Background: Physiological studies have shown that many preterm infants and infants with chronic lung disease may suffer chronic hypoxaemia, which possibly leads to poor growth and development. Anecdotal reports indicate that there is a drive to increase the oxygen saturation target range to a higher level in these infants due primarily to perceived benefits derived from clinical experience and from uncontrolled observational studies of babies discharged on home oxygen. Objective The BOOST (Benefits Of Oxygen Saturation Targeting) trial is the first randomised trial to assess the long-term benefits and harms of two different oxygen saturation target ranges. Methods: BOOST was a multicentre, double blinded, randomised controlled trial that enrolled 358 infants born at less than 30 weeks� gestation who remained oxygen-dependent at 32 weeks postmenstrual age. They were randomly assigned to target either a functional oxygen saturation range of 91-94% (standard or control group) or 95-98% (higher or treatment group). The primary outcomes were growth and neurodevelopmental measures at 12 months corrected age. Secondary outcomes included length of hospital stay, retinopathy of prematurity, health service utilisation, parental stress, and infant temperament. Results: Prognostic baseline characteristics did not differ between the two groups. Mean birth weight and gestational age of enrolled infants was 917g and 26.5 weeks respectively. The rate of antenatal corticosteroid use was 83%.

Orientador: Emilio Carlos Elias Baracat / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T15:05:19Z (GMT). No. of bitstreams: 1 Pupin_MelissaKarina_M.pdf: 1472103 bytes, checksum: f436fa1af6c6cd56ad2ce4e74db10cf1 (MD5) Previous issue date: 2008 / Resumo: Há controvérsias a respeito da indicação de técnicas de fisioterapia respiratória no tratamento de Bronquiolite Viral Aguda (BVA). As técnicas convencionais de fisioterapia parecem não contribuir na evolução clínica da BVA, enquanto as técnicas atuais ou ¿a fluxo¿, como o aumento do fluxo expiratório (AFE), ainda não foram avaliadas e permanecem como possibilidades terapêuticas. Objetivo: Comparar os efeitos da AFE e vibração associada à drenagem postural (DP) nos parâmetros cardiorrespiratórios de freqüência cardíaca (FC), freqüência respiratória (FR) e saturação transcutânea de oxigênio (SpO2) de lactentes com BVA. Casuística e Métodos: Foram analisados lactentes com BVA, atendidos na Unidade de Emergência Referenciada de Pediatria do Hospital de Clínicas da Universidade Estadual de Campinas no período de julho de 2005 a agosto de 2007. Os valores de FC, FR e SpO2 foram registrados em quatro tempos: antes do procedimento (tempo 1), imediatamente após (tempo 2), 30 (tempo 3) e 60 minutos do término do procedimento (tempo 4). Os pacientes foram divididos em três grupos de intervenção: grupo A submetido à AFE, grupo B vibração associada à DP, e grupo C (controle). A análise de dados foi feita por Análise de Variância (ANOVA), teste Qui-quadrado e teste exato de Fischer. Resultados: Foram incluídos no estudo 81 lactentes, 48 do gênero masculino e 33 do gênero feminino, média de idade de 4,52 meses e peso médio de 6,56 kg. 81,5% dos lactentes apresentavam-se no primeiro episódio de sibilância e 76,5% não tinham doença associada. Na comparação global entre os grupos e os tempos, a análise das médias da FR apresentou tendência de diferença significante (p = 0,0536) em relação ao grupo controle, com valores menores após o procedimento nos grupos A e B. Não houve diferença significante entre os três grupos na análise das médias da FC e SpO2 (p > 0,05). Conclusão: A aplicação das técnicas de fisioterapia respiratória, AFE e vibração associada à DP, parecem contribuir na diminuição da freqüência respiratória de lactentes com BVA / Abstract: There are controversies over the prescription of respiratory techniques in the treatment of Acute Viral Bronchiolitis (AVB). The conventional techniques don¿t seem to contribute to the clinical evolution of AVB, whereas the techniques of flow, as the increase in expiratory flow (IEF), haven¿t been evaluated yet and remain as therapeutical possibility. Objective: Compare the effects of IEF and the vibration associated to Postural Drainage (PD) in the heart respiratory parameters of heart rate (HR), respiratory rate (RR) and transcutaneous oxygen saturation (SpO2) of infants with AVB. Cause and Methods: Infants with AVB, taken to the Pediatrics Emergency Unit in Campinas State University Clinical Hospital, were analyzed in the period from July 2005 to August 2007. The values of HR, RR and SpO2 were registered four times: before the procedure (time 1), immediately after (time 2), 30 and 60 minutes from the end of procedure (times 3 and 4 respectively). The patients were divided into three intervention groups: group A submitted to IEF, group B to vibration associated to PD, and group C (control). The analysis of data was performed by Variance Analysis (ANOVA), qui quadratic and Fischer¿s exact test. Results: 81 infants were included in the study, 48 males and 33 females, average age of 4.52 years old and average weight of 6.56 kg. 81.5% of the infants presented the first episode of sibilance and 76.5% had no disease associated. In the global comparison between the groups in the four times, the analysis of the HR average presented a significant difference tendency (p = 0.0536) in relation to the control group, with smaller values in A and B groups. There was no significant difference between the three groups in the analysis of RR and SpO2 average (p > 0.05). Conclusion: The application of physiotherapy techniques, IEF and the vibration associated to PD seem to contribute to the decrease of the respiratory rate in infants with AVB / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Searching to trace the clinical profile, epidemiologist, evolution and laboratorial of the internments of patients with Sickle Cell Disease (SCD); to identify factors that can be related with the sprouting and evolution of Acute Chest Syndrome (ACS), as well as; to evaluate if the average saturation of oxygen through the oximetry of pulse is diagnosis or prognostic of ACS; a study of coorte with 168 carrying patients was carried through of SCD. During all the year of 2006, 168 patients with SCD had been studied, had predominance of the males (51.8%) and of the age band between 5 and 15 years (53.3%), 81 (48.2%) patient ones had suffered at least a hospital internment, 34 (41.9%) had diagnosis of ACS in at least an internment and 47 (58.1%) had other causes internment as intense painful and anemia crisis. When we compare the ambulatorial accompaniment of the patients who had interned with of that they had not interned in 2006, perceive that the splenomegaly presence was more common between the patients whom they had interned (27.3%), with significance statistics (p = 0, 0006). The average saturation of oxygen through the oximetry of pulse also was significantly different (p = 0, 0092) between the two groups, a time that the patients who had suffered internment had gotten one better performance (95.6%) against 94,1 % of the patients who had not interned in 2006. When analyzing the variable hemoglobin and white cell count, we do not find differences significant. In relation to the patients with ACS, the fever complaint was more prevalent (70.6%), whereas the pain complaint more was related by the patients with other causes of internment (93.3%). With regard to the age band, it enters the older than 15 years, we notice minors indices (6.1%) of internment for ACS (p= 0, 04). It did not have significant difference with regard to the hemoglobin and the saturation of oxygen through the oximetry of pulse when compared the out results with the ones of the hospital admission. The total white globule counting was significantly superior in the occasion of the internment (p=0,001). One concludes that the average saturation of oxygen by pulse oximetry was not capable to identify the patients who would come to be interned with ACS. / Buscando traçar o perfil clínico, epidemiológico, evolutivo e laboratorial das internações de pacientes com Anemia Falciforme (AF); identificar fatores que possam estar relacionados com surgimento e evolução de Síndrome Torácica Aguda (STA), bem como; avaliar se a saturação média de oxigênio através da oximetria de pulso é diagnóstica ou prognóstica em relação a STA; foi realizado um estudo de coorte com 168 pacientes portadores de AF. Houve predomínio do gênero masculino (51,8%) e da faixa etária entre 5 e 15 anos (53,3%), 81(48,2%) pacientes sofreram pelo menos uma internação hospitalar, 34 (41,9%) tiveram diagnóstico de STA em pelo menos uma internação e 47 (58,1%) tiveram outras causas internação como crise dolorosa e anemia intensa. Quando comparamos o acompanhamento ambulatorial dos pacientes que internaram com o dos que não internaram em 2006, percebemos que a presença de esplenomegalia foi mais comum entre os pacientes que internaram (27,3%), com significância estatística (p = 0,0006). A saturação média de oxigênio através da oximetria de pulso também foi significativamente diferente (p = 0,0092) entre os dois grupos, uma vez que os pacientes que sofreram internação obtiveram um melhor desempenho (95,6%) contra 94,1% dos pacientes que não internaram em 2006. Ao analisarmos as variáveis hemoglobina e leucometria, não encontramos diferença estatisticamente significativa. Em relação aos pacientes com STA, a queixa de febre foi mais prevalente (70,6%), enquanto que a queixa de dor foi mais referida pelos pacientes com outras causas de internação (93,3%). Com relação à faixa etária, entre os maiores de 15 anos, notamos menores índices (6,1%) de internação por STA (p= 0,04). Não houve diferença estatisticamente significante com relação à hemoglobina e a saturação de oxigênio através da oximetria de pulso quando comparados os resultados ambulatoriais com os da admissão hospitalar. A contagem total de glóbulos brancos foi significativamente superior na ocasião da internação (p=0,001). Conclui-se que a saturação transcutânea média de oxigênio não foi capaz de identificar os pacientes que viriam a ser internados com STA.

A verificação da vitalidade pulpar depende de recursos semiotécnicos específicos, e, entre eles, os mais comumente empregados são os testes térmicos e elétrico. Tais testes apresentam limitações clínicas que interferem na análise e interpretação dos dados obtidos pelos mesmos. Os testes de sensibilidade são estímulos de origem térmica, elétrica ou mecânica aplicáveis ao dente e que são transmitidos às fibras nervosas sensitivas pulpares. Portanto, não leva em consideração a atividade circulatória do tecido pulpar e as condições de oxigenação, que são os reais indicadores da vitalidade do tecido. Nos casos de traumatismos dentários, por diversos fatores, a resposta pulpar se torna ainda mais difícil de obter. Assim, faz-se necessário avaliar o comportamento fisiológico pulpar através de testes denominados fisiométricos, destacando-se nesta área a oximetria de pulso, que é um método não invasivo e objetivo para determinação da saturação de oxigênio e taxa de pulso de um determinado tecido. Este estudo procurou estabelecer parâmetros para a utilização do oxímetro de pulso como teste de vitalidade pulpar, avaliando, comparativamente, os níveis de saturação de oxigênio obtidos do dedo indicador, de dentes controle positivo e de dentes permanentes traumatizados dos mesmos pacientes. Os dentes traumatizados apresentavam resposta negativa ao teste de sensibilidade pulpar com gás refrigerante e ausência de outro sinal ou sintoma indicativo de necrose pulpar. Os resultados mostraram que não houve diferença estatisticamente significante comparando-se as taxas de oxigenação dos dentes traumatizados nos três tempos (inicial, 30 e 60 dias) e que houve correlação entre as taxas de oxigenação do dedo indicador e dos dentes traumatizados e entre os dentes controle e os dentes traumatizados. Comparando-se as leituras obtidas neste estudo pode-se afirmar que taxas de oxigenação obtidas nos dentes traumatizados são confiáveis, permitindo ainda um monitoramento da condição pulpar ao longo do tempo. / The evaluation of pulp vitality depends on diagnosis methods. The most widely used are thermal and electric stimulation. However, thermal and electric testing has limitations in providing accurate diagnosis. These tests are subjective and depend upon perceived response of the patient to a stimulus, as well as the interpretation of that response by the dentist. The limitations with present pulp testing methods are that they only indirectly monitor pulp vitality by measuring neural responses and not circulation. For traumatized teeth, the pulp can be affected in a variety of ways as a function of the severity of the injury therefore, that teeth may not respond to vitality test and establishing an accurate and expedient diagnosis is even more complicated. Pulse oximetry is a completely objective test, requiring no sub jective response from the patient and directly measures the blood oxygen levels. This present study purpose was to evaluate the efficiency of pulse oximetry for testing pulp vitality by establishing correlation parameters between blood oxygen levels from the patient’s index finger, positive control teeth and traumatized permanent teeth which do not respond positively to thermal test with refrigerant spray and do not show any other sign or symptom of mortification. The results showed that there was no statistical significance between blood oxygen levels from traumatized teeth at the three different measure times (initial, 30 and 60 days) and there was a correlation between blood oxygen levels from index finger and the traumatized teeth and control teeth and traumatized teeth.

O objetivo deste trabalho foi avaliar a taxa de oxigenação (%SpO2) do tecido pulpar em pacientes com tumores malignos intraoral e de orofaringe, tratados através de radioterapia (RT). As mensurações da %SpO2 foram realizadas com o oxímetro de pulso (OP), o qual gera valores relativos à quantidade de oxigênio viável circulante no tecido pulpar, o que o caracteriza como um método fisiométrico de avaliação do status da polpa dental. Foram selecionados 20 pacientes, sendo avaliados dois dentes de cada um (n=40), independente do quadrante e da área de irradiação, em quatro tempos distintos: I- antes da RT; II- no início da RT com dose de radiação entre (30Gy 35Gy); III- ao final da RT (60Gy 70Gy) e IV- depois de 4 5 meses do início do tratamento oncológico. As médias obtidas nos quatro tempos avaliados foram de 93%, 83%, 77% e 85% de SpO2, respectivamente. Através do teste t de Student (p0.01) foram encontradas diferenças estatisticamente significantes entre o Tempo I e todos os outros três tempos, o Tempo III também mostrou diferença quando comparado ao Tempo II e, não houve diferença estatística entre os Tempos II e IV. É possível concluir que as taxas de %SpO2 antes da RT são maiores do que aquelas obtidas trans e pós RT e, como os valores no Tempo IV ficam próximos aos obtidos no Tempo II, pode haver uma recondutibilidade sanguínea normal posterior a radiação ionizante. / The aim of this study was to evaluate pulp oxygenation level (%SpO2) in patients with malignant intraoral and oropharyngeal tumors treated by radiotherapy (RT). Pulp oxygenation level was measured by pulse oximetry, which shows the amount of oxygen circulating in viable pulp tissue and is a physiometric method for assessment of dental pulp status. Twenty patients were selected and two teeth of each of them (n = 40) were analyzed, regardless of the quadrant and the area irradiated, at four different times: I- before RT; IIat the beginning of RT with radiation doses between 30Gy 35Gy; III- at the end of RT (60Gy 70Gy) and IV- after 4-5 months of the beginning of the cancer treatment. Mean %SpO2 in the different times was 93%, 83%, 77% and 85%, respectively. Students t test (p0.01) showed statistically significant differences between Time I and the other three times. Time III was also different when compared to Time II, and there was no statistical difference between Times II and IV. It was concluded that %SpO2 before RT was greater than that observed during and after therapy and, as values obtained in Time IV were close to those of Time II, pulp tissue may show normal blood flow after radiation therapy.

Pulse oximeters are used in operating rooms and recovery rooms as a monitoring device for oxygen in the respiratory system of the patient. The advantage of pulse oximeters over other methods of oxygen monitoring is that they are easy to use and they are non-invasive, which means it is not necessary break the skin to extract blood for information to be obtained. The standard for the measurement of partial pressure of CO2 and O2 is an arterial blood gas analysis (ABG). However routine monitoring using this method on a continuous basis is impractical since it is slow, painful and invasive. Measuring carbon dioxide is critical to preventing ailments such as carbon dioxide poisoning or hypoxia. The problem is, currently there is no known effective non-invasive method for accurately measuring carbon dioxide in the body to properly assess the adequacy of ventilation. The objective of this study was to experimentally use spectroscopy in the visible spectrum and the principles of operation of a pulse oximeter to incorporate a method of non-invasive real-time carbon dioxide monitoring that is as quick and easy to use.

No description available.

No description available.

Thesis (MScEng)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The monitoring of patients in healthcare is of prime importance to ensure their efficient treatment. The monitoring of blood oxygen saturation in tissues affected by diseases or conditions that may negatively affect the function is a field that has grown in importance in recent times. This study involved the development and testing of a highly sensitive noninvasive blood oxygen saturation device. The device can be used to continuously monitor the condition of tissue affected by diseases which affect the blood flow through the tissue, and the oxygen usage in tissue. The device’s system was designed to specifically monitor occluded tissue which has low oxygen saturations and low perfusion. With the use of the device, it is possible to monitor the status of tissue affected by diseases such as meningococcemia and diabetes mellitus or conditions such as the recovery after plastic surgery. The study delved into all aspects involved in the development of a non-invasive artificial pulse oximeter, including but not limited to that of a detailed device design, signals analysis, animal in-vivo and laboratory in-vitro system design for the calibration of the system as well as human clinical validation and testing procedures. All these aspects were compared to determine the relative accuracies of the different models. Through testing it was shown that it is possible to non-invasively measure the mixed oxygen saturation in occluded tissue. However, without accurate validation techniques and methods of obtaining both arterial and venous blood samples in occluded tissue the system could not be fully validated for determining both the arterial and venous oxygen saturations in the human invivo study. Although the system was unable to accurately measure specifically the venous oxygenation it was able to measure the mixed oxygen saturation. With further research it would be possible to validate the system for measuring both the arterial and venous oxygen saturations. / AFRIKAANSE OPSOMMING: Die monitering van pasiënte in gesondheidsorg is van uiterste belang om doeltreffende behandeling te verseker. Die monitering van bloedsuurstofversadiging in weefsels wat geaffekteer word deur siektes of toestande wat ’n negatiewe impak kan hê op die funksie daarvan is ’n gebied wat aansienlike groei getoon het in die onlangse verlede. Die studie het die ontwikkeling en toetsing van ’n hoogs sensitiewe nieindringende bloedsuurstofversadigingsensor ingesluit. Hierdie sensor kan gebruik word om deurentyd die toestand van weefsel te monitor wat geaffekteer word deur siektes wat bloedvloei deur weefsel affekteer sowel as die suurstofgebruik in die weefsel. Die stelsel is ontwerp om spesifiek die ingeslote weefsel wat lae suurstofversadiging en lae perfusie het, te monitor. Deur gebruik te maak van die toestel is dit moontlik om die toestand van die weefsel wat geaffekteer word deur siektes soos meningococcemia en diabetes mellitus of toestande soos die herstel na plastiese sjirurgie te monitor. Die studie het gekyk na alle aspekte wat betrokke is in die ontwikkeling van ’n nie-indringende kunsmatige pols-oksimeter, insluitend maar nie beperk tot gedetailleerde ontwerp nie, sein analise, dier in-vivo en laboratorium in-vitro stelselontwerp vir die kalibrasie van die stelsel sowel as menslike kliniese bekragtiging en toetsprosedures. Al hierdie aspekte is vergelyk om die relatiewe akkuraatheid van die verskillende modelle te bepaal. Die toetse het gewys dat dit moontlik is om nie-indringend die gemengde suurstofversadiging in weefsel te bepaal. Sonder akkurate bekragtigingstegnieke en metodes om beide arteriële en vene bloedmonsters te versamel in ingeslote weefsel kan die stesel nie ten volle bekragtig word om beide arteriële- en veneversadigings in menslike in-vivo studie te bepaal nie. Hoewel die stelsel nie ’n akkurate meting van die aarsuurstof kon kry nie, is daar wel ’n akkurate meting geneem van die gemengde suurstofversadiging. Toekomstige navorsing kan lei tot die bekragtiging van die stelsel om beide arteriële en slagaar suurstofversadigings te meet.

Although steady progress has been made towards the development of a wearable pulse oximeter to aid in remote physiological status monitoring (RPSM) and triage operations, the ability to extract accurate physiological data from a forehead pulse oximeter during extended periods of activity and in the presence of pressure disturbances acting on the sensor remains a significant challenge. This research was undertaken to assess whether the attachment method used to secure a pulse oximeter sensor affects arterial oxygen saturation (SpO2) and heart rate (HR) accuracy during motion. Additionally, two sensor housings were prototyped to assess whether isolating the sensor from external pressure disturbances could improve SpO2 and HR accuracy. The research revealed that measurement accuracy during walking is significantly affected by the choice of an attachment method. Specifically, the research indicated that an elastic band providing a contact pressure of 60 mmHg can result in decreased measurement error and improved reliability. Furthermore, the research validated that the two isolating housings we have investigated improve SpO2 and HR errors significantly at pressures as high as 1200 mmHg (160 kPa) compared to current commercial housings. This information may be helpful in the design of a more robust pulse oximeter sensor for use in RPSM.