Pulse Oxygen Saturation Research Articles

SMART SAFETY SHOES: INTERNET OF THINGS BASED ANTI FATIGUE SENSORS TO PREVENT MUSCULOSKELETAL DISORDERS

Background: Occupational injuries in Indonesia increase every year where one of the causes is fatigue. Musculoskeletal disorders (MSDs) is the most common occupational injuries that happen. This problem can be caused by ergonomic factors such as standing position for long periods of time. Purpose: Safety shoes can be personal protective equipment to prevent MSDs complaints on the feet. Method: Additional designs and features are needed to increase the effectiveness of safety shoes. Smart Safety Shoes are shoes equipped with anti-fatigue sensors where there is a pulse detector and a heating sensor and apply Internet of Things technology by focusing attention to ergonomic concepts. The sensor system in the shoes is connected to the android application via wifi network. The application displays pulse rate, temperature, oxygen saturation, warning and recommendation information, as well as heating sensor control. Result: From the results of trials using a random sample, the levels of comfort and safety of these shoes are 83,3% and 83,3%, so they are quite effective to use. Conclusion: Foot fatigue can be relieved by turning on the heating sensor for about 5-10 minutes for maximum comfort so that MSDs can be prevented as early as possible.

Efficacy of intraoperative sedation combined with preemptive analgesia for single-level kyphoplasty under local anesthesia: A randomized clinical trial

BackgroundKyphoplasty is widely used for Osteoporotic Vertebral Compression Fracture (OVCF) under general or local anesthesia, more attention was paid to its post-operative efficacy. Patients' pain and discomfort control strategies during surgery have not been taken seriously. ObjectiveThis study aimed at assessing the efficacy of preoperative preemptive analgesia combined with intraoperative sedation for pain and tension relief in OVCF patients undergoing kyphoplasty under local anesthesia. MethodsWe enrolled 128 patients with single-level OVCF who underwent kyphoplasty in our hospital from July 2013 to July 2016. The patients were randomly allocated into three groups: conventional group (i.e., local anesthesia with 0.5% lidocaine (1); n = 42), preemptive group (i.e, (1) + oral 200 mg Celecoxib on the night before surgery with intravenous 40 mg parecoxib sodium an hour before surgery (2); n = 43), and combined group (i.e., (1) + (2) + continuous intravenous 0.5 μg/kg/h dexmedetomidine intraoperatively; n = 43). Hemodynamic variations (heart rate, blood pressure, pulse oxygen saturation (SpO2)), Pain Visual Analogue Score (VAS), Ramsay score, and adverse events were recorded during perioperative period. ResultsBlood pressure and heart rate were more stable with significantly smaller values in the combined group than in the conventional and preemptive groups both intra- and postoperatively. In contrast, SpO2 showed no significant difference among the groups throughout the perioperative period. Intraoperative VAS scores revealed significant differences among the groups with the combined group having the smallest values followed by the preemptive group. Similarly, intraoperative Ramsay scores reflected significantly more favorable effects of sedation in the combined than in conventional group. Both VAS and Ramsay scores showed no significant differences among the groups postoperatively, and no differences in complication incidences were noted among the groups as well. ConclusionsFor kyphoplasty under local anesthesia for single-level OVCF, intraoperative sedation combined with preemptive analgesia worked better in mitigating pain and tension intraoperatively and in preventing hemodynamic changes intra- and post-operatively, as compared to local anesthesia alone or additional preemptive analgesia.

Efficacy of high-flow nasal oxygenation compared with tracheal intubation for oxygenation during laryngeal microsurgery: a randomised non-inferiority study

BackgroundOxygenation via a high-flow nasal cannula (HFNC) can be an alternative to tracheal intubation during short apnoeic procedures. This randomised, non-inferiority study assessed the efficacy of HFNC compared with tracheal intubation in laryngeal microsurgery. MethodsPatients (≥20 yr old) undergoing laryngeal microsurgery under general anaesthesia and neuromuscular blockade were randomised to either the HFNC or tracheal intubation groups. The primary endpoint was lowest pulse oxygen saturation (SpO2) during the first 30 min of surgery. Secondary endpoints included incidence of desaturation (SpO2 <95%), hypercarbia (transcutaneous carbon dioxide [CO2] ≥8.7 kPa), and rescue intervention. ResultsAmongst 130 patients randomised, 118 were included in the analysis. The lowest SpO2 was 100 (98–100)% in the HFNC group (n=56) and 100 (100–100)% in the tracheal intubation group (n=62), with a mean difference of –1.4% (95% confidence interval: –2.4% and –0.3%), failing to confirm non-inferiority with a non-inferiority margin of 2%. The peak transcutaneous CO2 and end-tidal CO2 at the end of surgery were higher in the HFNC group compared with the tracheal intubation group. Incidences of desaturation, hypercarbia, and rescue intervention were more frequent in patients receiving HFNC compared with tracheal intubation. ConclusionsHFNC oxygenation was not non-inferior to tracheal intubation for maintaining oxygen saturation during laryngeal microsurgery. Considering more frequent desaturation, hypercarbia, and requirement for rescue intervention compared with tracheal intubation, HFNC should be used with cautious monitoring even for short duration airway surgery. Clinical trial registrationNCT03629353.

Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children: a prospective randomized controlled study.

To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children. A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group (n=60) and an observation group (n=58) using a random number table. The observation group received intravenous pumping of dexmedetomidine hydrochloride (2 μg/mL) at 1 μg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by dexmedetomidine hydrochloride pumped intravenously at 0.5-0.7 μg/(kg·h) 10 minutes later to maintain anesthesia. The control group was given intravenous pumping of propofol at 2 mg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by propofol pumped intravenously at 4-6 mg/(kg·h) 10 minutes later to maintain anesthesia. Fiberoptic bronchoscopy was performed after the children were unconscious. Heart rate (HR), respiratory rate, blood oxygen saturation, and mean arterial pressure (MAP) were recorded before inserting the bronchoscope (T0), at the time of inserting the bronchoscope (T1), when the bronchoscope reached the glottis (T2), when the bronchoscope reached the carina (T3), and when the bronchoscope entered the bronchus (T4). The intraoperative peak airway pressure (Ppeak), examination time, degree of sedation, extent of amnesia, incidence of adverse reactions, postoperative awakening time, and postoperative agitation score were also recorded. Compared with the control group, the observation group had significantly decreased MAP at T1 to T4 and HR at T1 to T3 (P<0.05). Compared with that at T0, MAP was significantly increased at T1 to T4 in the control group and at T3 in the observation group (P<0.05). HR was significantly higher at T1 to T3 than at T0 (P<0.05). Compared with the control group, the observation group showed significantly lower intraoperative Ppeak value, incidence of intraoperative adverse reactions, and postoperative agitation score, significantly shorter examination time, and better effects of amnesia and anesthesia (P<0.05). There was no significant difference in the degree of intraoperative sedation and postoperative awakening time between the two groups (P>0.05). Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.

The effect of high flow nasal oxygen therapy in intensive care units: a systematic review and meta-analysis

ABSTRACT Background High flow nasal oxygen (HFNO) therapy has been widely used in intensive care units (ICU); however, its efficacy remains inconclusive. This systematic review and meta-analysis aimed tocompare the efficacy of HFNO therapy with that of alternative noninvasive oxygen therapies such as conventional oxygen therapy (COT) and noninvasive ventilation (NIV) in ICU. Methods A Pubmed, Embase, Web of Science, Cochrane Library database search was performed in March 2020. Results: The meta-analysis ultimately included 17 clinical studies. Compared with the overall effect of COT and NIV, HFNO was associated with a low incidence of pneumonia (95% CI: 0.6–0.99, P = 0.04) and improvement in lowest pulse oxygen saturation (SpO₂) during oxygenation (95% CI: 0.02–1.61; P = 0.04). However, no differences were detected in the following outcomes: length of ICU stay, the rate of intubation or reintubation, mortality at day 28, hospital mortality, and SpO₂ at the end of oxygen therapy (all P > 0.05). Conclusions In adult patients in ICU, HFNO may improve oxygenation and decrease pneumonia rate without affecting the length of ICU stay, intubation or reintubation rate, mortality, and SpO₂ at the end of oxygen therapy.

ANESTHESIA MANAGEMENT OF PATIENTS UNDERGOING PERCUTANEOUS PULMONARY VALVE IMPLANTATION

Introduction To investigate the perioperative anesthesia management of percutaneous pulmonary valve implantation (PPVI). Methods Clinical data of 6 patients undergoing PPVI operation were retrospectively analyzed in children's heart center of Henan Provincial People's Hospital from December 2017 to January 2020, including 3 males and 3 females with mean age (16.3±5.4) years,weight 41.2±12.3Kg. All patients received endotracheal intubation under general anesthesia. Systolic blood pressure (SBP) and diastolic blood pressure (DBP),heart rate(HR),central venous pressure(CVP),pulse oxygen saturation(SPO2) were recorded before anesthesia induction (T1),after anesthesia induction (T2),before surgery (T3),before percutaneous pulmonary valve implantation (T4),during percutaneous pulmonary valve implantation (T5),after percutaneous pulmonary valve implantation (T6) and out of the operating room (T7). Right ventricular systolic (SRVP) and right ventricular diastolic (DRVP), pulmonary artery systolic (SPAP) and diastolic (DPAP) were recorded before T4 and after T6. Intraoperative complications were recorded. The time of tracheal catheter removal was recorded. The time of stay in ICU and the time of discharge was recorded. Results Compared with T1,T2,T3,T4,T6,T7,SBP,DBP,HR and SPO2 was significantly reduced at T5 (P Discussion Tracheal intubation general anesthesia is suitable for percutaneous PPVI surgery. Hemodynamic monitoring should be strengthened during pulmonary valve implantation to maintain circulatory stability.

Comparative study on pros and cons of sequential high-flow nasal cannula and non-invasive positive pressure ventilation immediately following early extubated patients with severe respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease

To explore the pros and cons of sequential high-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) immediately following early extubated patients with severe respiratory failure (SRF) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD), so as to provide evidence for clinical selection of optimal scheme. Consecutive AECOPD patients admitted to the respiratory intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 2019 to September 2020 were screened for enrollment. Patients were between 40 years old and 85 years old with acute exacerbation of bronchial-pulmonary infection, who received endotracheal intubation mechanical ventilation (ETI-MV) as the initial respiratory support method. The pattern of synchronous intermittent mandatory ventilation (SIMV) was used in the study. The parameters were set as follows: tidal volume (VT) 8 mL/kg, support pressure 10-15 cmH2O (1 cmH2O = 0.098 kPa), positive end-expiratory pressure (PEEP) 4-6 cmH2O and the ratio of inspiratory to expiratory time 1.5-2.5:1. Under these conditions, the plateau pressure (Pplat) was maintained less than 30 cmH2O. The minimum fraction of inspired oxygen was adjusted to keep the pulse oxygen saturation no less than 0.92. When the pulmonary infection control window (PIC window) occurred, the subjects were extubated immediately and randomly divided into two groups, with one group receiving HFNC (called HFNC group), the other group receiving NIPPV (called NIPPV group). Patients with failed sequential HFNC or NIPPV underwent tracheal re-intubation. The rate of tracheal re-intubation within 7 days of extubation, complications (such as nose and face crush injury and gastric distension), in-hospital mortality, duration of ETI before PIC window, length of RICU stay and length of hospital stay were compared, respectively. Forty-four patients were enrolled in the study, 20 in the HFNC group and 24 in the NIPPV group. There was no significant difference in the duration of ETI before PIC window between HFNC and NIPPV groups (hours: 95.9±13.1 vs. 91.8±20.4, P > 0.05). The rate of tracheal re-intubation within 7 days in the HFNC group was significantly higher than that in the NIPPV group [35.0% (7/20) vs. 4.2 % (1/24), P < 0.05]. However, the incidence of complication in the HFNC group was significantly lower than that in the NIPPV group [0% (0/20) vs. 25.0% (6/24), P < 0.05]. Compared with the NIPPV group, the in-hospital mortality in the HFNC group was slightly higher [5.0% (1/20) vs. 4.2% (1/24)], the length of RICU stay (days: 19.5±10.8 vs. 15.5±7.2) and the length of hospital stay (days: 27.4±12.2 vs. 23.3±10.9) were slightly longer, without statistical differences (all P > 0.05). For early extubated patients with SRF due to AECOPD, the compliance of sequential HFNC increased and the complications decreased significantly, but the final effect may be worse than sequential NIPPV.

Risk Factors for Sever Forms of COVID-19 - A Second Level Moroccan Hospital Experience

The new coronavirus (2019-nCoV) has caused the death of more than 1.68 million patients worldwide, including 6,909 deaths registered in Morocco until 12/20/2020. The main objective of this study is to investigate epidemiological, clinical, and paraclinical factors predicting progression to the severity in order to identify patients at risk and adopt strategies for individualized management.We conduct this observational, descriptive, and analytical study from 01/09/2020 to 25/12/2020, at AL FARABI regional hospital in Oujda. 567 patients were eligible for our study out of 2000 patients who were admitted since our first case on April 2020. Our sample was divided into two groups based on pulse oxygen saturation on admission. We identified 294 as a Severe/Critical case and 273 as a Mild/Moderate form on admission. The mean age was significantly higher in the severe group (63.28 ± 12.4 vs 55.13 ± 17.2). The sex ratio M/F was 0.87. Compared with non-severe cases, severe cases exhibited more comorbidities, including diabetes (60.4% vs 39.6%; P 0.003), and hypertension (63.6% vs 26.4%; P 0.002). Several biological parameters were associated with disease severity in univariate analysis, the most important being lymphopenia, elevated C-reactive protein, and ferritin levels. lymphopenia (OR 3.76; 95% CI, 4.25-9.23), elevated C-reactive protein (OR, 5.7; 95% CI, 3.84-8.48) ferritin levels (OR, 3.6; 95% CI, 1.64-7.89) were significantly associated with severe cases of COVID-19. Mortality is 2.9% for all of our patients; it increases to 4.5% if we consider severe cases only. Identification and evaluation of epidemiological, clinical, and paraclinical parameters are important to identify patients at high risk of SARS-COV2 severity to guide treatment.

Good news on masks

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

An in vivo, randomized, controlled comparative evaluation of efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years.

To compare and evaluate the efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years. 100 participants were randomly distributed to receive either 4% articaine using infiltration anesthesia or 2% lidocaine using inferior alveolar nerve block on each side of the mandibular arch, in two different appointments, after a 1-week interval. The pain perception was evaluated using visual analog scale (VAS) and Wong-Baker Faces pain rating scale (WBFPRS). In both the appointments, the efficacy and onset of anesthesia were evaluated using an electric pulp tester. Hemodynamic parameters, which included pulse rate and oxygen saturation levels, were evaluated using a pulse oximeter. Postoperative complications were evaluated at 24-hour follow-up. Pain score recorded with block was more painful compared to infiltration (P < .05). Anesthetic success was observed with both the local anesthetic agents, with no significant differences (P > .05). Shorter onset of action was observed with articaine (P < .05). Statistically significant differences between groups were noted with regard to heart rate (P < .05). Oxygen saturation levels did not show significant differences (P > .05). When postoperative complications were evaluated with either 4% articaine or 2% lidocaine, very few adverse effects were recorded (P > .05). Buccal infiltration using 4% articaine has the potential to replace 2% lidocaine using inferior alveolar nerve block in children.(Quintessence Int 2021;52:780-786; doi: 10.3290/j.qi.b1492247).

Observation of the curative effect of conservative oxygen therapy in mechanical ventilation of patients with severe pneumonia

To compare the effects of conservative oxygen therapy and conventional oxygen therapy on the efficacy and prognosis of mechanical ventilation support in patients with severe pneumonia. A prospective randomized controlled study were conducted, 110 patients with severe pneumonia requiring mechanical ventilation in intensive care unit (ICU) of Hefei First People's Hospital from May 2019 to May 2021 were selected and divided into conventional oxygen therapy group (51 cases) and conservative oxygen therapy group (55 cases) according to random number table method. Patients in both groups were treated with invasive to non-invasive sequential mechanical ventilation strategy, and the target of oxygen therapy in the conventional oxygen therapy group was set as the arterial partial pressure of oxygen (PaO2) > 150 mmHg (1 mmHg = 0.133 kPa) or pulse oxygen saturation (SpO2) > 0.96. In the conservative oxygen therapy group, PaO2 was set at 70-100 mmHg or SpO2 at 0.90-0.92. The changes of blood gas analysis, mechanical ventilation time, ICU stay time, ICU mortality, new organ dysfunction and infection more than 48 hours after admission were observed in two groups before and after treatment. Kaplan-Meier method was used to analyze the difference in cumulative survival rate between the two groups. After treatment, pH value, PaO2 and oxygenation index (PaO2/FiO2) in both groups were significantly higher than before treatment, and arterial partial pressure of carbon dioxide (PaCO2) was significantly lower than before treatment. pH value in the conservative oxygen therapy group was significantly higher than that in the conventional oxygen therapy group (7.4±0.1 vs. 7.3±0.3). PaO2, PaCO2 and PaO2/FiO2 were significantly lower than those in conventional oxygen therapy group [PaO2 (mmHg): 68.9±4.7 vs. 75.2±6.0, PaCO2 (mmHg): 42.1±5.6 vs. 50.5±7.5, PaO2/FiO2 (mmHg): 329±126 vs. 365±108, all P < 0.05]. The mechanical ventilation time in the conservative oxygen therapy group was significantly longer than that in the conventional oxygen therapy group (days: 19.7±3.5 vs. 13.9±4.5, P < 0.05), but there was no significant difference in ICU hospitalization time between the conservative oxygen therapy group and the conventional oxygen therapy group (days: 26.5±5.0 vs. 25.5±4.6, P > 0.05). Compared with the conventional oxygen therapy group, the ICU mortality, the incidence of nosocomial bloodstream infection, and the incidence of liver insufficiency, shock, and ICU acquired weakness (ICUAW) were decreased significantly in the conservative oxygen therapy group [ICU mortality: 27.3% (15/55) vs. 45.1% (23/51), liver insufficiency: 1.8% (1/55) vs. 7.8% (4/51), shock: 3.6% (2/55) vs. 9.8% (5/51), ICUAW: 5.5% (3/55) vs. 11.8% (6/51), the incidence of new bloodstream infection: 5.5% (3/55) vs. 11.8% (6/51), all P < 0.05]. Kaplan-Meier analysis showed that the cumulative survival rate of the conservative oxygen therapy group was significantly higher than that of the conventional oxygen therapy group (72.7% vs. 54.9%; Log-Rank test: χ2 = 4.244, P = 0.039). Conservative oxygen therapy can reduce ICU mortality, the incidence of shock, liver insufficiency, ICUAW, and bloodstream infection in patients with severe pneumonia, but prolong mechanical ventilation time.

New Predictive Equation for Optimal Continuous Positive Airway Pressure in Adult Patients with Obstructive Sleep Apnea

Objective: This study aimed to develop and validate a new continuous positive airway pressure (CPAP) prediction equation and compare it with other formulas.Material and Methods: We retrospectively included patients with obstructive sleep apnea who underwent a CPAP titration study between January 2012 and December 2016. All clinical and polysomnographic data were collected. The new prediction equation was developed using the first data set, and the predictability performance was validated using the second data set.Results: Among the 266 enrolled patients, 73.7% were male, and the mean body mass index (BMI) was 30.8±7.4 kg/m2 . Five variables, namely age, BMI, neck circumference (NC), apnea–hypopnea index (AHI), and minimum pulse oxygen saturation (Min SpO2 ), highly correlated with the optimal titration pressure, and were therefore included in the equation, as stated below:Predicted pressure (cm H2 O) = 2.26 + (0.02xAge) + (0.04xBMI) + (0.11xNC) + (0.04xAHI) - (0.04xMin SpO2 )This equation accounted for 54.4% of the variance in predicting the optimal titration pressure (R2 =0.544, p-value &lt;0.001). Its optimal estimation was 62.0% in the validated group. The equation-derived predicted pressure correlated with good agreement with the laboratory-derived optimal titration pressure (r=0.70, 95% CI=0.6335–0.755, p-value&lt;0.001) according to Bland–Altman analysis. Conclusion: Our equation is highly consistent with the CPAP titration study in predicting fixed CPAP pressure, and is thereby beneficial for sleep technicians in establishing a starting pressure for such studies at a sleep laboratory.

Sustained Inflation Versus Intermittent Positive Pressure Ventilation for Preterm Infants at Birth: Respiratory Function and Vital Sign Measurements

To characterize respiratory function monitor (RFM) measurements of sustained inflations and intermittent positive pressure ventilation (IPPV) delivered noninvasively to infants in the Sustained Aeration of Infant Lungs (SAIL) trial and to compare vital sign measurements between treatment arms. We analyzed RFM data from SAIL participants at 5 trial sites. We assessed tidal volumes, rates of airway obstruction, and mask leak among infants allocated to sustained inflations and IPPV, and we compared pulse rate and oxygen saturation measurements between treatment groups. Among 70 SAIL participants (36 sustained inflations, 34 IPPV) with RFM measurements, 40 (57%) were spontaneously breathing prior to the randomized intervention. The median expiratory tidal volume of sustained inflations administered was 5.3mL/kg (IQR 1.1-9.2). Significant mask leak occurred in 15% and airway obstruction occurred during 17% of sustained inflations. Among 34 control infants, the median expiratory tidal volume of IPPV inflations was 4.3mL/kg (IQR 1.3-6.6). Mask leak was present in 3%, and airway obstruction was present in 17% of IPPV inflations. There were no significant differences in pulse rate or oxygen saturation measurements between groups at any point during resuscitation. Expiratory tidal volumes of sustained inflations and IPPV inflations administered in the SAIL trial were highly variable in both treatment arms. Vital sign values were similar between groups throughout resuscitation. Sustained inflation as operationalized in the SAIL trial was not superior to IPPV to promote lung aeration after birth in this study subgroup. Clinicaltrials.gov: NCT02139800.

Acute Effects of the Wim Hof Breathing Method on Repeated Sprint Ability: A Pilot Study.

The Wim Hof breathing method (WHBM) combines periods of hyperventilation (HV) followed by voluntary breath-holds (BH) at low lung volume. It has been increasingly adopted by coaches and their athletes to improve performance, but there was no published research on its effects. We determined the feasibility of implementing a single WHBM session before repeated sprinting performance and evaluated any acute ergogenic effects. Fifteen amateur runners performed a single WHBM session prior to a Repeated Ability Sprint Test (RAST) in comparison to voluntary HV or spontaneous breathing (SB) (control) in a randomized cross-over design. Gas exchange, heart rate, and finger pulse oxygen saturation (SpO2) were monitored. Despite large physiological effects in the SpO2 and expired carbon dioxide (VCO2) levels of both HV and WHBM, no significant positive or negative condition effects were found on RAST peak power, average power, or fatigue index. Finger SpO2 dropped to 60 ± 12% at the end of the BHs. Upon the last HV in the WHBM and HV conditions, end-tidal CO2 partial pressure (PETCO2) values were 19 ± 3 and 17 ± 3 mmHg, indicative of respiratory alkalosis with estimated arterial pH increases of +0.171 and of +0.181, respectively. Upon completion of RAST, 8 min cumulated expired carbon dioxide volumes in the WHBM and HV were greater than in SB, suggesting lingering carbon dioxide stores depletion. These findings indicate that despite large physiological effects, a single WHBM session does not improve anaerobic performance in repeated sprinting exercise.

Self-health Monitoring and Reporting System for COVID-19 Patients Using CAN Data Logger

In the evolving situation of highly infectious coronavirus, the number of confirmed cases in India has largely increased, which has resulted in a shortage of health care resources. Thus, the Ministry of Health and Family Welfare- Government of India issued guidelines for the ‘Home isolation of COVID-19 positive patients’ methodology for asymptomatic patients or with mild symptoms. During home isolation, the patients are required to monitor and record the pulse rate, body temperature, and oxygen saturation three times a day. This paper proposes a system that can request data from the required sensor to measure the pulse rate, body temperature, or oxygen saturation. The requested data is sensed by the respective sensor placed near the patients’ body and sent to the CAN data logger over the CAN bus. The CAN data logger live streams the sensor values and stores the same to an excel sheet along with details like the patient’s name, patient’s age, and date. The physicians can then access this information.

Silent Hypoxemia in Patients with COVID-19 Pneumonia: A Review

During the coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, patients presented with COVID-19 pneumonia of varying severity. The phenomenon of severe hypoxemia without signs of respiratory distress is also known as silent or hidden hypoxemia. Although silent hypoxemia is not unique to pneumonia due to SARS-CoV-2 infection, this phenomenon is now recognized to be associated with severe COVID-19 pneumonia. Proper management of critically ill patients is the key to reducing mortality. Herein, we summarize the possible and rare factors contributing to silent hypoxemia in patients with COVID-19. Microvascular thrombosis causes dead space ventilation in the lungs, and the flow of pulmonary capillaries is reduced, which leads to an imbalance in the V/Q ratio. The dissociation curve of oxyhemoglobin shifts to the left and limits the release of oxygen to the tissue. SARS-CoV-2 interferes with the synthesis of hemoglobin and reduces the ability to carry oxygen. The accumulation of endogenous carbon monoxide and carboxyhemoglobin will reduce the total oxygen carrying capacity and interfere with pulse oxygen saturation readings. There are also some non-specific factors that cause the difference between pulse oximetry and oxygen partial pressure. We propose some potentially more effective clinical alternatives and recommendations for optimizing the clinical management processes of patients with COVID-19. This review aims to describe the prevalence of silent hypoxemia in COVID-19 pneumonia, to provide an update on what is known of the pathophysiology, and to highlight the importance of diagnosing silent hypoxemia in patients with COVID-19 pneumonia.

PHYSIOLOGICAL CHANGES DURING VAMAN PROCEDURE

Introduction: Vaman karma (therapeutic emesis) is one of the five Shodhan (purificatory) procedures mentioned in Ayurveda. It helps to expel vitiated Doshas from Urdhvabhaga i.e. mouth. A person performing Vaman regularly has very less chances of suffering from any disease. It is used as both a preventive and curative measure in healthy and diseased persons, respectively. So here in this study efforts have been made to observe the physiological changes occurring in various parameters like Pulse rate, Blood Pressure, Temperature, and oxygen saturation at different intervals, before the onset of Vega, just after 3-4 sec of completion of Vega, and during the whole of the Vaman procedure to understand the safety aspects of the procedure in patients and healthy volunteers. Methods: 20 subjects were selected irrespective of gender and religion from IPD of the Department of Panchakarma; they are first prepared with Deepan-Pachan followed by Snehan and Swedan before Vaman karma. Results: on keen ob- servation, it was found that there is a lot of variation in heart rate and sudden fluctuation in blood pressure at the time of vega during Vaman procedure. Conclusion: Vaman karma can be performed safely by anyone with proper assessment and examination of the patient without any complication. Keywords: Vaman, Panchakarma, physiological changes

Prediction of optimal continuous positive airway pressure in Thai patients with obstructive sleep apnea

Continuous positive airway pressure (CPAP) is simple and effective treatment for obstructive sleep apnea (OSA) patients. However, the CPAP prediction equation in each country is different. This study aimed to predict CPAP in Thai patients with OSA. A retrospective study was conducted in Thai patients, who OSA was confirmed by polysomnography and CPAP titration from January 2015 to December 2018. Demographics, body mass index (BMI), neck circumference (NC), Epworth sleepiness scale, apnea–hypopnea index (AHI), respiratory disturbance index (RDI), mean and lowest pulse oxygen saturation (SpO2), and optimal pressure were recorded. A total of 180 subjects were included: 72.8% men, age 48.7 ± 12.7 years, BMI 31.0 ± 6.3 kg/m2, NC 40.7 ± 4.1 cm, AHI 42.5 ± 33.0 per hour, RDI 47.1 ± 32.8 per hour, and lowest SpO2 77.1 ± 11.0%. Multiple linear regression analysis identified NC, BMI, RDI, and lowest SpO2. A final CPAP predictive equation was: optimal CPAP (cmH2O) = 4.614 + (0.173 × NC) + (0.067 × BMI) + (0.030 × RDI) − (0.076 × lowest SpO2). This model accounted for 50.0% of the variance in the optimal pressure (R2 = 0.50). In conclusion, a CPAP prediction equation can be used to explain a moderate proportion of the titrated CPAP in Thai patients with OSA. However, the CPAP predictive equation in each country may be different due to differences of ethnicity and physiology.Trial registration: TCTR20200108003.

Effect of Postoperative Analgesia with the Combination of Dexmedetomidine and Butorphanol after Posterior Spinal Surgery

&lt;p&gt;&lt;strong&gt;Background and Objective: &lt;/strong&gt;Opioid medications used to be the key method for the pain management after spine surgery; most of the opioids may cause many adverse reactions. The purpose of this research was to observe the role of dexmedetomidine combined with butorphanol in the pain management of patients after posterior spinal surgery.&lt;br /&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This research was conducted in the First Hospital Affiliated to Jinzhou Medical University, China from May 2018 to January 2019. Sixty patients who underwent posterior spinal surgery were equally divided into two groups randomly: Group B who received butorphanol 0.125 mg/kg and Group DB who received dexmedetomidine (DEX) 0.1 &amp;mu;g/kg/hour plus butorphanol 0.125 mg/kg. The patient-controlled analgesia was conducted to deliver a bolus dose of 0.5 ml. followed by an infusion of 2 ml/hour and a lockout time of 15 minutes. Heart rate, mean arterial pressure, respiration rate, pulse oxygen saturation, visual analog scale score (VAS), and Ramsay sedation score were recorded as follows: 1 hour (T1), 2 hours (T2), 6 hours (T3), 12 hours (T4), and 24 hours (T5) post‑surgery. The total number of buttons pressing of patient controlled intravenous analgesia (PCIA) and supplementary analgesic agents was observed and adverse drug reactions and total rate of patient satisfaction were evaluated statistically.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; VAS scores at different intervals in DB group were significantly lower compared with the B group after surgery; while the score of Ramsay sedation was remarkably higher in DB group. The total number of buttons pressing of PCIA was less than that of the B group and the frequency of nausea was notably lower in DB group (p &amp;lt; 0.05). The total rate of satisfaction with analgesia in DB group was higher after surgery.&lt;br /&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;DEX could enhance the analgesic effect of butorphanol after posterior spinal surgery with lesser adverse reactions&lt;/p&gt;

Near-Infrared Spectroscopy Monitoring of Cerebral Oxygenation and Influencing Factors in Neonates from High-Altitude Areas

Background: Accurate detection of cerebral oxygen saturation (rSO₂) may be useful for neonatal brain injury prevention, and the normal range of rSO₂ of neonates at high altitude remained unclear. Objective: To compare cerebral rSO₂ and cerebral fractional tissue oxygen extraction (cFTOE) at high-altitude and low-altitude areas in healthy neonates and neonates with underlying diseases. Methods: 515 neonates from low-altitude areas and 151 from Tibet were enrolled. These neonates were assigned into the normal group, hypoxic-ischemic encephalopathy (HIE) group, and other diseases group. Near-infrared spectroscopy was used to measure rSO₂ in neonates within 24 h after admission. The differences of rSO₂, pulse oxygen saturation (SpO₂), and cFTOE levels were compared between neonates from low- and high-altitude areas. Results: (1) The mean rSO₂ and cFTOE levels in normal neonates from Tibet were 55.0 ± 6.4% and 32.6 ± 8.5%, significantly lower than those from low-altitude areas (p < 0.05). (2) At high altitude, neonates with HIE, pneumonia (p < 0.05), anemia, and congenital heart disease (p < 0.05) have higher cFTOE than healthy neonates. (3) Compared with HIE neonates from plain areas, neonates with HIE at higher altitude had lower cFTOE (p < 0.05), while neonates with heart disease in plateau areas had higher cFTOE than those in plain areas (p < 0.05). Conclusions: The rSO₂ and cFTOE levels in normal neonates from high-altitude areas are lower than neonates from the low-altitude areas. Lower cFTOE is possibly because of an increase in blood flow to the brain, and this may be adversely affected by disease states which may increase the risk of brain injury.