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1.
Medicine (Baltimore) ; 99(43): e22884, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120832

RESUMO

Delirium is a neuropsychiatric syndrome commonly encountered in critically ill patients, and systemic inflammation has been strongly implicated to underlie its pathophysiology. This study aimed to investigate the predictive value of the platelet-to-lymphocyte ratio (PLR) for delirium in the intensive care unit (ICU).In this retrospective observational study, we analyzed the clinical and laboratory data of 319 ICU patients from October 2016 to December 2017. Using the Locally Weighted Scatterplot Smoothing technique, a PLR knot was detected at a value of approximately 100. Logistic regression was used to investigate the association between the PLR and delirium.Of the 319 patients included in this study, 29 (9.1%) were diagnosed with delirium. In the delirium group, the duration of mechanical ventilation was significantly longer than that in the no-delirium group (40.2 ±â€Š65.5 vs. 19.9 ±â€Š26.5 hours, respectively; P < .001). A multiple logistic regression analysis showed that PLR > 100 (odds ratio [OR]: 1.003, 95% confidence interval [CI]: 1.001-1.005), age (OR: 2.76, 95% CI: 1.110-6.861), and the ratio of arterial oxygen partial pressure to the inspired oxygen fraction (OR: 0.996, 95% CI: 0.992-0.999) were independent predictors of delirium.In our study, a high PLR value on ICU admission was associated with a higher incidence of delirium. Owing to easy calculability, the PLR could be a useful delirium predictive index in ICUs, thereby enabling early interventions to be implemented.


Assuntos
Plaquetas/citologia , Estado Terminal/psicologia , Delírio/sangue , Linfócitos/citologia , Idoso , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Estudos de Casos e Controles , China/epidemiologia , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/fisiopatologia , Feminino , Humanos , Incidência , Inflamação/metabolismo , Inflamação/patologia , Inalação/fisiologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Oxigênio/análise , Valor Preditivo dos Testes , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos
2.
PLoS One ; 15(9): e0239930, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986780

RESUMO

BACKGROUND: In our clinic, a substantial number of patients present with transtibial residual limb pain of no specific somatic origin. Silicone liner induced tissue compression may reduce blood flow, possibly causing residual limb pain. Thus, as a first step we investigated if the liner itself has an effect on transcutaneous oxygen pressure (TcPO2). METHODS: Persons with unilateral transtibial amputation and residual limb pain of unknown origin were included. Medical history, including residual limb pain, was recorded, and the SF-36 administered. Resting TcPO2 levels were measured in the supine position and without a liner at 0, 10, 20 and 30 minutes using two sensors: one placed in the Transverse plane over the tip of the Tibia End (= TTE), the other placed in the Sagittal plane, distally over the Peroneal Compartment (= SPC). Measurements were repeated with specially prepared liners avoiding additional pressure due to sensor placement. Statistical analyses were performed using SPSS. RESULTS: Twenty persons (9 women, 11 men) with a mean age of 68.65 years (range 47-86 years) participated. The transtibial amputation occurred on average 43 months prior to study entry (range 3-119 months). With liner wear, both sensors measured TcPO2 levels that were significantly lower than those measured without a liner (TTE: p < 0.001; SPC: p = 0.002) after 10, 20 and 30 minutes. No significant differences were found between TcPO2 levels over time between the sensors. There were no significant associations between TcPO2 levels and pain, smoking status, age, duration of daily liner use, mobility level, and revision history. CONCLUSION: Resting TcPO2 levels decreased significantly while wearing a liner alone, without a prosthetic socket. Further studies are required to investigate the effect of liner wear on exercise TcPO2 levels.


Assuntos
Cotos de Amputação/fisiopatologia , Amputação , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Membro Fantasma/sangue , Descanso , Tíbia/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Membro Fantasma/etiologia , Fatores Sexuais , Silicones
3.
Aging (Albany NY) ; 12(16): 15946-15953, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32833671

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) is the virus responsible for the coronavirus disease 2019(COVID-19) pandemic. Despite the extensive studies aiming to understand the pathology of COVID-19, the clinicopathological characteristics and risk factors associated with COVID-19 remain mostly unclear. In this study, we assessed the clinical course and features of COVID-19 patients. FINDINGS: There were 59 patients (54.1%) that had no fever. One-hundred(91.7%) patients required oxygen therapy, which improved percutaneous oxygen saturation (SpO2). Seventy-two (66.1%) patients aged over 60; these patients were more likely to develop respiratory symptoms. Only 13(11.9%) patients were positive for anti-SARS-CoV-2 antibodies, SARS-CoV-2 nucleic acid, and computed tomography (CT) findings. We found significant differences in age, respiratory symptoms, and heart rates between patients with and without underlying conditions. CONCLUSIONS: Our findings suggest that oxygen plays an important role in the treatment of COVID-19 patients and that age and underlying diseases are significant risk factors for COVID-19. Most COVID-19 patients have no fever, and CT provides higher detection rates than antibody- and nucleic acid-based detection methods. METHODS: We analyzed data from 109 confirmed COVID-19 cases. We compared the clinicopathological characteristic of patients stratified according to age and underlying diseases, as well as assessed the detection rates of different diagnostic methods.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus , Oxigenoterapia/métodos , Pandemias , Pneumonia Viral , Fatores Etários , Idoso , Monitorização Transcutânea dos Gases Sanguíneos/métodos , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Avaliação de Sintomas/métodos
4.
Surg Clin North Am ; 100(4): 807-822, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681878

RESUMO

Peripheral arterial disease (PAD) affects many individuals worldwide and is associated with increased morbidity and mortality. Controversy exists on whether or not to screen asymptomatic patients. Further complicating this is that many patients with a chronic lower extremity wound are often asymptomatic. PAD and traditional noninvasive vascular studies may be inaccurate in providing a correct diagnosis. A review of current and novel vascular assessment modalities along with their benefits and limitations are presented here. A combination of these vascular assessments may help improve accuracy in diagnosis, providing timely care to those patients in need.


Assuntos
Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/fisiopatologia , Índice Tornozelo-Braço , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Humanos , Pele/irrigação sanguínea , Dermatopatias Vasculares/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Sístole/fisiologia , Cicatrização/fisiologia
5.
Med. intensiva (Madr., Ed. impr.) ; 44(4): 233-228, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190575

RESUMO

OBJETIVO: Los valores de capnometría durante la resucitación son un factor predictor de la evolución de los riñones obtenidos a partir de donantes en asistolia no controlada. DISEÑO: Cohorte de comienzo retrospectivo de 37 donantes en asistolia y cohorte de validación de 55 trasplantados de riñón, entre 2013-2017. Ámbito: Población atendida por el servicio de urgencias y derivada al Hospital Universitario 12 de Octubre, Madrid, como potenciales donantes en asistolia no controlada. PACIENTES: Cincuenta y cinco trasplantados renales con hemodiálisis, procedentes de donantes en asistolia no controlada. INTERVENCIONES: Determinaciones de capnometría y capnografía en pacientes candidatos a donación en asistolia no controlada. Variables: Calores de capnometría inicial y en el momento de la transferencia en el hospital para su comparación con la viabilidad de los riñones extraídos; fallo renal y retraso en función renal. RESULTADOS: Treinta y siete potenciales donantes de los que se consiguen 30 utilizados, de los cuales se trasplantan 55 riñones. El resto de ellos fueron descartados por mala perfusión o signos de isquemia. Se encontró una asociación (p = 0,016) entre valores de capnometría durante la resucitación en los donantes utilizados (μ, = 22,8 mmHg) frente a los donantes no utilizados para el trasplante (μ, = 17,35 mmHg). CONCLUSIONES: Se ha demostrado que los valores de capnometría durante las maniobras de resucitación ofrecen un marcador a tener en cuenta en relación con la viabilidad de los órganos a trasplantar en la donación en asistolia no controlada


OBJECTIVE: The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. DESIGN: The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 trasplanted kidneys in the period 2013-2017. Scope: The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. PATIENTS: A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. INTERVENTIONS: Capnometry and capnography measurements in potential uncontrolled non-heart beating donors. Variables: Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. RESULTS: A total of 55 out of 74 extracted kidneys were trasplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (P = .016) between the capnometry values during resuscitation in the grafted kidneys (μ = 22.8 mmHg) and in the kidneys discarded for transplantation (μ = 17.35 mmHg). CONCLUSIONS: Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the trasplanted organs in uncontrolled non-heart beating donors


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Transplante de Rim , Parada Cardíaca/complicações , Doadores de Tecidos , Estudos de Coortes , Reanimação Cardiopulmonar , Estudos Retrospectivos , Análise Estatística
6.
Medicine (Baltimore) ; 99(12): e19525, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195955

RESUMO

BACKGROUND: To assess the arterial oxygen partial pressure (PaO2) at defined time points during preoxygenation and to compare high-flow heated humidified nasal oxygenation with standard preoxygenation using oxygen insufflation via a facemask for at least 5 minutes, before intubation during induction of general anesthesia. METHODS: This randomized, single-blinded, prospective study will be conducted in patients undergoing head and neck surgery. After standard monitoring, the artery catheter at the radial artery or dorsalis pedis artery will be placed and arterial blood gas analysis (ABGA) for baseline values will be performed simultaneously. Each group will be subjected to 1 of 2 preoxygenation methods (high-flow nasal cannula or simple facemask) for 5 minutes, and ABGA will be performed twice. After confirming intubation, we will start mechanical ventilation and check the vital signs and perform the final ABGA. DISCUSSION: This trial aims to examine the trajectory of PaO2 levels during the whole preoxygenation procedure and after intubation. We hypothesize that preoxygenation with the high-flow nasal cannula will be superior to that with the face mask. STUDY REGISTRATION: This trial was registered with the Clinical Trial Registry (NCT03896906; ClinicalTrials.gov).


Assuntos
Anestesia Geral/tendências , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Cabeça/cirurgia , Oxigenação Hiperbárica/tendências , Pescoço/cirurgia , Gasometria , Cânula/normas , Cânula/estatística & dados numéricos , Humanos , Intubação Intratraqueal/métodos , Máscaras/normas , Máscaras/estatística & dados numéricos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Oxigênio/sangue , Estudos Prospectivos , Artéria Radial/cirurgia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Dispositivos de Acesso Vascular/normas
7.
Clin Hemorheol Microcirc ; 75(1): 107-119, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929152

RESUMO

BACKGROUND: Non-invasive tests are still required to improve the holistic diagnostic approach of thoracic outlet syndrome (TOS). OBJECTIVES: We aimed to analyze the diagnostic accuracy of the decrease from rest oxygen pressure (DROP) index of transcutaneous oximetry (TcpO2) in TOS. METHODS: Seventy-six patients and 40 asymptomatic volunteers (Controls) were enrolled. In TOS-suspected patients, the arteriograms were investigated for the presence of≥75% stenosis. The area under receiver operating characteristics curve (AUC) analysis tested the ability of forearm TcpO2 during provocative maneuvers to discriminate patients from controls and, to predict a positive arteriographic findings in the 44 TOS-suspected patients that had an arteriography. RESULTS: The media [25/75° centile] DROP values of controls and patients were -14 [-8/-22] mmHg and -22 [-12/-42] mmHg, respectively (p for Mann-Whitney<0.02). AUC analysis showed a significant ability of TcpO2 to predict the presence of subclavian arterial compression on arteriography (AUC, 0.694). CONCLUSIONS: Although time consuming, tcpO2 is independent of the observer expertise and could be useful in TOS-suspected patients to select the patients that should undergo arteriography.


Assuntos
Angiografia/métodos , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Síndrome do Desfiladeiro Torácico/diagnóstico , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estudos Prospectivos
8.
Angiology ; 71(3): 208-216, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31387360

RESUMO

Transcutaneous oxygen tension measurement (TcPO2) is widely applied for the evaluation of chronic limb-threatening ischemia (CLTI). Nevertheless, studies that focused on the clinical value of TcPO2 have shown varying results. We identified factors that potentially play a role in TcPO2 measurement variation such as probe placement, probe temperature, and the use of a reference probe. In this review of the current literature, we assessed the application of these factors. A systematic search was conducted. Parameters that were assessed were probe placement, probe temperature, and mentioning and/or use of a reference probe. In total, 36 articles were eligible for analysis. In 24 (67%) studies, probes were placed on specific anatomical locations. Seven (19%) studies placed probes, regardless of the location of the ulcer, adjacent to an ischemic lesion or ulcer (perilesion). Selected temperature setting of the probe differed; in 18 (50%), a default probe temperature of 44°C was selected, and in 13 (36%), a different temperature was selected. In 31 (84%) studies, the use of a reference probe was not reported. Transcutaneous oxygen tension measurement is applied diversely in patients with CLTI. Homogeneity in TcPO2 protocols is warranted for reliable clinical application and to compare future TcPO2 research.


Assuntos
Isquemia/metabolismo , Perna (Membro)/fisiopatologia , Oxigênio/metabolismo , Doenças Vasculares Periféricas/metabolismo , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Doença Crônica , Humanos , Isquemia/fisiopatologia , Doença Arterial Periférica/metabolismo , Doença Arterial Periférica/fisiopatologia , Doenças Vasculares Periféricas/fisiopatologia , Temperatura
9.
Clin Respir J ; 14(3): 214-221, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31799796

RESUMO

BACKGROUND: Patients with neuromuscular disorders (NMDs) are likely to develop respiratory failure which requires noninvasive ventilation (NIV). Ventilation via a mouthpiece (MPV) is an option to offer daytime NIV. OBJECTIVES: To determine the preferred equipment for MPV by patients with NMDs. METHODS: Two MPV equipment sets were compared in 20 patients with NMDs. Set 1, consisted of a non-dedicated ventilator for MPV (PB560, Covidien) with a plastic angled mouthpiece. Set 2, consisted of a dedicated MPV ventilator (Trilogy 100, Philips Respironics) without backup rate and kiss trigger combined with a silicone straw mouthpiece. The Borg dyspnea score, ventilator free time, transcutaneous oxygen saturation (SpO2) and carbon dioxide tension (TcCO2 ) were recorded with and without MPV. Patient perception was assessed by a 17-items list. RESULTS: Carbon dioxide tension measurements and total perception score were not different between the two MPV sets. Dyspnea score was lower with the non-dedicated versus dedicated equipment, 1 (0.5) versus 3 (1-6), P < 0.01. All patients with a ventilator free time lower than 6 hours preferred a set backup rate rather than a kiss trigger. Sixty five percent of patients preferred the commercial arm support and 55% preferred the plastic angled mouthpiece. CONCLUSIONS: Dedicated and non-dedicated MPV equipment are deemed effective and comfortable. Individualization of arm support and mouthpiece is advised to ensure success of MPV. A ventilator free time lower than 6 hours seems to be a useful indicator to a priori set a backup rate rather than a rate at zero associated to the kiss trigger.


Assuntos
Doenças Neuromusculares/complicações , Ventilação não Invasiva/instrumentação , Insuficiência Respiratória/terapia , Ventiladores Mecânicos/estatística & dados numéricos , Adolescente , Adulto , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Dióxido de Carbono/metabolismo , Estudos de Casos e Controles , Estudos Cross-Over , Dispneia/diagnóstico , Desenho de Equipamento , Feminino , Humanos , Masculino , Percepção , Fatores de Tempo , Ventiladores Mecânicos/tendências , Adulto Jovem
10.
Pediatr Int ; 62(2): 169-174, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31845473

RESUMO

BACKGROUND: This study aimed to investigate the utility of transcutaneous (tc) measurements of partial pressure of oxygen (tcPO2 ) and carbon dioxide (tcPCO2 ) monitoring in neonatal intensive care units (NICUs) in Japan. METHODS: At the end of 2016,we sent a survey questionnaire on tc monitoring to all 106 NICUs registered with the Japanese Neonatologist Association. The questions included usage, subjects, methods, management, and the practical usefulness of tc monitoring. RESULTS: The questionnaire was returned by 69 NICUs (65.1% of response rate). Seventeen institutions (24.6%) measured both tcPCO2 and tcPO2 , and 42 (60.9%) measured tcPCO2 alone. Transcutaneous PCO2 or tcPO2 monitoring was applied for "pre-viable" infants born at 22-23 weeks' gestational age (18.6% vs 23.5%), and infants of <500 g birthweight (30.5% vs 17.6%). The tcPCO2 and tcPO2 monitoring was started at birth in 49.2% and 70.6% of the newborn infants, respectively. The temperature of the sensor was set at <38°C for tcPCO2 in 54.3% and >42°C for tcPO2 in 58.9% of NICUs. The accuracy for tcPO2 was rated as good in 35.3% or moderate in 64.7%, of institutions but or for tcPCO2 as 1.7% or 93.2%of institutions , respectively. CONCLUSION: Transcutaneous monitoring was widely, but limitedly, used for preterm infants. The lower temperature of the tcPCO2 sensor compared to that reported in other developed countries might compromise the accuracy but increase the feasibility of tc monitoring in Japan.


Assuntos
Monitorização Transcutânea dos Gases Sanguíneos/métodos , Dióxido de Carbono/sangue , Oxigênio/sangue , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/sangue , Unidades de Terapia Intensiva Neonatal , Japão , Inquéritos e Questionários
11.
Clin Respir J ; 13(12): 773-780, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31556240

RESUMO

INTRODUCTION: The aim of this study is to determine the serum endocan levels in patients with pulmonary thromboembolism (PTE) and investigate whether a relationship exists between serum endocan levels and the disease severity. MATERIALS AND METHODS: The study included 85 patients with acute PTE and 40 healthy control subjects. The patients with PTE were divided into three groups at admission as "high-risk", "intermediate-risk" and "low-risk", considering the guidelines of the European Society of Cardiology. Serum endocan levels in all participants' blood samples were measured. RESULTS: The mean serum endocan levels were significantly higher in the PTE group, compared to the control subjects (P < 0.001). Serum endocan levels were significantly higher in the "high-risk" group when compared with patients in the "low-risk" and "intermediate-risk" groups (P < 0.001 and P < 0.01 respectively). Similarly, serum endocan levels were higher in the "intermediate-risk" group compared to those in the "low-risk" group (P < 0.001). There was a negative correlation between serum endocan levels and partial oxygen pressure (r = -0.262, P = 0.016), whereas a positive correlation was found between the serum endocan levels and systolic pulmonary arterial pressure (r = 0.296, P = 0.006). Additionally, endocan had an area under the curve in the receiver operating characteristic curve of 0.837 (0.768-0.907; 95% CI; P < 0.001) and cut-off value was 194.5 pg/mL (sensitivity 80%, specificity 72.5%). CONCLUSION: Serum endocan levels were higher and related to the severity of the disease in PTE patients. Additionally, endocan could be an indicator to be used in the diagnosis of PTE and in the prediction of the disease severity.


Assuntos
Endotélio/fisiopatologia , Proteínas de Neoplasias/sangue , Proteoglicanas/sangue , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/metabolismo , Doença Aguda , Adulto , Idoso , Biomarcadores/sangue , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Pressão Sanguínea/fisiologia , Angiografia por Tomografia Computadorizada/métodos , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Artéria Pulmonar/fisiologia , Embolia Pulmonar/patologia , Pressão Propulsora Pulmonar/fisiologia , Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/metabolismo
13.
Eur J Anaesthesiol ; 36(12): 904-910, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31464713

RESUMO

BACKGROUND: Transcutaneous carbon dioxide measurement (TcCO2) is frequently used as a surrogate for arterial blood gas sampling in adults and children with critical illness. Data from noninvasive TcCO2 monitoring assists with clinical decisions regarding mechanical ventilation settings, estimation of metabolic consumption and determination of adequate end-organ tissue perfusion. OBJECTIVES: To report TcCO2 values obtained from various fruits, vegetables and elite critical care medicine specialists. DESIGN: Prospective, observational, nonblinded cohort study. SETTINGS: Single-centre, tertiary paediatric referral centre and organic farmers' market. PARTICIPANTS: Vegetables and fruits included 10 samples of each of the following: red delicious apple (Malus domestica), manzano banana (Musa sapientum), key lime (Citrus aurantiifolia), miniature sweet bell pepper (Capsicum annuum), sweet potato (Ipomoea batatas) and avocado (Persea americana). Ten human controls were studied including a paediatric intensivist, a paediatric inpatient hospital physician, four paediatric resident physicians and four paediatric critical care nurses. INTERVENTIONS: None. MAIN OUTCOME MEASURES: TcCO2 values for each species and device response times. RESULTS: TcCO2 readings were measurable in all study species except the sweet potato. Mean ±â€ŠSD values of TcCO2 for human controls [4.34 ±â€Š0.37 kPa (32.6 ±â€Š2.8 mmHg)] were greater than apples [3.09 ±â€Š0.19 kPa (23.2 ±â€Š1.4 mmHg), P < 0.01], bananas [2.73 ±â€Š0.28 kPa (20.5 ±â€Š2.1 mmHg), P < 0.01] and limes [2.76 ±â€Š0.52 kPa (20.7 ±â€Š3.9 mmHg), P < 0.01] but no different to those of avocados [4.29 ±â€Š0.44 kPa (32.2 ±â€Š3.3 mmHg), P = 0.77] and bell peppers [4.19 ±â€Š1.13 kPa (31.4 ±â€Š8.5 mmHg), P = 0.68]. Transcutaneous response times did not differ between research cohorts and human controls. CONCLUSION: We found nonroot, nontuberous vegetables to have TcCO2 values similar to that of healthy, human controls. Fruits yield TcCO2 readings, but substantially lower than human controls.


Assuntos
Monitorização Transcutânea dos Gases Sanguíneos/métodos , Dióxido de Carbono/análise , Frutas/química , Verduras/química , Adulto , Monitorização Transcutânea dos Gases Sanguíneos/normas , Feminino , Humanos , Masculino , Estudos Prospectivos , Valores de Referência
14.
Dig Dis Sci ; 64(12): 3549-3556, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31165379

RESUMO

BACKGROUND AND AIMS: Computer-assisted propofol sedation (CAPS) allows non-anesthesiologists to administer propofol for gastrointestinal procedures in relatively healthy patients. As the first US medical center to adopt CAPS technology for routine clinical use, we report our 1-year experience with CAPS for esophagogastroduodenoscopy (EGD). METHODS: Between September 2014 and August 2015, 926 outpatients underwent elective EGDs with CAPS at our center. All EGDs were performed by 1 of 17 gastroenterologists certified in the use of CAPS. Procedural success rates, procedure times, and recovery times were compared against corresponding historical controls done with midazolam and fentanyl sedation from September 2013 to August 2014. Adverse events in CAPS patients were recorded. RESULTS: The mean age of the CAPS cohort was 56.7 years (45% male); 16.2% of the EGDs were for variceal screening or Barrett's surveillance and 83.8% for symptoms. The procedural success rates were similar to that of historical controls (99.0% vs. 99.3%; p = 0.532); procedure times were also similar (6.6 vs. 7.4 min; p = 0.280), but recovery time was markedly shorter (31.7 vs. 52.4 min; p < 0.001). There were 11 (1.2%) cases of mild transient oxygen desaturation (< 90%), 15 (1.6%) cases of marked agitation due to undersedation, and 1 case of asymptomatic hypotension. In addition, there were six (0.6%) patients with more pronounced desaturation episodes that required brief (< 1 min) mask ventilation. There were no other serious adverse events. CONCLUSIONS: CAPS appears to be a safe, effective, and efficient means of providing sedation for EGD in healthy patients. Recovery times were much shorter than historical controls.


Assuntos
Período de Recuperação da Anestesia , Anestésicos Intravenosos/administração & dosagem , Sedação Consciente/métodos , Quimioterapia Assistida por Computador/métodos , Endoscopia do Sistema Digestório/métodos , Monitorização Intraoperatória/métodos , Duração da Cirurgia , Propofol/administração & dosagem , Adulto , Idoso , Anestesistas , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Determinação da Pressão Arterial/métodos , Capnografia/métodos , Eletrocardiografia/métodos , Feminino , Fentanila/uso terapêutico , Gastroenterologistas , Estudo Historicamente Controlado , Humanos , Hipotensão/induzido quimicamente , Hipóxia/induzido quimicamente , Masculino , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Enfermeiras e Enfermeiros , Dor Processual
15.
Laryngoscope ; 129(12): E415-E419, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31034638

RESUMO

OBJECTIVES/HYPOTHESIS: To determine if electron paramagnetic resonance (EPR) oximetry is a viable technology to aid in flap monitoring. STUDY DESIGN: Prospective cohort. METHODS: This was a cohort study assessing accuracy and speed of EPR oximetry in detecting ischemia of a saphenous artery-based flap in a rat model, using transcutaneous oximetry as a control. Measurements were obtained under both resting and ischemic conditions for nine Sprague Dawley rats (18 flaps), for 3 postoperative days following flap elevation. RESULTS: The mean partial pressure of oxygen prior to tourniquet application was 66.9 ± 8.9 mm Hg with EPR oximetry and 64.7 ± 5.2 mm Hg with transcutaneous oximetry (P = .45). Mean partial pressures of oxygen during tourniquet application were 8.9 ± 3.2 mm Hg and 8.5 ± 2.9 mm Hg for EPR oximetry and transcutaneous oximetry, respectively (P = .48), and 67.2 ± 6.9 mm Hg and 65.3 ± 6.1 mm Hg after tourniquet release for EPR oximetry and transcutaneous oximetry, respectively (P = .44). The mean ischemia detection time of EPR oximetry was 49 ± 21 seconds. CONCLUSIONS: Offering timely, accurate, and noninvasive tissue oxygen measurements, EPR oximetry is a promising adjunct in flap monitoring. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E415-E419, 2019.


Assuntos
Monitorização Transcutânea dos Gases Sanguíneos/métodos , Espectroscopia de Ressonância de Spin Eletrônica/métodos , Isquemia/metabolismo , Monitorização Fisiológica/métodos , Oxigênio/metabolismo , Retalhos Cirúrgicos/irrigação sanguínea , Animais , Modelos Animais de Doenças , Seguimentos , Isquemia/diagnóstico , Masculino , Período Pós-Operatório , Estudos Prospectivos , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Cicatrização/fisiologia
16.
Clin Pediatr (Phila) ; 58(5): 528-533, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30841742

RESUMO

PURPOSE: Shock is associated with increased tissue oxygen extraction. Near-infrared spectroscopy-derived thenar muscle tissue oxygenation (StO2) levels can provide an estimate of the oxygen supply-demand balance at the tissue level. We hypothesized that thenar StO2 levels would correlate with central venous oxygen saturation (ScvO2) levels, the gold standard for global tissue oxygen extraction in the body. METHODS: We prospectively enrolled 60 pediatric subjects admitted to pediatric intensive care unit or who underwent cardiac catheterization from September 2015 to March 2018. Thenar StO2 levels were measured using the InSpectra StO2 probe. Concurrent measurements of ScvO2 and peripheral tissue oxygenation (StO2) were achieved through simultaneous testing. For ScvO2, a central line placed in the superior vena cava was utilized for serum specimen collection, while the InSpectra probe recorded StO2 measurements from the thenar eminence of the patient's right hand. RESULTS: Sixty observations of thenar StO2 and ScvO2 levels were derived from 60 subjects. Mean thenar StO2 levels were 74.72 ± 11.18% and displayed significant correlation with paired ScvO2 measurements ( m = 72.17 ± 9.77%; ρ = 0.317, P = .018). Correlation was much more significant in subjects who were not on mechanical ventilatory support as opposed to those who were on it ( ρSORA = 0.496, PSORA = .003, vs ρVENT = 0.161, PVENT = .433). A thenar StO2 of 73% had a sensitivity of 80% and a specificity of 77.8% in predicting an ScvO2 of less than 65%. CONCLUSION: This is the first study to report correlation of thenar StO2 and ScvO2 levels in children. Our study results show a significant correlation between these levels. Thenar StO2 measurements may have a role in the bedside management of critically ill children in whom ScvO2 monitoring is not available.


Assuntos
Monitorização Transcutânea dos Gases Sanguíneos/métodos , Cuidados Críticos/métodos , Músculo Esquelético/irrigação sanguínea , Oxigênio/sangue , Polegar/irrigação sanguínea , Adolescente , Biomarcadores/sangue , Monitorização Transcutânea dos Gases Sanguíneos/instrumentação , Criança , Pré-Escolar , Estado Terminal , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho , Veias , Adulto Jovem
17.
Microvasc Res ; 124: 6-18, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30742844

RESUMO

Measurements of regional tissue oxygen serve as a proxy to monitor local perfusion and have the potential to guide therapeutic decisions in multiple clinical disciplines. Transcutaneous oximetry (tcpO2) is a commercially available noninvasive technique that uses an electrode to warm underlying skin tissue and measure the resulting oxygen tension at the skin surface. A novel approach is to directly measure interstitial tissue oxygen using subcutaneous oxygen microsensors composed of a biocompatible hydrogel carrier platform with embedded oxygen sensing molecules. After initial injection of the hydrogel into subcutaneous tissue, noninvasive optical measurements of phosphorescence-based emissions at the skin surface are used to sense oxygen in the subcutaneous interstitial space. The object of the present study was to characterize the in vivo performance of subcutaneous microsensors and compare with transcutaneous oximetry (tcpO2). Vascular occlusion tests were performed on the arms of 7 healthy volunteers, with repeated tests occurring 1 to 10 weeks after sensor injection, yielding 95 total tests for analysis. Comparative analysis characterized the response of both devices to decreases in tissue oxygen during occlusion and to increases in tissue oxygen following release of the occlusion. Results indicated: (I) time traces returned by microsensors and tcpO2 were highly correlated, with the median (interquartile range) correlation coefficient of r = 0.93 (0.10); (II) both microsensors and tcpO2 sensed a statistically significant decrease in normalized oxygen during occlusion (p < 0.001 for each device); (III) microsensors detected faster rates change (p < 0.001) and detected overshoot during recovery more frequently (38% vs. 4% of tests); (IV) inter-measurement analysis showed no correlation of baseline values between microsensors and tcpO2 (r = 0.03), but comparison of integrated oxygen dynamics showed similar variation in the normalized response to occlusion between devices (p = 0.06), (V) intra-measurement analysis revealed that microsensors detect greater physiological fluctuations than tcpO2 (p < 0.001) and may provide enhanced sensitivity to processes such as vasomotion. Additionally, the functional response of microsensors was not significantly different across time groupings (per month) post-injection (p = 0.61). Although the compared devices have differences in the mechanisms used to sense oxygen, these findings demonstrate that subcutaneous oxygen microsensors measure changes in interstitial tissue oxygen in human subjects in vivo.


Assuntos
Técnicas Biossensoriais/instrumentação , Monitorização Transcutânea dos Gases Sanguíneos/instrumentação , Oxigênio/metabolismo , Tela Subcutânea/metabolismo , Transdutores , Extremidade Superior/irrigação sanguínea , Adulto , Idoso , Artérias/fisiologia , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Miniaturização , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes
18.
Thorax ; 74(2): 157-163, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30209079

RESUMO

BACKGROUND: Transcutaneous carbon dioxide (TcCO2) monitoring is a non-invasive alternative to arterial blood sampling. The aim of this review was to determine the accuracy and precision of TcCO2 measurements. METHODS: Medline and EMBASE (2000-2016) were searched for studies that reported on a measurement of PaCO2 that coincided with a measurement of TcCO2. Study selection and quality assessment (using the revised Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2)) were performed independently. The Grading Quality of Evidence and Strength of Recommendation approach was used to summarise the strength of the body of evidence. Pooled estimates of the mean bias between TcCO2 and PaCO2 and limits of agreement with outer 95% CIs (termed population limits of agreement) were calculated. RESULTS: The mean bias was -0.1 mm Hg and the population limits of agreement were -15 to 15 mm Hg for 7021 paired measurements taken from 2817 participants in 73 studies, which was outside of the clinically acceptable range (7.5 mm Hg). The lowest PaCO2 reported in the studies was 18 mm Hg and the highest was 103 mm Hg. The major sources of inconsistency were sensor location and temperature. The population limits of agreement were within the clinically acceptable range across 3974 paired measurements from 1786 participants in 44 studies that applied the sensor to the earlobe using the TOSCA and Sentec devices (-6 to 6 mm Hg). CONCLUSION: There are substantial differences between TcCO2 and PaCO2 depending on the context in which this technology is used. TcCO2 sensors should preferentially be applied to the earlobe and users should consider setting the temperature of the sensor higher than 42°C when monitoring at other sites. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO; CRD42017057450.


Assuntos
Monitorização Transcutânea dos Gases Sanguíneos/métodos , Dióxido de Carbono/sangue , Monitorização Transcutânea dos Gases Sanguíneos/instrumentação , Dióxido de Carbono/análise , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
19.
Int Wound J ; 16(1): 176-182, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30311727

RESUMO

Percutaneous transluminal angioplasty (PTA) is now more frequently used to improve tissue perfusion in ischemic diabetic feet. However, there are concerns about its feasibility and effectiveness in severely ischaemic feet. This study aimed to compare the perfusion values after PTA according to the ischaemic degree of diabetic feet. This study included 133 ischaemic diabetic feet. The foot transcutaneous oxygen pressure (TcPO2 ) and toe pressure were measured before the procedure and every second postoperative week for 6 weeks. The patients were divided into three groups according to ischaemic severity on the basis of TcPO2 and toe pressures. In the "severely ischaemic" group, the TcPO2 increased from 7.5 ± 4.9 to 40.3 ± 11.3 mm Hg (5.4-fold) 6 weeks after the PTA (P < 0.001). The toe pressure increased from 8.5 ± 8.8 to 42.2 ± 19.3 mm Hg (5.0-fold, P < 0.001). In the "mild" group, the TcPO2 increased from 35.4 ± 2.5 to 41.8 ± 12.4 mm Hg (1.2-fold, P = 0.003), and the toe pressure increased from 45.7 ± 12.3 to 54.3 ± 31.3 mm Hg (1.2-fold, P > 0.05). Results of the "intermediate" group were in between. The most severely ischaemic group had the most dramatic increase of tissue perfusion after PTA. As such, PTA can be an effective method for increasing tissue perfusion even in the severely ischaemic diabetic feet.


Assuntos
Angioplastia/métodos , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Pé Diabético/fisiopatologia , Pé Diabético/cirurgia , Isquemia/cirurgia , Doenças Vasculares Periféricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia
20.
Med. clín (Ed. impr.) ; 151(11): 435-440, dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174174

RESUMO

Introducción y objetivo: La eficacia de la ventilación mecánica no invasiva (VMNI) domiciliaria se evalúa mediante la determinación de los valores gasométricos sanguíneos en vigilia, la evolución de la sintomatología, y la monitorización de la ventilación durante la noche. Nuestro objetivo es evaluar si alcanzar unos valores definidos mediante la oximetría nocturna en la monitorización ambulatoria de la ventilación mecánica no invasiva (VMNI) se relaciona con la evolución clínica, gasométrica y la supervivencia de una muestra de pacientes con VMNI domiciliaria. Material y métodos: Estudio observacional de cohortes retrospectivo de una serie de pacientes en tratamiento con VMNI domiciliaria por diferentes causas. Se excluyeron los pacientes con esclerosis lateral amiotrófica y/o menos de 3 meses de seguimiento. Se valora la evolución de la sintomatología, la gasometría arterial basal en vigilia, y los registros oximétricos nocturnos domiciliarios, en cada visita ambulatoria. Se definió buen control oximétrico mantenido (COM) cuando se alcanzan unos valores y se mantienen hasta la última revisión. Se consideraron 2 grupos de pacientes, según alcanzaron o no un buen COM durante el seguimiento. Resultados: se evaluaron 400 pacientes, fueron incluidos finalmente 364 (91%), con una edad mediana de 68 años, el 51% varones. El 37,6% presentaban buen COM a lo largo del seguimiento. Comparando los pacientes con vs. sin buen COM, se obtuvo una menor mortalidad a largo plazo (16,8 vs. 28,2%; p=0,013), mejoría en la sintomatología (33,8 vs. 18,6%; p=0,002), y una menor proporción de pacientes con una PaCO2 persistentemente>50mmHg (14,2 vs. 33,9%; p<0,001). Conclusión: En el seguimiento de pacientes con VMNI domiciliaria en nuestro medio, unos valores definidos en la oximetría nocturna domiciliaria (buen COM) se asocia de forma positiva con una mejoría clínica, gasométrica y una mayor supervivencia a largo plazo


Introduction and objective: The effectiveness of home non-invasive mechanical ventilation (NIMV) is assessed by determining blood gas values in wakefulness, the evolution of their symptoms, and the monitoring of ventilation at night. The aim of our study is to evaluate whether defined values reached with outpatient monitoring by oximetry is related to the clinical, arterial gases and survival of a sample of patients with home NIMV. Material and method: Retrospective observational cohort study of a series of patients receiving home NIMV treatment for different causes. Patients with amyotrophic lateral sclerosis and less than 3 months of follow-up were excluded. The evolution of the patient's symptoms, their baseline arterial blood gases in wakefulness, and home nocturnal oximetry records, are evaluated at each outpatient visit. Good maintained oximetry control (MOC) was defined when mean O2 saturation values were reached and maintained until the last revision. Patient groups were considered, according to whether or not a good MOC was achieved during follow-up. Result: Four hundred patients were evaluated. Three hundred and sixty four (91%) were included in the study; their median age was 68 years, 51% were male. 37.6% had a good MOC during follow-up. Compared to patients with not good MOC, a better long-term mortality was obtained (16.8% vs 28.2%, P=.013), and an improvement in symptoms (33.8% vs 18.6%, P=.002) and a lower proportion of patients with persistently>50mmHg PaCO2 (14.2% vs. 33.9%, P<.001) was observed. Conclusion: In the follow-up of patients with home NIMV in our context, values defined in home nocturnal oximetry (good MOC) are positively associated with clinical, gasometric and longer-term survival


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Respiração Artificial/mortalidade , Ventilação não Invasiva/métodos , Serviços Hospitalares de Assistência Domiciliar , Insuficiência Respiratória/sangue , Oximetria/métodos , Vigília , Hiperventilação , Estudo Observacional , Estudos de Coortes , Respiração Artificial/métodos , Prognóstico , Insuficiência Respiratória/fisiopatologia , Monitorização Transcutânea dos Gases Sanguíneos/métodos
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