Arterial oxygen saturation and hypoxemia in hemodialysis patients with COVID-19

Abstract Background Maintenance hemodialysis (MHD) patients are particularly vulnerable to COVID-19, a viral disease that may cause interstitial pneumonia, impaired alveolar gas exchange, and hypoxemia. We ascertained the time course of intradialytic arterial oxygen saturation (SaO2) in MHD patients between 4 weeks pre- and the week post-diagnosis of COVID-19. Methods We conducted a quality improvement project in confirmed COVID-19 in-center MHD patients from 11 dialysis facilities. In patients with an arterio-venous access SaO2 was measured 1x/minute during dialysis using the Crit-Line monitor (Fresenius Medical Care, Waltham, MA). We extracted demographic, clinical, treatment, and laboratory data and COVID-19 related symptoms from the patients’ electronic health records. Results Intradialytic SaO2 was available in 52 patients (29 males; age 66.5±15.7 years) contributing 338 hemodialysis treatments. Mean time between onset of symptoms indicative of COVID-19 and diagnosis was 1.1 days (median 0; range 0 to 9). Prior to COVID-19 diagnosis the rate of hemodialysis treatments with hypoxemia, defined as treatment-level average SaO2 < 90%, increased from 2.8% (2 to 4 weeks pre-diagnosis) to 12.2% (1 week) and 20.7% (3 days pre-diagnosis). Intradialytic oxygen supplementation increased sharply post-diagnosis. Eleven patients died from COVID-19 within 5 weeks. Compared to patients who recovered from COVID-19, demised patients showed a more pronounced decline in SaO2 prior to COVID-19 diagnosis. Conclusion In hemodialysis patients, hypoxemia may precede the onset of clinical symptoms and the diagnosis of COVID-19. A steep decline of SaO2 is associated with poor patient outcomes. Measurements of SaO2 may aid the pre-symptomatic identification of patients with COVID-19.

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Tracking Arteriovenous Fistula Maturation: A Novel Approach

Blood Purification ◽

10.1159/000494742 ◽

2018 ◽

Vol 47 (1-3) ◽

pp. 240-245 ◽

Cited By ~ 1

Author(s):

Laura M. Rosales ◽

Hanjie Zhang ◽

Marilou Mateo ◽

Brenda Chan ◽

Israel Campos ◽

...

Keyword(s):

Oxygen Saturation ◽

Arteriovenous Fistula ◽

Arterial Oxygen Saturation ◽

Central Venous Oxygen Saturation ◽

The United States ◽

Upper Body ◽

Arterial Oxygen ◽

Central Venous ◽

Hemodynamic Changes ◽

Improvement Project

Background: The time between the creation of an arteriovenous fistula (AVF) and its successful use is significantly longer in hemodialysis (HD) patients in the United States compared to those in other countries, and there is an urgent need to reduce the residence time of central-venous catheters (CVC). Methods: Successful AVF creation and maturation results in typical hemodynamic changes, such as an increase in cardiac output and upper body blood flow (UBBF). In patients with CVC as vascular access, we measured once per minute intradialytic central-venous oxygen saturation (ScvO2) and hemoglobin levels simultaneously using the Crit-Line Monitor. Under conditions of stable upper body oxygen consumption and arterial oxygen saturation, ScvO2 and hemoglobin concentration allows the calculation of estimated UBBF (eUBBF). In a quality improvement project, we used ScvO2 and eUBBF to track the hemodynamic changes accompanying AVF maturation. Results: Out of 11 patients (9 incident to HD, 1 female, age 61 ± 13 years), AVF maturation was successful in 9. In 1 patient, the AVF did not mature. One patient died from sudden cardiac death with a maturing AVF. In the 9 patients with successful AVF maturation, ScvO2 increased from 60.9 ± 2.7% prior to AVF creation to 73.4 ± 3.6% a week after AVF creation (19.6 ± 6.3% increase). eUBBF increased from 1.3 ± 0.3 to 2.2 ± 0.6 L/min (62.7 ± 37.5% increase); no material ScvO2 or eUBBF changes occurred in the other 2 patients. Conclusion: Our results indicate the potential utility of ScvO2 and eUBBF to track the hemodynamic response to AVF maturation. To what extent these insights translate into shortening of the time between AVF creation and successful cannulation warrants further investigations.

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SP734INTRADIALYTIC ARTERIAL OXYGEN SATURATION IN CHRONIC HEMODIALYSIS PATIENTS - RESULTS FROM A LARGE US POPULATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfv200.53 ◽

2015 ◽

Vol 30 (suppl_3) ◽

pp. iii620-iii620

Author(s):

Hanjie Zhang ◽

Anna Meyring-Wösten ◽

Xiaoling Ye ◽

Doris H Fuertinger ◽

Franz Kappel ◽

...

Keyword(s):

Oxygen Saturation ◽

Arterial Oxygen Saturation ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Arterial Oxygen

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Effect of hyperoxia and hypoxia on exercise-induced breathlessness in normal subjects

Clinical Science ◽

10.1042/cs0740531 ◽

1988 ◽

Vol 74 (5) ◽

pp. 531-537 ◽

Cited By ~ 40

Author(s):

N. Chronos ◽

L. Adams ◽

A. Guz

Keyword(s):

Oxygen Saturation ◽

Oxygen Concentration ◽

Time Course ◽

Minute Ventilation ◽

Arterial Oxygen Saturation ◽

Normal Subjects ◽

Secondary Response ◽

Arterial Oxygen ◽

Air Breathing ◽

Inspired Oxygen

1. The subjective changes accompanying alterations in inspired oxygen concentration during heavy exercise have been investigated single blind, in normal subjects. 2. In particular, the intensity of the sensation of breathlessness was quantified using a visual analogue scale and changes were compared with those in objective ventilatory measures. 3. Eleven subjects performed three steady-state workload exercise tests on different days and 100% O2, 15% O2 or air were randomly administered for a fixed interval during each test. 4. Compared with air breathing, all subjects felt less breathless during 100% O2 breathing, and ten of them felt more breathless when inspiring 15% O2; these changes were reversed on return to air breathing. 5. During and after 100% O2, the time course of changes in breathlessness was similar to those for ear arterial oxygen saturation and minute ventilation such that it could be a secondary response to either. However, during and after inspiration of 15% O2, changes in breathlessness occurred relatively more quickly than those in ventilation, more closely reflecting changes in oxygen saturation; this suggests that hypoxia, per se, could contribute to the genesis of this sensation. 6. Individual variability in breathlessness responses to exercise and changes in inspired oxygen concentration did not correlate with objective ventilatory changes; neither were changes in breathlessness in the group particularly associated with changes in respiratory frequency or tidal volume.

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Study of the relation between arterial oxygen saturation and intradialytic hypertension in regular hemodialysis patients

Journal of The Egyptian Society of Nephrology and Transplantation ◽

10.4103/jesnt.jesnt_25_20 ◽

2021 ◽

Vol 21 (1) ◽

pp. 48

Author(s):

Ahmed Ragheb ◽

SaidS.A Khamis ◽

KhaledM. El Zorkany ◽

WassamEl-Din H El-Shafey ◽

SaraA.Ibrahim Kasher

Keyword(s):

Oxygen Saturation ◽

Arterial Oxygen Saturation ◽

Hemodialysis Patients ◽

Arterial Oxygen ◽

Regular Hemodialysis

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Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study

Scientific Reports ◽

10.1038/s41598-021-88608-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shinshu Katayama ◽

Jun Shima ◽

Ken Tonai ◽

Kansuke Koyama ◽

Shin Nunomiya

Keyword(s):

Oxygen Saturation ◽

Pulse Oximetry ◽

Prospective Observational Study ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Arterial Blood Gas ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Arterial Blood ◽

Ventilated Patients

AbstractRecently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable.Trial registration UMIN000027671. Registered 7 June 2017.

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Modelling the relationships between arterial oxygen saturation, exercise intensity and the level of aerobic performance in acute hypoxia

European Journal of Applied Physiology ◽

10.1007/s00421-021-04667-8 ◽

2021 ◽

Author(s):

Xavier Woorons ◽

Jean Paul Richalet

Keyword(s):

Oxygen Saturation ◽

Exercise Intensity ◽

Acute Hypoxia ◽

Arterial Oxygen Saturation ◽

Aerobic Performance ◽

Arterial Oxygen

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BIOCHEMICAL STUDIES ON SHOCK

Journal of Experimental Medicine ◽

10.1084/jem.79.1.9 ◽

1944 ◽

Vol 79 (1) ◽

pp. 9-22 ◽

Cited By ~ 26

Author(s):

Frank L. Engel ◽

Helen C. Harrison ◽

C. N. H. Long

Keyword(s):

Blood Pressure ◽

Amino Acids ◽

Oxygen Saturation ◽

Hepatic Artery ◽

Arterial Oxygen Saturation ◽

Amino Nitrogen ◽

Arterial Oxygen ◽

High Positive Correlation ◽

Peripheral Tissues ◽

Arterial Blood

1. In a series of rats subjected to hemorrhage and shock a high negative correlation was found between the portal and peripheral venous oxygen saturations and the arterial blood pressure on the one hand, and the blood amino nitrogen levels on the other, and a high positive correlation between the portal and the peripheral oxygen saturations and between each of these and the blood pressure. 2. In five cats subjected to hemorrhage and shock the rise in plasma amino nitrogen and the fall in peripheral and portal venous oxygen saturations were confirmed. Further it was shown that the hepatic vein oxygen saturation falls early in shock while the arterial oxygen saturation showed no alteration except terminally, when it may fall also. 3. Ligation of the hepatic artery in rats did not affect the liver's ability to deaminate amino acids. Hemorrhage in a series of hepatic artery ligated rats did not produce any greater rise in the blood amino nitrogen than a similar hemorrhage in normal rats. The hepatic artery probably cannot compensate to any degree for the decrease in portal blood flow in shock. 4. An operation was devised whereby the viscera and portal circulation of the rat were eliminated and the liver maintained only on its arterial circulation. The ability of such a liver to metabolize amino acids was found to be less than either the normal or the hepatic artery ligated liver and to have very little reserve. 5. On complete occlusion of the circulation to the rat liver this organ was found to resist anoxia up to 45 minutes. With further anoxia irreversible damage to this organ's ability to handle amino acids occurred. 6. It is concluded that the blood amino nitrogen rise during shock results from an increased breakdown of protein in the peripheral tissues, the products of which accumulate either because they do not circulate through the liver at a sufficiently rapid rate or because with continued anoxia intrinsic damage may occur to the hepatic parenchyma so that it cannot dispose of amino acids.

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