Peripheral Perfusion Research Articles

Perfusion index: could it be a new tool for early identification of pulmonary embolism severity?

Perfusion index (PI) is a promising indicator for monitoring peripheral perfusion. The present study aimed to compare the efficiency of PI and PESI score in estimating the 30-day mortality and treatment needs of patients diagnosed with pulmonary embolism in the emergency department. This study was prospective and observational. The demographic features of the patients, comorbidities, vital signs, PESI score, PI, treatment applied to the patient and airway management, right ventricular diameter/left ventricular diameter ratio, length of hospital stay, outcome, and 30-day mortality were recorded. A total of 94 patients were included. All patients' vital signs and PI values were recorded on admission. The mean pulse rate (p = 0.001) and shock index (p = 0.017) values of deceased patients were statistically significantly higher, while the mean PI (p = 0.034) was statistically significantly lower. PESI score and PI were statistically significant to predict the need for mechanical ventilation (PI, p = 0.004; PESI score, p < 0.001), inotropic treatment (PI, p = 0.047; PESI score p = 0.005), and thrombolytic therapy (PI, p = 0.035; PESI score p = 0.003). According to the ROC curve, the mortality prediction power of both PESI (AUC: 0.787, 95% CI 0.688-0.886, cutoff: 109.5, p < 0.001) and PI index (AUC: 0.668, 95% CI 0.543-0.793, cutoff: 1, p = 0.011) were determined as statistically significant. PI might be helpful in clinical practice as a tool that can be applied to predict mortality and treatment needs in PE.

Real-time regurgitation estimation in percutaneous left ventricular assist device fully supported condition using an unscented Kalman filter

Objective. Significant aortic regurgitation is a common complication following left ventricular assist device (LVAD) intervention, and existing studies have not attempted to monitor regurgitation signals and undertake preventive measures during full support. Regurgitation is an adverse event that can lead to inadequate left ventricular unloading, insufficient peripheral perfusion, and repeated episodes of heart failure. Moreover, regurgitation occurring during full support due to pump position offset cannot be directly controlled through control algorithms. Therefore, accurate estimation of regurgitation during percutaneous left ventricular assist device (PLVAD) full support is critical for clinical management and patient safety. Approach. An estimation system based on the regurgitation model is built in this paper, and the unscented Kalman filter estimator (UKF) is introduced as an estimation approach. Three offset degrees and three heart failure states are considered in the investigation. Using the mock circulatory loop experimental platform, compare the regurgitation estimated by the UKF algorithm with the actual measured regurgitation; the errors are analyzed using standard confidence intervals of ±2 SDs, and the effectiveness of the mentioned algorithms is thus assessed. The generalization ability of the proposed algorithm is verified by setting different heart failure conditions and different rotational speeds. The root mean square error and correlation coefficient between the estimated and actual values are quantified and the statistical significance of accuracy differences in estimation is illustrated using one-way analysis of variance (One-Way ANOVA), which in turn assessed the accuracy and stability of the UKF algorithm. Main results. The research findings demonstrate that the regurgitation estimation system based on the regurgitation model and UKF can relatively accurately estimate the regurgitation status of patients during PLVAD full support, but the effect of myocardial contractility on the estimation accuracy still needs to be taken into account. Significance. The proposed estimation method in this study provides essential reference information for clinical practitioners, enabling them to promptly manage potential complications arising from regurgitation. By sensitively detecting LVAD adverse events, valuable insights into the performance and reliability of the LVAD device can be obtained, offering crucial feedback and data support for device improvement and optimization.

Role of local vasoconstrictors in diving performance of two pinniped species

Diving mammals extend submergence time through bradycardia and reduced peripheral perfusion to certain tissues. Thus, local blood flow regulation under hypoxia may be an essential physiological strategy that fine-tunes metabolic expenditures during breath-hold. We focused on a potent local vasoconstrictor, Endothelin-1 (ET1) and its receptors ETR-A and ETR-B, to determine their potential role in mammalian diving. We hypothesized that less perfused organs (kidney) would have higher signatures of local vasoconstriction (i.e. higher ET1 and receptors), compared to organs known to have higher relative perfusion underwater (heart/left ventricle). Additionally, we compared pinniped species with higher (Weddell seal) and lower (California sea lion) relative dive capabilities. Differences in mRNA expression of vasoconstrictive elements were assessed by 2-way ANOVA to compare tissue and species. In adult animals (n=7 both species) there were significant differences in expression of ET1 between species (F1,16=9.2, p=0.08) and tissues (F1,16=18.4, p=0.0006), with sea lions having consistently higher levels of ET1. ET1 expression was highest in the kidney, with sea lion kidney expressing 25x more ET1 mRNA than heart (posthoc p=0.0007). The expression ratio of ET A and B receptors also differed across tissue (F1,16=19.83 p=0.0004) with B/A highest in the kidney in both species. This is counter to expectations that submergence capability would relate to vasoconstriction potential across species, but supports the hypothesis that within a species, the less-perfused kidney should demonstrate higher potential for local vasoconstriction compared to the heart. Relative expression of ET receptors between tissues also runs counter to our hypothesis. In both divers, the heart expresses relatively more ETR-A, which has a critical role in vasoconstrictive signaling. On the other hand, ETR-B can signal for either vasoconstriction or vasodilation depending on its location within the endothelium or smooth muscle. Kidney in both species expresses relatively more ETR-B, indicating potential for nuanced vasoregulatory control through the endothelin pathway in this tissue. Receptor localization will be determined by immuno-staining to investigate functional differences between tissues. We also investigated the development of diving by comparing the same biomarkers in adults versus pups (n=10 seals, n=3 sea lions) using a separate 2-way ANOVA for each species. We expected that signatures of vasoregulatory potential would be less evident in the novice diving pups. Concordantly, ET1 is lower in sea lion pups than adults (F1,12=5.097, p=0.043); ET1 mRNA is 23x lower in the pup kidney compared to adult (posthoc p=0.02). Receptor expression followed the same patterns in both species, with the highest expression of ETR-A noted in the pup heart, indicating high vasoconstrictive potential in pups, but through tissue specific mechanisms. These results point to differences in the control of local vasoconstriction that occur with development and highlight the physiological components essential to the development of diving. Funding by NSF #2020706. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Tissue perfusion monitoring in children with acute circulatory dysfunction: narrative review

Sepsis is one of the main causes of admission to Intensive Care Units (ICU). The hemodynamic objectives usually sought during the resuscitation of the patient in septic shock correspond to macrohemodynamic parameters (heart rate, blood pressure, central venous pressure). However, persistent alterations in microcirculation, despite the restoration of macrohemodynamic parameters, can cause organ failure. This dissociation between the macrocirculation and microcirculation originates the need to evaluate organ tissue perfusion, the most commonly used being urinary output, lactatemia, central venous oxygen saturation (ScvO2), and veno-arterial pCO2 gap. Because peripheral tissues, such as the skin, are sensitive to disturbances in perfusion, noninvasive monitoring of peripheral circulation, such as skin temperature gradient, capillary refill time, mottling score, and peripheral perfusion index may be helpful as early markers of the existence of systemic hemodynamic alterations. Peripheral circulation monitoring techniques are relatively easy to interpret and can be used directly at the patient's bedside. This approach can be quickly applied in the intra- or extra-ICU setting. The objective of this narrative review is to analyze the various existing tissue perfusion markers and to update the evidence that allows guiding hemodynamic support in a more individualized therapy for each patient.

Is Kinesio taping acutely effective for peripheral tissue perfusion in women with mild to moderate chronic venous insufficiency? A randomized controlled trial

Objective To evaluate the acute effect of Kinesio Taping® (KT) on peripheral tissue perfusion in women with chronic venous insufficiency (CVI). Methods: This randomized, double-blind controlled trial included 59 women with mild to moderate CVI. They were randomized to a control group (n = 23; 54.08 ± 9.04 years) and KT group (n = 36; 55.87 ± 9.97 years). Near-infrared spectroscopy was positioned in the medial gastrocnemius muscle for assessment of resting tissue perfusion 48 h after the first day of evaluation and after placement of the Kinesio Taping® tape. The evaluation also consisted of performing movements of the plethysmography examination. To verify the comparisons of pre- and post-Kinesio Taping® data, the variation delta was used for analysis. Mann–Whitney U test was performed an an alpha of 5% was considered statistically significant. Results: There wasn't a significant difference between groups regarding the peripheral tissue perfusion evaluation variables Peripheral Oxygen Saturation Difference – DELTA_SPO2: (KT Group 3.21 (0.84–3.62); Control 2.21 (1.59–4.83), p = 0.219) and Difference in deoxygenate hemoglobin values – DELTA_HHB (units) KT Group -0.62 (-2.14–0.67); Control Group -0.07 (-2.15–2.62) p = 0.238). Despite the lack of statistical significance, the KT group had a 785.7% greater drop in HHB values than the control group. Conclusions: Acute use of Kinesio Taping® in women with CVI did not significantly alter tissue perfusion of calf muscles. However, it was possible to observe percentage differences in venous retention to be considered from a clinical point of view

Buerger-Allen exercises' effectiveness for improving lower limb circulation

Impaired peripheral perfusion in the legs is the most common complaint experienced by patients with type 2 Diabetes Mellitus (DM). One nursing intervention in the form of physical exercise that can be administered to DM patients to prevent peripheral perfusion disorders and increase vascularization of the lower extremities is the Buerger-Allen Exercise (BAE). The goal of this study was to analyze the effectiveness of BAE in improving lower extremity circulation. The population consisted of patients with type 2 DM. The research design employed a quasi-experiment with pre-test and post-test, including a control group. A sample of 24 respondents was divided into an intervention group and a control group. The sampling technique used was purposive sampling. Data were obtained through direct Ankle-Brachial Index (ABI) measurement using a Doppler ultrasound and an aneroid sphygmomanometer, temporary blood sugar level measurements using a glucometer, and leg sensitivity measurements using a monofilament tool. Paired T-tests and independent T-tests were used as statistical tests. The results of the Paired T-test for lower limb circulation in the intervention group yielded a p-value of 0.000, indicating a significant difference in the circulation of the lower extremities before and after the intervention. The results of the independent T-test also showed a p-value of 0.000, indicating significance. Thus, BAE can improve lower limb circulation in patients with type 2 DM.

Peripheral perfusion index stratifies risk in patients with intraoperative anemia: A multicentre cohort study

Study objectiveEvidence for red blood cell (RBC) transfusion thresholds in the intraoperative setting is limited, and current perioperative recommendations may not correspond with individual intraoperative physiological demands. Hemodynamics relevant for the decision to transfuse may include peripheral perfusion index (PPI). The objective of this prospective study was to assess the associations of PPI and hemoglobin levels with the risk of postoperative morbidity and mortality. DesignMulticenter cohort study. SettingBispebjerg and Hvidovre University Hospitals, Copenhagen, Denmark. PatientsWe included 741 patients who underwent acute high risk abdominal surgery or hip fracture surgery. InterventionsNo interventions were carried out. MeasurementsPrincipal values collected included measurements of peripheral perfusion index and hemoglobin values. MethodsThe study was conducted using prospectively obtained data on adults who underwent emergency high-risk surgery. Subjects were categorized into high vs. low subgroups stratified by pre-defined PPI levels (PPI: > 1.5 vs. < 1.5) and Hb levels (Hb: > 9.7 g/dL vs. < 9.7 g/dL). The study assessed mortality and severe postoperative complications within 90 days. Main resultsWe included 741 patients. 90-day mortality was 21% (n = 154), frequency of severe postoperative complications was 31% (n = 231).Patients with both low PPI and low Hb had the highest adjusted odds ratio for both 90-day severe postoperative complications (2.95, [1.62–5.45]) and 90-day mortality (3.13, [1.45–7.11]).A comparison of patients with low PPI and low Hb to those with high PPI and low Hb detected significantly higher 90-day mortality risk in the low PPI and low Hb group (OR 8.6, [1.57–162.10]). ConclusionHigh PPI in acute surgical patients who also presents with anemia was associated with a significantly better outcome when compared with patients with both low PPI and anemia. PPI should therefore be further investigated as a potential parameter to guide intraoperative RBC transfusion therapy.

Nursing process in a pregnant patient with preeclampsia, based on Gordon's model

Cesarean section is the surgical treatment in severe preeclampsia, which allows rapid access to the fetus through the abdominal cavity and is performed in emergency cases to ensure the maternal condition and complete the pregnancy in the shortest possible time, improving the quality of life and survival of the patient. Through the nursing method, a humanized care with quality and safety can be provided, contributing to the recovery of the patient's health. The objective is to develop the nursing care process for a post-cesarean patient for preeclampsia under the approach of Marjory Gordon's functional patterns. Qualitative study, single case type. It included a 23-year-old patient. The stages of the nursing care process were followed: assessment, with the assessment framework validated by experts in the area, formulation of diagnoses and planning of nursing care according to the NANDA, NOC, NIC taxonomy. The results were evaluated according to the difference in final and baseline scores. Nine altered patterns were found; Three patterns were prioritized: exercise activity, adaptation[1]tolerance to the situation and stress and cognitive perceptual. Thirteen nursing diagnoses were identified; Three were prioritized: Risk of ineffective peripheral tissue perfusion, acute pain and anxiety, based on the SSPFR format (signs and symptoms, problem and related factor); change score of +1, +2, +2, which subsequently tends to improve with care management. It is concluded that according to the problems identified in the patient, the nursing care process was managed in its five stages, improving the health status of the patient, but survival and the success of the treatment provided depend on the timely identification of the symptoms. problems and appropriate choice of treatment.

Comparison of the optical coherence tomography-angiography (OCT-A) vascular measurements between molecularly confirmed MODY and age-matched healthy controls.

Previous structural, vascular density, and perfusion studies have mostly comprised type 1 and type 2 diabetes, even in the absence of retinopathy. The current study aimed to compare macular vessel density (VD) measurements between maturity-onset diabetes of the young (MODY) patients and controls. The macular VD of superficial, deep retina, and choriocapillaris (CC), and central macular thickness (CMT), foveal avascular zone (FAZ), FAZ perimetry, VD of the total retina at 300µm around the FAZ (FD), and acirculatory index (AI) measurements were taken and analyzed via OCT-A (RTVue XR 100-2 Avanti, AngioVue) and were compared between molecularly confirmed MODY (glucokinase (GCK) variants) patients and healthy controls. Twenty-five MODY patients and 30 healthy controls were included in the study. The mean plasma hemoglobin A1c level in the MODY group was 6.39 ± 0.38. The mean age was 13.8 ± 2.1 in the MODY group and was 12.6 ± 2.5years among controls. There was no significant difference in terms of the age, superficial and deep retinal VD, FAZ, FAZ perimetry, CMT, FD, or AI between the groups. Compared to the healthy controls, a slight but significant increase in the CC-VD was detected in the MODY group, but only in the parafoveal and perifoveal regions (p = 0.034, p = 0.009). The significant CC-VD increase in the MODY group might be associated with hyperglycemia and/or relatively poor and vulnerable peripheral vascular CC perfusion compared to the central. Previous thickness and VD results of childhood or adolescent diabetes were distributed in a wider range, suggesting that various factors, including some not yet clearly defined, may affect the choroidal vasculature independently of glycemia or as a contributing factor.

A Case of a Pediatric Finger Tendon Rupture Diagnosed by Point-of-Care Ultrasound

BackgroundPediatric tendon injuries to the finger are rare, and their diagnosis can be challenging due to the difficulty in sensorimotor assessment in pediatric patients. Point-of-care ultrasound (POCUS) has currently been used for identifying tendon injury in adult acute care, but reports of its use in pediatric emergency departments are scarce. Case reportA previously healthy 14-year-old male patient visited our emergency department due to a finger laceration that occurred when he was cutting sausages using a knife. Physical examination revealed a 1.5 cm laceration over the palmer surface of the left fifth proximal phalanx. Tendon exposure was unremarkable, and the peripheral perfusion and sensation of the injured finger were intact. Flexion of the proximal and distal interphalangeal joints was limited due to pain. POCUS showed the disruption of the tendon structure over the laceration site, suggesting the flexor tendon rupture. Wound exploration by the orthopedic team revealed a transected flexor digitorum superficialis and flexor digitorum profundus and a tendon repair was performed. The patient was discharged with immobilization of the injured hand. Why Should an Emergency Physician Be Aware of This?Pediatric tendon injuries to the finger are rare, and their diagnosis can be challenging to diagnose due to the difficulty in sensorimotor assessment in pediatric patients. POCUS can directly visualize a tendon structure without procedural sedation or radiation exposure, empowering physicians to diagnose tendon injuries and optimize patient care.

No effect of dislocation status at arrival in emergency department on outcome of knee joint dislocations.

Knee dislocation is a rare but severe injury of the lower extremities. The aim of this study was to report on the epidemiology, diagnostics and treatment of such injuries and to identify negative predictors of clinical outcomes. This retrospective analysis included all knee dislocations treated at a Level I Trauma Centre in Germany between 2009 and 2021. Medical records were categorised, collected and analysed in a standardised manner. A follow-up visit 1 year after the injury focused on limitations in knee mobility. A total of 120 knee dislocations were included in the study. 29.3% of patients presented to the emergency department with a dislocated joint, and 17.5% (n = 21) had a neurovascular lesion. At follow-up 12 months after the injury, 65.8% of the patients reported limitations in the range of motion, and 11.7% (n = 14) reported severe limitations in daily activities. Site infections due to surgery occurred in 3.3% of patients. Increased body weight (r = 0.294; p < 0.001 and r = 0.259; p = 0.004), an increased body mass index above 25 kg/m2 (body mass index, r = 0.296; p < 0.001 and r = 0.264; p = 0.004) and deficits in peripheral perfusion as well as sensory and motor function (r = 0.231;p = 0.040 and r = -0.192; p = 0.036) were found to be negative predictive factors for clinical outcome. For posttraumatic neurovascular injury, lack of peripheral perfusion, insufficient sensory and motor function (r = -0.683; p < 0.0001), as well as a higher Schenck grade (r = 0.320; p = 0.037),were identified as independent risk factors. The status of dislocation at the site of the accident and on arrival at the emergency department had no impact on the outcome or neurovascular injury. Knee dislocation is a rare injury with a high rate of severe complications such as neurovascular lesions. In particular, the initial status of neurovascular structures and injury classification showed a relevant negative correlation with the posttraumatic status of nerves and vessels. In particular, patients with these characteristics need close monitoring to prevent negative long-term consequences. Level III.

Pulsatile flow increases METTL14-induced m 6 A modification and attenuates septic cardiomyopathy: an experimental study.

Septic cardiomyopathy is a sepsis-mediated cardiovascular complication with severe microcirculatory malperfusion. Emerging evidence has highlighted the protective effects of pulsatile flow in case of microcirculatory disturbance, yet the underlying mechanisms are still elusive. The objective of this study was to investigate the mechanisms of N 6 -methyladenosine (m 6 A) modification in the alleviation of septic cardiomyopathy associated with extracorporeal membrane oxygenation (ECMO)-generated pulsatile flow. Rat model with septic cardiomyopathy was established and was supported under ECMO either with pulsatile or non-pulsatile flow. Peripheral perfusion index (PPI) and cardiac function parameters were measured using ultrasonography. Dot blot assay was applied to examine the m 6 A level, while qRT-PCR, Western blot, immunofluorescence, and immunohistochemistry were used to measure the expressions of related genes. RNA immunoprecipitation assay was performed to validate the interaction between molecules. The ECMO-generated pulsatile flow significantly elevates microcirculatory PPI, improves myocardial function, protects the endothelium, and prolongs survival in rat models with septic cardiomyopathy. The pulsatile flow mediates the METTL14-mediated m 6 A modification to zonula occludens-1 (ZO-1) mRNA (messenger RNA), which stabilizes the ZO-1 mRNA depending on the presence of YTHDF2. The pulsatile flow suppresses the PI3K-Akt signaling pathway, of which the downstream molecule Foxo1, a negative transcription factor of METTL14, binds to the METTL14 promoter and inhibits the METTL14-induced m 6 A modification. The ECMO-generated pulsatile flow increases METTL14-induced m 6 A modification in ZO-1 and attenuates the progression of septic cardiomyopathy, suggesting that pulsatility might be a new therapeutic strategy in septic cardiomyopathy by alleviating microcirculatory disturbance.

The use of thermal imaging for evaluation of peripheral tissue perfusion in surgical patients with septic shock

BackgroundIn this study, we aimed to evaluate the ability of central-to-peripheral temperature gradients using thermal imaging to predict in-hospital mortality in surgical patients with septic shock.MethodsThis prospective observational study included adult patients with septic shock admitted to the intensive care unit postoperatively. Serum lactate (in mmol/L), capillary refill time (CRT) (in seconds), toe (peripheral) and canthal (central) temperature by infrared thermography and the corresponding room temperature in (Celsius [°C]) were assessed at the time of admission, 6- and 12 h after admission. The canthal-toe and room-toe temperature gradients were calculated. According to their final outcomes, patients were divided into survivors and non-survivors. The ability of canthal-toe temperature gradient (primary outcome), room-toe temperature gradient, toe temperature, serum lactate and CRT, measured at the prespecified timepoints to predict in-hospital mortality was analyzed using the area under receiver operating characteristic curve (AUC).ResultsFifty-six patients were included and were available for the final analysis and 41/56 (73%) patients died. The canthal-toe and room-toe temperature gradients did not show significant accuracy in predicting mortality at any timepoint. Only the toe temperature measurement at 12 h showed good ability in predicting in-hospital mortality with AUC (95% confidence interval) of 0.72 (0.58–0.84) and a negative predictive value of 70% at toe temperature of ≤ 25.5 °C. Both serum lactate and CRT showed good ability to predict in-hospital mortality at all timepoints with high positive predictive values (> 90%) at cut-off value of > 2.5–4.3 mmol/L for the serum lactate and > 3-4.2 s for the CRT.ConclusionIn post-operative emergency surgical patients with septic shock, high serum lactate and CRT can accurately predict in-hospital mortality and were superior to thermal imaging, especially in the positive predictive values. Toe temperature > 25.5 °C, measured using infrared thermal imaging can exclude in-hospital mortality with a negative predictive value of 70%.

Evaluation of pulse oximeter at the nasal septum during general anesthesia: comparison with finger oximeter.

Though the finger is generally recommended for pulse oxygen saturation (SpO2) monitoring site, its reliability may be compromised in conditions of poor peripheral perfusion. Therefore, we compared the performance of nasal septum SpO2 monitoring with finger SpO2 monitoring relative to simultaneous arterial oxygen saturation (SaO2) monitoring in generally anesthetized patients. In 23 adult patients, comparisons of SpO2 measured at the nasal septum and finger with simultaneous SaO2 were made at four time points during the 90min study period. A pulse oximetry monitoring failure was defined as a > 10s continuous failure of in an adequate SpO2 data acquisition. Core temperature as well as finger-tip and nasal septum temperatures were simultaneously measured at 10min intervals. A total of 92 sets of SpO2 and SaO2 measurements were obtained in 23 patients. The bias and precision for SpO2measured at the nasal septum were - 0.8 ± 1.3 (95% confidence interval: - 1.1 to - 0.6), which was similar to those for SpO2measured at the finger (- 0.6 ± 1.4; 95% confidence interval: - 0.9 to - 0.4) (p = 0.154). Finger-tip temperatures were consistently lower than other two temperatures at all time points (p < 0.05), reaching 33.5 ± 2.3°C at 90min after induction of anesthesia. While pulse oximetry monitoring failure did not occur for nasal septum probe, two cases of failure occurred for finger probe. Considering the higher stability to hypothermia with a similar accuracy, nasal septum pulse oximetry may be an attractive alternative to finger pulse oximetry. Trail registration This study was registered with Clinical Research Information Service (CRIS: https://cris.nih.go.kr/cris/en/ ; ref: KCT0008352).

Liraglutide for Lower Limb Perfusion in People With Type 2 Diabetes and Peripheral Artery Disease

Peripheral artery disease (PAD) in diabetes may lead to diabetic foot ulcer and lower-extremities amputation. Glucagon-like peptide 1 receptor agonists have proven cardiovascular benefits in trials of people with type 2 diabetes at high cardiovascular risk. To examine the effect of liraglutide on peripheral perfusion measured as peripheral transcutaneous oxygen pressure (TcPo2) in individuals with type 2 diabetes and PAD. This open-label randomized clinical trial was conducted between February 1, 2021, and June 30, 2022, with a final follow-up on December 30, 2022, at University of Campania "Luigi Vanvitelli," Naples, Italy. Fifty-five individuals with type 2 diabetes, PAD, and TcPo2 between 30 and 49 mm Hg were included. Patients were randomized to receive 1.8 mg of subcutaneous liraglutide or conventional treatment of cardiovascular risk factors (control group) for 6 months. Coprimary outcomes were the change from baseline of peripheral perfusion between groups and the comparison of the proportion of individuals who reached 10% increase of TcPo2 from baseline in each group. Fifty-five participants (mean [SD] age, 67.5 [8.5] years; 43 [78%] male) were randomized (27 to the liraglutide group and 28 to the control group) and analyzed. Participants had a median (IQR) hemoglobin A1c level of 6.9% (6.5%-7.8%) and a mean (SD) TcPo2 of 40.3 (5.7) mm Hg. Transcutaneous Po2 increased over time in both groups, with significant differences favoring the liraglutide group after 6 months (estimated treatment difference, 11.2 mm Hg; 95% CI, 8.0-14.5 mm Hg; P < .001). The 10% increase of TcPo2 occurred in 24 participants (89%) in the liraglutide group and 13 (46%) in the control group (relative risk, 1.91; 95% CI, 1.26-2.90; P < .001). Compared with the control group, individuals in the liraglutide group had a significant reduction of C-reactive protein (-0.4 mg/dL; 95% CI, -0.7 to -0.07 mg/dL; P = .02), urinary albumin to creatinine ratio (-119.4 mg/g; 95% CI, -195.0 to -43.8 mg/g; P = .003), and improvement of 6-minute walking distance (25.1 m; 95% CI, 21.8-28.3 m; P < .001). In this randomized clinical trial of people with type 2 diabetes and PAD, liraglutide increased peripheral perfusion detected by TcPo2 measurement during 6 months of treatment. These results support the use of liraglutide to prevent the clinical progression of PAD in individuals with type 2 diabetes. ClinicalTrials.gov Identifier: NCT04881110.

Pengaruh Foot Exercise Terhadap Neuropati Motorik Pada Pasien DM Tipe 2 Di Wilayah Kerja Puskesmas Benteng

Diabetes Mellitus is a chronic, progressive disease characterized by the body's inability to metabolize carbohydrates, fats and proteins, leading to hyperglycemia. DM can be associated with serious complications such as kidney damage, eye problems, cardiovascular disease, nerve damage and skin and foot problems, so DM sufferers need to take precautions to avoid complications. Foot exercise is a type of foot exercise performed by diabetics which can increase peripheral perfusion and thus prevent worsening of diabetic neuropathy. Foot exercise can also reduce the risk and progression of peripheral neuropathy because it can improve blood flow to the periphery, increase muscle strength and improve motor function. Objective: to determine the effect of foot exercise on motor neuropathy in type 2 DM patients. Method: The design in this study used a quasi-experimental approach using a one group pretest posttest design. The sample for this research was 18 respondents. Data analysis used the paired sample t-test. Results: based on the results of statistical tests using the Paired Samples t Test, the resulting P value is 0.000 &lt; 0.05, where it can be concluded that there is an influence of foot exercise on Motor Neuropathy in type 2 DM patients. Conclusion: It can be concluded that there is an influence of foot exercise on Motor Neuropathy in type 2 DM patients in the working area of Benteng Sukabumi City Health Center.

Prediction of preload dependency using phenylephrine-induced peripheral perfusion index during general anaesthesia: a prospective observational study

BackgroundTracking preload dependency non-invasively to maintain adequate tissue perfusion in the perioperative period can be challenging.The effect of phenylephrine on stroke volume is dependent upon preload. Changes in stroke volume induced by phenylephrine administration can be used to predict preload dependency. The change in the peripheral perfusion index derived from photoplethysmography signals reportedly corresponds with changes in stroke volume in situations such as body position changes in the operating room. Thus, the peripheral perfusion index can be used as a non-invasive potential alternative to stroke volume to predict preload dependency. Herein, we aimed to determine whether changes in perfusion index induced by the administration of phenylephrine could be used to predict preload dependency.MethodsWe conducted a prospective single-centre observational study. The haemodynamic parameters and perfusion index were recorded before and 1 and 2 min after administering 0.1 mg of phenylephrine during post-induction hypotension in patients scheduled to undergo surgery. Preload dependency was defined as a stroke volume variation of ≥ 12% before phenylephrine administration at a mean arterial pressure of < 65 mmHg. Patients were divided into four groups according to total peripheral resistance and preload dependency.ResultsForty-two patients were included in this study. The stroke volume in patients with preload dependency (n = 23) increased after phenylephrine administration. However, phenylephrine administration did not impact the stroke volume in patients without preload dependency (n = 19). The perfusion index decreased regardless of preload dependency. The changes in the perfusion index after phenylephrine administration exhibited low accuracy for predicting preload dependency. Based on subgroup analysis, patients with high total peripheral resistance tended to exhibit increased stroke volume following phenylephrine administration, which was particularly prominent in patients with high total peripheral resistance and preload dependency.ConclusionThe findings of the current study revealed that changes in the perfusion index induced by administering 0.1 mg of phenylephrine could not predict preload dependency. This may be attributed to the different phenylephrine-induced stroke volume patterns observed in patients according to the degree of total peripheral resistance and preload dependency.Trial registrationUniversity Hospital Medical Information Network (UMIN000049994 on 9/01/2023).

Comparison of Predictive Ability of Macrocirculation and Microcirculation Markers on Outcomes of Patients with Septic Shock During Initial Fluid Resuscitation: A Prospective Observational Study

IntroductionThis study aimed to compare the predictive abilities of macrocirculation markers (mean arterial pressure, heart rate, and central venous pressure), microcirculation markers (capillary refill time and peripheral perfusion index), as well as fluid balance, lactate level, and lactate clearance on the outcomes of patients with septic shock during initial resuscitation.MethodsIn this prospective, single-center observational study, adult patients with septic shock admitted to the intensive care unit (ICU) at Shohada Hospital in Tabriz, Iran, between December 2020 and September 2021, were included. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess the associations between macrocirculation markers (heart rate, mean arterial pressure, central venous pressure, and fluid balance) and microcirculation markers (capillary refill time, peripheral perfusion index, mottling score, lactate level, and lactate clearance level) with outcomes such as ICU length of stay, need for renal replacement therapy (RRT), vasopressor requirements, duration of mechanical ventilation (MV), and mortality rate. Assessments were performed at baseline, 6 h, and 24 h after fluid resuscitation.ResultsA total of 100 patients with septic shock (55 men and 45 women) were enrolled in the study. The area under the curve (AUC) values for the macrocirculation and microcirculation markers in predicting mortality ranged from 0.517 to 0.770 and 0.695 to 0.993, respectively. Among the macrocirculation markers, central venous pressure and mean arterial pressure at baseline showed the best predictive values for mortality, with AUCs of 0.770 and 0.753, respectively.ConclusionIn patients with septic shock, microcirculation markers, particularly the peripheral perfusion index (PPI), demonstrated better predictive accuracy for mortality compared to macrocirculation markers. Furthermore, the combination of markers had a higher AUC, sensitivity, and specificity for predicting outcomes compared to individual markers alone.

Comparison between Portable Pulse Oximeter and Conventional ICU Pulse Oximeter measurements in healthy adults: A Cross Sectional Study

ABSTRACT: Objective: To assess the agreement between oxygen saturation reading between portable pulse oximeter and conventional ICU monitor pulse oximeter. Methods: This cross-sectional study was conducted at Department of Medicine, Fatima Hospital Baqai Medical University, Karachi, from 1st March 2023 to 31st March 2023. Participants in the study in- cluded healthy health care workers and medical students who were over the age of 18 and did not have any known co-morbid conditions like hypertension or diabetes that may affect peripheral perfu- sion. None of the participants had hypotension, clinical evidence of anemia, fingernail paint or poor peripheral perfusion as these are the factors that may influence pulse oximetry readings. Both the portable pulse oximeter and the traditional intensive care unit (ICU) monitors were utilized to take and record the oxygen saturation levels of each of the ten fingers in a sequential manner while the patient was seated. Data was analyzed using SPSS version 22. Readings of both instruments were com- pared employing Regression analysis. Bland-Altman analysis was applied to measure the level of agreement between readings of portable pulse oximeter and conventional ICU monitors. Results: Total 200 participants were enrolled for this study and most of them were from younger age group. (Mean age of participants = 33.05 ± 10.31). There was no significant difference between oxy- gen saturation readings of respective finger from portable pulse oximeter and conventional ICU moni- tors on regression analysis (p &gt; 0.05). Highest mean oxygen saturation was recorded in right middle finger using portable pulse oximeter (98.71 ± 1.21). On the ICU monitor pulse oximeter, it was 2nd highest in right middle finger (98.33 ± 2.49). Therefore, Bold-Altman analysis applied between oxygen saturation reading for two devices in right middle finger and was found to be comparable. (Mean dif- ference (bias) = 0.375 with 95% confidence interval). Conclusion: Modern portable pulse oximeters can reliably be used to rule out hypoxemia.

The perfusion index as a noninvasive method for monitoring revascularized and replanted digits.

Monitoring replanted digits remains a challenging task in microsurgical units. Previous studies have indicated the perfusion index (PI), a parameter directly proportional to the blood flow, might be a useful tool. The PI is evaluated as a monitoring tool in patients with replanted digits. This prospective, non-interventional study includes 31 patients with revascularized or replanted digits. After successful revascularization or replantation, the PI and peripheral oxygen saturation of the affected finger and its contralateral equivalent were measured simultaneously. The values were detected by the device Radical-97® Pulse CO-Oximeter® (Masimo Corporation, 52 Discovery, Irvine, CA 92618, USA). The median PI of affected fingers was 3.5±0.56 for revascularized and 2.2±0.8 for replanted fingers. The difference between the PI values of replanted digits and the healthy contralateral side was highly significant (p < 0.0001). The area under the curve in the receiver operating characteristics was 0.92 for a PI difference > 80.49% and predicted a loss of replant with a specificity of 100% and a sensitivity of 75%. The assessment of the PI in patients with reperfusion of a vascular compromised digit is a useful tool to continuously monitor peripheral perfusion. The dynamic behavior of the PI is essential to detect perfusion disturbance.