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1.
Artigo em Inglês | MEDLINE | ID: mdl-33153145

RESUMO

Wearing face masks is recommended for the prevention of contracting or exposing others to cardiorespiratory infections, such as COVID-19. Controversy exists on whether wearing face masks during vigorous exercise affects performance. We used a randomized, counterbalanced cross-over design to evaluate the effects of wearing a surgical mask, a cloth mask, or no mask in 14 participants (7 men and 7 women; 28.2 ± 8.7 y) during a cycle ergometry test to exhaustion. Arterial oxygen saturation (pulse oximetry) and tissue oxygenation index (indicator of hemoglobin saturation/desaturation) at vastus lateralis (near-infrared spectroscopy) were assessed throughout the exercise tests. Wearing face masks had no effect on performance (time to exhaustion (mean ± SD): no mask 622 ± 141 s, surgical mask 657 ± 158 s, cloth mask 637 ± 153 s (p = 0.20); peak power: no mask 234 ± 56 W, surgical mask 241 ± 57 W, cloth mask 241 ± 51 W (p = 0.49)). When expressed relative to peak exercise performance, no differences were evident between wearing or not wearing a mask for arterial oxygen saturation, tissue oxygenation index, rating of perceived exertion, or heart rate at any time during the exercise tests. Wearing a face mask during vigorous exercise had no discernable detrimental effect on blood or muscle oxygenation, and exercise performance in young, healthy participants (ClinicalTrials.gov, NCT04557605).


Assuntos
Infecções por Coronavirus/prevenção & controle , Exercício Físico , Máscaras/classificação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Betacoronavirus , Teste de Esforço , Feminino , Humanos , Masculino , Oximetria , Consumo de Oxigênio , Adulto Jovem
2.
Acute Med ; 19(4): 183-191, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33215171

RESUMO

INTRODUCTION: COVID-19 pneumonia presented a unique problem for healthcare systems with the potential to overwhelm hospitals and lead to unnecessary morbidity and mortality. Safe triage and follow up systems are required to manage this unprecedented demand. METHODS: We designed a pathway for the triage and assessment of patients based on their resting oxygen saturations and response to a 30 metre rapid walking test. We admitted patients to a 'Virtual Ward' for remote oximetry monitoring from the Emergency Department, step down from inpatient wards and from the local Primary Care 'Hot Hub'. This allowed the safe and managed readmission of those patients who deteriorated at home. RESULTS: During the first wave of COVID-19 we entered 273 onto the pathway for Virtual Ward follow up. Of these, 31 patients were readmitted to hospital, two were admitted to Intensive Care and one patient died. Median oxygen saturation at presentation was 97 % (IQR 96-98%) and following a 30 metre walk test 96% (IQR 94-97%). Median NEWS-2 score was 2 (IQR 1-3). On feedback 99.5% of patients were likely or extremely likely to recommend the service to their family and friends. There was a cost avoidance of £107,600 per month. CONCLUSION: It is safe, feasible and cost effective to set up a triage system with remote oximetry monitoring for patients with COVID-19 and overwhelmingly patients find it a positive experience.


Assuntos
Infecções por Coronavirus/diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Oximetria , Pneumonia Viral/diagnóstico , Consulta Remota , Triagem , Betacoronavirus , Humanos , Pandemias , Readmissão do Paciente
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4079-4084, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018895

RESUMO

We propose a smart mandibular advancement device (MAD) that can monitor cardiorespiratory parameters intraorally. The device comprises a flexible hybrid wireless monitoring platform integrated with a MAD. This monitoring platform is based on acquiring the intraoral photoplethysmography (PPG) signals. It is designed on a double-sided flexible polyimide substrate. Our experimental measurements show that the PPG signals captured intraorally are highly correlated with the conventional PPG signals received from the fingertip. Intraoral PPG signals have vital information as well as adequate quality to be utilized for estimation of multiple-physiological parameters, such as heart-rate (HR), respiration rate (RR), respiration pattern (RP) and blood oxygen saturation (SpO2). The estimated values of HR, RR, and SpO2 from the intraoral PPG signals recorded by our smart MAD show an accuracy of over 96% with reference to the conventional monitoring techniques.


Assuntos
Placas Oclusais , Processamento de Sinais Assistido por Computador , Oximetria , Fotopletismografia , Taxa Respiratória
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5339-5342, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019189

RESUMO

Sleep apnea is a common sleep disorder that can significantly decrease the quality of life. An accurate and early diagnosis of sleep apnea is required before getting proper treatment. A reliable automated detection of sleep apnea can overcome the problems of manual diagnosis (scoring) due to variability in recording and scoring criteria (for example across Europe) and to inter-scorer variability. This study explored a novel automated algorithm to detect apnea and hypopnea events from airflow and pulse oximetry signals, extracted from 30 polysomnography records of the Sleep Heart Health Study. Apneas and hypopneas were manually scored by a trained sleep physiologist according to the updated 2017 American Academy of Sleep Medicine respiratory scoring rules. From pre-processed airflow, the peak signal excursion was precisely determined from the peak-to-trough amplitude using a sliding window, with a per-sample digitized algorithm for detecting apnea and hypopnea. For apnea, the peak signal excursion drop was operationalized at ≥85% and for hypopnea at ≥35% of its pre-event baseline. Using backward shifting of oximetry, hypopneas were filtered with ≥3% oxygen desaturation from its baseline. The performance of the automated algorithm was evaluated by comparing the detection with manual scoring (a standard practice). The sensitivity and positive predictive value of detecting apneas and hypopneas were respectively 98.1% and 95.3%. This automated algorithm is applicable to any portable sleep monitoring device for the accurate detection of sleep apnea.


Assuntos
Oximetria , Qualidade de Vida , Algoritmos , Europa (Continente) , Humanos , Polissonografia , Estados Unidos
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5943-5947, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019327

RESUMO

Everyday wearables such as smartwatches or smart bands can play a pivotal role in the field of fitness and wellness and hold the prospect to be used for early disease detection and monitoring towards Smart Health (sHealth). One of the challenges is the extraction of reliable biomarkers from data collected using these devices in the real world (Living Labs). In this yearlong field study, we collected the nocturnal instantaneous heart rate from 9 participants using wrist-worn commercial smart bands and extracted heart rate variability features (HRV). In addition, we measured core body temperature using our custom-designed flexible Inkjet-Printed (IJP) temperature sensor and SpO2 with a finger pulse oximeter. The core body temperature along with user-reported symptoms have been used for automated spatiotemporal monitoring of flu symptoms severity in real-time. The extracted HRV feature values are within the 95% confidence interval of normative values and shows an anticipated trend for gender and age. The resulting dataset from this study is a novel addition and may be used for future investigations.Clinical Relevance- The findings of this study shows usability of wearables in detection and monitoring of diseases such as obstructive sleep apnea reducing the prevalence of undiagnosed cases. This framework also has potentials to monitor outbreaks of flu and other diseases with spatiotemporal distribution.


Assuntos
Dispositivos Eletrônicos Vestíveis , Articulação do Punho , Exercício Físico , Frequência Cardíaca , Humanos , Oximetria
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 6135-6138, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019371

RESUMO

Newborns admitted to the neonatal intensive care unit (NICU) require a high level of care due to their precarious condition. Nurses typically monitor their vital signs continuously using wearable sensors such as electrocardiogram (ECG) electrodes placed on their chest and a pulse oximeter on a limb. When the patient moves, this can cause motion artifacts on one or more physiologic signals, potentially resulting in a false alarm on the patient monitor. We therefore propose a motion detection algorithm to mitigate these alarms by providing context. Using a camera positioned above the crib or overhead warming bed, we recorded videos from six patients and annotated all patient movements. These data were used to train and evaluate two different approaches for non-contact motion detection. Results were stronger for the optical flow technique than for the long short-term memory network approach. This represents a challenging problem due to variable lighting, patient clothing and bed coverings, and the complex clinical environment in the NICU.


Assuntos
Unidades de Terapia Intensiva Neonatal , Oximetria , Eletrocardiografia , Humanos , Recém-Nascido , Monitorização Fisiológica , Movimento (Física)
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4656-4659, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019032

RESUMO

In this paper, we report about the miniaturized and thin wireless wearable percutaneous arterial oxygen saturation (SpO2) sensor module with bendable build-up substrate. As one of an effective approach for miniaturizing and thinning a wearable device, there is a method of applying the folding structure to the module. In order to realize folding structure, we have studied bending characteristics of the bendable build-up substrate and considered for wearable application. In addition, we developed the SpO2 sensor module with folding structure, and then realized the display system of SpO2 sensing data on a tablet.


Assuntos
Dispositivos Eletrônicos Vestíveis , Oximetria
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5115-5118, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019137

RESUMO

The state-of-the-art non-invasive measurement of peripheral oxygen saturation (SpO2) during sleep is mainly based on pulse oximetry at the fingertip. Although this approach is noninvasive, it can still be obtrusive and cumbersome to apply, in particular for ambulatory monitoring over several nights.We developed a wrist-worn reflectance pulse oximetry device which can be embedded in a watch, making it less obtrusive and easy to apply. This device was tested in an ongoing clinical study on 57 subjects (33 patients and 24 healthy volunteers) undergoing a full overnight polysomnography recording. The accuracy was evaluated against state-of-the-art fingertip SpO2 measurements.In the 54 subjects available for analysis we obtained an SpO2 accuracy (ARMS) of 3.4 % when automatically rejecting 17.7 % of signals due to low quality. When further excluding measurements suffering from insufficient contact of the watch with the skin an ARMS of 2.7 % was obtained while rejecting a total of 23.2 % measurements. These accuracies comply with the ISO standard and the FDA guidance for pulse oximeters.The present results are promising and pave the way for unobtrusive and continuous monitoring of SpO2 to screen for sleep disordered breathing. Nonetheless, contact pressure and venous blood have shown to adversely affect the SpO2 estimation and remain a challenge for wrist-based reflectance pulse oximetry.


Assuntos
Articulação do Punho , Punho , Dedos , Humanos , Oximetria , Oxigênio
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5335-5338, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019188

RESUMO

Nocturnal pulse oximetry has been proposed as a tool for diagnosing sleep apnea. We established criteria in determining previous occurrences of apnea events by extracting quantitative characteristics caused by apnea events over the duration of changes in blood oxygen saturation values in our previous studies. In addition, the apnea-hypopnea index was estimated by regression modeling. In this paper, the algorithm presented in the previous study was applied to the data collected from the sleep medicine center of other hospitals to verify its performance. As a result of applying the algorithm to pulse oximetry data of 15 polysomnographic recordings, the minute-by-minute apneic segment detection exhibited an average accuracy of 87.58% and an average Cohen's kappa coefficient of 0.6327. In addition, the correlation coefficient between the estimated apnea-hypopnea index and the reference was 0.95, and the average absolute error was 5.02 events/h. When the algorithm is evaluated on the data collected by the other sleep medicine center, they still detected semi real-time sleep apnea events and showed meaningful results in estimating apnea-hypopnea index, although their performance was somewhat lower than before. With the recent popularity of devices for mobile healthcare, such as the wearable pulse oximeter, the results of this study are expected to improve the user value of devices by implementing mobile sleep apnea diagnosis and monitoring functions.


Assuntos
Síndromes da Apneia do Sono , Algoritmos , Humanos , Oximetria , Oxigênio , Polissonografia , Síndromes da Apneia do Sono/diagnóstico
10.
Recenti Prog Med ; 111(10): 584-592, 2020 10.
Artigo em Italiano | MEDLINE | ID: mdl-33078008

RESUMO

INTRODUCTION: The MonCOVID study aimed to assess the feasibility of early home management and monitoring of patients with suspected or confirmed CoViD-19, and to evaluate if this would ensure a rapid and adequate transfer to hospital care. METHODS: This pilot, open-label, single-arm study included adult symptomatic patients with suspected or confirmed CoViD-19 for whom the general practitioner or other carer had decided not to proceed to hospitalization. Participants were monitored daily at home, by measuring the pulse oximetry (SpO2) at rest and after a rapid walking test. The study assessed feasibility outcomes (at least 80% of patients recommended to be sent to the competent emergency room actually transferred within 24 hours from reporting) and efficacy (SpO2 at emergency room admission). Patients with SpO2 values below 90% (86% if affected by chronic pulmonary diseases) at rest or with a decrease in SpO2 of five percentage points after a rapid walking test were recommended for hospital care. RESULTS: Thirty-seven participants reported by the local health unit of Alessandria and the Metropolitan City of Turin were included in the study. Enrollment, initially planned for two months to reach a target of 340, was interrupted early due to the drastic reduction in the number of cases. On average, each participant was monitored for 8.2 (median 6.0) days, for a total of 302 visits. The participants showed milder symptoms than those observed in the first phase of the epidemic, at least in terms of pulmonary impairment. No patient had a decrease in SpO2 of 5 percentage points or greater and only one patient required hospitalization due to a worsening of the disease. DISCUSSION: The cases collected were not sufficient to demonstrate or refute the hypothesis of the monitoring test effectiveness. However, the study showed the feasibility of such a program, and raised some elements of interest regarding hospital territory integration, the need to develop tools to support home care and the variability of the clinical manifestations of the CoViD-19 disease.


Assuntos
Infecções por Coronavirus/terapia , Serviços de Assistência Domiciliar , Oximetria , Pneumonia Viral/terapia , Teste de Caminhada , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/fisiopatologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Projetos Piloto , Pneumonia Viral/fisiopatologia , Adulto Jovem
11.
Adv Clin Exp Med ; 29(10): 1187-1191, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33030316

RESUMO

BACKGROUND: The cranial osteopathic manipulative medicine has been shown to alter regional cerebral tissue oxygenation (cStO2) in adult patients; however, there are no reports regarding the neonatal population. OBJECTIVES: To assess the influence of compression of the 4th ventricle (CV4) osteopathic procedure on cStO2 in neonates. MATERIAL AND METHODS: Thirty-one patients born between 25 and 39 weeks of gestation were screened for inclusion in the neonatal unit. Twenty-two infants presenting with hyperstimulation of autonomous nervous system (ANS) according to the Neonatal Behavioral Assessment Scale were enrolled in the study. Near-infrared spectroscopy was used for continuous cStO2 monitoring; pulse oximeter oxygen saturation (SpO2) and heart rate (HR) measured with pulse oximetry were simultaneously monitored 10 min before CV4, during the therapy and 10 min after it was stopped. RESULTS: Patients' condition remained stable throughout the study. There were no significant differences in the mean cStO2 values recorded before (69 ±8%), during (69 ±8%) and after CV4 (70 ±8%; p > 0.05). Mean SpO2 was almost constant during the study (96 ±4% before, 95 ±3% during and 95 ±4% after the intervention). Heart rate was also stable pre-, during and post-therapy (153 ±21 min, 151 ±18 min and 151 ±20/min, respectively). CONCLUSIONS: Compression of the 4th ventricle osteopathic procedure does not influence the cStO2 in newborns. This method seems to be well-tolerated but its clinical efficacy needs to be further investigated in this group of patients.


Assuntos
Quarto Ventrículo , Encéfalo , Humanos , Recém-Nascido , Oximetria , Oxigênio , Crânio , Espectroscopia de Luz Próxima ao Infravermelho
13.
Artigo em Inglês | MEDLINE | ID: mdl-33017916

RESUMO

A sufficient oxygen supply of the fetus is necessary for a proper development of the organs. Transabdominal fetal pulse oximetry is a method that allows to measure the oxygenation of the fetal blood non-invasively by placing the light sources and photodetectors on the belly of the pregnant woman. The shape of the measured fetal pulse wave is needed to extract parameters for the estimation of the oxygen saturation. This work presents an extension of our previously presented signal processing strategy that allows to extract an average shape of the fetal pulse wave from noisy mixed photoplethysmograms (PPG) with dominating maternal and very weak fetal signal components. An adaptive noise canceller and a comb filter are used to suppress the maternal component. The quality of the resulting fetal signal is sufficient to identify single pulse waves in time domain. Further processing demonstrates the extraction of the mean shape of a single fetal pulse wave by synchronous averaging of several detected pulses. The method is evaluated with different datasets of several simulated and synthetic signals measured with a tissue mimicking phantom. The feasibility of the approach is demonstrated by preparing the mixed PPGs to perform fetal pulse oximetry in future studies. However, clinical measurements are needed to finally evaluate the proposed system beyond synthetic datasets.


Assuntos
Monitorização Fetal , Oxigênio , Feminino , Frequência Cardíaca , Humanos , Oximetria , Gravidez , Cuidado Pré-Natal
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 374-377, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018006

RESUMO

Continuous monitoring of blood oxygen saturation levels is vital for patients with pulmonary disorders. Traditionally, SpO2 monitoring has been carried out using transmittance pulse oximeters due to its dependability. However, SpO2 measurement from transmittance pulse oximeters is limited to peripheral regions. This becomes a disadvantage at very low temperatures as blood perfusion to the peripherals decreases. On the other hand, reflectance pulse oximeters can be used at various sites like finger, wrist, chest and forehead. Additionally, reflectance pulse oximeters can be scaled down to affordable patches that do not interfere with the user's diurnal activities. However, accurate SpO2 estimation from reflectance pulse oximeters is challenging due to its patient dependent, subjective nature of measurement. Recently, a Machine Learning (ML) method was used to model reflectance waveforms onto SpO2 obtained from transmittance waveforms. However, the generalizability of the model to new patients was not tested. In light of this, the current work implemented multiple ML based approaches which were subsequently found to be incapable of generalizing to new patients. Furthermore, a minimally calibrated data driven approach was utilized in order to obtain SpO2 from reflectance PPG waveforms. The proposed solution produces an average mean absolute error of 1.81% on unseen patients which is well within the clinically permissible error of 2%. Two statistical tests were conducted to establish the effectiveness of the proposed method.Clinical relevance- The proposed method ameliorates our current understanding of reflectance based pulse oximetry and provides a method to estimate SpO2 from reflectance pulse oximeters.


Assuntos
Oximetria , Oxigênio , Dedos , Testa , Humanos , Articulação do Punho
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 633-636, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018067

RESUMO

In this study, we use the overnight blood oxygen saturation (SpO2) signal along with convolutional neural networks (CNN) for the automatic estimation of pediatric sleep apnea-hypopnea syndrome (SAHS) severity. The few preceding studies have focused on the application of conventional feature extraction methods to obtain information from the SpO2 signal, which may omit relevant data related to the illness. In contrast, deep learning techniques are able to automatically learn features from raw input signal. Thus, we propose to assess whether CNN, a deep learning algorithm, could automatically estimate the apnea-hypopnea index (AHÍ) from nocturnal oximetry to help establish pediatric SAHS presence and severity. A database of 746 SpO2 recordings is involved in the study. CNN was trained using 20-min segments from the SpO2 signal in the training set (400 subjects). Hyperparameters of the CNN architecture were tuned using a validation set (100 subjects). This model was applied to a test set (246 subjects), in which the final AHI of each patient was obtained as the average of the output of the CNN for all the segments of the corresponding SpO2 signal. The AHI estimated by the CNN showed a promising diagnostic performance, with 74.8%, 90.7%, and 95.1% accuracies for the common AHI severity thresholds of 1, 5, and 10 events per hour (e/h), respectively. Furthermore, this model reached 28.6, 32.9, and 120.0 positive likelihood ratios for the above-mentioned AHI thresholds. This suggests that the information extracted from the oximetry signal by deep learning techniques may be useful to both establish pediatric SAHS and its severity.


Assuntos
Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Algoritmos , Criança , Humanos , Redes Neurais de Computação , Oximetria , Síndromes da Apneia do Sono/diagnóstico
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 863-866, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018121

RESUMO

Photoplethysmography can be used to estimate many physiological parameters based on features extracted from the measured waveform. Following the single parameter estimations that have been reviewed in part 1 of this paper, we here review methods where the waveform is used in conjunction with other measured physiological signals. Being a low-cost, non-invasive, and user friendly technique, many PPG-based physiological data extraction methods are being researched. The parameters reviewed that can be estimated using the PPG waveform plus additional inputs include cardiac output, blood pressure, venous function assessment, blood oxygen saturation, and fetal heart rate and fetal oxygen saturation. The different processing techniques, algorithms and methods are reviewed in addition to providing a comparison of results with the reference standards to validate the different methods. Future research considerations for each parameter estimation are also discussed. This paper could be helpful for future research on PPG based wearable devices for physiological multi-parameter estimations.


Assuntos
Oximetria , Fotopletismografia , Pressão Sanguínea , Determinação da Pressão Arterial , Débito Cardíaco , Feminino , Humanos , Gravidez
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 923-927, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018135

RESUMO

Photoplethysmography is a non-invasive and easy to administer optical method used primarily to mea-sure blood oxygen saturation, but also used widely to estimate and measure various other physiological parameters. /is paper reviews several physiological parameter estimations that have been done with just this waveform signal, i.e. heart rate, lipid profiling by morphological PPG analysis, blood glucose, ankle brachial pressure, and respiratory rate. Additional physiological estimations which use additional input measurements are reviewed in Part 2 of this paper. The different methods and signal processing techniques based on the principle of operation are discussed in this review. /e validity of each of these optical measurement techniques are reviewed where the results were compared with the results obtained using the gold reference standards. Future research considerations for non-invasive wearable devices for physiological parameter measurements are also highlighted in this review which could be helpful for future research.


Assuntos
Oximetria , Fotopletismografia , Frequência Cardíaca , Taxa Respiratória , Processamento de Sinais Assistido por Computador
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