Use Of Pulse Oximetry Research Articles

Anesthesia Dogmas and Shibboleths

Anesthesia Dogmas and Shibboleths

Taking the pulse of pulse oximetry in Africa

The use of pulse oximetry for anesthesia monitoring during surgery has become the standard of care in the developed world. Although a causal link between pulse oximetry and anesthesia death rates has not been firmly established, there is a consensus belief that ability to monitor the oxygenation of

Extubation of the difficult airway – an important but neglected topic

Extubation of the difficult airway – an important but neglected topic

The use of overnight pulse oximetry for obstructive sleep apnoea in a resource poor setting in Sri Lanka

The Journal of the Ceylon College of Physicians (JCCP) is a peer-reviewed, open access journal published bi-annually by the Ceylon College of Physicians (CCP) in the last week of June and December.The objective of the Journal is to promote good clinical practice and influence policy making across the medical world through publication of original research and peer reviewed articles on current issues and to foster responsible and balanced debate on issues that affect medicine and health care in Sri Lanka. Contributions to the JCCP reflect its national and multidisciplinary readership and include current thinking across a range of medical specialties.

Enlargement of the Inferior Intercavernous Sinus: A New Sign for the Diagnosis of Craniospinal Hypotension

<h3>Background:</h3> Oxygen is widely used but poorly studied in emergency medicine, with a limited evidence base for its use in specific conditions. There are safety concerns about the underuse of oxygen in patients with critical illness and its overuse in conditions such as chronic obstructive pulmonary disease (COPD). A baseline audit was required to assess current practice prior to the introduction of new national emergency oxygen guidelines in late 2008. <h3>Methods:</h3> The use of pulse oximetry and oxygen therapy was audited in patients brought by ambulance to the “majors” section of the emergency department (ED) in a university hospital. Oxygen therapy in the ambulance and the ED was subsequently documented. Oxygen use in ambulances was compared with Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidance and with subsequent patient management. <h3>Results:</h3> The ambulance and ED records of 1022 patients were audited manually. Oxygen saturation (Spo₂) was recorded for 90% of patients, 17% of whom had Spo₂ &lt;94% at some time and 7% had Spo₂ &lt;90%, including 33% of patients with COPD and 5.5% of patients without COPD. 34% of patients received oxygen in the ambulance and almost half of these had oxygen discontinued in the ED. Only 62% of ambulance oxygen use was in accordance with JRCALC guidance, but most “undertreated” patients were stable normoxaemic patients for whom guidance recommends high-flow oxygen. Only 58% of patients with COPD were correctly identified in the ambulance and 73% of these patients were treated with flow rates &gt;4 l/min (equivalent to &gt;35% oxygen). <h3>Conclusions:</h3> Oxygen use in ambulances is very common, equivalent to 2.2 million episodes annually in the UK. The quality of oxygen use is suboptimal, especially for patients with COPD. Emergency oxygen therapy will become simpler when new evidence-based UK emergency oxygen guidelines are published, and it is hoped that future audits will show better protocol adherence.

Pulse Oximetry in Pediatric Practice

The introduction of pulse oximetry in clinical practice has allowed for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation. Pulse oximetry is routinely used in the emergency department, the pediatric ward, and in pediatric intensive and perioperative care. However, clinically relevant principles and inherent limitations of the method are not always well understood by health care professionals caring for children. The calculation of the percentage of arterial oxyhemoglobin is based on the distinct characteristics of light absorption in the red and infrared spectra by oxygenated versus deoxygenated hemoglobin and takes advantage of the variation in light absorption caused by the pulsatility of arterial blood. Computation of oxygen saturation is achieved with the use of calibration algorithms. Safe use of pulse oximetry requires knowledge of its limitations, which include motion artifacts, poor perfusion at the site of measurement, irregular rhythms, ambient light or electromagnetic interference, skin pigmentation, nail polish, calibration assumptions, probe positioning, time lag in detecting hypoxic events, venous pulsation, intravenous dyes, and presence of abnormal hemoglobin molecules. In this review we describe the physiologic principles and limitations of pulse oximetry, discuss normal values, and highlight its importance in common pediatric diseases, in which the principle mechanism of hypoxemia is ventilation/perfusion mismatch (eg, asthma exacerbation, acute bronchiolitis, pneumonia) versus hypoventilation (eg, laryngotracheitis, vocal cord dysfunction, foreign-body aspiration in the larynx or trachea). Additional technologic advancements in pulse oximetry and its incorporation into evidence-based clinical algorithms will improve the efficiency of the method in daily pediatric practice.

93 The Use of Pulse Oximetry as a Quick Screening Tool for Limb Ischemia in the Emergency Department

93 The Use of Pulse Oximetry as a Quick Screening Tool for Limb Ischemia in the Emergency Department

Managing Oxygen Therapy during Delivery Room Stabilization of Preterm Infants

In October 2010, the International Liaison Committee on Resuscitation released new guidelines for neonatal resuscitation, which expanded on the previous recommendations for the use of pulse oximetry during neonatal resuscitation. In this Commentary, we discuss oxygen treatment in the delivery room. Where available, we have used evidence from randomized controlled trials (RCTs). Where this evidence is lacking, we have relied on observational and animal data to inform our strategy for using supplemental oxygen in the delivery room.

Bronchiolitis in infants and wheeze in preschool children

Bronchiolitis (table 1) is one of the main causes of hospitalisation in infants aged <1 yr [1]. Approximately 2–3%, without underlying diseases, are hospitalised for bronchiolitis during epidemics. Recently the number of the hospital admission has increased, with the use of pulse oximetry possibly contributing to the higher admission rate [2]. Respiratory syncytial virus (RSV) infection is the most common cause of severe bronchiolitis [3]. The incidence peaks in December–March. Nearly all children are infected by RSV before the age of 2 [1], usually reporting only a mild upper respiratory tract infection. In some cases, lower respiratory symptoms leading to respiratory failure characterise the clinical course of bronchiolitis. Many risk factors have been found to be associated with the severity of the disease, but the reason why viruses cause lower respiratory infection and consolidation only in some children is still unknown. View this table: Table 1 Definition of bronchiolitis Recently, respiratory viruses other than RSV have been detected in infants with bronchiolitis. Rhinovirus (RV), the major cause of the common cold, was considered to be confined in the upper respiratory tract. Nowadays, RV seems to be as common as RSV, often affecting older children, and those with atopic dermatitis and eosinophilia [4]. The treatment is mainly supportive [5], with supplemental oxygen, nasal washing, i.v. fluids and, in some cases, mechanical ventilation. Clinical trials, testing β2-agonists [6, 7], glucocorticoids [8], epinephrine [9], recombinant human DNase [10, 11] and hypertonic saline [12] in bronchiolitis have been very controversial. Routine use of those different therapies is not recommended. On the contrary, a personalised strategy for each infant is to be performed, in order to reduce hospital stay and health-care expenditures associated with this disease. Bronchiolitis is a …

Expert’s comment concerning Grand Rounds case entitled “The routine intra-operative use of pulse oximetry for monitoring can prevent severe thromboembolic complications in anterior surgery” (by M.A. König, Y. Leung, S. Jürgens, S. MacSweeney and B.M. Boszczyk)

Routine monitoring of left extremity circulation with pulse oximetry during anterior lumbar surgery may help diagnose left iliac artery thrombosis and will lead to quick treatment of this potentially catastrophic complication.

Pulse oximetry in primary care

Pluddeman et al 1 write about the use of pulse oximetry. This seems to be one of the new trio of diseases — the other two being D-dimers for blood clots, and troponin for the detection of myocardial damage. All three tests need to be used appropriately in their clinical situation. It seems from observation that the SpO2 …

The routine intra-operative use of pulse oximetry for monitoring can prevent severe thromboembolic complications in anterior surgery

Anterior access to the lumbar spine is established for disc replacement surgery and anterior interbody fusion in the lumbar spine. The spine is accessed normally from the left side either by a transperitoneal or retroperitoneal approach through a midline or oblique skin incision. After reaching the retroperitoneum and depending on the level of exposure, the surgeon has to mobilise and retract the aorta or left common iliac artery, as well as the left common iliac vein or internal vena cava to the right lateral border to address the whole disc space. The left common iliac artery is especially stretched during intervertebral disc exposure putting it at a greater risk of adverse events. Not surprisingly, vascular adverse events like direct injuries, thrombosis and embolism are feared complications in anterior surgery. Permanent intra-operative left leg oxygen saturation surveillance via pulse oximetry can help detecting embolic situations thereby allowing immediate treatment minimising the leg ischemia or preventing limb loss. In the presented case, a 61-year-old male patient undergoing a two-level anterior interbody fusion lost oxygen saturation in the left leg after vessel retraction for exposure. After cage insertion and release of the retractor blades, the pulse oximetry signal did not return and no pulses were found during instant Doppler investigation below the femoral artery, indicating severe embolism in the left leg. The left common iliac artery was clamped and opened showing a ruptured calcified plaque with adherent fresh thrombotic material. An endovascular embolectomy in the superficial and deep femoral artery revealed several small thrombi. An artherectomy of the common iliac artery followed by patch closure was performed. Immediately after clamp release, pulse oximetry returned and Doppler signals were detectable at the tibialis posterior and dorsalis pedis artery. Post-operative recovery was uneventful and pulses were palpable at all times. Arterial adverse events in anterior access surgery are rare complications but none the less, it is of paramount importance to detect and treat these situations immediately. This case highlights the need of routine pulse monitoring during the whole anterior surgery to prevent embolic complications. Even manual pulse control might not be sufficient to rule out any distal embolic events creating severe leg ischemia.

Neonatal Cyanosis from a Hemoglobin Variant

To the Editor: In their article on a hemoglobin variant associated with neonatal cyanosis and anemia, Crowley et al. (May 12 issue)1 describe their use of testing of arterial blood gases, a review of family medical history, and other tailored testing for well-appearing newborns with cyanosis. Universal screening in the nursery for cyanotic congenital heart disease with the use of pulse oximetry was recently recommended by a federal advisory committee.2 Although the condition described by Crowley et al. is rare, routine neonatal screening for low oxygen saturation will inevitably uncover more patients with hemoglobinopathies with low oxygen affinity.3 We describe . . .

Monitoring of standard hemodynamic parameters: Heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2

Continuous monitoring of various clinical parameters of hemodynamic and respiratory status in pediatric critical care medicine has become routine. The evidence supporting these practices is examined in this review. A search of MEDLINE, EMBASE, PubMed, and the Cochrane Database was conducted to find controlled trials of heart rate, electrocardiography, noninvasive and invasive blood pressure, atrial pressure, end-tidal carbon dioxide, and pulse oximetry monitoring. Adult and pediatric data were considered. Guidelines published by the Society for Critical Care Medicine, the American Heart Association, the American Academy of Pediatrics, and the International Liaison Committee on Resuscitation were reviewed, including further review of references cited. Use of heart rate, electrocardiography, noninvasive and arterial blood pressure, atrial pressure, pulse oximetry, and end-tidal carbon dioxide monitoring in the pediatric critical care unit is commonplace; this practice, however, is not supported by well-controlled clinical trials. Despite the majority of literature being case series, expert opinion would suggest that use of routine pulse oximetry and end-tidal carbon dioxide is the current standard of care. In addition, literature would suggest that invasive arterial monitoring is the current standard for monitoring in the setting of shock. The use of heart rate, electrocardiography. and atrial pressure monitoring is advantageous in specific clinical scenarios (postoperative cardiac surgery); however, the evidence for this is based on numerous case series only.

Axillary arterial catheter use associated with hand ischemia in a multi-trauma patient: case report and literature review

A case of hand ischemia associated with use of an axillary arterial catheter in a multi-trauma patient is presented. Despite removal of the arterial catheter and limb salvage procedures, distal hand gangrene developed. Simple measures such as minimizing dressings, use of distal continuous pulse oximetry, placement of invasive arterial catheters in the nondominant extremity, and avoiding their use whenever possible may prevent complications and minimize morbidity.

Impact of Obesity on the Severity and Therapeutic Responsiveness of Acute Episodes of Asthma

Background. It has been suggested that obesity adversely influences both the severity and the therapeutic responsiveness of chronic asthma. However, it is unclear if it also impacts acute situations. Methods. To determine whether adiposity worsens the clinical and physiological manifestations of acute asthma and limits therapeutic effectiveness of standard treatment, we contrasted signs, symptoms, medication use, arterial oxygen saturation, peak expiratory flow rate, and the bronchodilator response to standard doses of albuterol in 90 non-obese and 90 obese asthmatics as they presented for urgent care. Treatment and clinical decisions were systematized using published care paths and the peak flow was measured with standard techniques. Body mass index (BMI) was calculated according to consensus criteria. Results. Other than BMI (p < .001), there were no between-group differences in age, gender, race, signs, symptoms, pulse oximetry, or pre-presentation medication use. The pretreatment peak flow in the obese population was 22.4% higher on average (p = .007), but there were no differences in the distribution of severity (p = .38), the response to albuterol (p = .61), or admission–discharge ratios (p = .62). Conclusions. Obesity does not adversely influence the severity or the resolution of acute episodes of asthma.

Knowledge of Oxygen Administration, Aerosol Medicine, and Chest Physiotherapy Among Pediatric Healthcare Workers in Italy

Oxygen administration, aerosol devices and drugs, or the use of chest physiotherapy are common practices in pediatrics; however, little is known about the knowledge of pediatric healthcare workers concerning the right utilization of these tools. The aim of this study was to fill this gap as a preliminary step in the implementation of appropriate educational programs. This cross-sectional survey of a nationally representative sample of Italian pediatricians and nurses was carried out between September 1 and October 8, 2008. A self-administered, anonymous questionnaire concerning the approach to respiratory disease in infants and children was distributed to all of the participants at the Annual Congress of the Italian Society of Pediatrics, together with a stamped envelope addressed to the trained study researchers. Of the 900 distributed questionnaires, 76.7% were completed and returned by 606 physicians (199 primary care pediatricians, 245 hospital pediatricians, and 162 pediatric residents) and 84 pediatric nurses. The vast majority of the respondents did not know the percentage of hemoglobin saturation indicating hypoxemia that requires oxygen administration. Most of the nurses admitted to overusing mucolytics and inhalatory corticosteroids, did not know the role of ipratropium bromide, were unable to indicate the first-line drug for respiratory distress, and did not know the correct dose of salbutamol. Only a minority of the respondents were able to specify the indications for chest physiotherapy. The nurses gave the fewest correct answers regardless of their age, gender, work setting, or the frequency with which they cared for children with respiratory distress in a year cared. The knowledge of primary care pediatricians, hospital pediatricians, and pediatric nurses in Italy concerning the use of pulse oximetry, aerosol devices and drugs, and chest physiotherapy is far from satisfactory and should be improved. Educational programs are therefore required for both nurses and pediatricians.

The Use of Newborn Screening Pulse Oximetry to Detect Cyanotic Congenital Heart Disease: A Survey of Current Practice at Army, Navy, and Air Force Hospitals

To determine the prevalence of newborn screening pulse oximetry (+POx) among military hospitals, including barriers to instituting protocols. An internet-based questionnaire was forwarded to the senior pediatricians at military hospitals worldwide supporting newborn deliveries. Forty seven of 53 hospitals (88%) supporting deliveries responded to the survey. Thirty percent of hospitals utilize a +POx protocol. Eight centers cited no problems with implementation. All hospitals screened at > or = 24 hours of life. The site of recording, positive values, and follow-up for positive screens varied. Cardiology consult and echocardiogram were not mandated. Most hospitals (34/47) are unable to obtain a pediatric cardiology consult without transfer. Few hospitals (9/47) utilize a telemedicine system. Seventy-five percent (24/32) of hospitals not utilizing a protocol are interested in instituting one. Though slightly less than one-third of military hospitals use a +POx, there is a greater interest in its use. More reliable consultative services and a robust telemedicine system may aid its implementation.

Retracted: Neonatal Pulse oximetry screening: A National Survey

Studies suggest that universal pulse oximetry (PO) screening of all neonates before hospital discharge improves the detection rate of congenital heart disease (CHD). The aim is to survey the use of Pulse Oximetry (PO) screening in UK. A telephone interview was conducted between late 2009 to mid-2010 of all maternity units using a standardised questionnaire. 209(93%) of 224 responding units did not routinely use PO. Among the 15 that performed PO, 5 measured pre and post ductal saturations, 9 measured only post-ductal saturations, and 1 measured only pre-ductal saturations. There were differences in the values used to trigger further investigation, ranging from <94% to <96% and/or difference of > 2-3% between pre and post-ductal saturations. When saturations were abnormal, 13 units performed echocardiography locally. In addition to an echocardiogram, 2 units performed chest x-ray (CXR); 2 units performed electrocardiogram (ECG) and 2 units performed both CXR and ECG. Only a minority of hospitals across the UK use PO to supplement the postnatal examination with inconsistent practice. National guidelines should be developed if PO screening is implemented with an agreed management plan if abnormal results are obtained.

La pulsioximetría y su aplicación en pruebas de esfuerzo máximo

Pulse oximetry is used to determine the percentage saturation of oxygen in blood. Its main feature is that it is a noninvasive and relatively inexpensive. There are few studies relating physical activity and pulse oximetry with most abundant studies are clinical trials. The authors review the definition of pulse oximetry, the grounds upon which it is based. We review the application of pulse oximetry to maximum exercise testing, and the behavior of oxygen saturation in the blood for testing of maximum effort. In addition, different studies on the oxygen saturation values in blood during physical exercise and its correlation with other ventilatory variables. We analyze the consequences of the use of pulse oximetry in tests of maximal effort.