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Objective To examine metrologic properties of near-infrared spectroscopy (NIRS) versus transcutaneous oxygen tension (TcPO 2 ) for microcirculatory assessment of vascular transtibial stumps at the stabilized period of prosthesis fitting, as a preliminary step before exploring its ability to predict stump healing, considering the previously identified limits of TcPO 2 (borderline area between 15 and 35mmHg). Design Prospective single-center observational study. Setting University-based rehabilitation center. Participants Individuals with unilateral transtibial amputation for peripheral artery disease, at the definitive stage of prosthesis fitting, able to perform a 2-minute walk test (N=30). Interventions Not applicable. Main Outcome Measures Test-retest, with the stump being evaluated in supine and inclined positions, first by NIRS (tissue saturation index [TSI], oxyhemoglobin, deoxyhemoglobin, and total hemoglobin) and second by TcPO 2 . Subjects carried out a 2-minute walk test and visual analog scales (wound healing and pain). Results Feasibility and tolerance of NIRS were satisfactory. The reliability of NIRS and TcPO 2 values was good (intraclass correlation coefficient >0.7; P <.05). No significant relation was found between NIRS and TcPO 2 . No responsiveness (inclined vs supine) was reported ( P >.05). A significant relation between TSI and the 2-minute walk test ( r >.49, P <.05) was found. Conclusions NIRS is painless, complication-free, and feasible, with good reliability. NIRS evaluates others domain than TcPO 2 that are more linked to metabolic adaptation. Its capacity to predict stump healing and tolerance to early prosthesis fitting is therefore interesting to estimate in future studies. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the utility of home-based, unsupervised transcutaneous partial pressure of carbon dioxide (tc-Pco 2) monitoring/oxygen saturation by pulse oximetry (Spo 2) for detecting nocturnal hypoventilation (NH) in individuals with neuromuscular disorders. Design: Retrospective case series analyzed consecutively. Setting: Multidisciplinary neuromuscular respiratory failure (NMRF) clinic at an academic institution. Participants: Subjects (N=35, 68.6% men; mean age, 46.9y) with spinal cord injury (45.7%) or other neuromuscular disorders underwent overnight tests with tc-Pco 2/Spo 2 monitoring. Fifteen (42.9%) were using nocturnal ventilatory support, either bilevel positive airway pressure (BiPAP) or tracheostomy ventilation (TV). Interventions: A respiratory therapist brought a calibrated tc-Pco 2/Spo 2 monitor to the patient’s home and provided instructions for data collection during the subject’s normal sleep period. Forced vital capacity (FVC), body mass index (BMI), and exhaled end-tidal Pco 2 (ET-Pco 2) were recorded at a clinic visit before monitoring. Main Outcome Measures: Detection of NH (tc-Pco 2 ≥50mmHg for ≥5% of monitoring time). Data were also analyzed to determine whether nocturnal oxygen desaturation (Spo 2 ≤88% for ≥5% of monitoring time), FVC, BMI, or daytime ET-Pco 2 could predict the presence of NH. Results: NH was detected in 18 subjects (51.4%), including 53.3% of those using BiPAP or TV. NH was detected in 43.8% of ventilator-independent subjects with normal daytime ET-Pco 2 (present for 49.4%±31.5% [mean ± SD] of the study period), and in 75% of subjects with an elevated daytime ET-Pco 2 (present for 92.3%±8.7% of the study period). Oxygen desaturation, BMI, and FVC were poor predictors of NH. Only 3 attempted monitoring studies failed to produce acceptable results. Conclusions: Home-based, unsupervised monitoring with tc-Pco 2/Spo 2 is a useful method for diagnosing NH in NMRF. [Copyright &y& Elsevier]

Abstract: Gélis A, Fattal C, Dupeyron A, Pérez-Martin A, Colin D, Pelissier J. Reproducibility of transcutaneous oxygen pressure measurements in persons with spinal cord injury. Objectives: To assess the reproducibility and the effects of the subjects'' characteristics on the reproducibility of transcutaneous oxygen pressure (TcPO2) measurements in the sacral area in persons with spinal cord injury during loading in the supine position. Design: Test-retest study. Setting: Physical medicine and rehabilitation center. Participants: Thirty spinal cord–injured American Spinal Injury Association grade A subjects. Main Outcome Measures: Two TcPO2 monitoring sessions in the sacral area during loading in the supine position were performed at 24-hour intervals, including the measurement of absolute resting sacral and chest TcPO2 values and the calculation of regional perfusion index (RPI) and delta from rest oxygen pressure, taking into account systemic TcPO2 changes. Results: The intraclass coefficient of the sacral TcPO2 absolute resting value, RPI, and delta from rest oxygen pressure was .787 and .798, .704 and .635, .760 and .465, respectively, at 20 and 40 minutes. The only characteristic with an influence on RPI reproducibility was the subject''s smoking status, whereas age, weight, time since injury, lesion level, and presence of pressure ulcer showed no influence. Conclusions: TcPO2 measurement is a reproducible method for assessing cutaneous microcirculation during loading over 20-minute monitoring sessions, with RPI exhibiting better reproducibility than delta from rest oxygen pressure at 40 minutes. [Copyright &y& Elsevier]