Differences in muscle blood flow in upper and lower extremities of patients after correction of coarctation of the aorta.

Background: The literature on the outcomes of tunneled femoral catheters compared to that of jugular catheters is scarce and derived mainly from small cohorts. Material and Methods: Seven hundred and sixty six catheters were placed in 673 hemodialysis patients, 622 in the jugular/subclavian veins and 144 in the femoral veins. Patients were followed prospectively for 36 months. Results: The survival of the tunneled catheters was 771 days 95% CI (737–805) for jugular and 660 days 95% CI (582–739) for femoral veins. Blood flow (0.292 ± 0.003 L/min) and infection rate (0.25 × 1,000 days/catheter) were similar for upper and lower extremities vascular accesses. Factors including sex, age, diabetes and previous catheters did not affect the outcome. Conclusions: Femoral catheters provide outstanding vascular access with excellent, function and low risk of infection.

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Using Pulse Oximetry Waveforms to Detect Coarctation of the Aorta

10.21203/rs.2.20499/v4 ◽

2020 ◽

Author(s):

Matthew Sorensen ◽

Ismail Sadiq ◽

Gari D. Clifford ◽

Kevin O. Maher ◽

Matthew E. Oster

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulse Oximetry ◽

Congenital Heart ◽

Lower Extremities ◽

Coarctation Of The Aorta ◽

Waveform Analysis ◽

P Value ◽

Critical Congenital Heart Disease ◽

Upper And Lower Extremities

Abstract Background Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods infants with coarctation may present with life threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. Methods and Results Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children’s Healthcare of Atlanta. Patients with coarctation were receiving Prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual’s upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. Conclusions We were able to identify specific features in pulse oximetry waveforms that were unique to patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

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Effect of orthostasis on the regulation of skin blood flow in upper and lower extremities in human

Microcirculation ◽

10.1111/micc.12655 ◽

2020 ◽

Author(s):

Irina V. Tikhonova ◽

Andrey A. Grinevich ◽

Irina E. Guseva ◽

Arina V. Tankanag

Keyword(s):

Blood Flow ◽

Skin Blood Flow ◽

Lower Extremities ◽

Upper And Lower Extremities

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Using Pulse Oximetry Waveforms to Detect Coarctation of the Aorta

10.21203/rs.2.20499/v2 ◽

2020 ◽

Author(s):

Matthew Sorensen ◽

Ismail Sadiq ◽

Gari D. Clifford ◽

Kevin O. Maher ◽

Matthew E. Oster

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulse Oximetry ◽

Congenital Heart ◽

Lower Extremities ◽

Coarctation Of The Aorta ◽

Waveform Analysis ◽

P Value ◽

Critical Congenital Heart Disease ◽

Upper And Lower Extremities

Abstract Background Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods infants with coarctation may present with life threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. Methods and Results Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children’s Healthcare of Atlanta. Patients with coarctation were receiving Prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual’s upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. Conclusions We were able to identify specific features in pulse oximetry waveforms that were unique to patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

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Using Pulse Oximetry Waveforms to Detect Coarctation of the Aorta

10.21203/rs.2.20499/v3 ◽

2020 ◽

Author(s):

Matthew Sorensen ◽

Ismail Sadiq ◽

Gari D. Clifford ◽

Kevin O. Maher ◽

Matthew E. Oster

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulse Oximetry ◽

Congenital Heart ◽

Lower Extremities ◽

Coarctation Of The Aorta ◽

Waveform Analysis ◽

P Value ◽

Critical Congenital Heart Disease ◽

Upper And Lower Extremities

Abstract Background Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods infants with coarctation may present with life threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. Methods and Results Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children’s Healthcare of Atlanta. Patients with coarctation were receiving Prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual’s upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. Conclusions We were able to identify specific features in pulse oximetry waveforms that were unique to patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

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BLOOD FLOW AND VENOUS DISTENSIBILITY IN THE UPPER AND LOWER EXTREMITIES OF NEWBORN INFANTS

Acta Paediatrica ◽

10.1111/j.1651-2227.1976.tb04934.x ◽

1976 ◽

Vol 65 (4) ◽

pp. 571-575 ◽

Cited By ~ 2

Author(s):

W. H. WONG ◽

P. Y. K. WU ◽

H. KAFKA ◽

R. I. FREEDMAN ◽

N. E. LEVAN

Keyword(s):

Blood Flow ◽

Newborn Infants ◽

Lower Extremities ◽

Venous Distensibility ◽

Upper And Lower Extremities

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Using Pulse Oximetry Waveforms to Detect Coarctation of the Aorta

10.21203/rs.2.20499/v1 ◽

2020 ◽

Author(s):

Matthew Sorensen ◽

Ismail Sadiq ◽

Gari D. Clifford ◽

Kevin O. Maher ◽

Matthew E. Oster

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulse Oximetry ◽

Congenital Heart ◽

Lower Extremities ◽

Coarctation Of The Aorta ◽

Waveform Analysis ◽

P Value ◽

Critical Congenital Heart Disease ◽

Upper And Lower Extremities

Abstract Background Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods infants with coarctation may present with life threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta.Methods and Results Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children’s Healthcare of Atlanta. Patients with coarctation were receiving Prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual’s upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity.Conclusions We were able to identify specific features in pulse oximetry waveforms that were unique to patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.

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