Comparison of pocket pulse oximeter and standard pulse oximeter with ABG analysis in critically ill patients

Background: Pulse oximetry (SpO2) is a standard monitoring device in patients presenting to EMDs and intensive care units (ICUs). Pocket pulse oximeters (PPOs) are used widely in wards, EMDs, and small hospitals/clinics. These inexpensive PPOs also guide therapeutic interventions. Few studies have evaluated the accuracy of SpO2 in patients presenting to critical care areas vis-à-vis devices like PPO and standard pulse oximeter (SPO). This study becomes extremely relevant in view of the ongoing crisis of the COVID-19 pandemic wherein SpO2 monitoring is very important in hospitals, quarantine centers, small clinics, or even at home.Methods: Patients presenting to critical areas who underwent arterial blood gases (ABG) analysis on the recommendation of the treating physician between November 2016 and October 2018 were included in this study. Along with the ABG analysis, a simultaneous assessment of SpO2 was done with a single PPO and SPO and all values were noted. Statistical analysis was done using the SPSS v.21.0 for Windows.Results: The study included 300 patients. We compared the O2 saturations of ABG, SPO, and PPO with respect to sex, different age groups, and at different levels of ABG pCO2, HCO3, and pH in all patients. All parameters were compared using the Pearson’s correlation test; the results showed that ABG O2 saturations were closer to the SPO than the PPO but the differences were not statistically significant as the Pearson’s correlation values for all parameters were >0.8. We also compared the parameters by Bland Altman Plot and all observations were outside 95% CI (confidence interval), which means that there was a good agreement between O2 saturations by all three methods, that is, ABG, SPO, and PPO; however, ABG O2 saturations were closer to SPO than PPO but this difference was not statistically significant. Hence, we conclude that the PPO is a useful tool for reliable monitoring of O2 saturations.Conclusion: This study highlights that inexpensive and noninvasive PPO can be used as a standard monitoring device with reliability in critically ill patients presenting to EMDs, ICUs, and small hospitals/clinics, quarantine centers, and even at home

Comparison of Pocket Pulse Oximeter and Standard Pulse Oximeter With ABG Analysis in Critically Ill Patients

Background: Pulse oximetry (SpO2) is a standard monitoring device in patients presenting to EMDs and intensive care units (ICUs). Pocket pulse oximeters (PPOs) are used widely in wards, EMDs, and small hospitals/clinics. These inexpensive PPOs also guide therapeutic interventions. Few studies have evaluated the accuracy of SpO2 in patients presenting to critical care areas vis-à-vis devices like PPO and standard pulse oximeter (SPO). This study becomes extremely relevant in view of the ongoing crisis of the COVID-19 pandemic wherein SpO2 monitoring is very important in hospitals, quarantine centers, small clinics, or even at home.  Methods: Patients presenting to critical areas who underwent arterial blood gases (ABG) analysis on the recommendation of the treating physician between November 2016 and October 2018 were included in this study. Along with the ABG analysis, a simultaneous assessment of SpO2 was done with a single PPO and SPO and all values were noted. Statistical analysis was done using the SPSS v.21.0 for Windows.  Results: The study included 300 patients. We compared the O2 saturations of ABG, SPO, and PPO with respect to sex, different age groups, and at different levels of ABG pCO2, HCO3, and pH in all patients. All parameters were compared using the Pearson’s correlation test; the results showed that ABG O2 saturations were closer to the SPO than the PPO but the differences were not statistically significant as the Pearson’s correlation values for all parameters were >0.8. We also compared the parameters by Bland Altman Plot and all observations were outside 95% CI (confidence interval), which means that there was a good agreement between O2 saturations by all three methods, that is, ABG, SPO, and PPO; however, ABG O2 saturations were closer to SPO than PPO but this difference was not statistically significant. Hence, we conclude that the PPO is a useful tool for reliable monitoring of O2 saturations.  Conclusion: This study highlights that inexpensive and noninvasive PPO can be used as a standard monitoring device with reliability in critically ill patients presenting to EMDs, ICUs, and small hospitals/clinics, quarantine centers, and even at home

Case matched comparison study of the necrosectomy by retroperitoneal approach with transperitoneal approach for necrotizing pancreatitis in patients with CT severity score of 7 and above

AbstractBackgroundMinimally invasive necrosectomy through a retroperitoneal approach has shown promising results for the treatment of necrotizing pancreatitis. There is however, little evidence from comparative studies in favor of these techniques over laparotomy.AimTo perform a case matched comparison of patients with necrotizing pancreatitis who underwent necrosectomy by the retroperitoneal approach with transperitoneal approach, thus minimizing the risk of confounding and selection bias.MethodsBetween August 2008 and March 2011, 85 patients were admitted with pancreatic necrosis. Each of the 15 patients who underwent necrosectomy by retroperitoneal approach using a small flank incision (RP group) were compared with 15 of those treated with necrosectomy by transperitoneal approach (TP group). These patients were matched for the age (±10 years), status of infection, CT severity score (±2 points), preoperative organ failure and timing for surgery (±7 days).ResultsPostoperative complications occurred in 4 patients (26.6%) in the RP group and 8 (53.3%) in the TP group (p = 0.248). Reintervention, was required in 4 patients (26.6%) in the RP group and 7 (46.6%) in the TP group (p = 0.366). The median post operative ICU stay was 10 days in the RP group compared to 15 days in the TP group (p = 0.317). Median post operative hospital stay was 26 days in the RP group and 32 days in the TP group (p = 0.431). The total hospital stay among the survivors was 31 days in the RP group and 40 days in the TP group (p = 0.285).ConclusionsThe RP approach for pancreatic necrosectomy through a small flank incision was associated with less post operative morbidity compared to TP approach. The surgical outcomes in terms of post operative new onset organ failure and in hospital mortality were similar in both the groups, but the post op ICU/hospital stay and the total hospital stay was lower in the RP approach group. These results still requires to be confirmed by further randomized studies

Rheumatological manifestation of diabetes: “Namaste” sign

In addition to the well-known complications such as neuropathy, nephropathy, retinopathy, diabetes mellitus can also result in a variety of rheumatologic manifestations, some of which can significantly affect a patient's quality of life. Diabetic cheiroarthropathy (DCA), which affects the hands clinically, manifests as painless limited extension of the proximal metacarpophalangeal joints and/or interphalangeal joints with spontaneous flexion of the fingers. There is decreased ability to fully flex or fully extend the fingers. This is the so-called “Namaste” or “Prayer” sign. This sign gives an indication of metabolic control of diabetes and microvascular disease. We hereby report a middle-age male patient admitted for fever and was incidentally found positive for this sign. Fundoscopy revealed nonproliferative diabetic retinopathy and there was microalbuminuria. The diagnosis is mainly clinical. It is imperative for clinicians to remember that the presence of DCA carries with it a significant relationship with microvasculopathy

A rare cause for recurrent cystitis

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Post pancreaticoduodenectomy haemorrhage: outcome prediction based on new ISGPS Clinical severity grading

Objective & background data. Mortality following pancreatoduodenectomy (PD) has fallen below 5%, yet morbidity remains between 30 and 50%. Major haemorrhage following PD makes a significant contribution to this ongoing morbidity and mortality. The aim of the present study was to validate the new International Study Group of Pancreatic Surgery (ISGPS) Clinical grading system in predicting the outcome of post pancreaticoduodenectomy haemorrhage (PPH). Material and methods. Between January 1998 and December 2007 a total of 458 patients who underwent Whipple's pancreaticoduodenectomy in our department were analysed with regard to haemorrhagic complications. The onset, location and severity of haemorrhage were classified according to the new criteria developed by an ISGPS. Risk factors for haemorrhage, management and outcome were analysed. Results. Severe PPH occurred in 14 patients (3.1%). Early haemorrhage (<24 hours) was recorded in five (36%) patients, and late haemorrhage (>24 hours) in nine (64%) patients. As per Clinical grading of ISGPS 7 (50%) belongs to Grade C and 7 (50%) belongs to Grade B. Haemostasis was attempted by surgery in 10 (71%) patients; angioembolisation was successful in two (14%) and endotherapy in one (7%) patient. The overall mortality is 29%(n=4). Age >60 years (p=0.02), sentinel bleeding (p=0.04), pancreatic leak (p=0.04) and ISGPS Clinical grade C (p=0.02) were associated with increased mortality. Conclusion. Early haemorrhage was mostly managed surgically with better outcome when endoscopy is not feasible. Late haemorrhage is associated with high mortality due to pancreatic leak and sepsis. ISGPS Clinical grading of PPH is useful in predicting the outcome