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1.
Sci Rep ; 13(1): 442, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624254

RESUMO

Non-invasive oxygen saturation (SpO2) is a central vital sign used to shape the management of COVID-19 patients. Yet, there have been no report quantitatively describing SpO2 dynamics and patterns in COVID-19 patients using continuous SpO2 recordings. We performed a retrospective observational analysis of the clinical information and 27 K hours of continuous SpO2 high-resolution (1 Hz) recordings of 367 critical and non-critical COVID-19 patients hospitalised at the Rambam Health Care Campus, Haifa, Israel. An absolute SpO2 threshold of 93% most efficiently discriminated between critical and non-critical patients, regardless of oxygen support. Oximetry-derived digital biomarker (OBMs) computed per 1 h monitoring window showed significant differences between groups, notably the cumulative time below 93% SpO2 (CT93). Patients with CT93 above 60% during the first hour of monitoring, were more likely to require oxygen support. Mechanical ventilation exhibited a strong effect on SpO2 dynamics by significantly reducing the frequency and depth of desaturations. OBMs related to periodicity and hypoxic burden were markedly affected, up to several hours before the initiation of the mechanical ventilation. In summary, OBMs, traditionally used in the field of sleep medicine research, are informative for continuous assessment of disease severity and response to respiratory support of hospitalised COVID-19 patients. In conclusion, OBMs may improve risk stratification and therapy management of critical care patients with respiratory impairment.


Assuntos
COVID-19 , Humanos , COVID-19/terapia , Estudos Retrospectivos , Oximetria , Oxigênio , Taxa Respiratória
2.
Sci Rep ; 13(1): 457, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36627381

RESUMO

In neonates with hypoxic ischemic encephalopathy, the computation of wavelet coherence between electroencephalogram (EEG) power and regional cerebral oxygen saturation (rSO2) is a promising method for the assessment of neurovascular coupling (NVC), which in turn is a promising marker for brain injury. However, instabilities in arterial oxygen saturation (SpO2) limit the robustness of previously proposed methods. Therefore, we propose the use of partial wavelet coherence, which can eliminate the influence of SpO2. Furthermore, we study the added value of the novel NVC biomarkers for identification of brain injury compared to traditional EEG and NIRS biomarkers. 18 neonates with HIE were monitored for 72 h and classified into three groups based on short-term MRI outcome. Partial wavelet coherence was used to quantify the coupling between C3-C4 EEG bandpower (2-16 Hz) and rSO2, eliminating confounding effects of SpO2. NVC was defined as the amount of significant coherence in a frequency range of 0.25-1 mHz. Partial wavelet coherence successfully removed confounding influences of SpO2 when studying the coupling between EEG and rSO2. Decreased NVC was related to worse MRI outcome. Furthermore, the combination of NVC and EEG spectral edge frequency (SEF) improved the identification of neonates with mild vs moderate and severe MRI outcome compared to using EEG SEF alone. Partial wavelet coherence is an effective method for removing confounding effects of SpO2, improving the robustness of automated assessment of NVC in long-term EEG-NIRS recordings. The obtained NVC biomarkers are more sensitive to MRI outcome than traditional rSO2 biomarkers and provide complementary information to EEG biomarkers.


Assuntos
Lesões Encefálicas , Hipóxia-Isquemia Encefálica , Acoplamento Neurovascular , Recém-Nascido , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Oximetria , Eletroencefalografia/métodos
3.
Sensors (Basel) ; 23(2)2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36679533

RESUMO

Mathematical and signal-processing methods were used to obtain reliable measurements of the heartbeat pulse rate and information on oxygen concentration in the blood using short video recordings of the index finger attached to a smartphone built-in camera. Various types of smartphones were used with different operating systems (e.g., iOS, Android) and capabilities. A range of processing algorithms were applied to the red-green-blue (RGB) component signals, including mean intensity calculation, moving average smoothing, and quadratic filtering based on the Savitzky-Golay filter. Two approaches-gradient and local maximum methods-were used to determine the pulse rate, which provided similar results. A fast Fourier transform was applied to the signal to correlate the signal's frequency components with the pulse rate. We resolved the signal into its DC and AC components to calculate the ratio-of-ratios of the AC and DC components of the red and green signals, a method which is often used to estimate the oxygen concentration in blood. A series of measurements were performed on healthy human subjects, producing reliable data that compared favorably to benchmark data obtained by commercial and medically approved oximeters. Furthermore, the effect of the video recording duration on the accuracy of the results was investigated.


Assuntos
Processamento de Sinais Assistido por Computador , Smartphone , Humanos , Frequência Cardíaca , Oximetria/métodos , Oxigênio
4.
PLoS One ; 18(1): e0280436, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36662703

RESUMO

PURPOSE: This prospective observational study aimed to establish the frequency of postoperative nocturnal respiratory abnormalities among patients undergoing major surgery who received ward-level care. These abnormalities may have implications for postoperative pulmonary complications (PPCs). METHODS: Eligible patients underwent blinded noninvasive continuous capnography with pulse oximetry using the Capnostream™ 20p monitor over the first postoperative night. All patients received oxygen supplementation and patient-controlled opioid analgesia. The primary outcome was the number of prolonged apnea events (PAEs), defined as end-tidal carbon dioxide (EtCO2) ≤5 mmHg for 30-120 seconds or EtCO2 ≤5 mmHg for >120 seconds with oxygen saturation (SpO2) <85%. Secondary outcomes were the proportion of recorded time that physiological indices were aberrant, including the apnea index (AI), oxygen desaturation index (ODI), integrated pulmonary index (IPI), and SpO2. Exploratory analysis was conducted to assess the associations between PAEs, PPCs, and pre-defined factors. RESULTS: Among 125 patients who had sufficient data for analysis, a total of 1800 PAEs occurred in 67 (53.4%) patients. The highest quartile accounted for 89.1% of all events. Amongst patients who experienced any PAEs, the median (IQR) number of PAE/patient was four (2-12). As proportions of recorded time (median (IQR)), AI, ODI, and IPI were aberrant for 12.4% (0-43.2%), 19.1% (2.0-57.1%), and 11.5% (3.1-33.3%) respectively. Only age, ARISCAT, and opioid consumption/kg were associated with PPCs. CONCLUSIONS: PAE and aberrant indices were frequently detected on the first postoperative night. However, they did not correlate with PPCs. Future research should investigate the significance of detected aberrations.


Assuntos
Analgésicos Opioides , Apneia , Humanos , Analgésicos Opioides/efeitos adversos , Oxigênio , Oximetria , Dióxido de Carbono/análise , Capnografia
5.
Magn Reson Imaging ; 97: 112-121, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36608912

RESUMO

PURPOSE: The R1 relaxation rate of fat is a promising marker of tissue oxygenation. Existing techniques to map fat R1 in MR-oximetry offer limited spatial coverage, require long scan times, or pulse sequences that are not readily available on clinical scanners. This work addresses these limitations with a 3D voxel-wise fat R1 mapping technique for MR-oximetry based on a variable flip angle (VFA) approach at 3 T. METHODS: Varying levels of dissolved oxygen (O2) were generated in a phantom consisting of vials of safflower oil emulsion, used to approximate human fat. Joint voxel-wise mapping of fat and water R1 was performed with a two-compartment VFA model fitted to multi-echo gradient-echo magnitude data acquired at four flip angles, referred to as Fat DESPOT. Global R1 was also calculated. Variations of fat, water, and global R1 were investigated as a function of the partial pressure of O2 (pO2). Inversion-prepared stimulated echo magnetic resonance spectroscopy was used as the reference technique for R1 measurements. RESULTS: Fat R1 from Fat DESPOT was more sensitive than water R1 and global R1 to variations in pO2, consistent with previous studies performed with different R1 mapping techniques. Fat R1 sensitivity to pO2 variations with Fat DESPOT (median O2 relaxivity r1, O2 = 1.57× 10-3 s-1 mmHg-1) was comparable to spectroscopy-based measurements for methylene, the main fat resonance (median r1, O2= 1.80 × 10-3 s-1 mmHg-1). CONCLUSION: Fat and water R1 can be measured on a voxel-wise basis using a two-component fit to multi-echo 3D VFA magnitude data in a clinically acceptable scan time. Fat and water R1 measured with Fat DESPOT were sensitive to variations in pO2. These observations suggest an approach to 3D in vivo MR oximetry.


Assuntos
Oximetria , Oxigênio , Humanos , Oximetria/métodos , Espectroscopia de Ressonância Magnética , Imageamento por Ressonância Magnética/métodos
7.
Einstein (Sao Paulo) ; 21: eAO0025, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36629679

RESUMO

OBJECTIVE: To calculate the positive likelihood ratio to determine whether telemedicine is able to optimize referral to the emergency department. METHODS: Unicenter study with 182 consecutive patients admitted to Hospital Israelita Albert Einstein due to respiratory symptoms. All patients were submitted to oxygen saturation measurement using the standard method Welch Allyn finger device vital sign monitor and a 2-minute evaluation (Binah.ai mobile application). The reproducibility of oxygen saturation measurements made with both methods was investigated using interclass correlation coefficients and analysis of dispersion. Bland-Altman plots were constructed and kappa concordance coefficients used to examine data normality. Accuracy was also estimated. RESULTS: Oxygen saturation measurement differences between methods were ≤2% in more than 85% of cases. The mean difference (bias) between methods was near zero (0.835; Bland-Altman analysis). Oxygen saturation measurements made using the Binah.ai mobile application had an average ability to detect patients with altered oxygen saturation levels compared to the conventional method (ROC analysis). The positive likelihood ratio of the mobile application was 6.23. CONCLUSION: Mobile applications for oxygen saturation measurement are accessible user-friendly tools with moderate impact on clinical telemedicine evaluation of patients with respiratory symptoms, and may optimize referral to the emergency department.


Assuntos
Aplicativos Móveis , Oxigênio , Humanos , Reprodutibilidade dos Testes , Oximetria/métodos , Curva ROC
8.
Hosp Pediatr ; 13(1): 61-65, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36572634

RESUMO

BACKGROUND AND OBJECTIVES: Sleep is vital to recovery from illness, yet it is frequently interrupted in the hospital setting. Existing literature relying on survey data identifies vitals, medications, and pulse oximetry as major disruptors to sleep. This study was designed to assess the degree to which these candidate sleep disruptors are associated with objective room entries. METHODS: Room entry sensors were placed on doors to 18 rooms on acute medical-surgical units at a tertiary academic center. The number of entries into rooms between 10 Pm and 6 Am were logged on patients admitted to hospital medicine services from March 2021 through February 2022. Medical records were reviewed to extract orders for vital sign frequency, medication timing, continuous pulse oximetry, and intravenous fluid use overnight. Negative binomial regression was used to evaluate associations. RESULTS: Room entry data were collected for 112 admissions and 192 patient-nights. There was an average of 7.8 room entries per patient-night. After adjustments for the other variables and for patients represented in multiple nights, vitals ordered every 4 hours were associated with a 1.3-fold increase in room entries (95% confidence interval 1.0-1.5; P = .013), as were medications scheduled during overnight hours (1.3; 95% confidence interval 1.0-1.5; P = .016). There was no association between room entries and continuous pulse oximetry use. After adjustment, there was also no association with administration of intravenous fluids. CONCLUSIONS: Vitals ordered every 4 hours and medications scheduled during sleep hours are independently associated with increased room entries and may be reasonable initial targets for quality improvement interventions designed to minimize nighttime disruptions.


Assuntos
Hospitais , Sono , Humanos , Oximetria , Hospitalização , Fatores de Tempo
9.
ASAIO J ; 69(1): e28-e34, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36583777

RESUMO

The Extracorporeal Life Support Organisation (ELSO) recommends initiating veno-venous extracorporeal membrane oxygenation (ECMO) with sweep gas flow rate () of 2 L/min and extracorporeal circuit blood flow () of 2 L/min. We used an in-silico model to examine the effect on gas exchange of initiating ECMO with different and , and the effect of including 5% in sweep gas. This was done using a set of patient examples, each with different physiological derangements at baseline (before ECMO). When ECMO was initiated following ELSO recommendations in the patient examples with significant hypercapnia at baseline, sometimes fell to < 50% of the baseline , a magnitude of fall associated with adverse neurological outcomes. In patient examples with very low baseline arterial oxygen saturation (), initiation of ECMO did not always increase to > 80%. Initiating ECMO with of 1 L/min and of 4 L/min, or with sweep gas containing 5% , of 2 L/min, and of 4 L/min, reduced the fall in and increased the rise in compared to the ELSO strategy. While ELSO recommendations may suit most patients, they may not suit patients with severe physiological derangements at baseline.


Assuntos
Oxigenação por Membrana Extracorpórea , Humanos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Hipercapnia/etiologia , Hemodinâmica , Oximetria
11.
Crit Care Nurse ; 42(6): e1-e6, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36453063

RESUMO

BACKGROUND: Pulse oximetry is commonly used in critical care settings to monitor oxygenation status and assist with decision-making regarding oxygen therapy. Although it is imperative that nurses follow manufacturer guidelines, off-label use is common and could affect patient safety. OBJECTIVE: To increase staff members' knowledge and reduce the frequency of off-label pulse oximeter placement in the critical care setting. METHODS: A preintervention audit was completed to assess the frequency of off-label use, and a preintervention survey was given to staff. Health care staff in the critical care units received an educational intervention. A postintervention survey for health care staff and a postintervention audit were completed to assess outcomes. With the support of hospital management, 90 ear probes were purchased for critical care settings to address supply barriers to the use of appropriate pulse oximetry sensors. RESULTS: In the preintervention audit (508 observations), a finger probe was used off label on the ear in 77 patients (15.2%). In the postintervention audit (365 observations), a finger probe was used on the ear in only 3 patients (0.8%). CONCLUSION: Providing a brief educational session and making ear pulse oximeter probes readily available in the critical care setting increased compliance with manufacturer guidelines and helped ensure safe pulse oximetry monitoring.


Assuntos
Prática Clínica Baseada em Evidências , Segurança do Paciente , Humanos , Cuidados Críticos , Unidades de Terapia Intensiva , Oximetria
16.
Chest ; 162(6): e295-e299, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36494128

RESUMO

CASE PRESENTATION: A 77-year-old woman with asthma, hypothyroidism, irritable bowel syndrome, overactive bladder, and multiple rheumatologic conditions was sent from the clinic to the ED for evaluation of hypoxia. In the clinic, she reported dizziness without shortness of breath and was noted to have perioral cyanosis with an oxygen saturation measured by pulse oximetry (Spo2) of 80%. She was given a nonrebreather mask delivering oxygen at 8 L/min, but the Spo2 remained at 77% to 82%. In the ED, the patient reported intermittent shortness of breath, 2 to 3 days of mild left lower extremity swelling, and a brief episode of lightheadedness earlier in the day that had since resolved. She denied fevers/chills, upper respiratory symptoms, and chest pain. She had been referred to the pulmonology clinic 3 years earlier to evaluate mild hypoxia with Spo2 readings in the low 90% range, but pulmonary function testing failed to identify an etiology. There was no history of VTE. Her rheumatologic conditions included osteoarthritis, rheumatoid arthritis, Sjögren's syndrome, and fibromyalgia.


Assuntos
Hipóxia , Oximetria , Humanos , Feminino , Idoso , Hipóxia/diagnóstico , Hipóxia/etiologia , Testes de Função Respiratória , Oxigênio , Dispneia/diagnóstico , Dispneia/etiologia
17.
Georgian Med News ; (331): 116-123, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36539142

RESUMO

This study is devoted to the study of the prognostic value of cerebral oximetry of the brain and indicators of the outcome of brain damage. The purpose - to study the prognostic role of cerebral oximetry indicators as a predictor of mortality in vascular and traumatic brain injuries. A prospective cohort study involving 129 patients. Cerebral gas exchange and oxygenation, arteriovenous difference, neuron-specific markers (S100ß, NSE) and glucose, acid-base state and gas composition of arterial blood were studied during follow-up periods: at admission, on the 3rd, 5th and 7th days of patients' stay in the intensive care unit. The most significant risk factor for an unfavorable outcome is a marker with a threshold value or with a cut-off point rSO2<45%. Statistically significant direct connections were determined between dependent rSO2<45% with independent variables, such as: S100ß<0.6 mcg/l - OR is 4.22 (95%CI:10.76-1.66), p=0.0025; joining in a patient with a diagnosis of pneumonia - OR 6.21(95% CI:12.0-3.21), p<0.0001 and the patient's diagnosis was 8.13 (95% CI:25.59-2.59), p=0.0003. The measure of certainty of the obtained model was according to the criterion of pseudo R2 Nagelkerke -137.8; log Likelihood - 175.83. The cut-off point of 97.1% had the best predictive value of the model, the area under the AuROC curve was 0.846; sensitivity - 68.47%; specificity - 90.16%; NPV - 61.11%; PPV - 92.68%. The quantitative indicator rSO2 was obtained in relation to the independent variables GCS, ABP, NSE and pH and the quality characteristic of the model has: R2 = 16.7%; R2 (adjusted) = 15.5%; p<0.0001. This model can be used to predict the outcome in patients with acute cerebral pathology.


Assuntos
Neoplasias Encefálicas , Oximetria , Humanos , Estudos Prospectivos , Circulação Cerebrovascular , Encéfalo , Prognóstico
18.
Adv Exp Med Biol ; 1395: 45-51, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36527612

RESUMO

BACKGROUND: Although several studies published reference values for frontal cerebral tissue oxygen saturation (StO2) measured with near-infrared spectroscopy (NIRS) based cerebral oximetry, a detailed investigation, whether and which factors from systemic physiology are related to the individual StO2 values, is missing. AIM: We investigated how the state of the cardiorespiratory system is linked to StO2 values at rest. SUBJECTS AND METHODS: Absolute StO2 values (median over a 5 min resting-phase while sitting) were obtained from 126 healthy subjects (age: 24.0 ± 0.2 years, 45 males, 81 females) over the left and right prefrontal cortex (PFC) by employing frequency-domain NIRS as part of a systemic physiology augmented functional near-infrared spectroscopy (SPA-fNIRS) study. In addition, heart rate (HR) and respiration rate (RR) were measured, and the pulse respiration quotient (PRQ) was determined (PRQ = HR/RR). General additive models (GAM) were used to analyse the data. RESULTS: The GAM analysis revealed a specific relationship between the overall PFC StO2 values (mean over right and left PFC) and the variables HR and RR: HR was positively correlated with mean StO2, while RR showed no correlation. In the mirror case, RR was negatively linearly correlated with the frontal cerebral oxygenation asymmetry (FCOA), which was not correlated with HR. The right PFC StO2 was not linked to the RR, whereas the left PFC StO2 was. Positive correlations of the PRQ with the mean PFC StO2 as well as the FCOA were also found. GAM modelling revealed that the individual FCOA values are explained to a large extent (deviance explained: 88.8%) by the individual mean PFC StO2 and PRQ. We conclude that (i) the state of the cardiorespiratory system is significantly correlated with StO2 values and (ii) there is a mirror symmetry with regard to the impact of cardiorespiratory parameters on the mean PFC StO2 and FCOA.


Assuntos
Oximetria , Consumo de Oxigênio , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Oximetria/métodos , Consumo de Oxigênio/fisiologia , Circulação Cerebrovascular , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Frequência Cardíaca , Oxigênio
19.
Adv Exp Med Biol ; 1395: 127-131, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36527626

RESUMO

Surgical treatment should be considered for patients with severe vertebrobasilar artery (VBA) stenosis or progressive symptoms, but there is currently no clear treatment algorithm. We report a case of symptomatic intracranial vertebral artery stenosis with repeated cerebral infarction treated by percutaneous transluminal angioplasty (PTA) and stenting and monitoring of oxygen saturation by a brain oximeter. The patient was a 76-year-old man referred to our hospital due to infarction in the right cerebellum. Angiography showed 60% stenosis in the right vertebral artery and 90% stenosis in the left vertebral artery with progressive stenosis in the left. The patient was treated with intravenous and oral triple antiplatelet therapy but had dizziness again with new cerebral infarctions in the left cerebellum and right pontine. We shaved the patient's hair up to the superior nuchal line and placed left and right oximeter probes on each cerebellar hemisphere (2 cm lateral and 2 cm caudal from the external occipital protuberance). Under evaluation of blood flow in the posterior circulation with INVOS Cerebral/Somatic Oximeter, PTA and stent placement were performed for left vertebral artery stenosis. Postoperatively, the dizziness disappeared, and the patient was discharged on his own with good outcome. He has not had a recurrent stroke in over 6 years. Although medical treatment is generally considered the first choice for VBA stenosis, recurrent cerebral infarction occurs at a high rate in symptomatic lesions, and the prognosis is poor. In addition, the perioperative complication rate is not low, and there is no established method for evaluating perfusion of posterior circulation. The brain oximeter is already known to be useful in carotid artery (CA) revascularisation. In this report, we were able to perform a minimally invasive evaluation of blood flow in the posterior circulation using the brain oximeter which might be useful for surgical revascularisation not only in CA but also in VBA.


Assuntos
Tontura , Insuficiência Vertebrobasilar , Masculino , Humanos , Idoso , Constrição Patológica , Insuficiência Vertebrobasilar/terapia , Insuficiência Vertebrobasilar/cirurgia , Angioplastia , Stents , Oximetria , Encéfalo , Infarto Cerebral
20.
Adv Exp Med Biol ; 1395: 133-137, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36527627

RESUMO

In patients with severe traumatic brain injury (TBI), simultaneous measurement of intracranial and arterial blood pressure (ICP and ABP, respectively) allows monitoring of cerebral perfusion pressure (CPP) and the assessment of cerebral autoregulation (CA). CPP, a difference between ICP and ABP, is the pressure gradient that drives oxygen delivery to cerebral tissue. CA is the ability of cerebral vasculature to maintain stable blood flow despite changes in CPP and thus, is an important homeostatic mechanism. Pressure reactivity index (PRx), a moving Pearson's correlation between slow waves in ICP and ABP, has been most frequently cited in literature over the past two decades as a tool for CA evaluation. However, in some clinical situations, ICP monitoring may be unavailable or contraindicated. In such cases, simultaneous mean arterial pressure (MAP) monitoring and near-infrared spectroscopy (NIRS) can be used for CA assessment by cerebral oximetry index (COx), allowing calculation of the optimal blood pressure (MAPOPT). The purpose of this study was to compare regional oxygen saturation (rSO2)-based CA (COx) with ICP/ABP-based CA (PRx) in TBI patients and to compare MAPOPT derived from both technologies. Three TBI patients were monitored at the bedside to measure CA using both PRx and COx. Patients were monitored daily for up to 3 days from TBI. Averaged PRx and COx-, and PRx and COx-based MAPOPT were compared using Pearson's correlation. Bias analysis was performed between these same CA metrics. Correlation between averaged values of COx and PRx was R = 0.35, p = 0.15. Correlation between optimal MAP calculated for COx and PRx was R = 0.49, p < 0.038. Bland-Altman analysis showed moderate agreement with a bias of 0.16 ± 0.23 for COx versus PRx and good agreement with a bias of 0.39 ± 7.89 for optimal MAP determined by COx versus PRx. Non-invasive measurement of CA by NIRS (COx) is not correlated with invasive ICP/ABP-based CA (PRx). However, the determination of MAPOPT using COx is correlated with MAPOPT derived from PRx. Obtained results demonstrate that COx is not an acceptable substitute for PRx in TBI patients. However, in some TBI cases, NIRS may be useful in determining MAP determination.


Assuntos
Lesões Encefálicas Traumáticas , Espectroscopia de Luz Próxima ao Infravermelho , Humanos , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Circulação Cerebrovascular/fisiologia , Pressão Arterial/fisiologia , Oximetria , Pressão Intracraniana/fisiologia , Lesões Encefálicas Traumáticas/diagnóstico
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