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Pulse oximetry (SpO2) is a critical monitor for assessing oxygenation status and guiding therapy in critically ill patients. Race has been identified as a potential source of SpO2 error, with consequent bias and inequities in healthcare. This study was designed to evaluate the incidence of occult hypoxemia and accuracy of pulse oximetry associated with the Massey-Martin scale and characterize the relationship between Massey scores and self-identified race. This retrospective single institute study utilized the Massey-Martin scale as a quantitative assessment of skin pigmentation. These values were recorded peri-operatively in patients enrolled in unrelated clinical trials. The electronic medical record was utilized to obtain demographics, arterial blood gas values, and time matched SpO2 values for each PaO2 ≤ 125 mmHg recorded throughout their hospitalizations. Differences between SaO2 and SpO2 were compared as a function of both Massey score and self-reported race. 4030 paired SaO2-SpO2 values were available from 579 patients. The average error (SaO2-SpO2) ± SD was 0.23 ± 2.6%. Statistically significant differences were observed within Massey scores and among races, with average errors that ranged from − 0.39 ± 2.3 to 0.53 ± 2.5 and − 0.55 ± 2.1 to 0.37 ± 2.7, respectively. Skin color varied widely within each self-identified race category. There was no clinically significant association between error rates and Massey-Martin scale grades and no clinically significant difference in accuracy observed between self-reported Black and White patients. In addition, self-reported race is not an appropriate surrogate for skin color. [ABSTRACT FROM AUTHOR]

Improving patient outcomes in critical care settings is significantly connected to effective ventilation control. This research introduces a new method for improving ventilation methods in critical healthcare utilizing a long short-term memory (LSTM) network hosted in the cloud. Ventilators, pulse oximeters, and capnography are just a few examples of medical equipment that input data into the system, which then uploads the data to the cloud for analysis. The LSTM network can learn from data patterns and correlations, drawing on respiratory parameters' time dynamics, to provide real-time suggestions and predictions for ventilation settings. The system aims to improve clinical results and reduce the risk of ventilator-induced lung damage by tailoring ventilation techniques according to each patient's requirements and by forecasting potential issues. Due to remote monitoring technology, medical professionals can quickly analyze their patient's conditions and act accordingly. The system allows for continuous improvement using iterative learning of more data and feedback. With the ability to optimize breathing and enhance patient care in critical healthcare situations, a hopeful development in airway management is needed. [ABSTRACT FROM AUTHOR]

Background and aims: Predicting progression and prognosis in Interstitial Lung Diseases (ILD), especially Idiopathic Pulmonary Fibrosis (IPF) and Progressive Pulmonary Fibrosis (PPF), remains a challenge. Integrating patient-centered measurements is essential for earlier and safer detection of disease progression. Home monitoring through e-health technologies, such as spirometry and oximetry connected to smartphone applications, holds promise for early detection of ILD progression or acute exacerbations, enabling timely therapeutic interventions. Methods: The European ILD Registry Algorithm for Self-Assessment in ILD (eurILDreg ASA-ILD), developed by all eurILDreg principal investigators, includes questionnaires on symptom burden, respiratory infections, and quality of life (EQ5D VAS, K-BILD, LCQ). The algorithm also incorporates spirometry and oxygen saturation measurements, both at rest and during exercise (one-minute sit-to-stand test, 1STST). This ASA-ILD algorithm is integrated into the patientMpower Ltd. smartphone application, used for patient-led monitoring, research, and clinical care since 2016, and available on both Apple and Android platforms. Discussion: For patient-centered measurements, participants in the multicenter eurILDreg study will receive a patientMpower account, a handheld clinical-grade spirometer (Spirobank Smart, MIR, Italy), and a pulse oximeter (Nonin Medical, Inc. Plymouth, MN, USA), along with usage instructions. Artificial intelligence software (ArtiQ) will analyze spirometry maneuvers in real-time, ensuring compliance with recent ERS/ATS criteria and providing automated feedback. Pulse oximetry is integrated into the exercise testing within the application, following an automated in-app protocol developed with clinician involvement for safety and accuracy. The application will send reminders to participants to complete patient-reported outcome measures (PROMs) according to the study protocol. Conclusion: This study is designed to explore the potential of e-Health technologies, such as home monitoring via spirometry and oximetry, integrated with the eurILDreg ASA-ILD algorithm and patientMpower app, to improve early detection and management of ILD. A pilot trial showed promising adherence to spirometry, indicating that digital health interventions could enhance patient care and outcomes in ILD. Trial registration: The ethics committee of the Justus-Liebig-University of Giessen has approved the eurILDreg and this substudy with the protocol reference number 111/08. The research was conducted strictly according to the principles of the Declaration of Helsinki. Patients were included into the registry upon having signed the informed consent. The eurIPFreg and eurIPFbank are listed in ClinicalTrials.gov (NCT02951416). EurILDreg is registered in German Clinical Trials Register, DRKS 00028968. [ABSTRACT FROM AUTHOR]

Over the past ten years, there has been an increasing demand for reliable consumer wearables as users are inclined to monitor their health and fitness metrics in real-time, especially since the COVID-19 pandemic. Reflectance pulse oximeters in fitness trackers and smartwatches provide convenient, non-invasive SpO2 measurements but face challenges in achieving medical-grade accuracy, particularly due to difficulties in capturing physiological signals, which may be affected by skin pigmentation. Hence, this study sets out to investigate the influence of skin pigmentation, particularly in individuals with darker skin, on the accuracy and reliability of SpO2 measurement in consumer wearables that utilise reflectance pulse oximeters. A Monte Carlo model is developed to assess the effect on simulated reflectance pulse oximetry measurements across light, moderate, and dark skin types for oxygen saturation levels between 70 and 100%. The results indicate that a one-algorithm-fits-all calibration approach may be insufficient, and root mean square errors (RMSEs) of at least 0.3956%, 0.9132%, and 8.4111% for light, moderate, and dark skin are observed when compared to transmittance calibration algorithms. Further research is required to validate these findings and improve the performance of reflectance pulse oximeters in real-world applications, particularly in the context of consumer wearables. [ABSTRACT FROM AUTHOR]

The effect of skin pigmentation on photoplethysmography and, specifically, pulse oximetry has recently received a significant amount of attention amongst researchers, especially since the COVID-19 pandemic. With most computational studies observing overestimation of arterial oxygen saturation (SpO2) in individuals with darker skin, this study seeks to further investigate the root causes of these discrepancies. This study analysed intensity changes from Monte Carlo-simulated reflectance PPG signals across light, moderate, and dark skin types at oxygen saturations of 70% and 100% in MATLAB R2024a. With simulated intensity reflecting PPG amplitude, the results showed that systolic intensity decreased by 3–4% as pigmentation increased at 660 nm. It was also shown that the impact at 940 nm is minimal (<0.2%), indicating that the increased absorption of red light by melanin has a greater effect on the ratio of ratios calculations. These results suggest that in-built adjustments may be required for data collected from red-light sources in pulse oximeters that do not currently have the necessary post-processing algorithms to account for this difference between diverse skin populations. [ABSTRACT FROM AUTHOR]

Introduction: As wearable technology becomes increasingly popular and sophisticated, independent validation is needed to determine its accuracy and potential applications. Therefore, the purpose of this study was to evaluate the accuracy (validity) of VO2max estimates and blood oxygen saturation measured via pulse oximetry using the Garmin fēnix 6 with a general population participant pool. Methods: We recruited apparently healthy individuals (both active and sedentary) for VO2max (n = 19) and pulse oximetry testing (n = 22). VO2max was assessed through a graded exercise test and an outdoor run, comparing results from the Garmin fēnix 6 to a criterion measurement obtained from a metabolic system. Pulse oximetry involved comparing fēnix 6 readings under normoxic and hypoxic conditions against a medical-grade pulse oximeter. Data analysis included descriptive statistics, error analysis, correlation analysis, equivalence testing, and bias assessment, with the validation criteria set at a concordance correlation coefficient (CCC) > 0.7 and a mean absolute percentage error (MAPE) < 10%. Results: The Garmin fēnix 6 provided accurate VO2max estimates, closely aligning with the 15 s and 30 s averaged laboratory data (MAPE for 30 s avg = 7.05%; Lin's concordance correlation coefficient for 30 s avg = 0.73). However, it failed to accurately measure blood oxygen saturation (BOS) under any condition or combined analysis (MAPE for combined conditions BOS = 4.29%; Lin's concordance correlation coefficient for combined conditions BOS = 0.10). Conclusion: While the Garmin fēnix 6 shows promise for estimating the VO2max, reflecting its utility for both individuals and researchers, it falls short in accurately measuring BOS, limiting its application for monitoring acclimatization and managing pulmonary diseases. This research underscores the importance of validating wearable technology to leverage its full potential in enhancing personal health and advancing public health research. [ABSTRACT FROM AUTHOR]

Introduction Hypoxia presents a physiological challenge to the Warfighters during military aviation and subterranean warfare operations by decreasing the supply of oxygen to the brain, which results in a reduced cognitive function depending on the magnitude and duration of hypoxic exposure. Moderate hypoxic exposures, fractions of inspired oxygen (FiO2) of 0.11 to 0.14, show no effects on simple tasks, but complex tasks like working memory may be hindered. Unfortunately, people often cannot recognize their own symptoms of hypoxemia, which are individualistic at moderate hypoxic exposure. Thus, screening tools, like gamified cognitive assessments, during moderate hypoxia may provide personnel objective feedback to initiate safety protocols before a possible accident. However, whether gamified assessments of working memory are sensitive to moderate hypoxia is unknown. Therefore, we tested the hypothesis which moderate normobaric hypoxia decreases gamified working memory performance when accounting for the individualistic responses of arterial blood oxygen saturations. Materials and methods Following 3 consecutive days of 2 practice sessions per day, 30 healthy adults (25 ± 5 years, 10 women) completed three 1-min rounds of the tablet-based working memory game (Backtracker, Statespace Labs, Inc.) at baseline and 60 and 90 min after exposure to FiO2 (= 0.138 ± 0.002 [hypoxia] and 0.201± 0.004 [normoxia] oxygen). Both conditions were completed on the same day and administered in a single-blind, block randomized manner. Arterial oxyhemoglobin saturation was estimated via forehead pulse oximetry (SpO2). Data were analyzed using linear mixed effects modeling. Results Compared to normoxia (99 ± 1%), SpO2 was lower (P  < .001) at 60 (90 ± 2%) and 90 (90 ± 2%) min of hypoxia. A decrease in SpO2 was associated with a statistically significant decrease in the proportion of both tiles with the correct location (P  < .02; −0.016) and correct order of appearance recalled (P  < .01; −0.016). A decrease in SpO2 was associated with a statistically significant decrease in median time to first tap (P  < .01; −0.041 s) and median time between taps (P  < .01; −0.030 s). A significant interaction effect between the SpO2 decrease and baseline performance was found for proportion of tiles with the correct location recalled (P  < .05; −0.014), median time to first tap (P < .01; −0.070 s), and median time between taps (P  < .01; −0.037 s). A significant interaction effect between the SpO2 decrease and the path length was found for the proportion of tiles with the correct location recalled (P  < .01; +0.021), median time to first tap (P  < .01; −0.036 s), and median time between taps (P  < .01; −0.043 s). Conclusions These findings indicate that greater decreases in SpO2 during moderate hypoxic exposure hinder performance on a gamified assessment of working memory as measured by the proportion of correctly identified order and location of tiles. Considering the statistically significant decrease in both median time to first tap and median time between taps associated with the decrease in SpO2, participants are taking less time to plan or execute movements, which may compound or independently contribute to spatial and temporal memory mistakes. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction: Over the past decade, monitoring of body vitals has gained significant popularity, specifically during and post the recent COVID pandemic. Advancements in smartphones and wearables have been pivotal, providing accessible and cost-effective solutions for at-home health monitoring. Their development often requires a large corpus of labeled datasets, but such large and diverse datasets for developing smartphone-based vital estimation systems, particularly adapted to Indian context, are scarce. Aims and Objectives: This observational study focuses on development of such a dataset in a diverse Indian context and evaluation of smartphone-based pulse rate estimation based on this dataset. Methods: Data collection considered Indian patients with various medical conditions, body mass index profiles, blood pressure levels, ages, and smoking habits, reflecting a broad demographic spectrum. As part of this study, an algorithm was implemented to estimate the photoplethysmogram (PPG) signal from video recordings of fingers placed on the smartphone camera and subsequently to estimate pulse rate using the acquired PPG data. Smartphone-based pulse rate estimates were compared with readings from pulse oximeters to assess accuracy and feasibility. Results: The smartphone-based PPG algorithm provides reasonably accurate estimations of pulse rate when compared to traditional pulse oximeters under varied healthcare settings (mean absolute error < 5, intraclass correlation coefficient > 0.90). Conclusion: Results indicate that the smartphone-based PPG signal captures sufficient information of the cardiac cycle to reliably estimate the pulse rate. Furthermore, system accuracy is consistent across varied subjects and settings, highlighting the importance of tailored data collection for development and evaluation of vital estimation algorithms. [ABSTRACT FROM AUTHOR]

In general in ICUs, operation theatres, post-operative critical care units, and even ambulatory monitors, the patients are continuously examined with ECG and pulse oximeters PPG. In these situations, where the ECG and/or PPG are afflicted by severe artifacts, the idea of extracting respiratory signal from both ECG and PPG signals rather than from any one of them is tested in this work. As respiratory trend is present in both ECG and PPG signals, the common respiratory trend present in simultaneously recorded ECG and PPG signals is extracted, using a bivariate vector autoregressive modeling (BVAR) technique. This technique effectively reduced the inevitable artifacts and resulted in better estimation of the respiratory activity. For further improving the performance of the BVAR method, in extracting respiratory activity from ECG and PPG signals corrupted with sever artifacts, and also works for broad range of breathing rates, an improved BVAR (IB-VAR) technique is proposed. This technique is robust in the sense that it, firstly, works well even in the presence of various artifacts present in either of the signals, and extracts the signal common to both i.e. respiratory information, with a greater accuracy. Secondly, it also works even for a broad range of breathing rates covering as low as 6 breaths per minute (bpm) to as high as 90 bpm. The novel part of the proposed IB-VAR method is that the respiratory pole lying in that broad breathing range is automatically selected from among all other possible poles, which also include the ones corresponding to noises like motion artifact (MA) and baseline wander (BLW), making use of kurtosis values of extracted signals. An analog front end is developed to record ECG, PPG and respiratory signals with different breathing rates and respiration patterns simultaneously from the volunteers. The method, applied on the recorded data of fifteen healthy subjects, performed extremely well even in the presence of MA and BLW, compared to the well known wavelet based approach. Correlation analysis, done in both frequency and time domains, has shown a high degree of acceptance for the extracted respiratory signal with respect to the original reference respiratory signal. Higher values of accuracy rate (EDR: 98.10 ± 1.45, PDR: 98.45 ± 1.30) and lower values of NRMSE calculations (EDR: − 6.47 ± 4.29, PDR: − 6.50 ± 4.17) clearly confirmed the validity of the extracted respiratory signal. An important finding of this work is that the PPG derived respiratory signal very closely matched with the original than the ECG derived signal. [ABSTRACT FROM AUTHOR]

The article discusses sedation practices in gastrointestinal endoscopy, highlighting variations in sedation rates, preferred regimens, and patient monitoring practices among endoscopists. The European Society of Gastrointestinal Endoscopy (ESGE) conducted a survey among its members to gather information on sedation practices, training, and patient care during endoscopic procedures. The survey revealed a lack of standardized training in sedation administration, varied sedation options, and limited monitoring tools used post-procedure. Recommendations for new ESGE guidance include standardizing propofol use, improving training, and establishing discharge criteria. The survey emphasizes the need for continuous training, quality improvement initiatives, and standardized practices to enhance patient safety and procedural outcomes in GI endoscopy. [Extracted from the article]

Background: Peripherally measured oxygen saturation (SpO2) may often differ from arterial oxygen saturation (SaO2), measured by co‐oximetry, especially within the lower range of oxygen saturations. This can potentially impact clinical decisions and therapy in children with congenital heart disease, as critical hypoxemia might remain unnoticed. Aims: Our aim was to investigate the accuracy of two different pulse oximeters compared to SaO2 in infants with congenital heart diseases. Methods: Simultaneous recordings of SpO2, measured by two different pulse oximeters (Philips IntelliVue X3 Monitor and Nellcor™ OxiMax™), were compared to SaO2 obtained by arterial blood gas analysis. Results: A total of 153 measurements were performed in 44 infants with arterial oxygen saturation between 70 and 100%. We divided the measurements into 3 subgroups: group 1—SaO2 70.0%–85.0%, group 2—SaO2 85.1%–94.0%, group 3—SaO2 >94.1%. For Philipps, the median bias was 5.3 (IQR: 2.6–8.7) %, 2.3 (IQR: 0.9–6.0) % and 1.1 (IQR: −0.8–2.4) % in group 1, 2 and 3, respectively. For OxiMax™, the median bias was 2.7 (IQR: 0.5–5.1) %, 0.2 (IQR: −0.9–2.6) % and −0.5 (IQR: −1.3–0.6) % in group 1, 2 and 3, respectively. Regarding the accuracy of these oximeters, as evaluated with the Accuracy root mean squared index (Arms), it was 9.8 versus 4.5% in group 1, 4.5 versus 2.9% in group 2 and 2.4 versus 1.9% in group 3 for Philipps and OxiMax™, respectively. Conclusions: In lower range saturations between 70% and 85% the accuracy of both pulse oximeters exceeded the threshold of ≤3% recommended by the Food and Drug Administration (FDA). Therefore, peripheral pulse oximetry within the lower range of oxygen saturations should be interpreted with caution in infants with congenital heart diseases, taking into consideration its limitations. Direct co‐oximetry should be the preferred method to support clinical decisions in children with cyanotic congenital heart diseases. [ABSTRACT FROM AUTHOR]

Background: Pulse oximeters are vital for assessing blood oxygen levels but can produce inaccurate readings during patient motion, leading to false alarms and alarm fatigue. Analog SpO2 Technology, which uses analog waveforms to filter motion artifacts, may improve accuracy compared to digital sensors. However, the effectiveness of this technology in reducing false alarms in clinical settings remains unclear. This study assesses and compares the motion resistance of Analog SpO2 Technology of two devices in the market. Methods: Thirty healthy adults underwent controlled experiments (Control, Linear Motion, Angular Motion) using two pulse oximeters. Linear Motion tested hand displacement impact, while Angular Motion involved rhythmic hand motions at 120 bpm and 160 bpm. Results: Both devices performed similarly in Control, with no disruptions. In Linear Motion, mild disruptions occurred, but no significant differences in SpO2 readings or alarms. Angular Motion at 120 bpm showed stability with no alarms. At 160 bpm, Device B (Biolight Analog SpO2) had fewer technical alarms but more SpO2 alarms than Device A (Masimo Analog SpO2). Conclusions: Analog SpO2 exhibited motion resistance under static, linear and continuous waving angular motion up to 120 bpm and 160 bpm, but alarms occurred at 160 bpm with continuous tapping angular motion. These findings signify non-inferiority of either device in clinical settings. Further studies should include patients with cardiovascular and/or respiratory diseases. Trial Registration: The study was submitted to and approved by the Biolight Ethics Committee (S0723), and written informed consent from all participants was obtained. [ABSTRACT FROM AUTHOR]

Introduction: The pandemic saw widespread use of home pulse oximeters to patients diagnosed with COVID-19 to support early detection of low oxygen saturation levels and appropriate care. Rapid implementation made conventional evaluation challenging, highlighting the need for rigorous non-randomised methods to support decision-making about future use of these technologies. We used routine data to explore the benefits of pulse oximetry in Greater Manchester, under the 'COVID-19 oximetry at home' (CO@h) programme. Methods: We used data from the Greater Manchester Secure Data Environment and defined study parameters using a 'target trial' model to compare patients receiving pulse oximetry under the CO@h programme, with matched controls using various comparator groups. Primary outcomes were unplanned hospitalisation and all-cause mortality. This study is based on data from the Greater Manchester Care Record (GMCR), using anonymised, routinely collected data provided in a de-identified format for research. Informed written consent is needed for primary care patient data to be collected for service improvement and research, before data extraction to the GMCR. The study was approved under protocol GMCR RQ-048, on 12/05/2022. As indicated by the University of Manchester ethics decision tool, formal ethical approval was not required for this study. Results: The adjusted odds ratios for an unplanned hospitalisation were higher among patients receiving pulse oximetry: OR 1.86 (95% CI 1.54–2.25) at 28 days, 1.5 (95% CI 1.3–1.74) at 90 days and 1.63 (95% CI 1.44–1.83) at 1 year. Overall odds of mortality were lower among patients receiving pulse oximetry: adjusted ORs of 0.5 (95% CI 0.25–0.98) at 28 days, 0.5 (95% CI 0.32–0.78) at 90 days and 0.58 (95% CI 0.44–0.76) at 1 year. The results were robust to different comparison groups. Conclusion: Use of pulse oximetry at home under the CO@h programme, through the resulting prioritisation for appropriate care, was associated with a higher frequency of unplanned admissions and a reduction in the risk of mortality up to 1 year later. Therefore, it is likely effective for early detection of clinical deterioration and timely intervention among patients with COVID-19. Further research is needed to understand whether this is a cost-effective use of healthcare resources. [ABSTRACT FROM AUTHOR]

Background: Heart disease patients necessitate precise monitoring to ensure the safety and efficacy of their physical activities when managing conditions such as hypertension or heart failure. This study, therefore, aimed to evaluate the accuracy of photoplethysmography (PPG)-based monitoring of pulse rate (PR), interbeat-intervals (IB-I) and oxygen saturation (SpO2) during high-intensity interval training (HIIT). Methods: Between January and March 2024, healthy volunteers were subjected to a cycling HIIT workout with bike resistance increments to evaluate performance within different heart rate ranges. To determine the accuracy of PPG-based measurements for PR, IB-I, and SpO2 using the CardioWatch 287–2 (Corsano Health, the Netherlands), measurements throughout these ranges were compared to paired reference values from the Covidien Nellcor pulse oximeter (PM10N) and Vivalink's wearable ECG patch monitor. Subgroups were defined for Fitzpatrick skin type and gender. Results: In total, 35 healthy individuals participated, resulting in 7183 paired measurements for PR, 22,713 for IB-I, and 41,817 for SpO2. The PR algorithm showed an average root mean square (Arms) of 2.51 beats per minute (bpm), bias at 0.05 bpm, and limits of agreement (LoA) from −4.87 to 4.97 bpm. The IB-I algorithm achieved an Arms of 23.00 ms, a bias of 1.00 ms, and LoA from −43.82 to 46.21 ms. Finally, the SpO2 algorithm showed an Arms of 1.28%, a bias of 0.13%, and LoA from −2.37% to 2.62%. The results were consistent across different demographic subgroups. Conclusions: This study demonstrates that the PPG-based CardioWatch 287–2 can accurately monitor PR, IB-I, and SpO2 during HIIT. However, further research is recommended to evaluate the algorithm's performance in heart disease patients during demanding exercise. [ABSTRACT FROM AUTHOR]

Blood oxygen saturation (SpO2) is vital for patient monitoring, particularly in clinical settings. Traditional SpO2 estimation methods have limitations, which can be addressed by analyzing photoplethysmography (PPG) signals with artificial intelligence (AI) techniques. This systematic review, following PRISMA guidelines, analyzed 183 unique references from WOS, PubMed, and Scopus, with 26 studies meeting the inclusion criteria. The review examined AI models, key features, oximeters used, datasets, tested saturation intervals, and performance metrics while also assessing bias through the QUADAS-2 criteria. Linear regression models and deep neural networks (DNNs) emerged as the leading AI methodologies, utilizing features such as statistical metrics, signal-to-noise ratios, and intricate waveform morphology to enhance accuracy. Gaussian Process models, in particular, exhibited superior performance, achieving Mean Absolute Error (MAE) values as low as 0.57% and Root Mean Square Error (RMSE) as low as 0.69%. The bias analysis highlighted the need for better patient selection, reliable reference standards, and comprehensive SpO2 intervals to improve model generalizability. A persistent challenge is the reliance on non-invasive methods over the more accurate arterial blood gas analysis and the limited datasets representing diverse physiological conditions. Future research must focus on improving reference standards, test protocols, and addressing ethical considerations in clinical trials. Integrating AI with traditional physiological models can further enhance SpO2 estimation accuracy and robustness, offering significant advancements in patient care. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 38-year-old woman with methemoglobinemia and hypoxemic respiratory failure, focusing on the discrepancy between pulse oximetry (SpO2) and arterial blood gas (SaO2) readings. Topics discussed include noninvasive oxygen measurement via pulse oximetry, the impact of methemoglobinemia on oxygen delivery, and the differential diagnosis for an "SpO2–SaO2 gap."

Background: Consumer facing wearable devices capture significant amounts of biometric data. The primary aim of this study is to determine the accuracy of consumer-facing wearable technology for continuous monitoring compared to standard anesthesia monitoring during endoscopic procedures. Secondary aims were to assess patient and provider perceptions of these devices in clinical settings. Methods: Patients undergoing endoscopy with anesthesia support from June 2021 to June 2022 were provided a smartwatch (Apple Watch Series 7, Apple Inc., Cupertino, CA) and accessories including continuous ECG monitor and pulse oximeter (Qardio Inc., San Francisco, CA) for the duration of their procedure. Vital sign data from the wearable devices was compared to inroom anesthesia monitors. Concordance with anesthesia monitoring was assessed with interclass correlation coefficients (ICC). Surveys were then distributed to patients and clinicians to assess patient and provider preferences regarding the use of the wearable devices during procedures. Results: 292 unique procedures were enrolled with a median anesthesia duration of 34 min (IQR 25--47). High fidelity readings were successfully recorded with wearable devices for heart rate in 279 (95.5%) cases, oxygen in 203 (69.5%), and respiratory rate in 154 (52.7%). ICCs for watch and accessories were 0.54 (95% CI 0.46--0.62) for tachycardia, 0.03 (95% CI 0--0.14) for bradycardia, and 0.33 (0.22--0.43) for oxygen desaturation. Patients generally felt the devices were more accurate (56.3% vs. 20.0% agree, p < 0.001) and more permissible (53.9% vs. 33.3% agree, p < 0.001) to wear during a procedure than providers. Conclusion: Smartwatches perform poorly for continuous data collection compared to gold standard anesthesia monitoring. Refinement in software development is required if these devices are to be used for continuous, intensive vital sign monitoring. [ABSTRACT FROM AUTHOR]

Introduction: The incorporation of health-related sensors in wearable devices has increased their use as essential monitoring tools for a wide range of clinical applications. However, the signals obtained from these devices often present challenges such as artifacts, spikes, high-frequency noise, and data gaps, which impede their direct exploitation. Additionally, clinically relevant features are not always readily available. This problem is particularly critical within the H2020 BRAINTEASER project, funded by the European Community, which aims at developing models for the progression of Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS) using data from wearable devices. Methods: The objective of this study is to present the automated pipeline developed to process signals and extract features from the Garmin Vivoactive 4 smartwatch, which has been chosen as the primary wearable device in the BRAINTEASER project. The proposed pipeline includes a signal processing step, which applies retiming, gap-filling, and denoising algorithms to enhance the quality of the data. The feature extraction step, on the other hand, utilizes clinical partners' knowledge and feedback to select the most relevant variables for analysis. Results: The performance and effectiveness of the proposed automated pipeline have been evaluated through pivotal beta testing sessions, which demonstrated the ability of the pipeline to improve the data quality and extract features from the data. Further clinical validation of the extracted features will be performed in the upcoming steps of the BRAINTEASER project. Discussion: Developed in Python, this pipeline can be used by researchers for automated signal processing and feature extraction from wearable devices. It can also be easily adapted or modified to suit the specific requirements of different scenarios. [ABSTRACT FROM AUTHOR]

Background: There is growing concern that pulse oximeters are routinely less accurate in hospitalized patients with darker skin pigmentation, in turn increasing risk of undetected (occult) hypoxemia and adverse clinical outcomes. The aim of this systematic review and meta-analysis was to synthesize evidence on racial and ethnic disparities in occult hypoxemia prevalence and clinical impacts of undetected hypoxemia. Methods: Ovid MEDLINE, Embase, and CINAHL databases were searched for relevant articles published through January 2024. Eligible studies must have been conducted among adults in inpatient or outpatient settings and report occult hypoxemia prevalence stratified by patient race or ethnicity, or clinical outcomes stratified by patient race or ethnicity and occult hypoxemia status. Screening for inclusion was conducted independently by two investigators. Data extraction and risk of bias assessment were conducted by one investigator then checked by a second. Outcome data were synthesized using random-effects meta-analyses. Results: Fifteen primary studies met eligibility criteria and reported occult hypoxemia prevalence in 732,505 paired oximetry measurements from 207,464 hospitalized patients. Compared with White patients, occult hypoxemia is likely more common among Black patients (pooled prevalence ratio = 1.67, 95% CI 1.47 to 1.90) and among patients identifying as Asian, Latinx, Indigenous, multiracial, or other race or ethnicity (pooled prevalence ratio = 1.39, 95% CI 1.19 to 1.64). Findings from studies reporting clinical outcomes suggest that Black patients with undetected hypoxemia may experience poorer treatment delivery outcomes than White patients with undetected hypoxemia. No evidence was found from outpatient settings. Discussion: This review and included primary studies rely on self-identified race or ethnicity, which may obscure variability in occult hypoxemia risk. Findings underscore that clinicians should be aware of the risk of occult hypoxemia in hospitalized patients with darker skin pigmentation. Moreover, oximetry data from included studies suggests that the accuracy of pulse oximeters could vary substantially from patient to patient and even within individual patients. Trial Registration: PROSPERO (CRD42023402152). [ABSTRACT FROM AUTHOR]

Oximeters have significantly evolved since their invention and are essential for monitoring chronic diseases in home care. However, commercial models can present an economic barrier. Therefore, we conducted a review of the use of low-cost pulse oximeters in the home care of patients with respiratory diseases. Our review included studies addressing oxygen saturation and heart rate monitoring in adults, focusing on the use of portable devices. Our search identified advances in vital signs monitoring that could provide accessible solutions for non-clinical settings. Although there are challenges related to clinical validation and accuracy, these oximeters may improve medical care, particularly in resource-limited areas. As a result, the accessibility of these devices opens up new possibilities for patients with chronic respiratory diseases in home care, enabling regular self-monitoring and increasing control over their health. [ABSTRACT FROM AUTHOR]

Photoplethysmography is a non-invasive physical method used for measurement and monitoring of arterial blood flow in the subject's body with application of light. Pulse oximetry is the modification of photoplethysmography enriched with monitoring blood oxygen saturation. Acquisition of pulse oximetry data can be achieved using two types of pulse oximeters: transmission or reflectance. Both methods require the use of physical light sources and a receiver, set in specific positions. This results in different construction of devices and may lead to diverse ways of calculating the blood saturation values. One of these ways uses second-degree polynomial made from three constants and a variable calculated with ratio of red- to infrared-based variables. We used this method to develop the wireless pulse oximeter paired with the dedicated mobile application. The device acquired 400 samples per second and calculated oxygen saturation level and heart rate, as well as provided data for photoplethysmography curve. In this system data are transferred in real time to the application, which displays the saturation values and presents photoplethysmography curve for last several heartbeats. Calculation of the values was checked with a commercial pulse oximeter and the results were mostly similar, with the difference in SpO2 not greater than one percentage point and the difference in heart rate not greater than five beats per minute. The design of the pulse oximeter allows further miniaturization. Mobile application is intuitive for user and does not need any training. [ABSTRACT FROM AUTHOR]

Background: Nuisance and false alarms distract clinicians from urgent alerts, raising patient safety risks. Local Problem: High alarm rates in a pediatric progressive care unit resulted in experiencing 180-250 alarms per day or 1 alarm every 3 to 4 minutes per clinician. Methods: Through Plan-Do-Study-Act cycles, environmental, policy, and technology changes were implemented to decrease the average alarms/day/bed and percentage of time in alarm. Interventions: Alarm settings tailored to patient needs using features embedded within the patient monitoring system were implemented and monitored with the assistance of alarm champions. Results: The average number of alarms/day/bed decreased from 177.69 to 96.94 over the course of 10 years, a 45.45% reduction. The percentage of time in alarm decreased from 7.52% to 2.83%, a 62.37% reduction. Conclusions: Arming clinicians with technology to analyze real-time clinical data made alarms meaningful and actionable, decreasing false alarms without compromising patient safety. [ABSTRACT FROM AUTHOR]

Objective: To assess biceps brachii and erector spinae muscular oxygen saturation (SmO2) by near infrared spectroscopy (NIRS), during 10 minutes of resuscitation at simulated altitudes of 600, 3000 and 5000 m before and after carrying out a simulation program for adaptation to hypoxia. Performing and maintaining a goodquality cardiopulmonary resuscitation (CPR) at higher altitudes may pose a significant challenge to resuscitators due to decrease in arterial oxygen saturation. This fact adversely effects the quality of resuscitation. Methods: Participants performed 10 minutes of CPR on a mannequin in the laboratory in environments that simulated altitudes. Subsequently, a standardized altitude conditioning protocol was carried out using intermittent hypoxia. The participants performed CPR again under the conditions and altitudes previously referred to. Results: Initial heart rate (HR) at 5000 > 3000 m, and both > 600 m. HR at each altitude was higher conditioning at the end of CPR. The SmO2 of bothmuscles showed no differences at the beginning and at the end of CPR and was higher in both muscles after the conditioning program before and at the end of CPR. In both muscles, SmO2 values before and after conditioning show a slightly increasing trend during CPR. Conclusion: NIRS use allows developing an optimum training plan. The rescuer will know his limits and optimize his performance. The improvement in physical performance and recovery capacity induced by intermittent hypoxia conditioning programs increases the quality of CPR in prolonged cardiac arrests and in adverse conditions, such as at high altitudes. [ABSTRACT FROM AUTHOR]

Introduction: Nitric and hydrofluoric acids are commonly used in the commercial cleaning industry. We are unaware of reports of nitric acid inhalation forming methaemoglobin. Additionally, methaemoglobinaemia and treatment with methylthioninium chloride (methylene blue) may precipitate clinical uncertainty due to similar wavelengths of absorbance in pulse oximetry. Cases: We report two patients with respiratory distress from symptomatic methaemoglobinaemia following a prolonged, inhaled occupational exposure to nitric acid in the context of industrial cleaning. Their methaemoglobinaemia was successfully treated with methylthioninium chloride, per remote toxicology advice. However transient oxygen desaturation as reported by pulse oximetry resulted in concern from the treating team. Discussion: The liberation of oxides of nitrogen from nitric acid bypasses the upper airway without irritation and dissolves in the mucoid lower respiratory tract, oxidising haemoglobin to methaemoglobin. Prolonged undetected exposure with filter saturation, and impaired ventilation is the proposed cause of methaemoglobinaemia in the cases presented. Additionally, methylthioninium chloride absorbs light at the 660 nm wavelength interfering with pulse oximeter interpretation, precipitating the appearance of rapid, severe oxygen desaturation. Conclusion: Lack of upper airway irritation can lead to unrecognised prolonged nitric acid fume exposure causing methaemoglobinaemia. Remote toxicology advice should include pulse oximeter interference expectations in the presence of methaemoglobinaemia and when administering methylthioninium chloride. [ABSTRACT FROM AUTHOR]

This document contains summaries of various research studies conducted in the field of veterinary medicine. The studies cover a wide range of topics, including the use of computed tomography in identifying surgical lesions in cats, injuries sustained by dogs in motor vehicle accidents, and the effects of mild hypothermia on fluid therapy in cats. The findings of these studies provide valuable insights into specific areas of veterinary emergency and critical care. The document also includes studies on topics such as the use of handheld ultrasound devices in dogs, the treatment of NSAID toxicosis in dogs, and the management of anemia in dogs using a rapid infuser device. These studies contribute to the understanding and improvement of veterinary medical practices. [Extracted from the article]

Background: The pulse oximeter is a simple, cost‐effective and reliable device for estimating arterial blood oxygen saturation. Nurses are required to be knowledgeable in pulse oximeter use. Little is known about nurses' knowledge of pulse oximetry in the Middle East region. Aim: To assess nurses' knowledge of pulse oximetry among emergency and critical care nurses and to explore predictors of nurses' knowledge of pulse oximetry. Study Design: This is the second part of data analysis that was first presented in the 'proficiency in ECG' study conducted in Jordan. The original data used for both parts of analysis included a questionnaire with two tests; a knowledge of pulse oximeter test and an ECG proficiency test. Participants were asked to take, alone without receiving assistance, both tests. In this study, the second part of analysis, the focus is on the pulse oximeter test. The test consisted of 21 items that emphasize knowledge of basic physiological principles as well as device limitations; whether technical or interpretation. The test administration procedure also included asking participants to provide socio‐demographic variables. In the original data collected in both parts of analysis, nurses working in the emergency department, cardiac care units or intensive care units from nine different hospitals (1 governmental, 6 private and 2 educational) and holding a bachelor degree or higher were asked to participate. Results: The total number of participating nurses was 210; out of 247 approached (response rate, 85%). The mean score in the nurses' knowledge of pulse oximetry test was 12.33 out of 21, corresponding to 58.7%. The clinical area currently working in predicted the knowledge of pulse oximetry test score after controlling for all other variables. Emergency department and intensive care unit nurses scored higher than cardiac care unit nurses by 1.86 and 1.63 points respectively (58.2% and 60% respectively). Conclusion: Nurses consistently report inadequate education and training concerning pulse oximeter use and interpretation. A revision to hospital in‐service education seminars and undergraduate nurses' curriculum to assure adequate preparation is needed. Relevance to Clinical Practice: Knowledge of pulse oximetry among emergency and critical care nurses is modest. This is a challenge worldwide. Predictors of nurses' knowledge of pulse oximetery are the clinical area currently working in (ICU and ED nurses are more knowledgeable than CCU nurses), proficiency in electrocardiography and taking an advanced cardiac life support course. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the accuracy of peripheral oxygen saturation (SpO2) measurements from Polar Elixir™ pulse oximetry technology compared with arterial oxygen saturation (SaO2) measurements during acute stepwise steady-state inspired hypoxia at rest. A post hoc objective was to determine if SpO2 measurements could be improved by recalibrating the Polar Elixir™ algorithm with SaO2 values from a random subset of participants. Methods: The International Organization for Standardization (ISO) protocol (ISO 80601-2-61:2017) for evaluating the SpO2 accuracy of pulse oximeter equipment was followed whereby five plateaus of SaO2 between 70% and 100%were achieved using stepwise reductions in inspired O2 during supine rest. Blood samples drawn through a radial arterial catheter from 25 participants were first used to compare SaO2 with SpO2 measurements from Polar Elixir™. Then the Polar Elixir™ algorithm was recalibrated using SaO2 data from 13 random participants, and SpO2 estimates were recalculated for the other 12 participants. For SaO2 values between 70%and 100%, root mean square error, intraclass correlation coefficients (ICC), Pearson correlations, and Bland--Altman plots were used to assess the accuracy, agreement, and strength of relationship between SaO2 values and SpO2 values from Polar Elixir™. Results: The initial root mean square error for Polar Elixir™ was 4.13%. After recalibrating the algorithm, the RMSE was improved to 2.67%. The ICC revealed excellent levels of agreement between SaO2 and Polar Elixir™SpO2 values both before (ICC(1,3) = 0.837, df = 574, P < 0.001) and after (ICC(1,3) = 0.942, df = 287, P < 0.001) recalibration. Conclusions: Relative to ISO standards, Polar Elixir™ yielded accurate SpO2 measurements during stepwise inspired hypoxia at restwhen comparedwith SaO2 values, which were improved by recalibrating the algorithm using a subset of the SaO2 data. [ABSTRACT FROM AUTHOR]

The aims of this article are to: • Recognise the role of accurate oxygen saturation readings in guiding oxygen therapy. • Identify the limitations of the use of pulse oximetry in measuring oxygen saturation. • Understand the basic principles of the mechanism by which pulse oximeters obtain saturation readings. • Have an understanding of the studies investigating the degree of bias of skin colour on pulse oximetry readings. • Interpret pulse oximetry readings in the clinical setting with the knowledge that readings may be less reliable in patients with pigmented skin. Pulse oximetry is widely used to non-invasively estimate the oxygen saturation of haemoglobin in arterial blood (SpO 2). It is used widely throughout healthcare and was used extensively during the Covid-19 pandemic to detect and treat hypoxic patients. Research has suggested that pulse oximetry is less accurate in patients with darker skin. This led the US Food and Drug Administration agency (FDA) to issue a safety statement warning that pulse oximeters may be inaccurate when patients have pigmented skin. Evidence suggests that the oxygen saturation of arterial blood (SaO 2) may be being overestimated by measuring SpO 2 in those with pigmented skin. The degree of overestimation increases as SaO 2 decreases especially when SpO 2 reads below 80%. We review how pulse oximetry works and consider the implications for a patient's health when interpreting SpO 2 in individuals with pigmented skin. [ABSTRACT FROM AUTHOR]

The article comments on a study which observed the implementation of an automated oxygen control system in a tertiary care hospital. Emphasis is given on the need of automated oxygen control systems for accurate calibration to arterial oxygen saturation given the possible occurrence of software bugs. The potential benefits and potential disadvantages of routine use of automated oxygen administration systems are highlighted.

The L-band vegetation optical depth data garners significant interest for its ability to effectively monitor vegetation, thanks to minimal saturation within this frequency range. However, the existing datasets have limited temporal coverage, constrained by the start of the respective satellite missions. Global L-band equivalent AI-Based Vegetation Optical Depth or GLAB-VOD is a global long-term consistent microwave vegetation optical depth dataset created using machine learning to expand the SMAP-IB VOD dataset temporal coverage from 2015-2020 to 2002-2020. The GLAB-VOD dataset has an 18-day temporal resolution and 25 km spatial resolution on the EASE2 grid and covers 2002-2020. An auxiliary consistent daily brightness temperature product, called GLAB-TB, is developed in parallel and ensures the consistency of the VOD product across time periods with different microwave satellites. As a result of its temporal consistency, this dataset can be used to study long-term global and regional trends in vegetation biomass and utilized in any other applications where long-term consistency is necessary. The GLAB-VOD dataset shows excellent spatial correlation globally when compared with biomass (up to R = 0.92) and canopy height (R = 0.93), outperforming its target dataset, SMAP-IB VOD. [ABSTRACT FROM AUTHOR]

Pulse oximeter is the most commonly used instrument for clinical diagnosis of human blood oxygen saturation, so whether the measurement of blood oxygen saturation is stable and reliable. Medical staff should calibrate the pulse oximeter regularly to ensure its safety and reliability. The pulse oximeter in use can be calibrated with an intelligent calibration device. The purpose of this article is to design an intelligent digital wearable smart pulse oximeter calibration device. The device uses advanced digital technology combined with programming technology to achieve accurate calibration of wearable smart pulse oximeter. Through the device, the accurate measurement of parameters such as blood oxygen saturation and heart rate is realized, and real-time feedback and adjustment function is provided to ensure the stability and accuracy of the device. The implementation of this design is expected to improve the application effect of wearable smart pulse oximeter in the field of clinical and personal health monitoring, and provide users with more reliable health data support. The experimental results show that under the same test period (24 hours), the voltage change of the photosensor is 7mV, and the deviation of blood oxygen saturation is 0.4%, which may mean that the performance of the device under this condition is more stable and accurate compared with other experiments. [ABSTRACT FROM AUTHOR]

Pulse oximetry is arguably the most impactful monitor ever introduced into respiratory care practice. Recently there has been increased attention to the problem of occult hypoxemia in which patients are hypoxemic despite an acceptable SpO2. Although occult hypoxemia might be greater in Black patients than white patients, it is not insignificant in whites. In a given population of patients, the bias between SpO2 and arterial oxygen saturation (SaO2) might be close to zero. However, the limits of agreement can be wide, meaning that SpO2 might overestimate SaO2 in many individual patients, which can result in occult hypoxemia in some. Manufactures report accuracy of SpO2 derived from normal individuals, which might differ from that in the clinical setting. That SpO2 overestimates SaO2 in an important number of individuals has caused some to recommend higher SpO2 targets to avoid occult hypoxemia. There is also evidence that suggests that SpO2 might not accurately trend SaO2. Additional research is needed to investigate strategies to mitigate the bias between SpO2 and SaO2. Clinicians must be cognizant of the limitations of pulse oximetry when clinically using SpO2. The aim of this paper is to provide an update on pulse oximetry. [ABSTRACT FROM AUTHOR]

Rationale: Data on risk factors for chronic hypoxemia in low- and middle-income countries are lacking. Objectives: We aimed to quantify the association between potential risk factors and chronic hypoxemia among adults hospitalized in Kenya. Methods: A hospital-based, case–control study was conducted at Moi Teaching and Referral Hospital in Eldoret, Kenya. Adult inpatients were screened on admission and enrolled in a 1:2 case-to-control ratio. Cases were patients with chronic hypoxemia, defined as resting oxygen saturation as measured by pulse oximetry (SpO2) ⩽ 88% on admission and either 1-month postdischarge SpO2 ⩽ 88% or, if they died before follow-up, documented SpO2 ⩽ 88% in the 6 months before enrollment. Control subjects were randomly selected, stratified by sex, among nonhypoxemic inpatients. Data were collected using questionnaires and structured chart review. Regression was used to assess the associations between chronic hypoxemia and age, sex, smoking status, biomass fuel use, elevation, and self-reported history of tuberculosis and human immunodeficiency virus diagnosis. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Results: We enrolled 108 chronically hypoxemic cases and 240 nonhypoxemic control subjects into our Chronic Hypoxemia among Kenyan Adults (CHAKA) cohort. In multivariable analysis, compared with control subjects, chronically hypoxemic cases had significantly higher odds of older age (OR, 1.2 per 5-year increase [95% CI, 1.1–1.3]), female sex (OR, 3.6 [95% CI, 1.8–7.2]), current or former tobacco use (OR, 4.7 [95% CI, 2.3–9.6]), and prior tuberculosis (OR, 11.8 [95% CI, 4.7–29.6]) but no increase in the odds of human immunodeficiency virus diagnosis and biomass fuel use. Conclusions: These findings highlight the potential impact of prior tuberculosis on chronic lung disease in Kenya and the need for further studies on posttuberculosis lung disease. [ABSTRACT FROM AUTHOR]

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Introduction: Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala Trauma Score (KTS), developed in 1996 and last modified in 2002 as KTS II, is still widely being used to predict injury outcomes in resource-limited settings with no further revisions in the past two decades, despite ongoing criticism of some of its parameters. The New Trauma Score (NTS), a recent development in 2017, has shown potential in mortality prediction, but a dearth of evidence exist regarding its performance in the African population. Objectives: To compare NTS to the modified Kampala Trauma Score (KTS II) in the prediction of 30-day mortality, and injury severity amongst patients sustaining road traffic crashes in Ugandan low-resource settings. Methods: Multi-center prospective cohort study of patients aged 15 years and above. Of the 194 participants, 85.1% were males with a mean age of 31.7 years. NTS and KTS II were determined for each participant within 30-minutes of admission and followed-up for 30 days to determine their injury outcomes. The sensitivity, specificity, and area under receiver operating characteristics curve (AUC) for predicting mortality were compared between the two trauma scores using SPSS version 22. Ethical clearance: Research and Ethics Committee of Kampala International University Western Campus (Ref No: KIU-2022-125). Results: The injury severity classifications based on NTS vs. KTS II were mild (55.7% vs. 25.8%), moderate (29.9% vs. 30.4%), and severe (14.4% vs. 43.8%). The mortality rates for each injury severity category based on NTS vs. KTS II were mild (0.9% v 0%), moderate (20.7% vs. 5.1%), and severe (50% vs. 28.2%). The AUC was 0.87 for NTS (95% CI 0.808–0.931) vs. 0.86 (95% CI 0.794–0.919) for KTS II respectively. The sensitivity of NTS vs. KTS II in predicting mortality was 92.6% (95% CI: 88.9–96.3) vs. 70.4% (95% CI: 63.0-77.8) while the specificity was 70.7% (95% CI: 64.2–77.2) vs. 78.4% (95% CI: 72.1–84.7) at cut off points of 17 for NTS and 6 for KTS II respectively. Conclusions: NTS was more sensitive but its specificity for purposes of 30-day mortality prediction was lower compared to KTS II. Thus, in low-resourced trauma environment where time constraints and pulse oximeters are of concern, KTS II remains superior to NTS. [ABSTRACT FROM AUTHOR]

Background: Monitoring blood oxygenation is essential in immobilised rhinoceros, which are susceptible to opioid-induced hypoxaemia. This study assessed the reliability, clinical performance and trending ability of the Nonin PalmSAT 2500 A pulse oximeter's and the Masimo Radical-7 pulse co-oximeter's dual-wavelength technology, with their probes placed at two measurement sites, the inner surface of the third-eyelid and the scarified ear pinna of immobilised white rhinoceroses. Eight white rhinoceros were immobilised with etorphine-based drug combinations and given butorphanol after 12 min, and oxygen after 40 min, of recumbency. The Nonin and Masimo devices, with dual-wavelength probes attached to the third-eyelid and ear recorded arterial peripheral oxygen-haemoglobin saturation (SpO2) at pre-determined time points, concurrently with measurements of arterial oxygen-haemoglobin saturation (SaO2), from drawn blood samples, by a benchtop AVOXimeter 4000 co-oximeter (reference method). Reliability of the Nonin and Masimo devices was evaluated using the Bland-Altman and the area root mean squares (ARMS) methods. Clinical performance of the devices was evaluated for their ability to accurately detect clinical hypoxemia using receiver operating characteristic (ROC) curves and measures of sensitivity, specificity, and positive and negative predictive values. Trending ability of the devices was assessed by calculating concordance rates from four-quadrant plots. Results: Only the Nonin device with transflectance probe attached to the third-eyelid provided reliable SpO2 measurements across the 70 to 100% saturation range (bias − 1%, precision 4%, ARMS 4%). Nonin and Masimo devices with transflectance probes attached to the third-eyelid both had high clinical performance at detecting clinical hypoxaemia [area under the ROC curves (AUC): 0.93 and 0.90, respectively]. However, the Nonin and Masimo devices with transmission probes attached to the ear were unreliable and provided only moderate clinical performance. Both Nonin and Masimo devices, at both measurement sites, had concordance rates lower than the recommended threshold of ≥ 90%, indicating poor trending ability. Conclusions: The overall assessment of reliability, clinical performance and trending ability indicate that the Nonin device with transflectance probe attached to the third-eyelid is best suited for monitoring of blood oxygenation in immobilised rhinoceros. The immobilisation procedure may have affected cardiovascular function to an extent that it limited the devices' performance. [ABSTRACT FROM AUTHOR]

Remote Patient Monitoring has enjoyed strong growth to new heights driven by several factors, such as the COVID-19 pandemic or advances in technology, allowing consumers and patients to continuously record health data by themselves. This does not come without its challenges, however. A literature review was completed and highlights usability gaps when using wearables or home use medical devices in a virtual environment. Based on these findings, the Pi-CON methodology was applied to close these gaps by utilizing a novel sensor that allows the acquisition of vital signs at a distance, without any sensors touching the patient. Pi-CON stands for passive, continuous and non-contact, and describes the ability to acquire vital signs continuously and passively, with limited user interaction. The preference of vital sign acquisition with a newly developed sensor was tested and compared to vital sign tests taken with patient generated health-data devices (ear thermometer, pulse oximeter) measuring heart rate, respiratory rate and body temperature. In addition, the amount of operator errors and the user interfaces were tested and compared. Results show that participants preferred vital signs acquisition with the novel sensor and the developed user interface of the sensor. Results also revealed that participants had a mean error of.85 per vital sign measurement with the patient-generated health data devices and.33 with the developed sensor, confirming the beneficial impact available when using the developed sensor based on the Pi-CON methodology. [ABSTRACT FROM AUTHOR]

Background: Sleep apnea syndrome, characterized by recurrent cessation (apnea) or reduction (hypopnea) of breathing during sleep, is a major risk factor for postoperative respiratory depression. Challenges in sleep apnea assessment have led to the proposal of alternative metrics derived from oxyhemoglobin saturation (SpO2), such as oxygen desaturation index (ODI) and percentage of cumulative sleep time spent with SpO2 below 90% (CT90), as predictors of postoperative respiratory depression. However, their performance has been limited with area under the curve of 0.60 for ODI and 0.59 for CT90. Our objective was to propose novel features from preoperative overnight SpO2 which are correlated with sleep apnea severity and predictive of postoperative respiratory depression. Methods: Preoperative SpO2 signals from 235 surgical patients were retrospectively analyzed to derive seven features to characterize the sleep apnea severity. The features included entropy and standard deviation of SpO2 signal; below average burden characterizing the area under the average SpO2; average, standard deviation, and entropy of desaturation burdens; and overall nocturnal desaturation burden. The association between the extracted features and sleep apnea severity was assessed using Pearson correlation analysis. Logistic regression was employed to evaluate the predictive performance of the features in identifying postoperative respiratory depression. Results: Our findings indicated a similar performance of the proposed features to the conventional apnea–hypopnea index (AHI) for assessing sleep apnea severity, with average area under the curve ranging from 0.77 to 0.81. Notably, entropy and standard deviation of overnight SpO2 signal and below average burden showed comparable predictive capability to AHI but with minimal computational requirements and individuals' burden, making them promising for screening purposes. Our sex-based analysis revealed that compared to entropy and standard deviation, below average burden exhibited higher sensitivity in detecting respiratory depression in women than men. Conclusion: This study underscores the potential of preoperative SpO2 features as alternative metrics to AHI in predicting postoperative respiratory. [ABSTRACT FROM AUTHOR]

This publication presents the effect of hypochlorous acid dry mist as a disinfectant on selected bacteria, viruses, spores, and fungi as well as on portable Microlife OXY 300 finger pulse oximeters and electronic systems of Raspberry Pi Zero microcomputers. The impact of hypochlorous acid on microbiological agents was assessed at concentrations of 300, 500, and 2000 ppm of HClO according to PN-EN 17272 (Variant I). Studies of the impact of hypochlorous acid fog on electronic components were carried out in an aerosol chamber at concentrations of 500 ppm and 2000 ppm according to two models consisting of 30 (Variant II) and 90 fogging cycles (Variant III). Each cycle included the process of generating a dry mist of hypochlorous acid (25 mL/m3), decontamination of the test elements, as well as cleaning the chamber of the disinfectant agent. The exposure of the materials examined on hypochlorous acid dry mist in all variants resulted in a decrease in the number of viruses, bacteria, spores, and fungi tested. In addition, the research showed that in the variants of hypochlorous acid fogging cycles analyzed, no changes in performance parameters and no penetration of dry fog of hypochlorous acid into the interior of the tested medical devices and electronic systems were observed. [ABSTRACT FROM AUTHOR]

Background:Spinal route of approach is the standard mode of regional anesthesia for conducting caesarean section is considered the standard mode of anaesthesia in caesarean section and it is considered safe, low cost with patient compliance. Spinal anesthesia induced sympathetic blockade, supine hypotension syndrome and low baseline vascular tone cause post spinal hypotension in the mothers. Perfusion index is a real time non-invasive parameter for early detection of this post spinal hypotension. Therefore the aim of this study was early prediction of anypost spinal hypotension and its degree of correlation withperfusion index. Materialsand Methods:A prospective observation study was conduct on200parturient, based on inclusion exclusion criteria devoid of any co-morbidities undergoing elective caesarean section subjected to spinal anesthesia. After routine investigations parturient were posted for elective caesarean section maintaining proper fasting guidelines. The perfusion index was measured with pulse oximeter at fixed time interval along with other vital parameters. The final data were analyzed with appropriate statistical software. Results:The parturient whose baseline finger perfusion index (P.I) is >3.5 have more chance of post spinal hypotension with a significance of p< 0.0001. Finger P.I with degree of decrease of SBP has positive correlation with highly significant value (r=0.7,p value<0.0001) whereas for MAP, it is highly significant but notpositively correlated(r=0.4, p value<0.0001). Conclusion:Finger perfusion index is an effective non- invasive predictor for the post spinal hypotension undergoing elective caesarean section. Additionally, the finger perfusion index is a reliable indicator of the extent to which systolic and mean arterial pressure decreases. [ABSTRACT FROM AUTHOR]

The main aims of the current work are to design, fabricate, and test a low-cost, easy-to-operate portable pulse oximeter device capable of providing immediate blood oxygen saturation and heart rate readings with high accuracy for various disease conditions and all age groups. It can be used in intensive care departments, operating rooms, and health centers as well as at homes. The obtained results were compared using a calibrated device produced by a reputable company. The clinical examination results were evaluated by using the Export System 13.0 statistical software program. The readings are close to each other, with an error rate of less than 1%. The obtained results show that, in the case of a respiratory disease such as chronic obstructive pulmonary or other lung diseases, the percentage of oxygen saturation decreased to between 73 to 88 %. For patients with heart disease, it was found that the oxygen saturation level changes significantly according to the type of disease. These obtained values decreased by 11.11 %, and 7.08% compared to healthy people, respectively. For the smokers, the blood oxygen saturation rate decreased by 10.47% and 8.06% compared to healthy people, respectively. For those infected with the COVID-19 epidemic, the rate of blood oxygen saturation and heart rates decreased sharply by 31.51 % and 27.03 %, and by 14.67% and 16.67 % compared to healthy people for males and females, respectively. For asthma patients, the rate of blood oxygen saturation and heart rate decreased by 2.50 %, and 4.65 %, and increased by 4.65 % and 4.76 % compared to healthy people for male and female, respectively. For physical activities, such as athletes, the rate of blood oxygen saturation and heart rate were increased by 1.05 %, 3.19 %, 23.26 %, and 28.57 % compared to healthy people for males and females, respectively. [ABSTRACT FROM AUTHOR]