Oxygen Saturation in Neonate after Birth

Background: Oxygen saturation measures the quantity of haemoglobin in the blood that is saturated with oxygen. Hemoglobin is a component of red blood cells that binds oxygen and transports it to outlying tissues. Oxygen is commonly used throughout the world in neonatal units. Injudicious use of Oxygen may not maintain appropriate oxygen status rather can lead to hypoxemia or hyperoxemia, both of the conditions are injurious to neonatal health. Objective: To assess the oxygen saturation in neonate after birth.Methods:A cross-sectional study conducted in the Department of Neonatology BSMMU, Shahbag, Dhaka, Lab Aid Specialized Hospital, Dhaka, Bangladesh from October 2013 to March 2014. A total 317 patients were selected according to selection criteria. The parents were interviewed with a specific pre-designed and pre-tested questionnaire and some information were gathered by document review. All neonate both term and late preterm (˃34weeks) who would not be anticipated for resuscitation was included.Results:A total 317 neonate were selected according to selection criteria. Among the study subjects more than half were male (57.1%). Rests were female (42.9%). Average gestational age of the study subjects was 37.47± 1.16 (SD) with the range of 34-40. On the other hand average birth weight was 2.88±0.46 (SD) with the minimum birth weight 2.0 kg and maximum weight 4.2 kg. Illustrates the median (IQR) heart rate from one to ten min for preterm versus term births. At one to three minutes and at five minutes after birth preterm infants had significantly lower SpO2 measurements. From six to 10 minutes after birth and four minutes after birth there was no significant difference between SpO2 measurements for mode of delivery. Paired sample t test showed that average SpO2 was less in 1 minute[88.42±4.8(SD)] than in 5 minute [94.25±3.5(SD)] and statistically this differences were highly significant (t=24.44, p=0.000). Pearson correlation showed high positive correlation (p=0.000) and correlation co-efficient r=0.479. Correlation was significant at the 0.01 level.Conclusion:It is “normal” to have low oxygen saturation measurements in the first minutes after birth. It takes time for infants to reach oxygen saturation levels described as “normal” in the later postnatal period. Oxygen saturation increased with time i.e., it was more in 5 minutes than in 1 minute and similarly more in 10 minutes than in 5 minutes. Conversely heart rate was found more in one minute than to five and ten minutes. Oxygen saturation was ≥ 90% within 3 to 4 minutes. Significant changes were found in Oxygen saturation by mode of delivery in three minutes & in heart rate by two minutes after birth. At one to ten minutes after birth preterm infants had lower SpO2 measurements.

Serum HMGB1, DKK1, and ACE2 as a Function of Lung Injuries in COVID-19 Patients

There is a need for a biomarker for lung injury in COVID-19 patients. In the present study, an attempt was carried out to examine the role of Dickkopf-related protein 1 (DKK1), High-mobility group box 1 protein (HMGB1), angiotensin-converting enzyme 2 (ACE2) as a function for the lung abnormalities in CT-scan (LACTS). To perform the goals, DKK1, HMGB1, and ACE2 were measured in patients and controls using the ELISA technique. In contrast, other parameters were measured spectrophotometrically. The results showed decreased SpO2 and albumin and an increase in the serum biochemical parameters (glucose, urea, creatinine, D-dimer, ACE2, DKK1, and HMGB1) in COVID-19 patients compared with the control group. In COVID-19 patients, the percentages of the lung abnormalities in CT-scan% are 40.67±11.84. The results showed that those patients with LACTS patients are slightly older and have lower SpO2 than the patients without the LACTS group. ACE2 shows a significant correlation with SpO2 (ρ = 0.336, p<0.01) and a negative correlation with albumin (ρ = -0.197, p<0.05). Other parameters showed no significant correlation with the measured biomarkers. In conclusion, COVID-19 patients have higher ACE, DKK1, and HMGB1 indicating the involvement of the pathways of these biomarkers in the disease progression including lung injury.

Tent versus Mask-on Acute Effects during Repeated-Sprint Training in Normobaric Hypoxia and Normoxia

Repeated sprint in hypoxia (RSH) is used to improve supramaximal cycling capacity, but little is known about the potential differences between different systems for creating normobaric hypoxia, such as a chamber, tent, or mask. This study aimed to compare the environmental (carbon dioxide (CO2) and wet-globe bulb temperature (WGBT)), perceptual (pain, respiratory difficulty, and rate of perceived exertion (RPE)), and external (peak and mean power output) and internal (peak heart rate (HRpeak), muscle oxygen saturation (SmO2), arterial oxygen saturation (SpO2), blood lactate and glucose) workload acute effects of an RSH session when performed inside a tent versus using a mask. Twelve well-trained cyclists (age = 29 ± 9.8 years, VO2max = 70.3 ± 5.9 mL/kg/min) participated in this single-blind, randomized, crossover trial. Participants completed four sessions of three sets of five repetitions × 10 s:20 s (180 s rest between series) of all-out in different conditions: normoxia in a tent (RSNTent) and mask-on (RSNMask), and normobaric hypoxia in a tent (RSHTent) and mask-on (RSHMask). CO2 and WGBT levels increased steadily in all conditions (p < 0.01) and were lower when using a mask (RSNMask and RSHMask) than when inside a tent (RSHTent and RSNTent) (p < 0.01). RSHTent presented lower SpO2 than the other three conditions (p < 0.05), and hypoxic conditions presented lower SpO2 than normoxic ones (p < 0.05). HRpeak, RPE, blood lactate, and blood glucose increased throughout the training, as expected. RSH could lead to acute conditions such as hypoxemia, which may be exacerbated when using a tent to simulate hypoxia compared to a mask-based system.

Initial emergency department vital signs may predict PICU admission in pediatric patients presenting with asthma exacerbation

Objective: Severe asthma exacerbations account for a large share of asthma morbidity, mortality, and costs. Here, we aim to identify early predictive factors for pediatric intensive care unit (PICU) admission that could help improve outcomes. Methods: We performed a retrospective observational study of 6,014 emergency department (ED) encounters at a large children's hospital, including 95 (1.6%) resulting in PICU admission between 10/1/2015 and 8/31/2017 with ICD9/ICD10 codes for 'asthma,' 'bronchospasm,' or 'wheezing.' Vital signs and demographic information were obtained from EHR data and analyzed for each encounter. Predictive factors were identified using adjusted regression models, and our primary outcome was PICU admission. Results: Higher mean heartrates (HR) and respiratory rates (RR) and lower SpO2 within the first hour of ED presentation were independently associated with PICU admission. Odds of PICU admission increased 63% for each 10-beats/minute higher HR, 97% for each 10-breaths/minute higher RR, and 34% for each 5% lower SpO2. A binary predictive index using 1-hour vitals yielded OR 11.7 (95%CI 7.4-18.3) for PICU admission, area under the receiver operator characteristic curve (AUROC) 0.82 and overall accuracy of 81.5%. Results were essentially unchanged (AUROC 0.84) after adjusting for asthma severity and initial ED management. In combination with a secondary standardized clinical asthma distress score, positive predictive value increased by seven-fold (5.9% to 41%). Conclusions: A predictive index using HR, RR and SpO2 within the first hour of ED presentation accurately predicted PICU admission in this cohort. Automated vital signs trend analysis may help identify vulnerable patients quickly upon presentation.

Affective and Enjoyment Responses to Sprint Interval Exercise at Different Hypoxia Levels

Benefits of performing sprint interval training (SIT) under hypoxic conditions on improving cardiorespiratory fitness and body composition have been well-documented, yet data is still lacking regarding affective responses to SIT under hypoxia. This study aimed to compare affective responses to SIT exercise under different oxygen conditions. Nineteen active males participated in three sessions of acute SIT exercise (20 repetitions of 6 s of all-out cycling bouts interspersed with 15 s of passive recovery) under conditions of normobaric normoxia (SL: PIO2 150 mmHg, FIO2 0.209), moderate hypoxia (MH: PIO2 117 mmHg, FIO2 0.154, simulating an altitude corresponding to 2500 m), and severe hypoxia (SH: PIO2 87 mmHg, FIO2 0.112, simulating an altitude of 5000 m) in a randomized order. Perceived exertions (RPE), affect, activation, and enjoyment responses were recorded before and immediately after each SIT session. There were no significant differences across the three conditions in RPE or the measurements of affective responses, despite a statistically lower SpO2 (%) in severe hypoxia. Participants maintained a positive affect valence and reported increased activation in all the three SIT conditions. Additionally, participants experienced a medium level of enjoyment after exercise as indicated by the exercise enjoyment scale (EES) and physical activity enjoyment scale (PACES). These results indicated that performing short duration SIT exercise under severe hypoxia could be perceived as pleasurable and enjoyable as performing it under normoxia in active male population.

Effect of cardiopulmonary bypass reoxygenation on myocardial dysfunction following pediatric tetralogy of Fallot repair

Background Little is known regarding the effect of cardiopulmonary bypass (CPB) reoxygenation on cardiac function following tetralogy of Fallot repair. We hypothesized that hyperoxic reoxygenation would be more strongly associated with myocardial dysfunction in children with tetralogy of Fallot. Methods We investigated the association of perfusate oxygenation (PpO2) associated with myocardial dysfunction among children aged 6–72 months who underwent complete repair of tetralogy of Fallot in 2012–2018. Patients were divided into two groups: lower PpO2 group (≤ 250 mmHg) and higher PpO2 (> 250 mmHg) group based on the highest value of PpO2 during aortic occlusion. The odd ratio (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression models. Results This study included 163 patients perfused with lower PpO2 and 213 with higher PpO2, with median age at surgery 23.3 (interquartile range [IQR] 12.5–39.4) months, 164 female (43.6%), and median body mass index 15.59 (IQR 14.3–16.9) kg/m2. After adjustment for baseline, clinical and procedural variables, patients with higher PpO2 were associated with higher risk of myocardial dysfunction than those with lower PpO2 (OR 1.770; 95% CI 1.040–3.012, P = 0.035). Higher PpO2, lower SpO2, lower pulmonary annular Z-score, and longer CPB time were independent risk factors for myocardial dysfunction. Conclusions Association exists between higher PpO2 and myocardial dysfunction risk in patients with tetralogy of Fallot, highlighting the modulation of reoxygenation during aortic occlusion to reduce cardiovascular damage following tetralogy of Fallot repair. Trial registration Clinical Trials. gov number NCT03568357. June 26, 2018

Predictors of Extubation Failure In Thymomatous Myasthenia Gravis Patient After Thymectomy: Ten Years of Data From A Tertiary Teaching Hospital In Mainland China

Background: Thymectomy was consider to be the first line therapy for Patients with thymoma-associated myasthenia gravis(T-MG). But weaning is still a big challenge for MG patents, especially after surgery. The ideal time for extubation and the risk factors of extubation failure is uncertain. This study was to investigate the risk factors of extubation failure in T-MG patients after thymectomy.Methods: Retrospective review of consecutive T-MG patients admitted in intensive care unit after thymectomy and need mechanical ventilation at least 6h between January 2010 and December 2019. Weaning was according to a unified process. Extubation failure was defined as need for reintubation within 48h after extubation or death during ventilation. Univariate logistic regression was used to identify predictors of extubation failure.Results: 38 patients were included. 13 patients (34.2%) were extubation failure and with longer ventilation duration (153 vs. 29 h, p < 0.05) and hospital stay (26 vs. 13 days, p < 0.05). Univariate regression shows the ratio of transsternal thymectomy, the incident of never or diaphragm injury during the surgery or the PTMC, atelectasis, pneumonia during ventilation (p<0.05). Furthermore, even passed SBT, a higher HR, RR and lower SpO2 also indicate high risk of exutbation failure(p<0.05).Conclusions: Extubation failure is relatively common in T-MG patients after thymectomy. Minimizing surgical trauma may contributes to successful extubation. But the incidence of PTMC or pulmonary compliances during ventilation was associate with high risk of extubation failure. A higher HR, RR and lower SpO2 after SBT and also can be a reliable indicator.

The Use of Pulse Oximetry in the Assessment of Acclimatization to High Altitude

Background: Finger pulse oximeters are widely used to monitor physiological responses to high-altitude exposure, the progress of acclimatization, and/or the potential development of high-altitude related diseases. Although there is increasing evidence for its invaluable support at high altitude, some controversy remains, largely due to differences in individual preconditions, evaluation purposes, measurement methods, the use of different devices, and the lacking ability to interpret data correctly. Therefore, this review is aimed at providing information on the functioning of pulse oximeters, appropriate measurement methods and published time courses of pulse oximetry data (peripheral oxygen saturation, (SpO2) and heart rate (HR), recorded at rest and submaximal exercise during exposure to various altitudes. Results: The presented findings from the literature review confirm rather large variations of pulse oximetry measures (SpO2 and HR) during acute exposure and acclimatization to high altitude, related to the varying conditions between studies mentioned above. It turned out that particularly SpO2 levels decrease with acute altitude/hypoxia exposure and partly recover during acclimatization, with an opposite trend of HR. Moreover, the development of acute mountain sickness (AMS) was consistently associated with lower SpO2 values compared to individuals free from AMS. Conclusions: The use of finger pulse oximetry at high altitude is considered as a valuable tool in the evaluation of individual acclimatization to high altitude but also to monitor AMS progression and treatment efficacy.

Clinical characteristics of COVID-19 patients hospitalized at Clinique Ngaliema, a public hospital in Kinshasa, in the Democratic Republic of Congo: A retrospective cohort study

Objectives To describe the clinical characteristics of patients infected with SARS-CoV-2 at Clinique Ngaliema, a public hospital, in Kinshasa, in the Democratic Republic of Congo (DRC). Methods This retrospective study analyzed medical records including socio-demographics, past medical history, clinical manifestation, comorbidities, laboratory data, treatment and disease outcome of 160 hospitalized COVID-19 patients, with confirmed result of SARS-CoV-2 viral infection. Results The median age of patients was 54 years (IQR: 38–64), and there was no significant gender difference (51% of male). The most common comorbidities were hypertension (55 [34%]), diabetes (31 [19%]) and obesity (13 [8%]). Fever (93 [58%]), cough (92 [57%]), fatigue (87 [54%]), shortness of breath (72 [45%]) and myalgia (33 [21%]) were the most common symptoms, upon admission. Patients were categorized into mild (92 [57%]), moderate (19 [12%]) and severe (49 [31%]). Severe patients were older and were more likely to have comorbidities, compared to mild ones. The majority of patients (92% [147 of 160]) patients received hydroxychloroquine or chloroquine phosphate. Regression model revealed that older age, lower SpO2, higher heart rate and elevated AST at admission were all risk factors associated with in-hospital death. The prevalence of COVID-19 and malaria co-infection was 0.63% and 70 (44%) of all patients received antimalarial treatment before hospitalization. Conclusion Our findings indicated that the epidemiological and clinical feature of COVID-19 patients in Kinshasa are broadly similar to previous reports from other settings. Older age, lower SpO2, tachycardia, and elevated AST could help to identify patients at higher risk of death at an early stage of the illness. Plasmodium spp co-infection was not common in hospitalized COVID-19 patients.

Characteristics of COVID-19 patients admitted to a tertiary care hospital in Pune, India, and cost-effective predictors of intensive care treatment requirement

BackgroundMaharashtra is one of the worst affected states in this pandemic.2 As of 30th September, Maharashtra has in total 1.4 million cases with 38,000 deaths. Objective was to study associations of severity of disease and need for ICU treatment in COVID-19 patients.MethodsA retrospective study of clinical course in 800 hospitalized COVID-19 patients, and a predictive model of need for ICU treatment. Eight hundred consecutive patients admitted with confirmed COVID-19 disease.ResultsAverage age was 41 years, 16% were <20 years of age, 55% were male, 50% were asymptomatic and 16% had at least one comorbidity. Using MoHFW India severity guidelines, 73% patients had mild, 6% moderate and 20% severe disease. Severity was associated with higher age, symptomatic presentation, elevated neutrophil and reduced lymphocyte counts and elevated inflammatory markers. Seventy-seven patients needed ICU treatment: they were older (56 years), more symptomatic and had lower SpO2 and abnormal chest X-ray and deranged hematology and biochemistry at admission. A model trained on the first 500 patients, using above variables predicted need for ICU treatment with sensitivity 80%, specificity 88% in subsequent 300 patients; exclusion of expensive laboratory tests did not affect accuracy.ConclusionIn the early phase of COVID- 19 epidemic, a significant proportion of hospitalized patients were young and asymptomatic. Need for ICU treatment was predicted by simple measures including higher age, symptomatic onset, low SpO2 and abnormal chest X-ray. We propose a cost-effective model for referring patients for treatment at specialized COVID-19 hospitals.Key MessagesOf 800 patients, 73% had mild, 6% moderate and 20% had severe disease.Seventy-seven patients (9.6%) required ICU treatment, 25 (3%) died.ICU treatment was predicted by higher age, more symptomatic presentation, lower SpO2 and pneumonia on chest X-ray at admission.A machine learning model features in first 500 patients accurately predicted ICU treatment in subsequent 300 patients.A good clinical protocol, SpO2 and chest X-ray are adequate to predict and triage COVID-19 patients for hospital admissions in resource poor environments.