scholarly journals Assessment of Hypoxemia using Downes Score in Neonates with Respiratory Distress

2021 ◽  
Vol 23 (3) ◽  
pp. 194-197
Author(s):  
Sabina Shrestha ◽  
Sujit Kumar Shrestha ◽  
Gentle Sunder Shrestha ◽  
Madhu Sudhan Dhakal
Keyword(s):  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Sensitivity And Specificity ◽  
Neonatal Intensive Care ◽  
College Teaching ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Preterm Baby ◽  
Cross Sectional

Respiratory distress in newborn is a common problem leading to hypoxemia. Pulse oximetry is the tool for measuring oxygen saturation noninvasively and blood gas analysis is the gold standard for oxygen monitoring. Downes score can be used as an alternative to assess respiratory distress clinically and determine the need of oxygen supplementation when these facilities are not available. This study was done to evaluate the validity of Downes score to assess hypoxemia in newborn with respiratory distress. This is a cross sectional descriptive study conducted from June 2020 to February 2021 in Neonatal Intensive Care Unit of Nepal Medical College Teaching Hospital. Oxygen saturation of newborn with respiratory distress was measured by pulse oximetry. At the same time the neonate was assessed for respiratory distress clinically using Downes score. Downes score and oxygen saturation measured by pulse oximetry were compared. Hypoxemia was defined as oxygen saturation less than 90% in term/ post term newborn and less than 88% in preterm baby. Similarly, neonate was considered to be hypoxic when Downes score was ≥5. The accuracy of Downes score was assessed by its sensitivity and specificity in detecting hypoxemia. Altogether 121 neonates were included in the study. Sensitivity and specificity of Downes score of 5 was 94.12% and 93.10% respectively. In conclusion, Downes score can be used as a clinical diagnostic means for assessing hypoxemia in neonates with respiratory distress

scholarly journals Comparison of oxygen saturation measured by pulse oximetry and arterial blood gas analysis in neonates

2016 ◽  
Vol 43 (6) ◽  
pp. 211
Author(s):  
Srie Yanda ◽  
Munar Lubis ◽  
Yoyoh Yusroh
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Heart Defects ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Oxygenation ◽  
Blood Gas ◽  
Cross Sectional ◽  
Arterial Blood Gas ◽  
Arterial Blood

Background Arterial blood gas is usually beneficial to discern thenature of gas exchange disturbances, the effectiveness of com-pensation, and is required for adequate management. AlthoughPaO 2 is the standard measurement of blood oxygenation, oxygensaturation measured by pulse oximetry (SapO 2 ) is now a custom-ary noninvasive assessment of blood oxygenation in newborn in-fants.Objective To compare oxygen saturation measured by pulse oxi-metry (SapO 2 ) and arterial blood gas (SaO 2 ), its correlation withother variables, and to predict arterial partial pressure of oxygen(PaO 2 ) based on SapO 2 values.Methods A cross sectional study was conducted on all neonatesadmitted to Pediatric Intensive Care Unit (PICU) during February2001 to May 2002. Neonates were excluded if they had impairedperipheral perfusion and/or congenital heart defects. Paired t-testwas used to compare SapO 2 with SaO 2 . Correlation between twoquantitative data was performed using Pearson’s correlation. Re-gression analysis was used to predict PaO 2 based on SapO 2 val-ues.Results Thirty neonates were included in this study. The differ-ence between SaO 2 and SapO 2 was significant . There were sig-nificant positive correlations between heart rate /pulse rate andTCO 2 , HCO 3 ; respiratory rate and TCO 2 , HCO 3 , base excess (BE);core temperature and HCO 3 , BE; surface temperature and pH,TCO 2, HCO 3, BE; SapO 2 and pH, PaO 2 ; and significant negativecorrelation between SapO 2 and PaCO 2 ; the correlations were weak.The linear regression equation to predict PaO 2 based on SapO 2values was PaO 2 = -79.828 + 1.912 SapO 2 .Conclusion Pulse oximetry could not be used in place of arterialblood gas analysis available for clinical purpose

scholarly journals Relating oxygen partial pressure, saturation and content: the haemoglobin–oxygen dissociation curve

Breathe ◽  
2015 ◽  
Vol 11 (3) ◽  
pp. 194-201 ◽  
Author(s):  
Julie-Ann Collins ◽  
Aram Rudenski ◽  
John Gibson ◽  
Luke Howard ◽  
Ronan O’Driscoll
Keyword(s):  
Oxygen Saturation ◽  
Partial Pressure ◽  
Pulse Oximetry ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Oxygen Dissociation Curve ◽  
Blood Gas ◽  
Dissociation Curve ◽  
Oxygen Dissociation ◽  
The Relationship

Key PointsIn clinical practice, the level of arterial oxygenation can be measured either directly by blood gas sampling to measure partial pressure (PaO2) and percentage saturation (SaO2) or indirectly by pulse oximetry (SpO2).This review addresses the strengths and weaknesses of each of these tests and gives advice on their clinical use.The haemoglobin–oxygen dissociation curve describing the relationship between oxygen partial pressure and saturation can be modelled mathematically and routinely obtained clinical data support the accuracy of a historical equation used to describe this relationship.Educational AimsTo understand how oxygen is delivered to the tissues.To understand the relationships between oxygen saturation, partial pressure, content and tissue delivery.The clinical relevance of the haemoglobin–oxygen dissociation curve will be reviewed and we will show how a mathematical model of the curve, derived in the 1960s from limited laboratory data, accurately describes the relationship between oxygen saturation and partial pressure in a large number of routinely obtained clinical samples.To understand the role of pulse oximetry in clinical practice.To understand the differences between arterial, capillary and venous blood gas samples and the role of their measurement in clinical practice.The delivery of oxygen by arterial blood to the tissues of the body has a number of critical determinants including blood oxygen concentration (content), saturation (SO2) and partial pressure, haemoglobin concentration and cardiac output, including its distribution. The haemoglobin–oxygen dissociation curve, a graphical representation of the relationship between oxygen satur­ation and oxygen partial pressure helps us to understand some of the principles underpinning this process. Historically this curve was derived from very limited data based on blood samples from small numbers of healthy subjects which were manipulated in vitro and ultimately determined by equations such as those described by Severinghaus in 1979. In a study of 3524 clinical specimens, we found that this equation estimated the SO2 in blood from patients with normal pH and SO2 >70% with remarkable accuracy and, to our knowledge, this is the first large-scale validation of this equation using clinical samples. Oxygen saturation by pulse oximetry (SpO2) is nowadays the standard clinical method for assessing arterial oxygen saturation, providing a convenient, pain-free means of continuously assessing oxygenation, provided the interpreting clinician is aware of important limitations. The use of pulse oximetry reduces the need for arterial blood gas analysis (SaO2) as many patients who are not at risk of hypercapnic respiratory failure or metabolic acidosis and have acceptable SpO2 do not necessarily require blood gas analysis. While arterial sampling remains the gold-standard method of assessing ventilation and oxygenation, in those patients in whom blood gas analysis is indicated, arterialised capillary samples also have a valuable role in patient care. The clinical role of venous blood gases however remains less well defined.

scholarly journals Clinical efficacy of combinations of nebulised fluticasone, salbutamol and furosemide on lung function in premature calves with respiratory distress syndrome

2017 ◽  
Vol 62 (No. 10) ◽  
pp. 541-552 ◽  
Author(s):  
R. Yildiz ◽  
M. Ok
Keyword(s):  
Carbon Dioxide ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Distress Syndrome ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Control Group ◽  
Peripheral Oxygen Saturation ◽  
Arterial Blood

Surfactant deficiency, poor development of the lung structure and fibrosis as a result of inflammation are thought to play an important role in the development of respiratory distress syndrome in premature calves. Nebulised steroid (fluticasone), bronchodilator (salbutamol) and diuretics (furosemide) can be used in combination alongside standard treatment procedures for premature calves, and might improve viability as observed in infants, foals and horses with pulmonary disorders. Twenty-five premature calves with respiratory distress syndrome were used in this study. Oxygen and supportive treatment were administered to all groups. The first group was used as a control group (Group 1). The nebulised drug combinations were as follows: Group 2: fluticasone + salbutamol, Group 3: salbutamol + furosemide, Group 4: fluticasone + furosemide and Group 5: fluticasone + salbutamol + furosemide. During the 72-h time period of the study, fluticasone (15 µg/kg/12 h), salbutamol (0.025 mg/kg/6 h) and furosemide (1 mg/kg/12h) were applied for 5 min. Arterial blood samples were collected from the auricular artery at 0 h and at 1, 24, 48 and 72 h for blood gas analysis. Significant (P < 0.05) increases in arterial partial oxygen, oxygen saturation and peripheral oxygen saturation and decreases in arterial partial carbon dioxide, lactate and respiration rate were observed in all the nebulised treatment groups, while a statistical difference was observed only for arterial partial carbon dioxide in control group. When comparing the treated groups with the control, it may be concluded that nebulised drugs are highly effective in the therapy of premature calves with respiratory distress syndrome, while the different nebulised groups exhibited similar efficacies.

scholarly journals A Novel Hemoglobin, Bonn, Causes Falsely Decreased Oxygen Saturation Measurements in Pulse Oximetry

2008 ◽  
Vol 54 (3) ◽  
pp. 594-596 ◽  
Author(s):  
Berndt Zur ◽  
Andreas Hornung ◽  
Johannes Breuer ◽  
Ulrike Doll ◽  
Christine Bernhardt ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Globin Gene ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Low Oxygen ◽  
Hemoglobin Variant ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

Abstract Background: A 4-year-old boy and his father exhibited low oxygen saturation measured transcutaneously by pulse oximetry, a finding that could not be confirmed by arterial blood gas analysis. Both patients exhibited slight hemolysis in their blood, and the boy had a microcytic anemia. There was no evidence of hypoxemia or methemoglobinemia. Despite the normal results from the arterial blood gas analysis, a right-to-left-shunt was assumed in the boy until a cardiology examination excluded this diagnosis. Sleep apnea syndrome was suspected in the father and treated with nocturnal positive pressure respiration based on the low oxygen saturation values obtained with pulse oximetry. Only after consultation with our laboratory was a hemoglobin variant suspected and investigated. Methods: We performed hemoglobin protein analysis by HPLC, electrophoretic separation, and spectrophotometry and DNA sequence analysis of the α-globin gene. Results: Both HPLC chromatographic separation and alkaline electrophoresis revealed a unique hemoglobin peak. In both patients, α-globin gene sequencing revealed a mutation resulting in a histidine-to–aspartatic acid substitution at position α87. The low oxygen saturation measurement by pulse oximetry was due to hemoglobin Bonn oxyhemoglobin having an absorption peak at 668 nm, near the 660 nm measured by pulse oximeters. Conclusion: Hemoglobin Bonn is a novel hemoglobin variant of the proximal α-globin that results in falsely low oxygen saturation measurements with pulse oximetry.

scholarly journals The effect of clamped and unclamped umbilical cord samples on blood gas analysis

2021 ◽  
Author(s):  
Elisabetta Colciago ◽  
Simona Fumagalli ◽  
Elena Ciarmoli ◽  
Laura Antolini ◽  
Antonella Nespoli ◽  
...  
Keyword(s):  
Blood Gas Analysis ◽  
Cross Sectional Study ◽  
Gas Analysis ◽  
Blood Collection ◽  
Large Sample Size ◽  
Blood Gas ◽  
Delayed Cord Clamping ◽  
Cross Sectional ◽  
High Risk Women ◽  
Significant Difference

Abstract Purpose Delayed cord clamping for at least 60 s is recommended to improve neonatal outcomes. The aim of this study is to evaluate whether there are differences in cord BGA between samples collected after double clamping the cord or without clamping the cord, when blood collection occurs within 60 s from birth in both groups. Methods A cross-sectional study was carried out, collecting data from 6884 high-risk women who were divided into two groups based on the method of cord sampling (clamped vs unclamped). Results There were significant decrease in pH and BE values into unclamped group compared with the clamped group. This difference remained significant when considering pathological blood gas analysis parameters, with a higher percentage of pathological pH or BE values in the unclamped group. Conclusion Samples from the unclamped cord alter the acid–base parameters compared to collection from the clamped cord; however, this difference does not appear to be of clinical relevance. Findings could be due to the large sample size, which allowed to achieve a high power and to investigate very small numerical changes between groups, leading to a statistically significant difference in pH and BE between samples even when we could not appreciate any clinical relevant difference of pH or BE between groups. When blood gas analysis is indicated, the priority should be given to the timing of blood collection to allow reliable results, to assess newborns status at birth and intervene when needed.

scholarly journals Comparison of Blood Gas Analysis between Benchtop and Handheld Device

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Phey Liana ◽  
Iza Netiasa Haris ◽  
Yan Effendi Hasyim
Keyword(s):  
Clinical Decision Making ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
P Value ◽  
Strong Positive Correlation ◽  
Blood Gas ◽  
Cross Sectional ◽  
Handheld Device ◽  
Arterial Blood ◽  
Significant Difference

The use of blood gas analysis is to determine the Acid-base status required to treat patients with emergency conditionssuch as metabolic disorders and respiratory diseases. Benchtop device is commonly used in hospitals to analyze blood gas;however, handheld devices are recently more often used in emergency settings due to its quick and simple process. Thisstudy was performed to compare blood gas analysis results between the i-STAT handheld device and the Nova pHox Ultrabenchtop device that were currently being used in the central laboratory. This cross-sectional study was conducted by using42 arterial blood patients that were measured with i-STAT handheld device dan Nova pHox Ultra benchtop device. The pH,pCO2, and pO2 parameters were then evaluated. The data were analyzed using Spearman's correlation test, Mann-Whitneytest, and Bland-Altman plots. This study showed a very strong positive correlation for all parameters. Mann-Whitneycomparison test showed that there was no significant difference between the result of the two devices (p-value > 0.05). Allparameters showed that 95% of plots were within the acceptable limit. There was no clinical significance on the mean biasesof blood gas results between both devices. The i-STAT and Nova pHox Ultra devices showed a good agreement for bloodgas measurement. Therefore, both devices can be used interchangeably with minimal effect on clinical decision-making.

scholarly journals Outcome of Respiratory distress in Neonates with Bubble CPAP at Neonatal Intensive Care Unit of a Tertiary Hospital

2019 ◽  
Vol 57 (216) ◽  
Author(s):  
Sunil Raja Manandhar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Positive Airway Pressure ◽  
Neonatal Intensive Care Unit ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Neonatal Intensive Care ◽  
Positive Airway Pressure ◽  
College Teaching ◽  
Medical College

Introduction: Respiratory distress is one of the commonest problem seen in neonates during admission in Neonatal Intensive Care Unit. Hyaline Membrane disease, Meconium Aspiration Syndrome, septicemia, congenital pneumonia, Transient Tachypnea of Newborn are the major causes of respiratory distress in neonates. Bubble Continuous Positive Airway Pressure is a non-invasive respiratory support delivered to a spontaneously breathing newborn to maintain lung volume during expiration. The main objective of this study was to observe the outcome of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure. Methods: This was a descriptive cross-sectional study conducted at Kathmandu Medical College Teaching Hospital over six months (October 2018 – March 2019) period. All preterm, term and post term babies with respiratory distress were included. Ethical clearance was received from Institutional Review Committee of Kathmandu Medical College and statistical analysis was done with SPSS 19 version. Results: Sixty three babies with respiratory distress were included in this study with 45 (71%) male predominance. The mean birth weight receiving Bubble Continuous Positive Airway Pressure was 2661.75±84 gms and gestational age was 36.67±3.4 wks. The Bubble Continuous Positive Airway Pressure was started at 8.05±2 hr of life and duration of Bubble Continuous Positive Airway Pressure required for settling respiratory distress was 95.71±3 hrs. Out of 63 babies, improvement of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure was 39 (61%) with confidence interval of (38-62) whereas 24 (39%) babies required mechanical ventilation and other modalities. Conclusions: This study concludes usefulness of Bubble Continuous Positive Airway Pressure in neonates with respiratory distress.

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