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  • 1
    Online Resource
    Online Resource
    Effects of Skin Pigmentation on Pulse Oximeter Accuracy at Low Saturation
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Anesthesiology Vol. 102, No. 4 ( 2005-04-01), p. 715-719
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 102, No. 4 ( 2005-04-01), p. 715-719
    Abstract: It is uncertain whether skin pigmentation affects pulse oximeter accuracy at low HbO2 saturation. Methods The accuracy of finger pulse oximeters during stable, plateau levels of arterial oxygen saturation (Sao2) between 60 and 100% were evaluated in 11 subjects with darkly pigmented skin and in 10 with light skin pigmentation. Oximeters tested were the Nellcor N-595 with the OxiMax-A probe (Nellcor Inc., Pleasanton, CA), the Novametrix 513 (Novametrix Inc., Wallingford, CT), and the Nonin Onyx (Nonin Inc., Plymouth, MN). Semisupine subjects breathed air-nitrogen-carbon dioxide mixtures through a mouthpiece. A computer used end-tidal oxygen and carbon dioxide concentrations determined by mass spectrometry to estimate breath-by-breath Sao2, from which an operator adjusted inspired gas to rapidly achieve 2- to 3-min stable plateaus of desaturation. Comparisons of oxygen saturation measured by pulse oximetry (Spo2) with Sao2 (by Radiometer OSM3) were used in a multivariate model to determine the interrelation between saturation, skin pigmentation, and oximeter bias (Spo2 - Sao2). Results At 60-70% Sao2, Spo2 (mean of three oximeters) overestimated Sao2 (bias +/- SD) by 3.56 +/- 2.45% (n = 29) in darkly pigmented subjects, compared with 0.37 +/- 3.20% (n = 58) in lightly pigmented subjects (P & lt; 0.0001). The SD of bias was not greater with dark than light skin. The dark-light skin differences at 60-70% Sao2 were 2.35% (Nonin), 3.38% (Novametrix), and 4.30% (Nellcor). Skin pigment-related differences were significant with Nonin below 70% Sao2, with Novametrix below 90%, and with Nellcor at all ranges. Pigment-related bias increased approximately in proportion to desaturation. Conclusions The three tested pulse oximeters overestimated arterial oxygen saturation during hypoxia in dark-skinned individuals.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/00000542-200504000-00004
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
    detail.hit.zdb_id: 2016092-6
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  • 2
    Online Resource
    Online Resource
    Hypoxic ventilatory response predicts the extent of maximal breath-holds in man
    Elsevier BV ; 1995
    In:  Respiration Physiology Vol. 100, No. 3 ( 1995-6), p. 213-222
    Details
    In: Respiration Physiology, Elsevier BV, Vol. 100, No. 3 ( 1995-6), p. 213-222
    Type of Medium: Online Resource
    ISSN: 0034-5687
    URL: Article
    DOI: 10.1016/0034-5687(94)00132-J
    Language: English
    Publisher: Elsevier BV
    Publication Date: 1995
    detail.hit.zdb_id: 2010715-8
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  • 3
    Online Resource
    Online Resource
    Effects of Acute, Profound Hypoxia on Healthy Humans: Implications for Safety of Tests Evaluating Pulse Oximetry or Tissue Oximetry Performance
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Anesthesia & Analgesia Vol. 124, No. 1 ( 2017-01), p. 146-153
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 124, No. 1 ( 2017-01), p. 146-153
    Abstract: Extended periods of oxygen deprivation can produce acidosis, inflammation, energy failure, cell stress, or cell death. However, brief profound hypoxia (here defined as Sa o2 50%–70% for approximately 10 minutes) is not associated with cardiovascular compromise and is tolerated by healthy humans without apparent ill effects. In contrast, chronic hypoxia induces a suite of adaptations and stresses that can result in either increased tolerance of hypoxia or disease, as in adaptation to altitude or in the syndrome of chronic mountain sickness. In healthy humans, brief profound hypoxia produces increased minute ventilation and increased cardiac output, but little or no alteration in blood chemistry. Central nervous system effects of acute profound hypoxia include transiently decreased cognitive performance, based on alterations in attention brought about by interruptions of frontal/central cerebral connectivity. However, provided there is no decrease in cardiac output or ischemia, brief profound hypoxemia in healthy humans is well tolerated without evidence of acidosis or lasting cognitive impairment.
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/ANE.0000000000001421
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2018275-2
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  • 4
    Online Resource
    Online Resource
    Dark Skin Decreases the Accuracy of Pulse Oximeters at Low Oxygen Saturation: The Effects of Oximeter Probe Type and Gender
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Anesthesia & Analgesia Vol. 105, No. 6 ( 2007-12), p. S18-S23
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 105, No. 6 ( 2007-12), p. S18-S23
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/01.ane.0000285988.35174.d9
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 2018275-2
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  • 5
    Online Resource
    Online Resource
    Intraoperative Management of Liver Transplant Patients Without the Routine Use of Renal Replacement Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Transplantation Vol. 102, No. 5 ( 2018-05), p. e229-e235
    Details
    In: Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 102, No. 5 ( 2018-05), p. e229-e235
    Type of Medium: Online Resource
    ISSN: 0041-1337
    URL: Article
    DOI: 10.1097/TP.0000000000002137
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2035395-9
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  • 6
    Online Resource
    Online Resource
    The Association Between Vena Cava Implantation Technique and Acute Kidney Injury After Liver Transplantation
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Transplantation Vol. 104, No. 11 ( 2020-11), p. e308-e316
    Details
    In: Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 104, No. 11 ( 2020-11), p. e308-e316
    Abstract: Acute kidney injury (AKI) after liver transplantation is associated with increased morbidity and mortality. It remains controversial whether the choice of vena cava reconstruction technique impacts AKI. Methods. This is a single-center retrospective cohort of 897 liver transplants performed between June 2009 and September 2018 using either the vena cava preserving piggyback technique or caval replacement technique without veno-venous bypass or shunts. The association between vena cava reconstruction technique and stage of postoperative AKI was assessed using multivariable ordinal logistic regression. Causal mediation analysis was used to evaluate warm ischemia time as a potential mediator of this association. Results. The incidence of AKI (AKI stage ≥2) within 48 h after transplant was lower in the piggyback group (40.3%) compared to the caval replacement group (51.8%, P 〈 0.001). Piggyback technique was associated with a reduced risk of developing a higher stage of postoperative AKI (odds ratio, 0.49; 95% confidence interval, 0.37-0.65, P 〈 0.001). Warm ischemia time was shorter in the piggyback group and identified as potential mediator of this effect. There was no difference in renal function (estimated glomerular filtration rate and the number of patients alive without dialysis) 1 y after transplant. Conclusions. Piggyback technique, compared with caval replacement, was associated with a reduced incidence of AKI after liver transplantation. There was no difference in long-term renal outcomes between the 2 groups.
    Type of Medium: Online Resource
    ISSN: 0041-1337
    URL: Article
    DOI: 10.1097/TP.0000000000003331
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2035395-9
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  • 7
    Online Resource
    Online Resource
    Emergent Orthotopic Liver Transplantation for Hemorrhage from a Giant Cavernous Hepatic Hemangioma: Case Report and Review
    Springer Science and Business Media LLC ; 2011
    In:  Journal of Gastrointestinal Surgery Vol. 15, No. 1 ( 2011-1), p. 209-214
    Details
    In: Journal of Gastrointestinal Surgery, Springer Science and Business Media LLC, Vol. 15, No. 1 ( 2011-1), p. 209-214
    Type of Medium: Online Resource
    ISSN: 1091-255X , 1873-4626
    URL: Article
    DOI: 10.1007/s11605-010-1248-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2011
    detail.hit.zdb_id: 2057634-1
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  • 8
    Online Resource
    Online Resource
    Evaluating Pulmonary Function: An Assessment of Pao 2/Fio 2
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Critical Care Medicine Vol. 45, No. 1 ( 2017-01), p. e40-e48
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 1 ( 2017-01), p. e40-e48
    Abstract: Pa o 2 /F io 2 is used commonly for diagnosis of lung injury (acute respiratory distress syndrome and transfusion-related acute lung injury), for assessment of pulmonary disease course and therapy, and in pulmonary transplantation for evaluation of donor lungs and clinical outcome. It was developed for convenience, without formal mathematical and graphic assessment to validate its suitability for these purposes. Design: We examined, mathematically and graphically, the relationship of Pa o 2 /F io 2 to F io 2 at constant normal and several degrees of increased intrapulmonary shunting ( Qs/Qt ), assessing the impact of intra- and extrapulmonary factors on the relationship and thus the reliability of Pa o 2 /F io 2 . Measurements and Main Results: The relationship of Pa o 2 /F io 2 varies at all shunt fractions but most with Qs/Qt from 0.1 to 0.3 with F io 2 approximately greater than 0.4. At higher Qs/Qt , the relationship is more constant and changes less with F io 2 more than 0.4. Hemoglobin concentration and arterial-venous oxygen content difference have large effects that can confound interpretation of Pa o 2 /F io 2 . Barometric pressure has a substantial effect; P co 2 , base excess, and respiratory quotient have small effects. Conclusions: At high Qs/Qt with F io 2 more than 0.4, the relationship of Pa o 2 /F io 2 to F io 2 is relatively constant. However, with Qs/Qt of 0.1–0.3, Pa o 2 /F io 2 changes substantially with F io 2 . Understanding the important effects of nonpulmonary factors (especially hemoglobin concentration and arterial-venous oxygen content difference) should enhance appropriate clinical use, interpretation of Pa o 2 /F io 2 , and interpretation of previous publications and future studies (especially those seeking to assess effects of anemia or transfusion on lung function). The ratio of Pa o 2 /F io 2 is a good tool for some, but not many clinical circumstances, and is insufficiently robust for most research applications.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000002017
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2034247-0
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  • 9
    Online Resource
    Online Resource
    Effects of Changes in Arterial Carbon Dioxide and Oxygen Partial Pressures on Cerebral Oximeter Performance
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Anesthesiology Vol. 128, No. 1 ( 2018-01-01), p. 97-108
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 128, No. 1 ( 2018-01-01), p. 97-108
    Abstract: Cerebral oximetry (cerebral oxygen saturation; ScO2) is used to noninvasively monitor cerebral oxygenation. ScO2 readings are based on the fraction of reduced and oxidized hemoglobin as an indirect estimate of brain tissue oxygenation and assume a static ratio of arterial to venous intracranial blood. Conditions that alter cerebral blood flow, such as acute changes in Paco2, may decrease accuracy. We assessed the performance of two commercial cerebral oximeters across a range of oxygen concentrations during normocapnia and hypocapnia. Methods Casmed FORE-SIGHT Elite (CAS Medical Systems, Inc., USA) and Covidien INVOS 5100C (Covidien, USA) oximeter sensors were placed on 12 healthy volunteers. The fractional inspired oxygen tension was varied to achieve seven steady-state levels including hypoxic and hyperoxic Pao2 values. ScO2 and simultaneous arterial and jugular venous blood gas measurements were obtained with both normocapnia and hypocapnia. Oximeter bias was calculated as the difference between the ScO2 and reference saturation using manufacturer-specified weighting ratios from the arterial and venous samples. Results FORE-SIGHT Elite bias was greater during hypocapnia as compared with normocapnia (4 ± 9% vs. 0 ± 6%; P & lt; 0.001). The INVOS 5100C bias was also lower during normocapnia (5 ± 15% vs. 3 ± 12%; P = 0.01). Hypocapnia resulted in a significant decrease in mixed venous oxygen saturation and mixed venous oxygen tension, as well as increased oxygen extraction across fractional inspired oxygen tension levels (P & lt; 0.0001). Bias increased significantly with increasing oxygen extraction (P & lt; 0.0001). Conclusions Changes in Paco2 affect cerebral oximeter accuracy, and increased bias occurs with hypocapnia. Decreased accuracy may represent an incorrect assumption of a static arterial–venous blood fraction. Understanding cerebral oximetry limitations is especially important in patients at risk for hypoxia-induced brain injury, where Paco2 may be purposefully altered.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000001898
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2016092-6
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  • 10
    Online Resource
    Online Resource
    Room I, 10/16/2000 2: 00 PM - 4: 00 PM (PS) Oxyhemoglobin Desaturation Following Apnea Induced by Succinylcholine and Sodium Thiopental in Volunteers  
    Ovid Technologies (Wolters Kluwer Health) ; 2000
    In:  Anesthesiology Vol. 93, No. 3A ( 2000-09-01), p. A-1009
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 93, No. 3A ( 2000-09-01), p. A-1009
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/00000542-200009001-01009
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2000
    detail.hit.zdb_id: 2016092-6
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