SpO2 Group Research Articles

Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis.

Death and anoxic brain injury from unrecognized postoperative respiratory depression (PORD) is a serious concern for patient safety. The American Patient Safety Foundation has called for continuous electronic monitoring for all patients receiving opioids in the postoperative period. These recommendations are based largely on consensus opinion with currently limited evidence. The objective of this study is to review the current state of knowledge on the effectiveness of continuous pulse oximetry (CPOX) versus routine nursing care and the effectiveness of continuous capnography monitoring with or without pulse oximetry for detecting PORD and preventing postoperative adverse events in the surgical ward. We performed a systematic search of the literature databases published between 1946 and May 2017. We selected the studies that included the following: (1) adult surgical patients (>18 years old); (2) prescribed opioids during the postoperative period; (3) monitored with CPOX and/or capnography; (4) primary outcome measures were oxygen desaturation, bradypnea, hypercarbia, rescue team activation, intensive care unit (ICU) admission, or mortality; and (5) studies published in the English language. Meta-analysis was performed using Cochrane Review Manager 5.3. In total, 9 studies (4 examining CPOX and 5 examining continuous capnography) were included in this systematic review. In the literature on CPOX, 1 randomized controlled trial showed no difference in ICU transfers (6.7% vs 8.5%; P = .33) or mortality (2.3% vs 2.2%). A prospective historical controlled trial demonstrated a significant reduction in ICU transfers (5.6-1.2 per 1000 patient days; P = .01) and rescue team activation (3.4-1.2 per 1000 patient days; P = .02) when CPOX was used. Overall, comparing the CPOX group versus the standard monitoring group, there was 34% risk reduction in ICU transfer (P = .06) and odds of recognizing desaturation (oxygen saturation [SpO2] <90% >1 hour) was 15 times higher (P < .00001). Pooled data from 3 capnography studies showed that continuous capnography group identified 8.6% more PORD events versus pulse oximetry monitoring group (CO2 group versus SpO2 group: 11.5% vs 2.8%; P < .00001). The odds of recognizing PORD was almost 6 times higher in the capnography versus the pulse oximetry group (odds ratio: 5.83, 95% confidence interval, 3.54-9.63; P < .00001). No studies examined the impact of continuous capnography on reducing rescue team activation, ICU transfers, or mortality. The use of CPOX on the surgical ward is associated with significant improvement in the detection of oxygen desaturation versus intermittent nursing spot-checks. There is a trend toward less ICU transfers with CPOX versus standard monitoring. The evidence on whether the detection of oxygen desaturation leads to less rescue team activation and mortality is inconclusive. Capnography provides an early warning of PORD before oxygen desaturation, especially when supplemental oxygen is administered. Improved education regarding monitoring and further research with high-quality randomized controlled trials is needed.

Association between oxygen saturation and cognitive function in older adults from longevity areas in China

To explore the relationship between oxygen saturation (SpO2) and cognitive function in older adults from longevity areas in China. A total of 2 285 participants aged ≥65 years according to the 2012 Chinese Longitudinal Healthy Longevity Survey were included in this study. Among them, 1 739 participants aged 65-99 years were randomly selected, and 546 participants aged ≥100 years were totally involved. A standardized questionaire was used to collect the information of demographic characteristics, life styles, disease history, etc. Cognitive function was evaluated using the Mini Mental State Examination Scale. Arterial oxygen saturation and heart rate were measured by pulse oximetry. Differences in cognitive function between the low SpO2 group (<0.94) and normal SpO2 group (≥0.94) were analyzed, and logistic regression models were used to analyze the relationship between SpO2 and cognitive function. The total score of cognitive function was 22.6±9.7 for the 1 922 participants in the normal SpO2 group, and 18.8 ± 11.0 for the 363 participants in the low SpO2 group (t=6.11, P<0.001). The proportion of cognitive impairment in the low SpO2 group was 36.6% (n=133), and 22.9% (n=441) in the normal SpO2 group (χ(2)=30.44, P<0.001). RESULTS from stepwise logistic regression analysis showed that the risk of cognitive impairment increased with each year of increased age (OR 1.07; (95% CI: 1.05-1.09), P<0.001). Low SpO2, vision disorders, impaired activities of daily living, dyslipidemia, unmarried status, and lack of exercise were also associated with increased risk of cognitive impairment (OR 1.64; (95% CI: 1.11-2.43), OR 1.73; (95% CI: 1.27-2.35), OR 3.54; (95% CI: 2.62-4.79), OR 1.38; (95% CI: 1.02-1.86), OR 2.05; (95% CI: 1.34-3.13), OR 1.83; (95% CI: 1.13-2.97), respectively, P<0.05). Stratified analysis by age group showed that the association between SpO2 and cognitive impairment was most significant in participants aged ≥90 years (OR 1.58; (95% CI: 1.09-2.28), P=0.016). Low oxygen saturation was associated with higher risk of cognitive impairment in our population of elderly adults.

Value of heart murmurs and transcutaneous oxygen saturation in screening for neonatal congenital heart diseases

Objective To compare the importance of heart murmurs and transcutaneous oxygen saturation(SpO2)in screening neonatal congenital heart diseases(CHD), and to explore a reliable and easy-to-use method for the screening of CHD. Methods All infants (16 070 cases) born in Changzhou Maternal and Child Health Hospital from May 1st 2011 to April 30th 2013 were screened of CHD for heart murmurs and SpO2.The screen-positive infants were divided into 3 groups: heart murmurs group, abnormal SpO2 group and mixed group.All screen-positive infants received cardiac color ultrasound to make a definite diagnosis of CHD, so as to compare the values of heart murmurs and SpO2. Results Eight thousand seven hundred and ninety-nine boys and 7 271 girls were screened, in which the ratio was 1.21:1.00.One hundred and eighteen infants were screened positive, including 76 murmurs of which 45 were confirmed as CHD, 28 with abnormal SpO2 of which 18 were confirmed and 14 mixed of which 13 were confirmed, so the confirmation rates were 59.21%, 64.29% and 92.86%, respectively.The diagnostic rate of CHD in mixed group was higher than other 2 groups, which had statistical significance(P=0.045). The top three formation types of CHD were ventricular septal defect (VSD) (29/76 cases, 38.16%), patent ductus arteriosus (PDA) (13/76 cases, 17.11%) and atrial septal defect (ASD) (11/76 cases, 14.48%). Conclusions The combination of heart murmurs and SpO2 was useful in increasing detection and decreasing misdiagnosis of CHD. Key words: Infant, newborn; Congenital heart disease; Heart murmurs; Transcutaneous oxygen saturation; Screening

Lumbo-sacral epidural anaesthesia as a complement to dissociative anaesthesia during scrotal herniorrhaphy of livestock pigs in the field.

BackgroundIn Sweden, scrotal or inguinal herniorrhaphy of livestock pigs in the field has traditionally been an important part of the surgical skills training of veterinary students. Few substances meet the legal requirements for field anaesthesia of production animals in the European Union but a protocol based on azaperone-detomidine-butorphanol-ketamine does. Unfortunately the anaesthesia is characterised by unpredictable duration and depth and of abrupt awakenings which is not acceptable from an animal welfare perspective and impedes surgical training. Lumbo-sacral epidural analgesia is proven to provide sufficient analgesia to allow abdominal surgery, but there are few reports on the field use of this loco-regional technique. The study aim was to evaluate whether lumbo-sacral anaesthesia can be safely and successfully used in the field by a veterinary student and whether the combination of dissociative and lumbo-sacral epidural anaesthesia improves analgesia and anaesthesia to guarantee animal welfare during herniorrhaphy in livestock pigs, enabling surgical skills training.ResultsPigs in the control-group (placebo) responded significantly stronger to surgery, with five out of 11 requiring additional doses of detomidine and ketamine. There were no significant differences between groups in respiratory rate, heart rate, blood pressure, SpO2 or blood gases. SpO2 levels <94 % were recorded in several pigs in both groups. No post-injection complications were reported at follow-up.ConclusionsThe results from this study showed that lumbo-sacral epidural anaesthesia with lidocaine could successfully be administered during dissociative anaesthesia of livestock pigs by a veterinary student and without reported post-injection complications. It improved analgesia and anaesthesia during herniorrhaphy of sufficient duration to enable surgical skills training. The risks and consequences of hypoxaemia and hypoventilation should be considered.

P291 Obstructive Sleep Apnoea Screening For Patients Undergoing Bronchoscopy - Is It Required?

Introduction A recent meta-analysis shows obstructive sleep apnoea (OSA) increases the incidence of postoperative desaturation, respiratory failure, cardiac events, and ICU transfers (Kaw, R., et al, 2012). A study in gastrointestinal endoscopy showed no increased risk of cardiopulmonary complications in OSA screening positive patients (Mador, M. J., et al, 2012). There are no published studies in patients with OSA undergoing bronchoscopy, as far as we are aware. It has been suggested that patients should be screened for OSAS prior to endoscopy and bronchoscopy. Methods Nursing staff in the bronchoscopy suite used a validated OSA screening tool STOP-BANG score prior to the procedure. The physician performing the rpocedure was unaware of the score. The amount of sedation used during the procedure is recorded. Sedation score, Respiratory Rate (RR), Oxygen Sturation (SpO2) were documented 0,30,60,120 min post procedure. Results Procedures were performed in 57 patients; diagnostic bronchoscopy 28, EBUS 29. Twenty-three patients (40.3%) were identified high risk for OSA (STOP-BANG score 3 or above). The mean age was 64 +/- 15. Male 29 (50.8%). There was no statistically significant difference in: amount of sedation used (midazolam, fentanyl or both), lignocaine use, initial sedation score, RR, SpO2, between high and low risk group. (Table 1). There was no correlation between initial sedation score with STOP-BANG score. There was no evidence of deeper sedation, drop in RR or SpO2 noticed in the post procedure observation period in the high risk group. Median length of observation was same in both groups. There were no complications or emergency admissions. Conclusion In this small study there is no evidence of increased cardio respiratory complications in patients at high risk for OSA undergoing bronchoscopy under conscious sedation. References Kaw, R, et al. Meta-analysis of association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth 2012;109(6):897-906 Mador, MJ, et al. D patients at risk of sleep apnea have an increased risk of cardio-respiratory complications during endoscopy procedures? Sleep Breath 2012;16(3):609-615

Analysis on clinical effects of dexmedetomidine in the treatment for elderly prostate vaporization

Objective To explore the anesthetic effect of dexmedetomidine in the treatment for prostate vaporization.Methods 200 cases of prostate vaporization were randomly divided into group A and group B,two groups were treated with waist drunk-epidural anesthesia.Group A received infusion right prop microphone given 10 mins before the start of the surgery 0.5 μ g/kg dose infusion of the right prop microphone set,then to 0.5 μ g/kg/h maintain; group B received intravenous infusion of normal saline.Recording before anesthesia (T0),after anesthesia (T1) and after treatment 5 min (T2),30 min (T3),60 min (T4),MBP,HR,RR and SpO2 of the two groups,and scoring Ramsay.Results There was no significant difference between two groups in MBP,the HR,RR and Ramsay score at T0.Group A of medical T2 when the MBP (98 ± 8) mmHg,HR(84 ± 9) beats/min,were lower than those at T0 (106 ± 7) mmHg (88 ± 12)times/min (P＜ 0.05),Ramsay score T2 for (3.1 ± 0.4) points higher than T0 (2.0 ± 0.1) (P＜ 0.05).Group B was lower than group A in MBP,HR,Ramsay score from T2 to T4 (P＜ 0.05).There was no significant difference between two groups in RR and SpO2 from T1 to T4.Conclusion The effects of dexmedetomidine joint with waist drunk-epidural anesthesia in the treatment for elderly prostate vaporization are satisfactory,it can produce a good sedative effect and is worthy of clinical promotion. Key words: Dexmedetomidine; Waist drunk-epidural anesthesia; Prostate vaporization

Utilidad de la detección del aleteo nasal en la valoración de la gravedad de la disnea

To determine if the presence of nasal flaring is indicative of severe respiratory insufficiency. Prospective observational study of patients consulting in the Emergency Department because of dyspnea whose triage level is II or III in the Spanish Triage System (MAT-SET). Vital signs, SpO2, arterial blood gases and nasal flaring presence were recorded, as well as the need for hospital admission and length of hospital stay. Data are presented as median (25-75th percentile). A total of 43 patients were analyzed (70% men, aged 77 (67-82) years), 7 of whom showed nasal flaring. Those having flaring had higher respiratory rate (36 (34-40) vs. 25 (20-28) vs., p=0.001) and were more acidotic (pH 7.34 [7.23-7.40] vs. 7.42 [7.39-7.46] vs., p=0.03) than patients without this sign. There were no differences between groups in SpO2, PaCO2, heart rate and arterial pressure. There were no differences in the rate of hospital admission-(6 patients [85.7%] in nasal flaring group vs 29 patients [80.5%] in the non nasal flaring group [p=0,06], or in the length of the hospital stay-3 days [1-16] in nasal flaring group vs. 6 days [1-10] in the non nasal flaring group, p=0.6). All patients with nasal flaring had tachypnea. In our study, nasal flaring does not indicate severity in dyspneic patients in spite of its association with tachypnea and acidosis.

Relation between Nocturnal Arterial Oxygen Desaturation and Morning Blood Pressure

Objective. Arterial oxygen saturation (SpO2) in volunteers had been previously investigated, and the possibility that a decrease in SpO2 leads to an increase in blood pressure (BP) in airline passengers experiencing oxygen desaturation at high altitudes was reported. It was also shown that mean nocturnal SpO2 was lower in subjects with high-normal BP or mild hypertension than in those with normal BP. The present study investigated nocturnal SpO2, evening BP, and morning BP of volunteers during daily life and examined the relation between nocturnal SpO2 and change in BP (morning BP minus evening BP) to determine the influence of SpO2 on BP. Methods. Sixty-two volunteers (31 men and 31 women) aged 40–87 years (mean: 55.9 ± 12 [SD] years) underwent measurement of SpO2 and heart rate with a ring-shaped pulse oximeter during sleep at home. Evening BP and morning BP were measured by automatic BP recorder. Subjects that were classified as having high SpO2 (mean nocturnal SpO2 ≥ 95%; n = 23, 10 men and 13 women; mean age: 53.2 ± 12 years) or low SpO2 (mean nocturnal SpO2 < 94%; n = 21, 12 men and 9 women; mean age: 58.7 ± 13 years) were compared. The relation between mean nocturnal SpO2 and morning BP and the relation between mean nocturnal SpO2 and change in BP were investigated. Results. There was a significant negative correlation between mean nocturnal SpO2 and morning systolic BP (SBP; r = −0.50, p < 0.01) and between mean nocturnal SpO2 and morning diastolic BP (DBP; r = −0.37, p < 0.01). A significant negative correlation between mean nocturnal SpO2 and change in SBP was observed (r = −0.57, p < 0.01). Morning BP was significantly higher in the low nocturnal SpO2 group than in the high nocturnal SpO2 group (p < 0.001). Conclusion. The increase in morning BP from evening BP was significantly greater in subjects with a low nocturnal SpO2. The decrease in SpO2 during sleep may affect morning BP rise.