Arterial Blood Gas and Pulse Oximetry in Initial Management of Patients with Community-acquired Pneumonia

OBJECTIVE: To identify the factors associated with the use of arterial blood gas (ABG) and pulse oximetry (PO) in the initial management of patients with community-acquired pneumonia (CAP) and arterial hypoxemia at presentation. PARTICIPANTS: A total of 944 outpatients and 1,332 inpatients with clinical and radiographic evidence of CAP prospectively enrolled from 5 study sites in the United States and Canada. ANALYSES: Separate multivariate logistic regression analyses were used to 1) compare measurement of ABG and PO within 48 hours of presentation across sites while controlling for patient differences, and 2) identify factors associated with arterial hypoxemia (PaO(2)<60 mm Hg or SaO(2)<90% for non–African Americans and <92% for African Americans) while breathing room air. RESULTS: Range of ABG use by site was from 0% to 6.4% (P = .06) for outpatients and from 49.2% to 77.3% for inpatients (P < .001), while PO use ranged from 9.4% to 57.8% for outpatients (P < .001) and from 47.9% to 85.1% for inpatients (P < .001). Differences among sites remained after controlling for patient demographic characteristics, comorbidity, and illness severity. In patients with 1 or more measurements of oxygenation at presentation, hypoxemia was independently associated with 6 risk factors: age >30 years (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.7 to 5.9), chronic obstructive pulmonary disease (OR, 1.9; 95% CI, 1.4 to 2.6), congestive heart failure (OR, 1.5; 95% CI, 1.0 to 2.1), respiratory rate >24 per minute (OR, 2.3; 95% CI, 1.8 to 3.0), altered mental status (OR, 1.6; 95% CI, 1.1 to 2.3), and chest radiographic infiltrate involving >1 lobe (OR, 2.2; 95% CI, 1.7 to 2.9). The prevalence of hypoxemia among those tested ranged from 13% for inpatients with no risk factors to 54.6% for inpatients with ≥3 risk factors. Of the 210 outpatients who had ≥2 of these risk factors, only 64 (30.5%) had either an ABG or PO performed. In the 48 outpatients tested without supplemental O(2)with ≥2 risk factors 8.3% were hypoxemic. CONCLUSIONS: In the initial management of CAP, use of ABG and PO varied widely across sites. Increasing the assessment of arterial oxygenation among patients with CAP is likely to increase the detection of arterial hypoxemia, particularly among outpatients

Lightweight physiologic sensor performance during pre-hospital care delivered by ambulance clinicians

Acknowledgments We would like to extend our thanks to the Scottish Ambulance Service for granting us permission to undertake this research. We would also like to thank the ambulance clinicians who took part, and the patients. We also recognise the non-financial support given to us by the developers of the RESpeck sensor (University of Edinburgh). The research described here was supported by the award made by the RCUK Digital Economy programme to the dot.rural Digital Economy Hub; award reference: EP/G066051/1.Peer reviewedPublisher PD

Avaliação das medidas de oximetria de pulso em indivíduos sadios com esmalte de unha Evaluación de las medidas de oximetría de pulso en individuos sanos con esmalte de uña Evaluation of pulse oximetry measurements in healthy subjects with nail polish

OBJETIVO: Avaliar as alterações nas medidas da oximetria de pulso em indivíduos sadios com esmaltes de unha. MÉTODOS: Estudo transversal com 80 voluntárias sadias. As cores de esmalte utilizadas para avaliar a saturação periférica de oxigênio (SpO2) foram: café com leite, café, chocolate, vermelho e ameixa. Estas cores foram distribuídas entre as unhas dos dedos da mão esquerda. Os dedos da mão direita foram os controles. RESULTADOS: As cores vermelha (p=0,047) e café (p=0,024) mostraram valores menores na SpO2 quando comparados ao controle. As outras cores não alteraram a medida da SpO2. CONCLUSÃO: As cores vermelha e café causaram redução na medida da SpO2, porém a relevância clínica deste achado é questionável, pois os valores estavam dentro do intervalo de normalidade.<br>OBJETIVO: Evaluar las alteraciones en las medidas de la oximetría de pulso en individuos sanos con esmalte de uña. MÉTODOS: Estudio transversal realizado con 80 voluntarias sanas. Los colores de esmalte utilizados para evaluar la saturación periférica de oxígeno (SpO2) fueron: café con leche, café, chocolate, rojo y ciruela. Estos colores fueron distribuidos entre las uñas de los dedos de la mano izquierda. Los dedos de la mano derecha fueron los controles. RESULTADOS: Los colores rojo (p=0,047) y café (p=0,024) mostraron valores menores en la SpO2 cuando fueron comparados al control. Los otros colores no alteraron la medida del SpO2. CONCLUSIÓN: Los colores rojo y café causaron reducción en la medida del SpO2, sin embargo la relevancia clínica de este hallazgo es cuestionable, pues los valores estaban dentro del intervalo de normalidad.<br>OBJECTIVE: To evaluate the changes in measurements of pulse oximetry in healthy individuals with nail polish. METHODS: Cross sectional study with 80 healthy volunteers. The colors of enamel used to assess oxygen saturation (SpO2) were: coffee with milk, coffee, chocolate, red and plum. These colors were distributed among the finger nails of his left hand. The fingers of the right hand were the controls. RESULTS: The colors red (p = 0.047) and coffee (p = 0.024) showed lower values in SpO2 in comparison to the control. The other colors did not change the measurement of SpO2. CONCLUSION: The colors red and coffee caused reduction in the measurement of SpO2, but the clinical relevance of this finding is questionable, because the values were within the normal range