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1.
s.l; IETSI; 2 jul. 2020.
Non-conventional in Spanish | LILACS (Americas), BRISA | ID: biblio-1104045

ABSTRACT

INTRODUCCIÓN. La actual pandemia de COVID-19 constituye un reto sin precedentes para los sistemas de salud a nivel mundial. A medida que los médicos brindan atención cada vez a más pacientes con COVID-19 se ha notado y descrito en la literatura un fenómeno conocido extraoficialmente como "hipoxemia silenciosa" o "hipoxemia feliz". Este fenómeno poco común hace referencia a una disonancia entre los valores de saturación de oxígeno en sangre y la ausencia de síntomas relacionados con la dificultad respiratoria (taquipnea o respiración rápida, disnea, tiraje intercostal, fatiga, sofocación, hambre de aire, entre otros). En otras palabras, a pesar de no experimentar ningún síntoma o presentar únicamente síntomas generales leves (dolor de cabeza, tos leve, dolor de garganta, pérdida del olfato, entre otros), llama la atención que algunos pacientes no presenten síntomas de dificultad respiratoria notables a pesar de presentar bajos niveles de oxígeno en sangre (hipoxemia) (Tobin, Laghi, and Jubran 2020; Couzin-Frankel 2020). Inclusive, algunos autores han repo


Subject(s)
Humans , Pneumonia, Viral/therapy , Oximetry/instrumentation , Coronavirus Infections/therapy , Technology Assessment, Biomedical , Health Evaluation , Risk Factors
2.
Neuquén; s.n; jun. 2020.
Non-conventional in Spanish | LILACS (Americas), BRISA | ID: biblio-1116538

ABSTRACT

CONTEXTO: El diagnóstico y monitoreo del nivel de oxígeno1 (O2) en el organismo resulta de gran importancia en la atención de salud en diversos casos. La insuficiencia respiratoria hipoxémica es la primera causa de hospitalización en pediatría, el control estricto de la oxemia es mandatorio en pacientes neonatos prematuros, debido al riesgo de daños retinianos ante la exposición prolongada a concentraciones elevadas de oxígeno, también es utilizada la evaluación de la saturación de oxígeno en los miembros para descartar ciertas cardiopatías congénitas. En los pacientes críticos con necesidad de ventilación mecánica u otras modalidades, la determinación del oxígeno en sangre resulta un parámetro imprescindible para monitorear la calidad del tratamiento de soporte. En estos pacientes puede realizarse por determinación directa en catéteres arteriales, o indirectamente por métodos de saturometría de pulso. La evaluación de la hipoxemia se realiza con medición de gases arteriales y a través de metodologías no invasivas con saturometría de pulso, sin embargo, esta medición puede verse afectada por diversos factores como la intensidad de la luz ambiental, pigmentación de la piel, perfusión tisular, concentración de hemoglobina y otros. La cianosis es un signo tardío de hipoxemia apareciendo habitualmente con saturación de oxígeno menor a 75%. La oximetría de pulso es una herramienta que permite medir en forma no invasiva la saturación de oxígeno de la hemoglobina y ha significado una revolución en el manejo y monitorización de los pacientes con insuficiencia respiratoria. Se caracteriza por ser simple, no invasiva y razonablemente confiable en la mayoría de las circunstancias clínicas.En los últimos 15 años los avances tecnológicos y la competencia entre marcas y modelos van favoreciendo la aparición de oxímetros de pulso más pequeños y más económicos, difundiendo su utilización ampliamente. METODOLOGÍA: Se realizó una búsqueda en las bases de datos bibliográficas detalladas a continuación, en el repositorio y página de OMS y OPS, en BRISA de RedETSA, en sitios de Agencias de Evaluación de Tecnologías Sanitarias y Agencias nacionales e internacionales reguladoras de alimentos, medicamentos y dispositivos, las que se detallan más abajo, en Tripdatabase, Epistemonikos, buscadores genéricos de Internet como google académico. Se buscaron Guía de Práctica Clínica de las sociedades relacionadas con atención del recién nacido, neonatología, cuidados críticos, terapias respiratorias invasivas, priorizando las del Ministerio de Salud de la Nación Argentina y de la Provincia de Neuquén. RESULTADOS: Se realizó una búsqueda en los registros de la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT), de las opciones de oximetría de pulso disponibles para comercialización en Argentina. Descripción de la Tecnología: Se identifican dos tecnologías disponibles en Argentina que se corresponden con nuestra definición de nueva generación de oxímetro de pulso. Tecnologías alternativas: Medición de PO2 capilar por saturometría convencional y punción para medición de gases arteriales. CONCLUSIONES: La utilización de la oximetría de pulso está recomendada a nivel mundial para uso en pacientes críticos de neonatología y rastreo de cardiopatías congénitas en recién nacidos sanos . Al hablar de las nuevas generaciones de oximetría de pulso (tecnología SET y nuevos algoritmos) no existe evidencia de alta calidad que respalde el reemplazo de los convencionales, teniendo en cuenta su elevado costo, costo de oportunidad y potencial impacto en la equidad. Los expertos consultados muestran satisfacción con los resultados obtenidos con este tipo de nueva tecnología, pero no puede respaldarse su percepción en evidencias científicas sólidas con bajo riesgo de sesgos Al considerar que la tecnología SET está en uso desde hace 10 años en la neonatología del HPN mediante donaciones de programas verticales, se recomienda la gestión de estas adquisiciones en forma centralizada y de esta manera unificar los criterios para los Servicios de Neonatología de la provincia. Se recomienda centralizar y revisar los criterios de aceptación de donaciones de equipos médicos. Se recomienda la renovación de equipamientos según necesidad en el Servicio de Neonatología del HPN, siendo esta donde se internan los pacientes críticos y la redistribución de los equipos antiguos en el resto de los hospitales de la provincia. En todos los casos es necesario un plan de gestión del ciclo de la tecnología que incluya los correspondientes mantenimientos preventivos y correctivos, el monitoreo de fallas y la planificación a mediano y largo plazo.


Subject(s)
Oximetry/instrumentation , Oximetry/standards , Neonatology/organization & administration , Technology Assessment, Biomedical , Health Evaluation , Cost-Benefit Analysis
3.
Braz. dent. sci ; 23(1): 1-8, 2020. tab
Article in English | LILACS (Americas), BBO | ID: biblio-1049397

ABSTRACT

Background: the efficiency of the diagnostic aids plays an important role in the treatment plan. This study aims to assess the diagnostic accuracy of dental pulse oximeter with a customized sensor holder, thermal test and electric pulp tester in assessing the actual pulp status and to evaluate the oxygen saturation level in control healthy teeth, non-vital and teeth with irreversible pulpitis. Material and methods: thirty-seven single canal teeth requiring endodontic therapy were included in the study. The selected teeth were tested with dental pulse oximeter, electric pulp test, cold spray, and heated gutta percha stick. Between each test a time lag of 2 minutes was allowed for the central sensitization to occur. Three blinded operators were involved in the study. The actual status of the pulp was evaluated after the initiation of endodontic treatment, by direct visual examination of the accessed cavity. The data was statistically analysed using (ANOVA) Analysis of Variance and Post-hoc Tukey test. Results: sensitivity of pulse oximeter, heat test, cold and electric pulp test, was 100, 25, 50, and 12, respectively. The specificity of these tests was 100, 72 81, and 77, respectively. The ANOVA showed that there was statistical difference between all the groups (p=0.0005). Post-Hoc Tukey revealed that there was statistical difference among all the groups, nonvital group (p=0.0005), control group (p=0.01) and for irreversible pulpitis (p=0.01). The overall diagnostic accuracy of pulse oximeter was 100% followed by cold test 66%, heat test to be 49% and electric pulp test to be 45%. Conclusion: the custom-made holder used in the present study aided in providing accurate response for pulp vitality testing. In this study the diagnostic accuracy was high with dental pulse oximeter followed by cold, heat and the least was electric pulp tester in different pulpal conditions. (AU)


Fundamentação: a eficiência dos meios de diagnóstico desempenha um papel importante no plano de tratamento. Este estudo tem como objetivo avaliar a precisão diagnóstica do oxímetro de pulso odontológico com um suporte de sensor personalizado, teste térmico e testador de polpa elétrico na avaliação da condição pulpar e na avaliação do nível de saturação de oxigênio em dentes controle saudáveis, não vitais e dentes com pulpite irreversível. Material e métodos: trinta e sete dentes de canal único que necessitavam de terapia endodôntica foram incluídos no estudo. Os dentes selecionados foram testados com oxímetro de pulso, teste pulpar elétrico, spray frio e bastão de guta-percha aquecido. Entre cada teste, foi permitido um intervalo de tempo de 2 minutos para a sensibilização central ocorrer. Três operadores cegos foram envolvidos no estudo. A condição real da polpa foi avaliada após o início do tratamento endodôntico, por meio de exame visual direto da cavidade de acesso. Os dados foram analisados estatisticamente pelo teste de Análise de Variância (ANOVA) e pelo teste Post-hoc de Tukey. Resultados: a sensibilidade do oxímetro de pulso, teste de calor, de frio e teste pulpar elétrico foi de 100, 25, 50 e 12, respectivamente. A especificidade desses testes foi de 100, 72 81 e 77, respectivamente. O teste de ANOVA mostrou que houve diferença estatística entre todos os grupos (p = 0,0005). O teste Post-Hoc de Tukey revelou que houve diferença estatística entre todos os grupos, grupo não-vital (p = 0,0005), grupo controle (p = 0,01) e pulpite irreversível (p = 0,01). A precisão diagnóstica geral do oxímetro de pulso foi de 100%, seguida pelo teste a frio de 66%, o teste de calor a 49% e o teste pulpar elétrico a 45%. Conclusão: o suporte personalizado utilizado no presente estudo ajudou a fornecer uma resposta precisa para o teste de vitalidade pulpar. Neste estudo, a precisão diagnóstica foi alta com o oxímetro de pulso dental, seguido do teste com frio e calor, sendo o teste elétrico o menos eficaz nas diferentes condições pulpares testadas.(AU)


Subject(s)
Humans , Adult , Middle Aged , Oximetry , Dental Pulp Cavity , Endodontics
4.
Med. UIS ; 32(3): 19-25, Sep.-Dec. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1114973

ABSTRACT

Resumen La terapia con oxígeno a largo plazo mejoró la supervivencia de los pacientes con enfermedad pulmonar obstructiva crónica. Las medidas propuestas en las guías clínicas para evaluar la indicación y seguimiento de esta terapia son la presión arterial de oxígeno y la saturación arterial de oxígeno. Se ha generalizado el uso de la oximetría de pulso, pero la información para determinar si estas medidas son intercambiables es insuficiente. El objetivo es revisar los fundamentos fisiológicos de las variables relacionadas con la oxigenación y sus formas de medición. En la evaluación del paciente con patología respiratoria, la saturación de pulso es una ayuda clínica valiosa, sin embargo, sus limitaciones no le permiten, en ciertos rangos, reemplazar la valoración directa en sangre arterial (gasometría arterial) de la saturación arterial y la presión arterial de oxígeno, para determinar la indicación de la oxigenoterapia. MÉD.UIS.2019;32(3):19-25


Abstract Long-term oxygen therapy improves the survival of patients with chronic obstructive pulmonary disease. Measures proposed in clinical clinics to evaluate the indication and monitoring of arterial blood pressure therapy and arterial oxygen saturation. The use of pulse oximetry has been widespread, but the information to determine if these measures are interchangeable is insufficient. The objective is to review the physiological foundations of variables related to oxygenation and their forms of measurement. In the assessment of the patient with respiratory pathology, pulse saturation is a valuable clinical aid., however, its limitations do not allow, in certain ranges, to replace direct arterial blood pressure (arterial blood gas) measurement of arterial saturation and arterial oxygen pressure, to determine the indication of oxygen therapy. MÉD.UIS.2019;32(3):19-25


Subject(s)
Humans , Oximetry , Pulmonary Disease, Chronic Obstructive , Oxygen , Oxygen Inhalation Therapy , Pathology , Patients , Pressure , Pulse , Survival , Therapeutics , Weights and Measures , Blood , Blood Gas Analysis , Pulmonary Medicine , Oxygenation , Monitoring , Arterial Pressure , Survivorship
5.
Rev. Asoc. Méd. Argent ; 132(1): 28-32, Mar. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1010018

ABSTRACT

Introducción. La influenza A constituye uno de los principales problemas de salud que enfrenta la humanidad.El manejo clínico ambulatorio usando el protocolo de oseltamivir y saturomería permite realizar una práctica evaluación. Objetivo. Evaluar resultados usando protocolo de oseltamivir y saturometría en atención médica ambulatoria y emergencias en pacientes con influenza A. Métodos. Realizar un estudio clínico experimental aleatorio en pacientes con influenza A, usando protocolo con oseltamivir y saturometría y compararlo con tratamiento estándar. Conclusiones. La influenza A seguirá afectandónos por varios años más, debemos asumir una capacidad de respuesta, que incluya: la detección y confirmación de casos; así como su manejo clínico oportuno y eficaz. (AU)


Introduction. Influenza A is one of the main health problems facing humanity. Outpatient clinical management using the oseltamivir and saturomer protocol allows a practical evaluation. Objective. To evaluate results using oseltamivir protocol and saturometry in ambulatory medical care and emergencies in patients with influenza A. Methods. Perform a randomized experimental clinical study in patients with influenza A, using procolo with oseltamivir and saturometry and compare it with standard treatment. Conclusions. Influenza A will continue to affect us for several more years, we must assume a capacity to respond, that include: the detection and confirmation of cases; as well as its timely and effective clinical management. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Oximetry , Influenza, Human/diagnosis , Influenza, Human/therapy , Influenza A Virus, H1N1 Subtype , Oseltamivir/administration & dosage , Oseltamivir/therapeutic use , Antiviral Agents/therapeutic use , Influenza Vaccines , Diagnosis, Differential , Influenza, Human/prevention & control , Ambulatory Care
6.
Article in English | WPRIM (Western Pacific) | ID: wprim-759569

ABSTRACT

It is challenging to predict fluid responsiveness, that is, whether the cardiac index or stroke volume index would be increased by fluid administration, in the pediatric population. Previous studies on fluid responsiveness have assessed several variables derived from pressure wave measurements, plethysmography (pulse oximeter plethysmograph amplitude variation), ultrasonography, bioreactance data, and various combined methods. However, only the respiratory variation of aortic blood flow peak velocity has consistently shown a predictive ability in pediatric patients. For the prediction of fluid responsiveness in children, flow- or volume-dependent, noninvasive variables are more promising than pressure-dependent, invasive variables. This article reviews various potential variables for the prediction of fluid responsiveness in the pediatric population. Differences in anatomic and physiologic characteristics between the pediatric and adult populations are covered. In addition, some important considerations are discussed for future studies on fluid responsiveness in the pediatric population.


Subject(s)
Adult , Blood Pressure , Cardiac Output , Child , Fluid Therapy , Humans , Oximetry , Plethysmography , Pulse Wave Analysis , Stroke Volume , Ultrasonography , Ultrasonography, Doppler
7.
Article in English | WPRIM (Western Pacific) | ID: wprim-763934

ABSTRACT

OBJECTIVES: The Internet of Things (IoT) and its applications are growing simultaneously. These applications need new intelligent devices along heterogeneous networking. Which makes them costly to implement indeed. Platforms and open devices designed for open-source hardware are possible solutions. This research was conducted under an IoT design, implementation, and assessment model for the remote monitoring of pulse oximetry via oxygen partial saturation (SpO2) and heart rate (HR) with low-energy consumption. METHODS: This study focused on the development of SpO2 and HR measurements that will allow the monitoring and estimation in real time of the user's state and health related to the established parameters. Measurements were acquired and recorded using a remote web server that recorded the acquired variables for further processing. The statistical analysis data allows comparison of the registered data measured with theoretical models. RESULTS: The IoT model was developed use Bluetooth low-energy devices, which comply with low-cost and open-hardware solutions operated via ‘HTTP requests’ for data transmission and reception from a cloud server to an edge device. Network performance assessment was conducted to guarantee the availability and integrity of the acquired values and signals. The system measured SpO2 and HR variables. The most significant result was to achieve energy consumption 20% lower than that of devices in the market. CONCLUSIONS: In summary, the acquired data validation based on the IoT model had a transmission error of 0.001% which proves its applicability in healthcare.


Subject(s)
Delivery of Health Care , Heart Rate , Internet , Models, Theoretical , Monitoring, Physiologic , Oximetry , Oxygen , Remote Sensing Technology
8.
Clinical Endoscopy ; : 451-457, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-763475

ABSTRACT

Sedation, defined as the depressed level of consciousness, induced by drug administration, is widely used for gastrointestinal endoscopy to relieve a patient’s anxiety and discomfort. In addition, successful procedure is anticipated with control of unintended movements. Endoscopic sedation, however, cannot be free from the risk of serious adverse events, e.g., cardiopulmonary compromise. Therefore, principles on personnel, facility and equipment, as well as performance itself, should be followed to prevent unfavorable incidents. In this article, sedation guidelines for the Accreditation of Qualified Endoscopy Units, issued by the Korean Society of Gastrointestinal Endoscopy, are presented.


Subject(s)
Accreditation , Anxiety , Consciousness Disorders , Endoscopy , Endoscopy, Gastrointestinal , Oximetry
9.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-763245

ABSTRACT

PURPOSE: This prospective study was conducted to determine the incidence and related characteristics of respiratory medical device-related pressure ulcers (MDRPU) in children admitted to a pediatric intensive care unit (PICU). METHODS: The participants were 184 children who were admitted to the PICU of P University Hospital from April 2016 to January 2017. Data were collected on the occurrence of respiratory MDRPU and characteristics regarding the application of respiratory medical devices. RESULTS: Respiratory MDRPU occurred in 11.9% of participants (58.3%: stage I ulcers, 37.5%: mucosal ulcers). The devices associated with respiratory MDRPU were endotracheal tubes (54.2%), high-flow nasal cannulas (37.5%), and oximetry probes (8.3%). Respiratory MDRPU associated with an endotracheal tube were significant differences according to the site and strength of fixation, the use of a bite block and adhesive tape, skin dryness, and edema. In high-flow nasal cannulas, significant differences were found according to the site of fixation, immobility after fixation, and skin dryness. CONCLUSION: The occurrence of respiratory MDRPU is significantly affected by the method and strength of fixation, as well as skin dryness and edema. Therefore, appropriate consideration of these factors in nursing care can help prevent respiratory MDRPU.


Subject(s)
Adhesives , Catheters , Child , Critical Care , Edema , Humans , Incidence , Intensive Care Units , Methods , Nursing Care , Oximetry , Pressure Ulcer , Prospective Studies , Skin , Surgical Tape , Ulcer
10.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-761385

ABSTRACT

One-lung ventilation is an anesthesiological technique to accomplish surgical visualization during thoracic surgical procedures, and is often required unexpectedly during surgery. Traditionally the double lumen tube is considered the gold standard for lung separation. Despite being equally feasible for standard situations, there are special populations and circumstances requiring the use of a bronchial blocker to establish one-lung ventilation. We have experienced unexpected change to one-lung ventilation with bronchial blocker. A 40-year-old (158 cm, 48 kg) woman was scheduled for emergency exploratory laparotomy due to panperitonitis. A sudden diaphragmatic perforation occurred during the operation. Since oxygen saturation was reduced, intraoperative tube change was not available. Therefore, one-lung ventilation was done with bronchial blockers. After the bronchial blocker was placed, one-lung ventilation was well maintained and the operation was terminated successfully.


Subject(s)
Adult , Emergencies , Female , Humans , Laparotomy , Lung , One-Lung Ventilation , Oximetry , Oxygen , Thoracic Surgical Procedures , Thoracoscopy
11.
Neonatal Medicine ; : 121-127, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-760590

ABSTRACT

The incidence of cerebral palsy has not decreased despite advances in neonatal care. Preterm infants are at a high risk of cerebral palsy. Moreover, preterm infants might experience permanent neurological sequelae due to injury in the preterm brain. Although the etiology of preterm brain injury is not fully understood, preterm brain injury is strongly associated with abnormal cerebral perfusion and oxygenation. Monitoring systemic blood pressure or arterial oxygen saturation using pulse oximetry is not enough to guarantee proper cerebral perfusion or oxygenation. Early detection of improper cerebral perfusion can prevent irreversible cerebral damage. To decrease brain injury through the early detection of under-perfusion and deoxygenation, other diagnostic modalities are needed. Near-infrared spectroscopy can continuously and noninvasively monitor regional oxygen saturation (rSO₂), which reflects the perfusion and oxygenation status of tissues at bedside. Near-infrared spectroscopy represents a balance between tissue oxygen supply and demand. Cerebral rSO₂ monitoring has been used most frequently in neonatal cardiac surgery to monitor cerebral oxygenation and prevent hypoxic damage or shock. Recently, cerebral, renal, or splanchnic rSO₂ in neonates is frequently monitored. The progression of a disease, brain injury, and death can be prevented by detecting changes in rSO₂ values using near-infrared spectroscopy. In this article, the basic principles, usefulness, and applications of near-infrared spectroscopy in neonates are discussed.


Subject(s)
Blood Pressure , Brain , Brain Injuries , Cerebral Palsy , Cerebrovascular Circulation , Humans , Incidence , Infant, Newborn , Infant, Premature , Oximetry , Oxygen , Perfusion , Shock , Spectroscopy, Near-Infrared , Splanchnic Circulation , Thoracic Surgery
12.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-772489

ABSTRACT

This article describes the design of a portable blood oxygen simulation system that can be used to simulate various blood gas saturation states of the human body. The system can be used to simulate various states of blood gas saturation, and can also simulate large blood oxygen saturation dynamic range, pulse rate range and perfusion index range. It can be used for testing, but not for clinical examination instruments. Moreover, the system has the characteristics of small size and low cost compared with the commercial blood oxygen simulator. Although the simulation system is not directly used for the detection of blood gas saturation of patients, it is also an essential equipment in the production and testing process, so it has certain practical value.


Subject(s)
Heart Rate , Humans , Oximetry , Oxygen
13.
J. bras. pneumol ; 44(5): 390-397, Sept.-Oct. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-975950

ABSTRACT

ABSTRACT Objective: To determine the impact of adherence to long-term oxygen therapy (LTOT) on quality of life, dyspnea, and exercise capacity in patients with COPD and exertional hypoxemia followed for one year. Methods: Patients experiencing severe hypoxemia during a six-minute walk test (6MWT) performed while breathing room air but not at rest were included in the study. At baseline and after one year of follow-up, all patients were assessed for comorbidities, body composition, SpO2, and dyspnea, as well as for anxiety and depression, having also undergone spirometry, arterial blood gas analysis, and the 6MWT with supplemental oxygen. The Saint George's Respiratory Questionnaire (SGRQ) was used in order to assess quality of life, and the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index was calculated. The frequency of exacerbations and the mortality rate were noted. Treatment nonadherence was defined as LTOT use for < 12 h per day or no LTOT use during exercise. Results: A total of 60 patients with COPD and exertional hypoxemia were included in the study. Of those, 10 died and 11 experienced severe hypoxemia during follow-up, 39 patients therefore being included in the final analysis. Of those, only 18 (46.1%) were adherent to LTOT, showing better SGRQ scores, higher SpO2 values, and lower PaCO2 values than did nonadherent patients. In all patients, SaO2, the six-minute walk distance, and the BODE index worsened after one year. There were no differences between the proportions of adherence to LTOT at 3 and 12 months of follow-up. Conclusions: Quality of life appears to be lower in patients with COPD and exertional hypoxemia who do not adhere to LTOT than in those who do. In addition, LTOT appears to have a beneficial effect on COPD symptoms (as assessed by SGRQ scores). (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR-9b4v63 [http://www.ensaiosclinicos.gov.br])


RESUMO Objetivo: Determinar o impacto da adesão à oxigenoterapia de longa duração (OLD) na qualidade de vida, dispneia e capacidade de exercício em pacientes com DPOC e hipoxemia decorrente do esforço acompanhados durante um ano. Métodos: Foram incluídos no estudo pacientes que apresentaram hipoxemia grave durante um teste de caminhada de seis minutos (TC6) realizado enquanto respiravam ar ambiente, mas não em repouso. No início e após um ano de acompanhamento, todos os pacientes foram avaliados quanto a comorbidades, composição corporal, SpO2 e dispneia, bem como quanto a ansiedade e depressão, além de terem sido submetidos a espirometria, gasometria arterial e TC6 com oxigênio suplementar. O Saint George's Respiratory Questionnaire (SGRQ) foi usado para avaliar a qualidade de vida, e o índice Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE; índice de massa corporal, obstrução do fluxo aéreo, dispneia e capacidade de exercício) foi calculado. A frequência de exacerbações e a taxa de mortalidade foram registradas. Usar OLD durante < 12 h por dia ou não usar OLD durante o exercício caracterizaram não adesão ao tratamento. Resultados: Foram incluídos no estudo 60 pacientes com DPOC e hipoxemia decorrente do esforço. Destes, 10 morreram e 11 apresentaram hipoxemia grave durante o acompanhamento; portanto, foram incluídos na análise final 39 pacientes. Destes, apenas 18 (46,1%) aderiram à OLD, apresentando melhor pontuação no SGRQ, maior SpO2 e menor PaCO2 do que os pacientes que não aderiram à OLD. Em todos os pacientes, a SaO2, a distância percorrida no TC6 e o índice BODE pioraram após um ano. Não houve diferenças entre as proporções de adesão à OLD aos 3 e 12 meses de acompanhamento. Conclusões: A qualidade de vida parece ser menor em pacientes com DPOC e hipoxemia decorrente do esforço que não aderem à OLD do que naqueles que o fazem. Além disso, a OLD parece ter efeito benéfico nos sintomas da DPOC (avaliados pela pontuação obtida no SGRQ). (Registro Brasileiro de Ensaios Clínicos - ReBEC; número de identificação RBR- 9b4v63 [http://www.ensaiosclinicos.gov.br])


Subject(s)
Humans , Male , Female , Aged , Oxygen Inhalation Therapy , Pulmonary Disease, Chronic Obstructive/therapy , Dyspnea/physiopathology , Physical Exertion/physiology , Treatment Adherence and Compliance , Hypoxia/physiopathology , Quality of Life , Spirometry , Time Factors , Severity of Illness Index , Blood Gas Analysis , Oximetry , Follow-Up Studies , Pulmonary Disease, Chronic Obstructive/physiopathology , Walk Test
14.
Neumol. pediátr. (En línea) ; 13(3): 113-117, sept. 2018. graf, ilus, tab
Article in Spanish | LILACS (Americas) | ID: biblio-947620

ABSTRACT

Oxygen therapy is frequent in prematures to treat respiratory conditions typically associated with them. Long-term use is mainly due to Bronchopulmonary Dysplasia (BPD). However, the use of oxygen has been controversial in the last decade especially given the associated risk of hyperoxemia in these children. Pulse oximetry (SpO2) is a fundamental tool to guide oxygen therapy. Different trials have found that, in prematures born ≤28 weeks of gestational age who requires oxygen, a restrictive SpO2 target (85-89%) vs a liberal one (91-95%) may cause a higher mortality rate and enterocolitis, but less serious retinopathy. These targets are not normal SpO2 values. Studies on SpO2 reference values in preterm infants are scarce, heterogeneous and they do not necessarily use highly accurate and latest generation pulse oximeters. This contributes to the variation of oxygen therapy among different centers and reinforces the relevance of having SpO2 reference values in preterm infants to safely guide oxygen therapy.


La terapia con oxígeno es frecuente en prematuros para el tratamiento de patología respiratoria propia de su condición. En forma crónica la principal causa de su uso es Displasia Broncopulmonar (DBP). Sin embargo, el uso de oxígeno en prematuros ha sido motivo de debate en la última década fundamentalmente por los riesgos asociados a estados de hiperoxemia. La oximetría de pulso (SpO2) es una herramienta fundamental para guiar la oxigenoterapia. En prematuros que nacen ≤28 semanas de edad gestacional que requieren oxígeno, distintos estudios han demostrado que una meta de SpO2 restrictiva (85-89%) vs liberal (91-95%) tendría mayor mortalidad y enterocolitis, pero menor retinopatía grave. Estas metas no son valores normales de SpO2. Los estudios sobre valores de referencia de SpO2 en prematuros son limitados, heterogéneos y no necesariamente con oxímetros de última generación de mayor precisión. Esto contribuye a que la oxigenoterapia sea variable entre distintos centros y refuerza la relevancia de contar con valores de referencia de SpO2 en prematuros para guiar con seguridad el uso de oxígeno.


Subject(s)
Humans , Infant, Newborn , Oxygen Inhalation Therapy/methods , Infant, Premature , Oximetry/standards , Oxygen Consumption , Oxygen Inhalation Therapy/adverse effects , Reference Values , Monitoring, Physiologic
15.
Rev. cient. odontol ; 6(1): 39-50, ene.-jun. 2018. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-998743

ABSTRACT

Objetivo: Comparar los niveles de saturación de oxígeno medidos con dos dife- rentes oxímetros con relación al llanto y movimiento en pacientes odontope- diátricos atendidos bajo sedación cons- ciente. Metodología: Estudio obser- vacional descriptivo, conformado por 15 pacientes (8 mujeres y 7 varones) entre 3 y 6 años de edad, que reci- bieron tratamientos dentales bajo seda- ción consciente por vía oral en una clínica odontológica universitaria. Se evaluó la saturación de oxígeno en cada paciente, se realizaron 8 mediciones cada 5 minutos con dos oxímetros dife- rentes con sensor interno (SI) y sensor externo (SE) al mismo tiempo, con 120 mediciones en total. La investigadora se capacitó en la lectura de la escala de Houpt y monitoreo clínico para asegurar una adecuada medición. Se utilizaron las pruebas de T Student para el análisis de las variables y el nivel de significancia fue (p < 0,05). Resultados: Al evaluar el nivel de coincidencia entre ambos oxímetros, se encontró una diferencia estadísticamente significativa (p < 0,05) en los tiempos T2, T3, T4, T6, T7 y T8, pero esta diferencia de medidas llegó a estar entre un 2% y un 3%, principal- mente. La magnitud de diferencia de no coincidencia entre los dos oxímetros fue del 51,7%. Conclusión: Se encontraron discrepancias significativas no asociadas al llanto y movimiento entre las lecturas de saturación de oxígeno de los oxíme- tros con sensor interno y sensor externo en los pacientes evaluados. (AU)


Objective: To compare oxygen satura-tion levels measured with two different oximeters in relation to crying and body movement in pediatric dental patients treated under conscious sedation. Methodology: This descriptive obser-vational study, involving 15 patients (8 females and 7 males) between 3 and 6 years of age, who underwent dental treatment under conscious oral sedation in a university dental clinic, assessed oxygen saturation in each patient. 8 measurements were made simultaneously every 5 minutes with two different oximeters, with an internal sensor (IS) and external sensor (ES), producing a total of 120 measurements. The researcher was trained in reading the Houpt scale and clinical monitoring, in order to ensure correct measurement. Student's t-tests were used to analyze the variables and the level of significance was p <0.05. Results: when evaluating the level of coincidence between the two oximeters, a statistically significant difference was identified (p <0.05) in the T2, T3, T4, T6, T7 and T8 times, but this difference in measurements was mostly between 2% and 3%. The magnitude of difference of non-coincidence between the two oximeters was 51.7%. Conclu-sion: Significant discrepancies, not asso-ciated with crying and body movement, were found between the oxygen satura-tion readings of the internal sensor and external sensor oximeters in the patients evaluated.


Subject(s)
Humans , Male , Female , Child , Oximetry , Child , Conscious Sedation
16.
Rev. bras. ter. intensiva ; 30(2): 135-143, abr.-jun. 2018. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-959315

ABSTRACT

RESUMO Objetivo: Os distúrbios microcirculatórios estão implicados no prognóstico do choque séptico. A hiporresponsividade microvascular pode ser avaliada por meio do índice de perfusão, derivado da oximetria de pulso e hiperemia reativa. Com utilização do índice de perfusão, investigamos a hiperemia reativa e sua relação com a perfusão periférica e os parâmetros clínico-hemodinâmicos no choque séptico. Métodos: Avaliaram-se 82 pacientes, 47 deles com choque séptico e 35 controles. Os exames foram realizados dentro de 24 horas após a admissão. O índice de perfusão foi avaliado antes e após uma oclusão do fluxo sanguíneo durante 3 minutos, utilizando-se análise de resposta temporal por 5 minutos. O índice de perfusão foi também avaliado nas fases hiperêmicas, principalmente com derivação de mecanismos mecanossensitivos (ΔIP0-60) e metabólicos (ΔIP60-120). Realizaram-se testes de correlação entre a hiperemia reativa e dados clínicos hemodinâmicos. Resultados: A hiperemia reativa, medida pelo índice de perfusão, foi significantemente mais baixa no choque séptico apenas até 45 segundos após a desinflação do manguito. No período restante, não houve diferenças estatisticamente significantes entre os grupos. Os picos de índice de perfusão foram similares entre os grupos, embora o pico tenha sido atingido de forma mais lenta no grupo séptico. Os valores de ΔIP0-60 foram mais baixos no choque [1% (-19% - -40%) versus 39% (6% - 75%); p = 0,001]. No entanto, o ΔIP60-120 foi similar entre os grupos [43% (18% - 93%) versus 48% (18% - 98%); p = 0,58]. O tempo até o pico do índice de perfusão se correlacionou de forma positiva com o SOFA e negativamente com os níveis de proteína C-reativa. O pico de índice de perfusão se correlacionou de forma positiva com as doses de vasopressores; os valores de ΔIP60-120 tiveram correlação positiva com o nível de proteína C-reativa e as doses de vasopressores. Não ocorreram outras correlações significantes. Conclusões: Este estudo com base no índice de perfusão sugere que o choque séptico promove hiporresponsividade vascular periférica, enquanto a reatividade vascular posterior é consideravelmente preservada. Estes resultados demonstram resposta hiperêmica periférica dependente do tempo e significante reserva isquêmica no choque séptico.


ABSTRACT Objective: Microcirculation disturbances are implicated in the prognosis of septic shock. Microvascular hyporesponsiveness can be assessed by an oximetry-derived perfusion index and reactive hyperemia. Using this perfusion index, we investigated reactive hyperemia and its relationship with peripheral perfusion and clinical-hemodynamic parameters in septic shock. Methods: Eighty-two patients were evaluated: 47 with septic shock and 35 controls. Tests were performed within 24 hours after admission. The perfusion index was evaluated before and after a 3-min blood flow occlusion using a time-response analysis for 5 min. The perfusion index was also evaluated in the hyperemic phases and was mainly derived by mechanosensitive (ΔPI0-60) and metabolic mechanisms (ΔPI60-120). Correlation tests were performed between reactive hyperemia and clinical-hemodynamic data. Results: Reactive hyperemia measured by the perfusion index was significantly lower in patients with septic shock, but this was only observed for the first 45 seconds after cuff-deflation. In the remaining period, there were no statistical differences between the groups. The peaks in the perfusion index were similar between groups, although the peak was reached more slowly in the septic group. Values of ΔPI0-60 were lower in shock [01% (-19% - -40%) versus 39% (6% - 75%); p = 0.001]. However, ΔPI60-120 was similar between the groups [43% (18% - 93%) versus 48% (18% - 98%); p = 0.58]. The time-to-peak of the perfusion index was correlated positively with the SOFA scores and negatively with C-reactive protein; the peak of the perfusion index was positively correlated with vasopressor doses; and the ΔPI60-120 values were positively correlated with C-reactive protein and vasopressor doses. No other significant correlations occurred. Conclusions: This perfusion index-based study suggests that septic shock promotes initial peripheral vascular hyporesponsiveness and preserves posterior vascular reactivity to a considerable degree. These results demonstrate a time-dependent peripheral hyperemic response and a significant ischemic reserve in septic shock.


Subject(s)
Humans , Male , Female , Aged , Shock, Septic/therapy , Fluid Therapy/methods , Hyperemia/metabolism , Shock, Septic/physiopathology , Time Factors , Vasoconstrictor Agents/administration & dosage , C-Reactive Protein/metabolism , Oximetry/methods , Case-Control Studies , Organ Dysfunction Scores , Hemodynamics , Microcirculation , Middle Aged
17.
Neumol. pediátr. (En línea) ; 13(2): 56-60, mar. 2018. tab
Article in Spanish | LILACS (Americas) | ID: biblio-915604

ABSTRACT

The sleep physiology associated to high altitude hypobaric hypoxia is different from that observed at sea level. Normal parameters set by the North American and European consensus for interpretation of polysomnography (PSM) do not apply to high altitude (HA) conditions. This article reviews the PSM studies carried out in children at altitudes >2,500 m and provides a comparison with studies undertaken at sea level. The importance of interpreting PSM taking HA normal values into consideration is highlighted.


La fisiología del sueño, en el entorno de la hipoxia hipobárica que caracteriza a la altura, es diferente de la del nivel del mar. Los parámetros de normalidad de la polisomnografía (PSM) de los consensos norteamericano y europeo no son aplicables en la gran altura. Este artículo revisa los estudios publicados sobre PSM en niños en lugares ubicados por encima de los 2.500 metros y los compara con los del nivel del mar. Se insiste en la necesidad de interpretar la PSM de acuerdo a la normalidad de la altura donde se realizó.


Subject(s)
Humans , Child , Sleep/physiology , Polysomnography/methods , Sleep Apnea, Obstructive/physiopathology , Altitude , Oxygen Consumption , Oximetry , Sleep Apnea, Obstructive/diagnosis
18.
Article in English | WPRIM (Western Pacific) | ID: wprim-787090

ABSTRACT

A 33-year-old woman visited the emergency department presenting with fever and dyspnea. She was pregnant with gestational age of 31 weeks and 6 days. She had dysuria for 7 days, and fever and dyspnea for 1 day. The vital signs were as follows: blood pressure 110/70 mmHg, heart rate 118 beats/minute, respiratory rate 28/minute, body temperature 38.7℃, and oxygen saturation by pulse oximetry 84% during inhalation of 5 liters of oxygen by nasal prongs. Crackles were heard over both lung fields. There were no signs of uterine contractions. Chest X-ray and chest computed tomography scan showed multiple consolidations and air bronchograms in both lungs. According to urinalysis, there was pyuria and microscopic hematuria. She was diagnosed with community-acquired pneumonia and urinary tract infection (UTI) that progressed to severe sepsis and acute respiratory failure. We found extended-spectrum beta-lactamase producing Escherichia coli in the blood culture and methicillin-resistant Staphylococcus aureus in the sputum culture. The patient was transferred to the intensive care unit with administration of antibiotics and supplementation of high-flow oxygen. On hospital day 2, hypoxemia was aggravated. She underwent endotracheal intubation and mechanical ventilation. After 3 hours, fetal distress was suspected. Under 100% fraction of inspired oxygen, her oxygen partial pressure was 87 mmHg in the arterial blood. She developed acute kidney injury and thrombocytopenia. We diagnosed her with multi-organ failure due to severe sepsis. After an emergent cesarean section, pneumonia, UTI, and other organ failures gradually recovered. The patient and baby were discharged soon thereafter.


Subject(s)
Acute Kidney Injury , Adult , Hypoxia , Anti-Bacterial Agents , beta-Lactamases , Blood Pressure , Body Temperature , Cesarean Section , Dyspnea , Dysuria , Emergency Service, Hospital , Escherichia coli , Female , Fetal Distress , Fever , Gestational Age , Heart Rate , Hematuria , Humans , Inhalation , Intensive Care Units , Intubation, Intratracheal , Lung , Methicillin-Resistant Staphylococcus aureus , Oximetry , Oxygen , Partial Pressure , Pneumonia , Pregnancy Complications, Infectious , Pregnancy , Pyuria , Respiration, Artificial , Respiratory Insufficiency , Respiratory Rate , Respiratory Sounds , Sepsis , Sputum , Thorax , Thrombocytopenia , Urinalysis , Urinary Tract Infections , Uterine Contraction , Vital Signs
19.
Neonatal Medicine ; : 137-143, 2018.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-718346

ABSTRACT

PURPOSE: This study was performed to determine the clinical features of full-term infants with hypoxemia detected by pulse oximetry and to establish the diagnosis of critical congenital heart disease (CCHD). METHODS: We retrospectively reviewed the medical records of neonates who had been admitted to the neonatal intensive care unit within 2 weeks of birth at Korea University Ansan Hospital between January 2013 and October 2017 (n=450). We classified these neonates based on the presence of hypoxemia at admission and investigated neonatal characteristics, initial symptoms, echocardiographic findings, and final diagnosis associated with hypoxemic diseases. RESULTS: Of 450 term infants, 265 infants (58.9%) were identified hypoxemia by pulse oximetry at admission. The most common symptoms of them were cyanosis and tachypnea. Among them, 80.1% of infants (214/265) were diagnosed with respiratory tract disease and 8.3% of infants (22/265) had congenital heart disease. Thirteen infants (13/265, 4.9%) had CCHD and were treated with urgent surgery or transcatheter intervention within 28 days of birth. Majority of infants with respiratory tract disorder were transferred from hospital immediately after birth, but 46.1% of infants (6/13) with CCHD remained asymptomatic after birth and were admitted after 48 hours after birth. In addition, other hypoxemic illnesses were identified as neonatal infectious and neurological diseases. CONCLUSION: This study showed the importance of assessment in neonates with hypoxemia, including those diagnosed with CCHD. The possibility of CCHD should be considered in the differential diagnosis in neonates demonstrating hypoxemia after 48 hours of birth. A larger prospective study is needed to assess the effectiveness and outcomes of pulse oximetry for neonatal screening in Korea.


Subject(s)
Hypoxia , Cyanosis , Diagnosis , Diagnosis, Differential , Echocardiography , Heart Defects, Congenital , Humans , Infant , Infant, Newborn , Intensive Care, Neonatal , Korea , Medical Records , Neonatal Screening , Oximetry , Parturition , Prospective Studies , Respiratory System , Respiratory Tract Diseases , Retrospective Studies , Tachypnea
20.
Univ. med ; 59(3)2018. ilus, tab
Article in Spanish | LILACS (Americas), COLNAL | ID: biblio-994959

ABSTRACT

Introducción: el oxígeno (O2) es un medicamento que puede generar efectos adversos. Discrepancias en la lectura del flujómetro y metas de saturación de oxígeno (SpC>2) pueden repercutir en la toma de decisiones clínicas, paraclínicas y estancia hospitalaria de pacientes pediátricos. Objetivo: evaluar conocimientos sobre SpO2, efectos adversos del O2 y lectura del flujómetro en el personal de salud del Departamento de Pediatría del Hospital Universitario San Ignacio, Bogotá, Colombia. Métodos: estudio transversal, mediante encuesta autodiligenciada en una muestra por conveniencia durante diciembre de 2016 y enero de 2017. Evaluación de conocimientos sobre oxigenoterapia, SpC>2, efectos adversos y lectura del flujómetro mediante fotografías de flujómetros del hospital con diferente fracción inspirada de oxígeno (FiC>2). Resultados: de 259 personas, el 77% respondió la encuesta. El 22% de los participantes respondió que la SpC>2 aumenta o se mantiene igual cuando el niño duerme; el 78% sabía de complicaciones del uso prolongado de O2, y el 67%, las relacionadas con la administración de una FiC>2 mayor a la necesaria. Con relación a la población neonatal, el 10% consideró que se deben buscar metas de SpO2 iguales o superiores al 96%; entre el 9% y el 19% de las lecturas en las diferentes fotografías de flujómetros fueron respuestas incorrectas. Discusión: es necesario reforzar conceptos actualizados sobre oxigenoterapia, con énfasis en metas de saturación, efectos adversos y lectura de flujómetro mediante campañas educativas periódicas.


Introduction: Supplemental oxygen is considerad a pharmaceutical drug; therafora, it can produce adverse effects. Lack of consensus regarding the reading of oxygen flowmeters and peripheral oxygen saturation (SpC>2) goals can influence clinical and paraclinical decisions and hospital stay length. Objective: To assess knowledge on oxygen therapy, adverse effects, SpC>2 goals and oxygen flowmeter's reading among personnel in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia. Methodology: Cross-sectional study derived from convenience sampling through a self-applied poli between December 2016 and January 2017. The poli evaluated topics on supplemental oxygen therapy fundamentáis and adverse effects, SpC>2 goals and flowmeter readings through flowmeters photographs indicating a specific ffaction of inspirad oxygen (FÍO2). Results: Response rate was 77% from 259 subjects. 22% considered that the oxygen saturation either increases or remains the same during sleep periods in children. 78% participants knew at least one complication associated to prolonged oxygen therapy and 67% due to supplementary oxygen concentration greater than required amounts. In neonatal population, 10% considered oxygen saturation efectos adversos y lectura de flujómetro mediante campañas educativas periódicas.


Subject(s)
Oxygen Inhalation Therapy/nursing , Oximetry , Child
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