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1.
Ieee Journal of Selected Topics in Signal Processing ; 16(2):197-207, 2022.
Article in English | English Web of Science | ID: covidwho-1883130

ABSTRACT

Blood oxygen saturation (SpO(2)) is an important indicator forpulmonary and respiratory functionalities. Clinical findings on COVID-19 show that many patients had dangerously low blood oxygen levels not long before conditions worsened. It is therefore recommended, especially for the vulnerable population, to regularly monitor the blood oxygen level for precaution. Recent works have investigated how ubiquitous smartphone cameras can be used to infer SpO(2). Most of these works are contact-based, requiring users to cover a phone's camera and its nearby light source with a finger to capture reemitted light from the illuminated tissue. Contact-based methods may lead to skin irritation and sanitary concerns, especially during a pandemic. In this paper, we propose a noncontact method for SpO(2) monitoring using hand videos acquired by smartphones. Considering the optical broadband nature of the red (R), green (G), and blue (B) color channels of the smartphone cameras, we exploit all three channels of RGB sensing to distill the SpO(2) information beyond the traditional ratio-of-ratios (RoR) method that uses only two wavelengths. To further facilitate an accurate SpO(2) prediction, we design adaptive narrow bandpass filters based on accurately estimated heart rate to obtain the most cardiac-related AC component for each color channel. Experimental results show that our proposed blood oxygen estimation method can reach a mean absolute error of 1.26% when a pulse oximeter is used as a reference, outperforming the traditional RoR method by 25%.

2.
2nd IEEE International Conference on Technology, Engineering, Management for Societal Impact using Marketing, Entrepreneurship and Talent, TEMSMET 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1874351

ABSTRACT

In developing countries such as India, efficient use of resources and infrastructure is crucial in the light of healthcare crises such as the COVID-19 pandemic. Owing to overcrowded hospitals and inadequate medical infrastructure, traditional ways of examining and monitoring patients are ineffective. For the treatment of Chronic obstructive pulmonary diseases (COPDs) like COVID-19, monitoring a patient's SpO2 level along with the pulse rate is vital. This paper focuses on using IoT devices for documenting essential patient characteristics and performing data analytics on them for future predictions. Pulse oximeter sensor is used to obtain the patient's SpO2 level and pulse rate measurements. This sensor output is processed by Wi-Fi SoC NodeMCU. By unique identification of each patient, this data is displayed via a Mobile application to healthcare workers nearby. By analysing a patient's symptoms, a doctor can remotely regulate the supply of oxygen to the patient with the same mobile application. Machine learning algorithm is trained to analyse and predict a patient's future health conditions. With the adoption of such systems, the existing medical structure could improve vastly in its efficiency and capabilities during a healthcare crisis such as COVID-19. © 2021 IEEE.

3.
Value Health ; 25(6): 890-896, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1864607

ABSTRACT

OBJECTIVES: Since 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop symptoms necessitating a ventilator, some patients with COVID-19 can remain at home to mitigate hospital overcrowding. Remote pulse-oximetry (pulse-ox) monitoring of moderately ill patients with COVID-19 can be used to monitor symptom escalation and trigger hospital visits, as needed. METHODS: We analyzed the cost-utility of remote pulse-ox monitoring using a Markov model with a 3-week time horizon and daily cycles from a US health sector perspective. Costs (US dollar 2020) and outcomes were derived from the University Hospitals' real-world evidence and published literature. Costs and quality-adjusted life-years (QALYs) were used to determine the incremental cost-effectiveness ratio at a cost-effectiveness threshold of $100 000 per QALY. We assessed model uncertainty using univariate and probabilistic sensitivity analyses. RESULTS: Model results demonstrated that remote monitoring dominates current standard care, by reducing costs ($11 472 saved) and improving outcomes (0.013 QALYs gained). There were 87% fewer hospitalizations and 77% fewer deaths among patients with access to remote pulse-ox monitoring. The incremental cost-effectiveness ratio was not sensitive to uncertainty ranges in the model. CONCLUSIONS: Patient with COVID-19 remote pulse-ox monitoring increases the specificity of those requiring follow-up care for escalating symptoms. We recommend remote monitoring adoption across health systems to economically manage COVID-19 volume surges, maintain patients' comfort, reduce community infection spread, and carefully monitor needs of multiple individuals from one location by trained experts.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cost-Benefit Analysis , Humans , Monitoring, Physiologic , Oximetry , Quality-Adjusted Life Years , United States
4.
Lung India ; 39(SUPPL 1):S246, 2022.
Article in English | EMBASE | ID: covidwho-1857295

ABSTRACT

Introduction: Hypoxia is a very common symptom during this COVID-19 pandemic. Detailed history, clinical examination and relevant investigations are important in distinguishing rare causes from commonest. Case Report: 52-year-old lady presented to emergency room with sudden onset breathlessness. She was recently diagnosed with Idiopathic Thrombocytopenic Purpura (ITP). She was found to be hypoxic with a room air saturation of 82% in pulse oximeter. She was started on high flow oxygen. But her saturation didn't improve. Chest X-ray showed normal lung fields and bedside echocardiography revealed normal cardiac status. Point of care blood gas analysis (ABG) revealed a normal partial pressure of oxygen (Pao2-100). The discrepancy between oxygen saturation recorded in pulse oximetry and PaO2 in blood gas analysis tempted us to relook the ABG. It was found that the methaemoglobin level in ABG was 10.7%. When we analysed her drug history, we found that there was dapsone intake for the treatment of ITP which strongly supported us to reach the diagnosis of methemoglobinemia. She was then treated with intravenous methylene blue in the emergency room. She responded well and her repeated ABG revealed normalized level of methaemoglobin. Her hypoxia also resolved. Dapsone was later removed from her regular medications. Conclusion: Methemoglobinemia is an extremely rare cause for hypoxia. Though rare its potentially life threatening if not identified on time. Refractory hypoxia with a discrepancy in spo2 and PaO2 should raise the suspicion of methemoglobinemia. IV methylene blue is the recommended treatment for methemoglobinemia.

5.
Lung India ; 39(SUPPL 1):S17-S18, 2022.
Article in English | EMBASE | ID: covidwho-1857121

ABSTRACT

Introduction: Lung functions impairment in covid-19 pneumoniasurvivors cause continued symptoms.Forced oscillation technique (FOT) and impulse oscillometry are valuable in serial monitoring and management of postcovid respiratory symptoms. We aimed to study changes in pulmonary mechanics over 1 year period in covid-19 survivors. Methods: Covid-19 survivors of mixed severity of 18-80 age group underwent serial measurements of FOT using Antlia Caltech © device: on the first follow-up post-discharge, second at 4 weeks after the first and third one-year post-diagnosis of Covid-19. Demographic details, pulse oximetry at rest and modified medical research council scale (mMRC) for dyspnea were recorded at each visit. Pre and post-bronchodilator resistance and reactance were analysed. Results: Out of 94 patientsenrolled,17 completed 1-year follow-up post-covid. 3 patients had moderate, 1 severe and 13 mild covid-19 disease.Age group of participant was 45-75 years (Mean= 58.1±2.2) consisting of 13 males and 4 females. 4 had diabetes and an equal number had hypertension. Rest were without any comorbidity. Small airway resistance R5-R20 was0.87±0.57, [0.25-2.03] (Mean±SD, Range. (n=17), p=0.047), 0.79±0.52, [0.01- 1.93] and 0.66±0.49, [-0.05 - 1.59] similarly reactance-X5 was -0.18±0.12, [-0.43-(-0.04)], -0.16±0.1, [-0.36 - 0.001] and -0.16±0.13, [-0.47-(-0.03)] at first visit, 4 weeks and after 1 year respectively. Results of post-bronchodilator change in small airways are depicted in Figure-1. Conclusion: We found statistically significant change towards improvement in small airway resistance R5-R20. Reactance at 5Hz-X5during monitoring period showed decremental change over a year. Some post-bronchodilator reversibility persisted at the end of 1 year.

6.
IEEE Sensors Journal ; 2022.
Article in English | Scopus | ID: covidwho-1846126

ABSTRACT

The blood oxygen saturation level (SpO2) has become one of the vital body parameters for the early detection, monitoring, and tracking of the symptoms of coronavirus diseases 2019 (COVID-19) and is clinically accepted for patient care and diagnostics. Pulse oximetry provides non-invasive SpO2 monitoring at home and ICUs without the need of a physician/doctor. However, the accuracy of SpO2 estimation in wearable pulse oximeters remains a challenge due to various non-idealities. We propose a method to improve the estimation accuracy by denoising the red and IR signals, detecting the signal quality, and providing feedback to hardware to adjust the signal chain parameters like LED current or transimpedance amplifier gain and enhance the signal quality. SpO2 is calculated using the red and infrared photoplethysmogram (PPG) signals acquired from the wrist using Texas Instruments AFE4950EVM. We introduce the green PPG signal as a reference to obtain the window size of the moving average filter for baseline wander removal and as a timing reference for peak and valley detection in the red and infrared PPG signals. We propose the improved peak and valley detection algorithm based on the incremental merge segmentation algorithm. Kurtosis, entropy, and Signal-to-noise ratio (SNR) are used as signal quality parameters, and SNR is further related to the variance in the SpO2 measurement. A closed-loop implementation is performed to enhance signal quality based on the signal quality parameters of the recorded PPG signals. The proposed algorithm aims to estimate SpO2 with a variance of 1% for the pulse oximetry devices. IEEE

7.
The New England Journal of Medicine ; 386(19):1780, 2022.
Article in English | ProQuest Central | ID: covidwho-1839615

ABSTRACT

Antihypertensive agents and magnesium sulfate can help control the systemic manifestations of preeclampsia, which is usually resolved by delivery of the placenta. see Review Article, N Engl J Med 2022;386:1817-1832 Emphysematous Aortitis A 74-year-old man with end-stage kidney disease and coronary artery disease presented with decreased responsiveness, anorexia, and generalized weakness. [...]its struggles to enact a broader reform agenda reflect the daunting political constraints that limit U.S. health policy. see Perspective, N Engl J Med 2022;386:1773-1775 Supporting Innovation in Medicaid Policy Randomized, controlled trials remain underutilized within the Medicaid program, even though state Medicaid programs regularly implement new policies that require evaluation. What are the key barriers to implementing RCTs in Medicaid, and how can we increase their use? see Perspective, N Engl J Med 2022;386:1775-1777 Unmute Early in the Covid pandemic, the lead staffer on a state ventilator allocation committee follows the group’s virtual deliberations, while attending to the constant needs of her children and trying to avert exposure from her husband who’s caring for patients in the ICU. see Perspective, N Engl J Med 2022;386:1777-1779 Protection from Covid-19 after Third Vaccine Dose In a cohort of frontline health care workers, a third dose of an mRNA vaccine provided 91% protection against SARS-CoV-2 infection with the delta variant and 60% against the omicron variant. see Correspondence, N Engl J Med 2022;386:1855-1857 Pulse Oximetry in Covid-19 Pulse oximetry is frequently used to monitor the respiratory status of outpatients with Covid-19.

8.
Acta Odontologica Turcica ; 39(2):45-51, 2022.
Article in English | ProQuest Central | ID: covidwho-1837184

ABSTRACT

in English is at the end of the manuscript] Objective: This study aimed to evaluate the effect of long-term use of N95 masks on dentists' oxygen saturation values and pulse rates due to dental procedures performed during the COVID-19 pandemic, and to determine the subjective complaints that occur during use. Participants scored subjective symptoms ranging from 1 to 10, including questions about nausea, headache, dizziness, visual impairment, shortness of breath, tachycardia, confusion, communication difficulties, fatigue, breath odor, mask moisture, temperature, and itching. Nausea, visual impairment, temperature, and itching scores in the female group were significantly higher than the male group (p=0.001). Istatistiksel analizler için NCSS (Number Cruncher Statistical System) 2007 (Kaysville, UT, ABD) programi kullanildi.

9.
Respir Care ; 67(7): 801-806, 2022 07.
Article in English | MEDLINE | ID: covidwho-1835300

ABSTRACT

BACKGROUND: Pulse oximeters are often used at home by patients with chronic respiratory diseases and more recently for remote monitoring of patients with COVID-19. There are no published data outside a supervised telemedicine setting regarding patients' experiences with these devices. Our objective was to explore patients' usage patterns and perceptions of using pulse oximetry at home. METHODS: Patients with chronic respiratory disease who had a pulse oximeter at home were recruited to complete a structured survey. RESULTS: Thirty participants with a range of chronic respiratory diseases (mean age 71 y, 16 females) were recruited. Most participants (83%) used home oxygen therapy. Pulse oximeters were bought online (46.7%), at a pharmacy (40%), at a medical equipment store (6.7%), through a clinic (3.3%), or from an oxygen supplier (3.3%). Use was self-initiated in 56.7% of cases and was based on a health care-related recommendation in 26.7% of cases. Sixty percent of participants used the oximeter daily, with 90% expressing confidence in interpreting their oximeter readings primarily due to education from health care professionals and in-patient experiences. Almost all participants adjusted their activity levels or management based upon oximeter readings. Most participants reported that using a pulse oximeter at home was helpful in judging their physical limitations and provided reassurance and confidence in their disease management. CONCLUSIONS: Subjects appeared confident in their use of home pulse oximetry. Health professionals should identify patients who use pulse oximeters for monitoring and ensure that they are able to interpret readings correctly and, if appropriate, adjust management safely.


Subject(s)
COVID-19 , Lung Diseases , Respiration Disorders , Aged , Female , Humans , Oximetry , Oxygen
10.
JMIR Biomedical Engineering ; 7(1), 2022.
Article in English | ProQuest Central | ID: covidwho-1834175

ABSTRACT

Background: Many commodity pulse oximeters are insufficiently calibrated for patients with darker skin. We demonstrate a quantitative measurement of this disparity in peripheral blood oxygen saturation (SpO2) with a controlled experiment. To mitigate this, we present OptoBeat, an ultra–low-cost smartphone-based optical sensing system that captures SpO2 and heart rate while calibrating for differences in skin tone. Our sensing system can be constructed from commodity components and 3D-printed clips for approximately US $1. In our experiments, we demonstrate the efficacy of the OptoBeat system, which can measure SpO2 within 1% of the ground truth in levels as low as 75%. Objective: The objective of this work is to test the following hypotheses and implement an ultra–low-cost smartphone adapter to measure SpO2: skin tone has a significant effect on pulse oximeter measurements (hypothesis 1), images of skin tone can be used to calibrate pulse oximeter error (hypothesis 2), and SpO2 can be measured with a smartphone camera using the screen as a light source (hypothesis 3). Methods: Synthetic skin with the same optical properties as human skin was used in ex vivo experiments. A skin tone scale was placed in images for calibration and ground truth. To achieve a wide range of SpO2 for measurement, we reoxygenated sheep blood and pumped it through synthetic arteries. A custom optical system was connected from the smartphone screen (flashing red and blue) to the analyte and into the phone’s camera for measurement. Results: The 3 skin tones were accurately classified according to the Fitzpatrick scale as types 2, 3, and 5. Classification was performed using the Euclidean distance between the measured red, green, and blue values. Traditional pulse oximeter measurements (n=2000) showed significant differences between skin tones in both alternating current and direct current measurements using ANOVA (direct current: F2,5997=3.1170 × 105, P<.01;alternating current: F2,5997=8.07 × 106, P<.01). Continuous SpO2 measurements (n=400;10-second samples, 67 minutes total) from 95% to 75% were captured using OptoBeat in an ex vivo experiment. The accuracy was measured to be within 1% of the ground truth via quadratic support vector machine regression and 10-fold cross-validation (R2=0.97, root mean square error=0.7, mean square error=0.49, and mean absolute error=0.5). In the human-participant proof-of-concept experiment (N=3;samples=3 × N, duration=20-30 seconds per sample), SpO2 measurements were accurate to within 0.5% of the ground truth, and pulse rate measurements were accurate to within 1.7% of the ground truth. Conclusions: In this work, we demonstrate that skin tone has a significant effect on SpO2 measurements and the design and evaluation of OptoBeat. The ultra-low-cost OptoBeat system enables smartphones to classify skin tone for calibration, reliably measure SpO2 as low as 75%, and normalize to avoid skin tone–based bias.

11.
Sensors (Basel) ; 22(9)2022 Apr 29.
Article in English | MEDLINE | ID: covidwho-1820361

ABSTRACT

Nowadays, pulse oximetry has become the standard in primary and intensive care units, especially as a triage tool during the current COVID-19 pandemic. Hence, a deeper understanding of the measurement errors that can affect precise readings is a key element in clinical decision-making. Several factors may influence the accuracy of pulse oximetry, such as skin color, body temperature, altitude, or patient movement. The skin pigmentation effect on pulse oximetry accuracy has long been studied reporting some contradictory conclusions. Recent studies have shown a positive bias in oxygen saturation measurements in patients with darkly pigmented skin, particularly under low saturation conditions. This review aims to study the literature that assesses the influence of skin pigmentation on the accuracy of these devices. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to conduct a systematic review retrospectively since February 2022 using WOS, PubMed, and Scopus databases. We found 99 unique references, of which only 41 satisfied the established inclusion criteria. A bibliometric and scientometrics approach was performed to examine the outcomes of an exhaustive survey of the thematic content and trending topics.


Subject(s)
COVID-19 , Skin Pigmentation , Bibliometrics , Humans , Oximetry , Oxygen , Pandemics , Retrospective Studies
12.
Br J Anaesth ; 2022 Apr 13.
Article in English | MEDLINE | ID: covidwho-1797123

ABSTRACT

Recent reports highlight potential inaccuracies of pulse oximetry in patients with various degrees of skin pigmentation. We summarise the literature, provide an overview of potential clinical implications, and provide insights into how pulse oximetry could be improved to mitigate against such potential shortcomings.

13.
2021 IEEE International Humanitarian Technology Conference, IHTC 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1784503

ABSTRACT

A remote monitoring device for measuring oxygen saturation by finger pulse oximetry, axillary temperature and respiratory rate has been constructed. This device has been tested in a pilot study on patients with confirmed Covid-19, determined by antigen tests, who were undergoing home quarantine. The system uses a Raspberry pi CPU with a PiCamera attached to perform optical character recognition from the displays of low-cost finger pulse oximeters and digital axillary thermometers. The temperature of the finger being measured using pulse oximetry was also recorded, as an additional variable, using a thermistor in contact with the finger. In a pilot prototype validation study, undertaken in Peru with eleven patients, the average oxygen saturation of patients living at 3350 meters above sea level was 92.88%, with a standard deviation of 1.65%. A patient with moderate symptoms and a patient with a deteriorating condition had temporary saturation levels below 88%. Axillary temperature and respiratory rate did not vary considerably over the study period. Finger temperature data was used to determine correct human-computer interaction with respect to measurement errors, failed attempts and to control sampling efficiency, which can be affected by cold fingers. © 2021 IEEE.

14.
Int J Med Inform ; 162: 104735, 2022 Mar 18.
Article in English | MEDLINE | ID: covidwho-1747896

ABSTRACT

BACKGROUND AND OBJECTIVES: The need to monitor patients outside of a formal clinical setting, such as a hospital or ambulatory care facility, has become increasingly important since COVID-19. It introduces significant challenges to ensure accurate and timely measurements, maintain strong patient engagement, and operationalise data for clinical decision-making. Remote Patient Monitoring (RPM) devices like the pulse oximeter help mitigate these difficulties, however, practical approaches to successfully integrate this technology into existing patient-clinician interactions that ensure the delivery of safe and effective care are vital. The objective of this scoping review was to synthesise existing literature to provide an overview of the variety of user perceptions associated with pulse oximeter devices, which may impact patients' and clinicians' acceptance of the devices in a RPM context. METHODS: A search over three databases was conducted between April 2021 - June 2021 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. A total of 16 articles were included in this scoping review. RESULTS: Results indicate there has been an increase in use of pulse oximeters across hospital and community settings for continuous vital signs monitoring and remote monitoring of patients over time. Research in this area is shifting towards increasing accessibility of care through the development and implementation of telehealth systems and phone oximeters. Aspects of pulse oximeter UX most frequently investigated are usability and acceptability, however, these terms are often undefined, or definitions vary across studies. Perceived effectiveness, opportunity costs, and attitude towards use remain unexplored areas of UX. Overall, patients and clinicians view the pulse oximeter positively and find it user-friendly. A high level of learnability was found for the device and additional benefits included increasing patient self-efficacy and clinician motivation to work. However, issues getting an accurate reading due to device usability are still experienced by some patients and clinicians. CONCLUSION: This scoping review is the first to summarise user perceptions of the pulse oximeter in a healthcare context. It showed that both patients and clinicians hold positive perceptions of the pulse oximeter and important factors to consider in designing user-focused services include ease-of-use and wearability of devices; context of use including user's prior health and IT knowledge; attitude towards use and perceived effectiveness; impact on user motivation and self-efficacy; and finally, potential user costs like inconvenience or increased anxiety. With the rapid increase in research studies examining pulse oximeter use for RPM since COVID-19, a systematic review is warranted as the next step to consolidate evidence and investigate the impact of these factors on pulse oximeter acceptance and effectiveness.

15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S325, 2021.
Article in English | EMBASE | ID: covidwho-1746548

ABSTRACT

Background. Constraints on resources require healthcare systems to implement alternative and innovative means for delivering care. The COVID-19 pandemic amplified this issue throughout the world, leading to shortages of ventilators, hospital beds, and healthcare personnel. We report the results of an Acute Care at Home Program (ACHP) response to COVID-19, providing in-home hospital-level care to patients with mild symptoms, preserving in-hospital beds for more serious illness. Methods. Patients with COVID-19 were selected for ACHP after undergoing risk stratification for severe disease, including oxygen evaluation, time course of illness, and evaluation of comorbidities. Patients admitted to ACH met inpatient criteria, required oxygen supplementation of ≤4 liters, and received insurance approval. Services were provided consistent with best practice of inpatient care, including 24/7 provider availability via TeleMedicine, bedside care provided by paramedics and nurses, respiratory therapy, radiology and laboratory services, pulse oximetry monitoring, and administration of medications. Protocols existed for patient transfer to hospital in the event of clinical deterioration. Results. Our initial cohort included 62 patients enrolled October 1, 2020 - May 31, 2021. Of these, 57 patients were discharged successfully from ACHP. Patients presented with initial oxygen requirements of 0-4 liters. Average length-of-stay in ACHP was 5.4 days. Five patients required hospitalization after enrollment in ACHP;one subsequently expired, two were discharged home, one returned to ACHP after inpatient hospitalization, and one remains hospitalized. One additional patient that was successfully discharged home from ACHP was later readmitted and expired in a subsequent hospitalization. The patients that expired had significant immunocompromising conditions that may have contributed to their outcomes. Conclusion. ACHP can provide care equivalent to hospitalization for select COVID-19 patients. Immunocompromised hosts with COVID-19 may represent a subset of patients in which in-house hospitalization must be carefully considered, even with mild oxygen requirements. Health systems should consider ACHP as a substitution for hospitalization for COVID-19 patients with mild symptoms.

16.
Open Forum Infectious Diseases ; 8(SUPPL 1):S350-S351, 2021.
Article in English | EMBASE | ID: covidwho-1746499

ABSTRACT

Background. Patients affected by COVID-19 pneumonia who present severe symptoms with manifest hypoxemia and cytokine storm have a high mortality rate, which is why therapies focused on reducing inflammation and improving lung function have been used, one of them being jakinibs through of the blocking of the JAK tracks. Methods. Patients who presented data of severe pneumonia due to COVID-19 with data of severe hypoxemia and cytokine storm were selected, from June to August 2020, to whom the SaO2/FiO2 ratio is measured at the beginning, intermediate and end of treatment, as well as D dimer and serum ferritin. Comorbidity and drugs taken previously are analyzed. The patients being cared for at home. Results. We included data from 30 patients, 8 (27%) women and 22 (73%) men, with a median age of 58.5 (46.5 - 68.0) years. 23 patients (77%) had comorbidities, the most frequent being arterial hypertension (43%), followed by obesity (30%), type 2 diabetes mellitus (27%), among others. In the laboratory, the medians of D-Dimer 982 ng/ mL, Ferritin 1,375 ng/mL and C-Reactive Protein 10.0 mg/dL. Regarding the use of previous medications, we found that 29 (97%) patients had treatment with some medication, the most frequent: azithromycin (77%), ivermectin (53%) and dexamethasone (47%). The median number of medications received was 3. The initial pulse oximetry (SaO2) measurement with room air had a median of 80.5% and the median SaO2/FiO2 (SAFI) was 134;Regarding the type of SIRA, 90% had moderate SIRA and 10% had severe SIRA. The median day of evolution on which baricitinib was started was 10 days, all received 4 mg/day, and the median days of treatment with baricitinib was 14.0 days. At follow-up, SaO2 at 7 days had a median of 93.0% and the median SAFI at 7 days was 310.0;the median SaO2 at 14 days was 95.0% and the median SAFI at 14 days was 452.0. In comparative analysis, baseline SaO2/SAFI was significantly lower compared to 7 and 14 days (p = 0.001 for both comparisons). The outcomes, 27 (90%) patients improved and there were 3 (10%) who died. Conclusion. Baricitinib therapy in these patients with severe COVID-19 pneumonia who present with severe hypoxemia and cytokine storm presented good results by improving clinical status and pulmonary failure, with patients being cared for at home and avoiding mechanical ventilation.

17.
Open Forum Infectious Diseases ; 8(SUPPL 1):S355-S356, 2021.
Article in English | EMBASE | ID: covidwho-1746490

ABSTRACT

Background. There is a lack of data specifically addressing the effects of triple therapy consisting of baricitinib plus remdesivir plus dexamethasone compared to dual therapy with remdesivir plus dexamethasone among patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia. Methods. This retrospective study enrolled hospitalized adults with SARSCoV-2 receiving supplemental oxygen without invasive mechanical ventilation (IMV) being treated baricitinib (≤10 days) plus remdesivir (≤10 days) plus dexamethasone (≤10 days) or remdesivir (≤10 days) plus dexamethasone (≤10 days). The primary endpoint was 28-day mortality. Secondary objectives of this study were to measure progression to IMV, pulse oximetry (SpO2)/fraction of inspired oxygen (FiO2) from hospitalization to discharge, hospital length of stay (LOS), 14-day mortality, 14-day hospital readmissions, inflammatory markers, and safety outcomes. Results. Among patients receiving supplemental oxygen without IMV, 28-day mortality for triple therapy vs. dual therapy was 20% and 24%, respectively (P=1.000). The effect of triple therapy compared to dual therapy on lung function was demonstrated by a 76% vs. 25% increase in SpO2/FiO2. This benefit must be contextualized by an increased progression to IMV among patients receiving triple therapy compared to dual therapy (10 patients [50%] vs. 7 patients [28%], respectively;P=0.130). The increased incidence of IMV translated to a significantly longer hospital LOS among patients receiving triple therapy compared to dual therapy (26 days vs. 17 days, respectively;P=0.001). Conclusion. In patients receiving supplemental oxygen without IMV for SARSCoV-2, triple therapy was not associated with a clinically meaningful reduction in 28-day mortality when compared to dual therapy.

18.
Lancet Global Health ; 10(3):E348-E359, 2022.
Article in English | Web of Science | ID: covidwho-1743631

ABSTRACT

Background Pneumonia accounts for around 15% of all deaths of children younger than 5 years globally. Most happen in resource-constrained settings and are potentially preventable. Hypoxaemia is one of the strongest predictors of these deaths. We present an updated estimate of hypoxaemia prevalence among children with pneumonia in low-income and middle-income countries. Methods We conducted a systematic review using the following key concepts "children under five years of age" AND "pneumonia" AND "hypoxaemia" AND "low-and middle-income countries" by searching in 11 bibliographic databases and citation indices. We included all articles published between Nov 1, 2008, and Oct 8, 2021, based on observational studies and control arms of randomised and non-randomised controlled trials. We excluded protocol papers, articles reporting hypoxaemia prevalence based on less than 100 pneumonia cases, and articles published before 2008 from the review. Quality appraisal was done with the Joanna Briggs Institute tools. We reported pooled prevalence of hypoxaemia (SpO(2) <90%) by classification of clinical severity and by clinical settings by use of the random-effects meta-analysis models. We combined our estimate of the pooled prevalence of pneumonia with a previously published estimate of the number of children admitted to hospital due to pneumonia annually to calculate the total annual number of children admitted to hospital with hypoxaemic pneumonia. Findings We identified 2825 unique records from the databases, of which 57 studies met the eligibility criteria: 26 from Africa, 23 from Asia, five from South America, and four from multiple continents. The prevalence of hypoxaemia was 31% (95% CI 26-36;101 775 children) among all children with WHO-classified pneumonia, 41% (33-49;30 483 children) among those with very severe or severe pneumonia, and 8% (3-16;2395 children) among those with non-severe pneumonia. The prevalence was much higher in studies conducted in emergency and inpatient settings than in studies conducted in outpatient settings. In 2019, we estimated that over 7 million children (95% CI 5-8 million) were admitted to hospital with hypoxaemic pneumonia. The studies included in this systematic review had high t(2) (ie, 0.17), indicating a high level of heterogeneity between studies, and a high I-2 value (ie, 99.6%), indicating that the heterogeneity was not due to chance. This study is registered with PROSPERO, CRD42019126207. Interpretation The high prevalence of hypoxaemia among children with severe pneumonia, particularly among children who have been admitted to hospital, emphasises the importance of overall oxygen security within the health systems of low-income and middle-income countries, particularly in the context of the COVID-19 pandemic. Even among children with non-severe pneumonia that is managed in outpatient and community settings, the high prevalence emphasises the importance of rapid identification of hypoxaemia at the first point of contact and referral for appropriate oxygen therapy. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

19.
Indian J Pediatr ; 2022 Mar 11.
Article in English | MEDLINE | ID: covidwho-1739428

ABSTRACT

OBJECTIVE: To compare postductal heart rate and saturation (SpO2) measurements from the wireless PO device obtained by iVital+ against measurements by the standard Masimo (SET technology) monitor in the monitoring of neonates. METHODS: Pulse oximetry reading of newborns were assessed in terms of heart rate and saturations with two PO simultaneously attached to postductal site and data comparison was done. RESULTS: Out of the 1000 cumulative recordings, the mean difference between HR obtained from both PO was 0.415 and level of agreement was 2.3 beats per minute. For SpO2 mean difference between devices was 1.21 and level of agreement was 1.5%. There was very little difference between SpO2 measurements when the Masimo SpO2 was ≥ 70%. CONCLUSION: As this pulse oximeter is small, portable and accuracy is as comparable to Masimo, this provides a good solution for efficaciously monitoring neonates. It can also be used in the monitoring of children with suspected or affected with COVID-19 in hospital and ICU settings as also in the quarantine facilities. This reduces the need for constant presence of medical and nursing personnel.

20.
Biomedical Signal Processing and Control ; 75:103627, 2022.
Article in English | ScienceDirect | ID: covidwho-1734225

ABSTRACT

The Pandemic COVID-19 situation, a pulse Oximetry is significant to detect a varying blood oxygen saturation of a patient who needed the device to operate with continuous, rapid, high accuracy, and immune of moving artifacts. In this article, three main schemes for low-complexity pulse oximetry detection are proposed. In the first scheme, the light absorbance ratio (R) is obtained by separating the red and infrared photoplethysmography (PPG) amplitude modulation (AM) signals from the frequency-division multiplexing (FDM) signal with two different bandpass filters (BPFs), determining the ratio of modulation index of red and infrared PPG AM signals. In the second scheme, the output PPG AM signals for the red and infrared light wavelengths from the BPFs are transformed into the frequency domain such that the AC components of both PPG AM signals are the magnitudes of the highest peaks in their respective sidebands, while the DC components are the magnitude of their carrier frequencies;then, the AC/DC ratio of the red PPG AM signal is divided by the AC/DC ratio of the infrared PPG AM signal is R. In the last scheme, the FDM signal is transformed into the frequency domain without being passed through any BPF, and R is obtained in the same way as in the same second scheme. Experimental results obtained by using the first scheme have an average error of about 0.7138%, for the second and the last scheme have an average error of about 1%, and all the methods agree with the corresponding mathematical model.

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