Determining oxygenation targets in acute respiratory distress syndrome(ARDS)remains a challenge.Althoughoxygenation targets have been used since ARDS was first described,they have not been investigated in detail.Howev...Determining oxygenation targets in acute respiratory distress syndrome(ARDS)remains a challenge.Althoughoxygenation targets have been used since ARDS was first described,they have not been investigated in detail.However,recent retrospective and prospective trials have evaluated the optimal oxygenation threshold in patientsadmitted to the general intensive care unit.In view of the lack of prospective data,clinicians continue to relyon data from the few available trials to identify the optimal oxygenation strategy.Assessment of the cost-benefitratio of the fraction of inspired oxygen(FiO_(2))to the partial pressure of oxygen in the arterial blood(PaO_(2))is an additional challenge.A high FiO_(2) has been found to be responsible for respiratory failure and deaths innumerous animal models.Low and high PaO_(2) values have also been demonstrated to be potential risk factors inexperimental and clinical situations.The findings from this literature review suggest that PaO_(2) values rangingbetween 80 mmHg and 90 mmHg are acceptable in patients with ARDS.The costs of rescue maneuvers needed toreach these targets have been discussed.Several recent papers have highlighted the risk of disagreement betweenarterial oxygen saturation(SaO_(2))and peripheral oxygen saturation(SpO_(2))values.In order to avoid discrepanciesand hidden hypoxemia,SpO_(2) readings need to be compared with those of SaO_(2).Higher SpO_(2) values may beneeded to achieve the recommended PaO_(2) and SaO_(2) values.展开更多
Background:Post-operative pneumonia(POP)is a common complication of lung cancer surgery,and muscular tissue oxygenation is a root cause of post-operative complications.However,the association between muscular tissue d...Background:Post-operative pneumonia(POP)is a common complication of lung cancer surgery,and muscular tissue oxygenation is a root cause of post-operative complications.However,the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied.This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.Methods:This cohort study enrolled patients(≥55 years)who had undergone lobectomy with one-lung ventilation.Muscular tissue oxygen saturation(SmtO_(2))was monitored in the forearm(over the brachioradialis muscle)and upper thigh(over the quadriceps)using a tissue oximeter.The minimum SmtO_(2)was the lowest intra-operative measurement at any time point.Muscular tissue desaturation was defined as a minimum baseline SmtO_(2)of<80%for>15 s.The area under or above the threshold was the product of the magnitude and time of desaturation.The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO_(2)in the forearm and that in the thigh.Results:We enrolled 174 patients.The overall incidence of muscular desaturation(defined as SmtO_(2)<80%in the forearm at baseline)was approximately 47.1%(82/174).The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation(28.0%[23/82]vs.12.0%[11/92];P=0.008).The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia(odds ratio:2.995,95%confidence interval:1.080-8.310,P=0.035)after adjusting for age,American Society of Anesthesiologists status,Assess Respiratory Risk in Surgical Patients in Catalonia score,smoking,use of peripheral nerve block,propofol,and study center.Conclusion:Muscular tissue desaturation,defined as a baseline SmtO_(2)<80%in the forearm展开更多
目的评价早期监测局部氧饱和度(rSO_(2))及其衍生参数预测脓毒症相关性脑病(sepsis-associated encephalopathy,SAE)的价值,探讨其与SAE的关系。方法选择入住麻醉重症监护病房(AICU)的脓毒症患者。入住AICU 24 h内用组织氧合监护仪对患...目的评价早期监测局部氧饱和度(rSO_(2))及其衍生参数预测脓毒症相关性脑病(sepsis-associated encephalopathy,SAE)的价值,探讨其与SAE的关系。方法选择入住麻醉重症监护病房(AICU)的脓毒症患者。入住AICU 24 h内用组织氧合监护仪对患者进行脑氧饱和度(S_(c)O_(2))和鱼际肌氧饱和度(S_(m)O_(2))监测,计算肌-脑组织氧饱和度梯度(S_(m-c)O_(2))。患者每天接受ICU谵妄评估量表(confusion assessment method for the intensive care unit,CAM-ICU)的筛查。根据CAM-ICU结果分为两组:CAM-ICU阳性的为脓毒症合并脑病组(SAE组),阴性的为脓毒症未合并脑病组(NE组)。结果最终纳入脓毒症患者32例,SAE组18例,NE组14例。SAE的发病率为56%,28 d死亡率为56%。SAE组S_(m)O_(2)、S_(m-c)O_(2)较NE组升高(P<0.05)。两组间的S_(c)O_(2)差异无统计学意义(P>0.05)。S_(m)O_(2)、S_(m-c)O_(2)诊断SAE的准确性较高,AUC均>0.7。S_(m)O_(2)诊断SAE时界值为60.3%,敏感度、特异度分别为83.3%、71.5%。S_(m-c)O_(2)诊断SAE时界值为2.23%,敏感度、特异度分别为61.1%、78.6%。结论早期监测局部氧饱和度及其衍生参数可用于预测SAE的发生。展开更多
Photoacoustic imaging(PAI) or optoacoustic imaging, the modern application of an ancient physical discovery to biomedical imaging, is without doubt one of the most exciting imaging technologies that has drawn increasi...Photoacoustic imaging(PAI) or optoacoustic imaging, the modern application of an ancient physical discovery to biomedical imaging, is without doubt one of the most exciting imaging technologies that has drawn increasing attention from biomedical specialists. In PAI, the rich contrast of optical excitation is seamlessly combined with the high spatial resolution and large penetration depth of ultrasonic detection to produce clear images of optically scattering biological tissues. As a complementary imaging modality that surpasses the territory of traditional microscopic optical imaging, PAI has been explored for numerous biomedical studies, and hence enthusiastically embraced by researchers around the globe who have attested to its unique imaging capabilities, namely the deep penetration and functional sensitivity.Not surprisingly, as the market clearly sees the promise, the commercial production of PAI systems has grown apace with the technological advancements and clinical applications. The adoption of commercial PAI in research and clinical settings has however seen difficulties, majorly due to costs, regulatory blocks,and competition with mainstream technologies. Here, from a practical standpoint, a wide range of commercial PAI systems currently available in the market were introduced, their advantages and disadvantages were analyzed, and the design considerations for targeted applications were emphasized. The key technological, logistical, and clinical issues were also discussed that need to be solved to accelerate the technology translations. By doing so, it is hoped that a clearer picture of the future commercialization of PAI for clinicians, researchers, and industrial entrepreneurs will be presented.展开更多
文摘Determining oxygenation targets in acute respiratory distress syndrome(ARDS)remains a challenge.Althoughoxygenation targets have been used since ARDS was first described,they have not been investigated in detail.However,recent retrospective and prospective trials have evaluated the optimal oxygenation threshold in patientsadmitted to the general intensive care unit.In view of the lack of prospective data,clinicians continue to relyon data from the few available trials to identify the optimal oxygenation strategy.Assessment of the cost-benefitratio of the fraction of inspired oxygen(FiO_(2))to the partial pressure of oxygen in the arterial blood(PaO_(2))is an additional challenge.A high FiO_(2) has been found to be responsible for respiratory failure and deaths innumerous animal models.Low and high PaO_(2) values have also been demonstrated to be potential risk factors inexperimental and clinical situations.The findings from this literature review suggest that PaO_(2) values rangingbetween 80 mmHg and 90 mmHg are acceptable in patients with ARDS.The costs of rescue maneuvers needed toreach these targets have been discussed.Several recent papers have highlighted the risk of disagreement betweenarterial oxygen saturation(SaO_(2))and peripheral oxygen saturation(SpO_(2))values.In order to avoid discrepanciesand hidden hypoxemia,SpO_(2) readings need to be compared with those of SaO_(2).Higher SpO_(2) values may beneeded to achieve the recommended PaO_(2) and SaO_(2) values.
基金National Key R&D Program of China(No.2018YFC2001800)Project of Health Commission of Hebei Province(No.20190709)
文摘Background:Post-operative pneumonia(POP)is a common complication of lung cancer surgery,and muscular tissue oxygenation is a root cause of post-operative complications.However,the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied.This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.Methods:This cohort study enrolled patients(≥55 years)who had undergone lobectomy with one-lung ventilation.Muscular tissue oxygen saturation(SmtO_(2))was monitored in the forearm(over the brachioradialis muscle)and upper thigh(over the quadriceps)using a tissue oximeter.The minimum SmtO_(2)was the lowest intra-operative measurement at any time point.Muscular tissue desaturation was defined as a minimum baseline SmtO_(2)of<80%for>15 s.The area under or above the threshold was the product of the magnitude and time of desaturation.The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO_(2)in the forearm and that in the thigh.Results:We enrolled 174 patients.The overall incidence of muscular desaturation(defined as SmtO_(2)<80%in the forearm at baseline)was approximately 47.1%(82/174).The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation(28.0%[23/82]vs.12.0%[11/92];P=0.008).The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia(odds ratio:2.995,95%confidence interval:1.080-8.310,P=0.035)after adjusting for age,American Society of Anesthesiologists status,Assess Respiratory Risk in Surgical Patients in Catalonia score,smoking,use of peripheral nerve block,propofol,and study center.Conclusion:Muscular tissue desaturation,defined as a baseline SmtO_(2)<80%in the forearm
文摘目的评价早期监测局部氧饱和度(rSO_(2))及其衍生参数预测脓毒症相关性脑病(sepsis-associated encephalopathy,SAE)的价值,探讨其与SAE的关系。方法选择入住麻醉重症监护病房(AICU)的脓毒症患者。入住AICU 24 h内用组织氧合监护仪对患者进行脑氧饱和度(S_(c)O_(2))和鱼际肌氧饱和度(S_(m)O_(2))监测,计算肌-脑组织氧饱和度梯度(S_(m-c)O_(2))。患者每天接受ICU谵妄评估量表(confusion assessment method for the intensive care unit,CAM-ICU)的筛查。根据CAM-ICU结果分为两组:CAM-ICU阳性的为脓毒症合并脑病组(SAE组),阴性的为脓毒症未合并脑病组(NE组)。结果最终纳入脓毒症患者32例,SAE组18例,NE组14例。SAE的发病率为56%,28 d死亡率为56%。SAE组S_(m)O_(2)、S_(m-c)O_(2)较NE组升高(P<0.05)。两组间的S_(c)O_(2)差异无统计学意义(P>0.05)。S_(m)O_(2)、S_(m-c)O_(2)诊断SAE的准确性较高,AUC均>0.7。S_(m)O_(2)诊断SAE时界值为60.3%,敏感度、特异度分别为83.3%、71.5%。S_(m-c)O_(2)诊断SAE时界值为2.23%,敏感度、特异度分别为61.1%、78.6%。结论早期监测局部氧饱和度及其衍生参数可用于预测SAE的发生。
文摘Photoacoustic imaging(PAI) or optoacoustic imaging, the modern application of an ancient physical discovery to biomedical imaging, is without doubt one of the most exciting imaging technologies that has drawn increasing attention from biomedical specialists. In PAI, the rich contrast of optical excitation is seamlessly combined with the high spatial resolution and large penetration depth of ultrasonic detection to produce clear images of optically scattering biological tissues. As a complementary imaging modality that surpasses the territory of traditional microscopic optical imaging, PAI has been explored for numerous biomedical studies, and hence enthusiastically embraced by researchers around the globe who have attested to its unique imaging capabilities, namely the deep penetration and functional sensitivity.Not surprisingly, as the market clearly sees the promise, the commercial production of PAI systems has grown apace with the technological advancements and clinical applications. The adoption of commercial PAI in research and clinical settings has however seen difficulties, majorly due to costs, regulatory blocks,and competition with mainstream technologies. Here, from a practical standpoint, a wide range of commercial PAI systems currently available in the market were introduced, their advantages and disadvantages were analyzed, and the design considerations for targeted applications were emphasized. The key technological, logistical, and clinical issues were also discussed that need to be solved to accelerate the technology translations. By doing so, it is hoped that a clearer picture of the future commercialization of PAI for clinicians, researchers, and industrial entrepreneurs will be presented.
