) and two oxygen concentration levels (1.0 and .6) on non-hypoxemic apnea time during face mask ventilation of anesthesia induction. Sixty adult patients scheduled for elective surgery were enrolled in this study. The patients were randomized to receive anesthesia induction with four different ventilation strategy under volume-controlled ventilation. Patients assigned to the LOZP group received low fraction of inspiration O2 (FiO2 = .6) and 0 PEEP. Patients assigned to the LOHP group received low fraction of inspiration O2 (FiO2 = .6) and 6cmH2O PEEP. Patients assigned to the HOZP group received high fraction of inspiration O2 (FiO2 = 1.0) and 0 PEEP. Patients assigned to the HOHP group received high fraction of inspiration O2 (FiO2 = 1.0) and 6cmH2O PEEP. After 3min of ventilation, the patient was intubated but disconnected from the breathing circuit. Ventilation was not initiated until the pulse oximetry dropped to 90%. The primary outcome was non-hypoxemic apnea time defined as the time from cessation of ventilation to a pulse oximeter reading of 90%. The secondary outcome was the PaO2/FiO2 ratio immediately after ventilation. Results: The non-hypoxemic apnea time was significantly longer in the group of HOHP when compared to the other three groups (192s ± 70s, 221s ± 74s, 284s ± 101s, and 353s ± 85s in the LOZP, LOHP, HOZP, and HOHP group, respectively). The PaO2/FiO2 ratio immediately after ventilation was significantly higher in the group of LOHP when compared to the other three groups (LOZP 393 ± 130, LOHP 496 ± 97, HOZP 335 ± 58, HOHP 391 ± 50). When compared the PaO2/FiO2 ratio immediately after ventilation to its value before administration of anesthesia, the PaO2/FiO2 ratio in the group of LOHP was improved, the group LOZP and HOHP remained the same, while the group HOZP significantly decreased. Conclusion: Application of PEEP and 100% of oxygen during face mask ventilation of induction could maximize the non-hypoxemic apnea time. However, the use of PEEP and 60% of oxygen during preoxygenation resulted in improved PaO2/FiO2 ratio.

1040. Comparative Surge Data on SARS CoV-2 Variants in a Rural Community – A Virtual Hospital Experience

Abstract Background UNC Health Blue Ridge is a nonprofit community teaching hospital with 145 staffed beds. The COVID-19 pandemic has challenged rural hospitals like ours with high occupancy and periodic surges. UNC Health Blue Ridge COVID Virtual Hospital (CVH) created a home monitoring program for enrolled patients with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician follow-up. We report raw data that compare surge levels in our community for the Alpha (B.1.1.7), Delta (B.1.617.2) and Omicron (B.1.1.529) surges. Methods From April 2020 to present, the CVH enrolled patients diagnosed with COVID-19 based on FDA approved PCR tests. For this abstract, we defined any surge as an outpatient CVH census of greater than 50 patients or an inpatient census of &amp;gt;10 patients. We defined the maximum intensity of the surge as &amp;gt;20% outpatient SARS CoV-2 positivity and a CVH census &amp;gt;100 patients or &amp;gt;20 inpatients with SARS CoV-2 infection. Results For the outpatient setting, days of surge and maximum intensity were 144 / 98 days for Alpha, 92 / 71 days for Delta, 74 / 47 days for Omicron, respectively. Average daily CVH admissions during surges were 17.7 for Alpha, 26.15 for Delta, and 27.15 for Omicron. Total emergency department (ED) and urgent care visits were 12,765 and 23,696 for Delta, and 9701 and 16102 for Omicron. In the inpatient setting, days of surge and maximum intensity days were 102/76 days for Delta and 78/48 days for Omicron. Our peak inpatient COVID-19 daily census was 51 and 50 patients for Delta and Omicron. Conclusion Our CVH has enrolled over 8700 patients, and our hospital has not been on diversion during the COVID-19 pandemic, unlike many surrounding hospital systems of similar size. More importantly, the CVH has helped create a sustainable model that gathers local data to aid predictive algorithms and facilitate proactive rather than reactive resource allocations. This virtual model can be adapted for multiple other health conditions in the outpatient setting to improve patient safety and quality care. Disclosures All Authors: No reported disclosures.

Using of Oximeter and Sound Analysis for Detection of Lung Lesions in Buffalo Calves

Auscultation of the lung is the first line for the diagnosis of lung lesions. Analysis of the auscultated sounds is promising in the diagnosis confirmation. The aim of this study is to evaluate the use of sound analysis and oximeter for detection of the lung lesions in buffalo calves. The study included 100 calves showing respiratory symptoms and 30 clinically healthy calves serving as a control group which aged between (2-6) months from different areas in Mosul City. A pulse oximeter was used to measure the percentage of oxygen blood saturation, then measuring sound frequencies based on multi-resolution sound wave analysis by using digital program (WavePad). Affected calves showed coughing (100%), lacrimation (88%), nasal discharge (86%) and fever (58%). The sound analysis indicated that the natural sound frequency was (221) Hz, gradually increasing to (390.5) Hz in case of pneumonia. It then became (428) Hz in calves with wheezing sound. Diminished breathing sound had a frequency of 426) Hz synchronous with pauses that lasted (0.4) seconds after each complete inhalation and exhalation cycle. An oximeter reading had a positive correlation with each nasal discharge and eye lacrimation, while it had a negative correlation with both coughing and body temperature. The study concluded that sound wave analysis and oximeter were highly accurate in diagnosing the severity of the lung lesion compared to the detection of the clinical signs.

P074 Three models of pulse oximeters are within specifications when assessed using a benchtop pulse oximeter simulator

Abstract To assess possible SpO2 accuracy differences between 3 different (oximeter &amp; software) testing techniques. Hypothesised that differences in SpO2 would be within the oximeter manufacturer’s specification. A synthetic digit, OX-1 OxSim® Optical SpO2 Pulse Oximeter Simulator (Pronk Technologies Inc., Sun Valley, CA) can provide simulated SpO2 &amp; HR values : 85% (80BPM), 98% (80BPM), 98% (140BPM), 99% (80BPM) at low perfusion and 95% (40BPM) low HR. Simulated SpO2 delivered for 5 minutes, average calculated from signal recorded with corresponding download software: Rad-5 (Masimo, Irvine, CA, USA, 2sec averaging time) - Visi download (Stowood Scientific, Oxford, UK), the Rad-7 (Masimo, Irvine, CA, USA, 2-4sec averaging time) - PSG 4 (Compumedics, Melbourne, Australia), Wrist-Ox2® (Nonin Medical Inc, Plymouth, MN, USA, 3sec averaging time) - Noxturnal software (Nox Medical Inc, Reykjavik, Iceland). Four devices for each model Rad-5, Rad-7 and Nox Wrist-Ox2® were examined at 5 SpO2 &amp; HR settings. The SpO2 downloaded from each device was compared with the OxSim® values. Oximeter reading v OxSim® : at 85%, Rad-5 (y = -0.146x + 14.375, R² = 0.9627 bias 0.606), Rad-7 (y = -0.0897x + 8.737, R² = 0.5295 bias 0.295), Wrist-Ox2® (y = -0.0161x + 1.2261, R² = 0.0481 bias -0.281). At all other comparison values, including low perfusion and low HR, all values fell within +/- 2% SpO2. Small differences in the measured SpO2 for the 3 oximeter models &amp; paired software were noted, however all devices gave SpO2 values within 2% of simulated SpO2 values as per manufacturer specifications.

Impact of Nail Polish Colour on the Accuracy of Pulse Oximeter Reading in Healthy Individuals

Objective: To assess the effect of single-layered common nail polish colour on change in pulse oximeter reading.&#x0D; Study Design: Cross-sectional analytical study.&#x0D; Place and Duration of the Study: Combined Military Hospital, Peshawar, Pakistan, from Sep 2021 to Apr 2022.&#x0D; Methodology: Four hundred healthy females were included in the study that was normothermic, had an Oxygen saturation (SpO2) reading of 95% or more and do not have associated comorbidities, nailbed abnormalities or any history of trauma to limb. Individuals having any previous factors were excluded from the study. After informed consent, SpO2 was recorded using a portable infrared pulse oximeter in all four fingernails of the subjects at room temperature and then rechecked after the single-layered common nail polish was applied and dried. Red, green, black and purple were assigned to the index finger,middle finger, ring finger and little finger, respectively. In addition to oxygen saturation, other parameters, including age,gender, educational status, residence etc., were also recorded.&#x0D; Results: There was a statistically significant difference in oxygen saturation readings via portable infrared pulse oximeter in all four fingernails after applying single-layered common nail polish colours (p-value&lt;0.0001). However, there was no clinically significant difference in oxygen saturation reading recorded in any individual.&#x0D; Conclusion: A single layer of common nail polish affected the SpO2 reading measured through a portable pulse oximeter. This should be kept in mind when evaluating such patients in emergency reception.

Effects of High-Intensity Aerobic Interval Training on Cardiopulmonary Function in Patients With Chronic Heart Failure at The University Teaching Hospital, Lusaka, Zambia

Chronic heart failure patients present with a wide variety of symptoms such as, fatigue and dyspnea, which adversely affect their quality of life. Heart failure is a complex disease and a major cause of morbidity and mortality in developed and developing countries including Zambia. Through studies undertaken, high intensity aerobic interval training has been recommended in patients with chronic heart failure, to help improve symptoms and consequently the quality of life. Minimal research pertaining to effectiveness of aerobic exercise on various physiological parameters such as peripheral oxygen saturation, cardiopulmonary capacity and quality of life have been done in Africa and Zambia. Methods: This study evaluated the physiological effects of high intensity aerobic interval training on the cardiopulmonary function in New York Heart Association (NYHA) Class II and III chronic heart failure patients with a focus on peripheral oxygen delivery/saturation, cardiopulmonary capacity and the quality of life. This study utilised the Randomised Clinical Trial (RCT) study design and the study population was selected from the University Teaching Hospital-Heart clinic in Lusaka, Zambia. Results: A total number of 42 patients participated, and were randomly assigned to the two arms of the study. Twenty-one (21) were assigned to the interventional group (IG) and 21 to the control group (CG) respectively. The IG underwent a 12 week aerobic HIIT exercise-training program, while the CG was subjected to 30 minutes’ walk on a treadmill for the same period of 12 weeks. The expected primary outcomes were the baseline to endline differences in oxygen delivery/saturation readings, cardiopulmonary capacity test readings and the quality of life (measured using the Minnesota questionnaire) for both groups. The results obtained from the pulse oximeter readings, showed an increase in the oxygen saturation readings (97.90 to 98.62%), 6-minute walk distance readings (360.05 m to 429 m) and the questionnaire score totals of the different dimensions (physical, emotional/mental and socio-psychological factors) of the questionnaire (p-value ;0.0001) of the IG. The CG oxygen saturation readings (97.38 % to 97.90%) and 6-minute walk tests scores (359.14 to 370.9 m) showed minimal change. While, the questionnaire scores showed a statistical difference in the emotional/mental (p-value &lt; 0.0001), physical (p=0.005) and socio-psychological factors (p- value &lt; 0.0001). Conclusion: High intensity aerobic interval training has shown to improve the peripheral oxygen delivery, cardiopulmonary capacity and quality of life in chronic heart failure patients hence, must be considered as an adjunct therapy aside pharmacological management in stable chronic heart failure patients in Zambia.

RACIAL BIAS IN PULSE OXIMETRY IN ACUTE HYPOXEMIC RESPIRATORY FAILURE

RACIAL BIAS IN PULSE OXIMETRY IN ACUTE HYPOXEMIC RESPIRATORY FAILURE

Efficacy of nitrous oxide-oxygen inhalation versus oral midazolam-promethazine as sedative agents in pediatric patients

Background Managing difficult and uncooperative pediatric dental patients is a challenging task. Conscious sedation has been propagated as a pharmacological means for handling such situations. Objective To evaluate the effects of sedation using nitrous oxide-oxygen inhalation versus oral midazolam-promethazine in pediatric patients. Patients and methods A total of 100 pediatric patients were selected and divided into two equal categories: group 1 (midazolam-promethazine) and group 2 (N2O-O2). Ethical committee approval was obtained, and patients were assessed. Data collected were analyzed using an unpaired t test. Results Duration of sedation was found to be statistically significant, and a higher duration was found for group 1. No significant differences were noted in the behavior rating scale with either of the combinations and in pulse oximeter readings. Conclusion Midazolam/promethazine is better in inducing longer sedation than N2O/O2.

Remote Patient Monitoring System For Covid-19 Patient Using Wi-Fi-Based Pulse Oximeter Reading Sensor

Continuous Heart disease and blood pressure are diseases that demand immediate care. Heart disease is currently one of the world's most fatal illnesses, as it always results in death. Pulse Oximeter Reading must be continuously measured, analyzed, and monitored in real-time to ensure that relevant measures may be taken when necessary. In this paper, we present a model that employs IoT to inform users about the incidence of heart disease and high blood pressure in their daily health. The Remote Patient Monitoring System for Covid-19 Patients Based on Oximeter Reading Sensor uses the Web Server ESP32 MAX30100 to replace the present Oximeter Reading monitoring and public broadcasting approaches. In addition, the NodeMCU ESP8266 Wi-Fi module allows the devices to save data in the cloud when connected to the Internet. Also, it is possible to construct effective real-time Heart Rate and Oxygen Level (IoT) monitoring. The findings indicated that users might access and monitor Heart rate and oxygen level via the Web Server regardless of their location in the monitoring region. Furthermore, providing an LCD is incredibly beneficial as it can show readings and ensure the users receive Pulse Oximeter Reading monitoring information when the device is in operation.