Application value of regional oxygen saturation in prognosis evaluation of patients with acute lower limb ischemia / 中华急诊医学杂志

Objective:To explore the application value of regional oxygen saturation (rSO 2) level in the prognosis evaluation of patients with acute lower limb ischemia (ALLI). Methods:Retrospective analysis of clinical data of 82 ALLI patients admitted to the ICU of Xinjiang Uygur Autonomous Region People's Hospital from June 2021 to June 2022. The subjects were divided into event group and non-event group according to the incidence of adverse events during the follow-up. The general clinical data of the two groups were compared. Multiple stepwise linear regression was used to analyze the independent related factors of rSO 2. Multivariate Cox regression was used to analyze independent risk factors of adverse events. Receiver operating characteristic (ROC) curve was used to obtain the optimal cut-off value of rSO 2 prediction adverse events. The subjects were divided into high-value group and low-value group according to the optimal cut-off value. Kaplan-Meier curve was used to analyze the difference in survival rate between groups during the follow-up. Results:A total of 82 ALLI patients were included in this study, and the incidence of adverse events during follow-up was 25.6% (21 cases). The rSO 2 of four periods and maximum, minimum, average and ankle-brachial index in the event group were significantly lower than those in the non-event group. The troponin I, troponin T, myoglobin, creatine kinase, C-reactive protein, and lactate in the event group were significantly higher than those in the non event group ( P?0.05). Multiple stepwise linear regression analysis showed that: C-reactive protein ( β=-0.320, P=0.002), lactate ( β=-0.262, P=0.009), troponin Ⅰ ( β=-0.230, P=0.025), and smoking history ( β=-0.211, P=0.034) were all independent predictors of rSO 2. Multivariate Cox regression analysis showed that 24 h rSO 2 (mean) was an independent influencing factor for adverse events in ALLI patients (adjusted HR=0.67, 95% CI:0.54-0.83, P<0.001). The 24 h rSO 2 (mean) was good in predicting the incidence of adverse events at 30, 60, and 90 days in ALLI patients (AUC were 0.934, 0.867 and 0.823), and the corresponding optimal cut-off values of rSO 2 were 59.36, 59.03 and 59.03. The sensitivity and specificity to predict adverse events in ALLI patients were 85.7% and 85.3% when the 24 h rSO 2 (mean) was 59.36 as the best cut-off value. According to the optimal cut-off , the subjects were divided into high value group (rSO 2>59.36%, 59 cases) and low value group (rSO 2≤59.36%, 23 cases), Kaplan Meier survival curve analysis showed that there was significant difference in event free survival between the two groups ( P<0.001), the high value group significantly better than the low value group. Conclusion:The 24 h rSO 2 (mean) is an independent influencing factor for adverse events in ALLI patients, and has good predictive value for prognosis.

Evaluation of diagnostic efficacy and severity of necrotizing enterocolitis in premature infants by intestinal regional oxygen saturation and fecal calprotectin / 中国小儿急救医学

Objective:To evaluate the diagnostic value of intestinal regional oxygen saturation（rSO 2）and fecal calprotectin in the occurrence and severity of necrotizing enterocolitis（NEC）in premature infants. Methods:A prospective observational study was conducted among premature infants admitted to Quanzhou Children's Hospital from October 2019 to December 2022. Intestinal rSO 2 was monitored within two hours of diagnosis of NEC，and fecal calprotectin was measured. Results:A total of 60 patients were included, including 30 cases with NEC and 30 cases without NEC, 14 cases of medical NEC, 16 cases of surgical NEC, and eight infants died due to NEC. Infants with NEC had lower intestinal rSO 2 [49（30，60）% vs. 66（60，69）%] and higher calprotectin levels [479（297，886）μg/g vs. 203（113，275）μg/g] than those in infants without NEC ( P<0.01). The levels of intestinal rSO 2 were lower in surgical NEC than those in medical NEC，and were lower in the death group than that in the survival group ( P<0.01)，but no similar difference was found in the levels of calprotectin. ROC curve analysis showed that intestinal rSO 2 combined with calprotectin had a sensitivity of 73%，a specificity of 100%，and the largest area under curve of 0.91 in the diagnosis of NEC. Intestinal rSO 2 had an optimal cut-off value of 31% in predicting death in infants with NEC，with a sensitivity of 100%，a specificity of 95%，and an area under curve of 0.99. Conclusion:Intestinal rSO 2 and fecal calprotectin can effectively identify the presence of NEC，and their combined detection can improve the diagnostic efficiency. Intestinal rSO 2 is a good predictor of the severity of NEC，but not fecal calprotectin.

The application effect of anesthesia management based on cerebral oxygen saturation monitoring in elderly NSCLC radical surgery and its impact on cognitive function / 中国医师杂志

Objective:To explore the application effect of anesthesia management based on cerebral oxygen saturation monitoring in elderly non-small cell lung cancer (NSCLC) radical surgery and its impact on patient cognitive function.Methods:Ninety elderly NSCLC patients who were treated at the Sixth Affiliated Hospital of South China University of Technology from June 2022 to January 2023 were selected. The patients were divided into an observation group ( n=45) and a control group ( n=45) using the envelope method. Both groups underwent radical lung cancer surgery under general anesthesia, while the control group received routine anesthesia management and the observation group received anesthesia management based on cerebral oxygen saturation monitoring. The surgical time, intraoperative blood loss, anesthesia time, remifentanil dosage, and propofol dosage were observed in two groups. At the same time, differences in serum interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), and other levels were compared between the two groups. Results:There was no statistically significant difference in surgical time, intraoperative blood loss, anesthesia time, and remifentanil dosage between the two groups (all P>0.05); The dosage of propofol in the observation group was (880.41±41.06)mg, significantly lower than that in the control group ( P<0.05). The mean arterial pressure (MAP) and heart rate (HR) in the observation group were significantly higher than those in the control group at 5 minutes (T 1) and 30 minutes (T 2) after anesthesia (all P<0.05); The local cerebral oxygen saturation (rSO 2) and bispectral index (BIS) of the observation group at T 1, T 2, and postoperative (T 3) were significantly higher than those of the control group (all P<0.05). The serum levels of IL-6, CRP, PCT, tumor necrosis factor α (TNF-α), and S-100b in the observation group at 24 hours postoperatively were (13.36±1.22)mg/L, (10.08±1.12)ng/L, (0.94±0.15)ng/ml, (11.15±1.26)ng/L, and (1 445.15±180.05)ng/L, respectively, significantly lower than those in the control group (all P<0.05). The MMSE score of the observation group at 24 hours post surgery was (25.78±1.02), significantly higher than that of the control group ( P<0.05). The incidence of postoperative cognitive impairment in the observation group and the control group was 4.44%(2/45) and 8.89%(4/45), respectively, with no statistically significant difference ( P=0.673). Conclusions:Anesthesia management based on cerebral oxygen saturation monitoring has a good application effect in elderly NSCLC radical surgery, with small fluctuations in patient hemodynamic indicators, which can inhibit inflammatory factor levels and have a mild impact on postoperative cognitive function.

Value of near-infrared spectroscopy in monitoring intestinal tissue oxygen saturation in preterm infants with hemodynamically significant patent ductus arteriosus: a prospective research / 中国当代儿科杂志

OBJECTIVES@#To study the change in regional oxygen saturation (rSO@*METHODS@#The preterm infants with patent ductus arteriosus (PDA) who had gestational age <32 weeks and/or birth weight <1 500 g were prospectively enrolled, who were admitted to the Department of Neonatology, Shenzhen Longgang Central Hospital from October 2017 to October 2020.According to the diagnostic criteria for hsPDA, the preterm infants with patent ductus arteriosus (PDA) were divided into two groups: hsPDA and non-hsPDA. According to closure of the ductus arteriosus after oral administration of ibuprofen, the preterm infants in the hsPDA group were subdivided into two groups: hsPDA closure and hsPDA non-closure. Hemodynamic parameters were measured at diagnosis of PDA and after treatment, and the level of intestinal tissue rSO@*RESULTS@#A total of 241 preterm infants with PDA were enrolled, with 55 infants (22.8%) in the hsPDA group and 186 infants (77.2%) in the non-hsPDA group. There were 36 infants (65%) in the hsPDA closure group and 19 infants (35%) in the hsPDA non-closure group. Compared with the non-hsPDA group, the hsPDA group had a significantly higher left atrial diameter/aortic root diameter ratio and significantly lower left ventricular ejection fraction and fractional shortening (@*CONCLUSIONS@#hsPDA has an impact on intestinal tissue oxygenation in preterm infants, and continuous monitoring of intestinal tissue rSO

Changing trend of abdominal regional oxygen saturation in very/extremely low birth weight infants in the early postnatal stage: a prospective study / 中国当代儿科杂志

OBJECTIVES@#To study the changing trend of abdominal regional oxygen saturation (A-rSO@*METHODS@#The VLBW/ELBW infants who were admitted to the neonatal intensive care unit from September 2019 to May 2021 were enrolled as subjects. Near-infrared spectroscopy was used to monitor A-rSO@*RESULTS@#A total of 63 VLBW/ELBW infants were enrolled, with 30 infants in the <29 weeks group and 33 in the ≥29 weeks group. A-rSO@*CONCLUSIONS@#In infants with VLBW/ELBW, A-rSO

Combining regional oxygen saturation and lactate to predict early postoperative outcome in children undergoing congenital cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To assess the predictive abilities of postoperative regional oxygen saturation (rSO2) measured by near-infrared spectroscopy (NIRS) and lactate level for early postoperative outcome in children undergoing congenital heart disease surgery. Methods    A total of 73 children (43 males, 30 females, mean age of 91±18 days) undergoing cardiovascular surgery were enrolled from December 2016 to September 2017. The 73 children were divided into an early poor outcome group and a without poor outcome group. Binary logistic regression method was used to determine the independent factors of predicting early poor outcome. Receiver operating characteristic curve was used to identify the optimal cutoff values. Results    The early poor outcome rate was 47%. By regression analyses, nadir splanchnic rSO2 values, peak lactate level were 2 independent factors of predicting poor outcome. For nadir splanchnic rSO2 alone, the area under the ROC curve for poor outcome were 0.897. For peak lactate alone, the area under the ROC curve for poor outcome was 0.867. After combination of nadir splanchnic rSO2 and peak lactate, the area under the ROC curve for poor outcome increased to 0.944 (P<0.05). Conclusion    Combining the parameter of nadir splanchnic rSO2 and peak lactate during the first postoperatively 24 hours yielded to a more accurate predictive ability for early outcome in children undergoing congenital cardiac surgery.

Application of cerebral regional oxygen saturation monitoring in neonatal blood exchange transfusion / 中华实用儿科临床杂志

Objective@#To observe the changes in cerebral regional oxygen saturation (CrSO2) during neonatal blood exchange transfusion(BET) and its effect on the level of bilirubin in neonates with severe hyperbilirubinemia.@*Methods@#From January 2017 to March 2018, 52 newborns with severe hyperbilirubinemia were hospitalized in the Department of Neonatology, Children′s Hospital of Fudan University.Every newborn was treated with BET.Near infrared spectroscopy was used to monitor CrSO2 in the process of BET.The monitoring lasted from 2 hours before the beginning of BET to 2 hours after the completion of BET.The CrSO2 were recorded every 2 minutes and total surem bilirubin (TSB) and transcutaneous bilirubin(TCB) was measured.During this period, it is accompanied by the monitoring of neonatal body temperature, heart rate, respiration and bolld oxygen saturation(SpO2). The differences in CrSO2 changes at different time points during BET were compared.At the same time, the correlations between CrSO2 and blood oxygen saturation, TSB and TCB levels were analyzed.The results of repeated measurement analysis of variance compared between the two groups were corrected by Bonfferoni.@*Results@#Among the 52 children, there were 33 males (63.46%) and 19 females (36.54%). The gestational age, average birth weight and average head circumference of newborns were (38.6±2.1) weeks, (3 338±444) g and (33.6±3.2) cm, respectively.The Apgar score of newborn was (8.1±1.6) scores at 1 minute after birth.The level of TSB detected for the first time after admission was (457.9±97.8) μmol/L.The CrSO2 after BET (74.6%-76.0%) was significantly higher than that before BET (69.4%-69.0%), and the difference was statistically significant (P<0.05). Correlation analysis showed that during BET, CrSO2 showed a gradual upward trend, SpO2 also showed a synchronous increase, while the level of bilirubin showed a downward trend, and the downward trend of TSB level was more obvious than that of TCB.@*Conclusions@#CrSO2 can reflect the improvement of cerebral oxygenation during neonatal blood exchange transfusion and avoid cerebral hypoxia in the course of treatment.

Artroplastía total de hombro bajo monitoreo de la perfusión cerebral. Reporte del primer caso en México / Total shoulder arthroplasty under monitoring of cerebral perfusion. Report of the first case in Mexico

Resumen: Introducción: Desde hace algún tiempo es tema de controversia el mantenimiento de la perfusión cerebral durante la cirugía de hombro realizada en posición de silla de playa. El objetivo de este reporte es presentar el primer caso en México de una artroplastía total de hombro realizada con bloqueo interescalénico y monitoreo de la saturación cerebral de oxígeno. Este monitoreo se describió en 1977, pero sólo hasta la última década ha alcanzado relevancia desde el punto de vista clínico. Caso clínico: Paciente de 84 años programado para artroplastía total de hombro en posición de silla de playa bajo anestesia regional tipo bloqueo interescalénico guiado por ultrasonido, en la cual se monitoreó la saturación regional de oxígeno (CrSO2). Discusión: El monitoreo de la oximetría cerebral es una herramienta adecuada que nos permite tener una valoración continua durante todo el transanestésico, con lo que podemos tomar decisiones de forma más expedita. Con base en esto consideramos que este tipo de monitoreo debe ser básico en pacientes colocados en posición de silla de playa, así como el uso preponderante de anestesia regional; en los casos donde ésta no se pueda utilizar, este monitor es primordial.

Abstract: Introduction: The maintenance of cerebral perfusion during shoulder surgery performed in the beach chair position is controversial. The aim of this report is to present the first case in Mexico of a total shoulder arthroplasty performed with interscalene block and monitoring of the cerebral oxygen saturation. This monitoring was described in 1977, but only until the last decade has it reached relevance from the clinical point of view. Clinical case: We present an 84-year-old patient scheduled for total shoulder arthroplasty in beach chair position under regional anesthesia (ultrasound-guided interscalene block) in which the regional oxygen saturation (CrSO2) was monitored. Discussion: Monitoring of cerebral oximetry is a suitable tool that allows us to have a continuous assessment throughout the transanesthetic, so we can make decisions more expeditiously. On this basis, we believe that this type of monitoring should be fundamental in patients placed in a beach chair position, as well as predominantly use regional anesthesia. In cases where it cannot be used, this monitor is absolutely essential.

Evaluation of the prognosis of comatose patients in general ICU using cerebral oxygen saturation / 中华急诊医学杂志

Objective To investigate the correlation between regional cerebral oxygen saturation (rSO2) value and the prognosis of comatose patients in the intensive care unit (ICU).Methods From January 2013 to September 2014, a total of 64 comatose patients admitted in the department of ICU were enrolled.The patients were divided into two groups : consciousness group (n =25) and coma group (n =39).The level of the Glasgow coma scale (GCS), APACHE Ⅱ score and Full Outline of UnResponsiveness score (FOUR) of patients were monitored.The rSO2 was measured by Somanetics INVOS 5100 monitor.Results The differences in levels of FOUR and GCS at admission and GCS at discharge between the two groups were statistically significant (P ＜ 0.05).In the consciousness group, the levels of GCS、 FOUR and rSO2 were higher compared with the coma group (P ＜ 0.05).ROC curve analysis revealed that the areas under the curve of GCS, FOUR and rSO2 for predicting prognosis were 0.823 (0.718-0.928), 0.820 (0.728-0.912) and 0.924 (0.863-0.985) respectively.Conclusions The rSO2 was useful for estimating the prognosis of comatose patients in general ICU.