Search Results (227)

Background/Objectives: Red blood cell (RBC) transfusion is frequently used to treat anemia of prematurity, yet bedside metrics that capture its short-term impact on oxygenation stability are limited. We assessed whether pulse oximetry histogram-derived oxygen saturation (SpO₂) exposure changes after transfusion and whether responses differ across clinical subgroups. Methods: This prospective observational cohort included preterm infants born <32 weeks’ gestation who received a standardized RBC transfusion (15 mL/kg). Continuous SpO₂ histograms quantified the percentage of monitored time spent in hypoxemia (<85%), normoxemia (86–95%), and hyperoxemia (≥96%) during four intervals: 24 h pre-transfusion and 24, 48, and 72 h post-transfusion. Repeated-measures and subgroup analyses (BPD, sex, birth weight < 1000 g) were performed. Results: Thirty-three infants were analyzed (gestational age 29.4 ± 2.1 weeks; birth weight 1220.6 ± 316.9 g). Hemoglobin increased from 8.6 ± 1.1 to 11.7 ± 1.0 g/dL (p < 0.001). Cohort-level histogram shifts were modest: normoxemia increased from 68.4 ± 12.1% to 72.6 ± 11.4% at 24 h (p = 0.18), hypoxemia decreased from 10.3 ± 6.5% to 6.6 ± 4.8% (p = 0.09), and hyperoxemia remained stable (21.3 ± 9.2% to 20.8 ± 8.5%; p = 0.44). Infants with BPD and those <1000 g showed persistently higher hypoxemia and/or hyperoxemia at 72 h compared with counterparts. Exploratory ROC analyses showed modest discrimination of 24 h hypoxemia for ROP (AUC 0.71) and 72 h hyperoxemia for BPD (AUC 0.74). Conclusions: RBC transfusion corrected anemia but did not produce a consistent cohort-level improvement in SpO₂ histogram stability. Histogram metrics may help characterize heterogeneous oxygenation responses and support hypothesis generation for individualized monitoring strategies. Full article

Background/Objectives: Respiratory dysfunction in Parkinson’s disease (PD) is frequently underrecognized, particularly when resting oxygen saturation is preserved. Dynamic stress testing, however, may reveal exercise-induced oxygen desaturation, reflecting a latent functional respiratory impairment. The relationship between exertional oxygen desaturation and cognitive performance in PD remains insufficiently explored. Objective: To investigate the association between exercise-induced oxygen desaturation and global cognitive performance in patients with PD, and to explore the contribution of pulmonary gas exchange impairment assessed by diffusing capacity of the lung for carbon monoxide (DLCO). Methods: This prospective, cross-sectional, single-center observational study with consecutive enrollment included 50 patients with idiopathic Parkinson’s disease undergoing multidisciplinary respiratory evaluation following neurological assessment. Participants underwent cognitive evaluation using the Romanian version of the Montreal Cognitive Assessment (MoCA), pulmonary function testing including DLCO and total lung capacity (TLC), and a supervised 6-min walk test (6MWT) with continuous pulse oximetry. Exercise-induced oxygen desaturation was defined as a decrease in SpO₂ of ≥4% from baseline. Correlation analyses and multivariable regression models were applied. Results: Exercise-induced oxygen desaturation was frequent, with 60% of patients exhibiting a ≥4% decrease in SpO₂ during the 6MWT. Greater desaturation was significantly associated with lower MoCA scores (Spearman’s r = −0.383, p = 0.006). No significant associations were found between exertional desaturation and resting pulmonary function parameters, including DLCO and TLC. In multivariable analysis, lower MoCA score and levodopa–carbidopa intestinal gel treatment independently predicted greater oxygen desaturation during exercise. Conclusions: Exercise-induced oxygen desaturation is common in patients with PD despite preserved resting oxygenation and is associated with poorer cognitive performance. These findings suggest that exertional desaturation may reflect a dynamic functional impairment and may be associated with increased physiological vulnerability. Functional exercise testing with oxygen saturation monitoring may provide complementary information beyond resting pulmonary assessments. Full article

Background/Objectives: Children in paediatric palliative care often face school attendance barriers due to complex health needs. This study describes post-training perceptions of a training program by a pediatric hospice team to prepare school care assistants to safely include children with complex conditions, focusing on procedural skills, knowledge of the child, and family partnership. Methods: Care assistants who completed a structured course at the Paediatric Palliative Care Centre, University Hospital of Padua (2023–2024), were surveyed immediately after training. The program combined classroom instruction with hands-on simulation using high-fidelity mannequins and standard devices, including suction, pulse oximetry, ventilation, enteral feeding, and tracheostomy care. It also covered modules on urgent and emergency management, as well as family communication. An anonymous online questionnaire gathered socio-demographic data, prior training, clinical tasks performed, self-efficacy levels, and open-ended feedback. Quantitative results were analyzed descriptively, while qualitative comments were subjected to thematic analysis. Results: Of 130 invited assistants, 105 participated (81%). Participants reported strong perceived confidence: 85% selected the upper end of the 5-point scale (“very” or “extremely”) for routine-management ability, and 60% selected these same response options for emergency-management ability. In the most severe events recalled, 60.5% of incidents were resolved autonomously, 7.6% involved contacting emergency services, and 3.8% involved community or hospice nurses. Seventy-five percent judged the course comprehensive; thematic analysis of 102 comments identified satisfaction, requests for regular refreshers, stronger practical components, and requests for targeted topics. Conclusions: Immediately after the session, participants tended to select the upper end of the self-assurance item for both routine and emergency tasks. Combining core emergency procedures with personalized, child-specific modules and family-partnership training may support safety, trust, and inclusion. Regular refreshers and skills checks are advised. Full article

The COVID-19 pandemic has highlighted the importance of rapid clinical decision-making to facilitate the efficient usage of healthcare resources. Over the past decade, machine learning (ML) has caused a tectonic shift in healthcare, empowering data-driven prediction and decision-making. Recent research demonstrates how ML was used to respond to the COVID-19 pandemic. This paper puts forth new computer-aided COVID-19 disease screening techniques using six classes of ML algorithms (including penalized logistic regression, random forest, artificial neural networks, and support vector machines) and evaluates their performance when applied to a real-world clinical dataset containing patients’ demographic information and vital indices (such as sex, ethnicity, age, pulse, pulse oximetry, respirations, temperature, BP systolic, BP diastolic, and BMI), as well as ICD-10 codes of existing comorbidities, as attributes to predict the risk of having COVID-19 for given patient(s). Variable importance metrics computed using a random forest model were used to reduce the number of important predictors to thirteen. Using prediction accuracy, sensitivity, specificity, and AUC as performance metrics, the performance of various ML methods was assessed, and the best model was selected. Our proposed model can be used in clinical settings as a rapid and accessible COVID-19 screening technique. Full article

Background/Objectives: Flexible bronchoscopy (FB) enables airway exploration and diagnosis of various respiratory pathologies, but the sedation and instrumentation required during the procedure raise oxygen demand while reducing ventilation, which can lead to hypoxemia. Conventional oxygen therapy (COT) may not adequately prevent desaturations in high-risk groups, as patients with moderate respiratory deficiency. High-flow nasal cannula (HFNC) can deliver heated, humidified oxygen at high flow rates, generating low-level positive airway pressure, improving oxygenation, reducing dead-space, and enhancing procedure tolerance. Prior studies have shown that HFNC can improve gas exchange and reduce desaturations during bronchoscopy. However, evidence remains limited for patients with moderate respiratory deficiency, who are particularly vulnerable. Evaluating the feasibility and safety of HFNC in this population is essential to guide safe procedural practice. Methods: A retrospective observational study including patients undergoing FB with HFNC support between January and May 2025. Inclusion criteria were BMI between 18 and 30; age > 18 years old; moderate respiratory dysfunction, defined by pulse oximetry, Pulmonary Functional Tests (PFTs) and Arterial Blood Gas (ABG) analysis. Exclusion criteria were intolerance/contraindication to HFNC. Procedures were performed under basic monitoring. Primary outcome was occurrence of severe hypoxemia (SpO2 < 90%). Secondary outcomes were needed for rescue maneuvers, interruption for conversion to other ventilatory strategies, and hemodynamic instability. Results: No severe desaturations were recorded, all procedures were completed without rescue maneuvers or other ventilatory strategies, and no hypoxemia occurred. Mean duration of the procedure was 9 min. Vital parameters were maintained within the normal ranges, with a mean SpO₂ during bronchoscopy of 98%. Conclusions: HFNC enables oxygenation and ventilation without adverse events in sedations for FB in patients with moderate respiratory deficiency. Full article

Pulsoximeters are widely used in the medical care of preclinical patients to evaluate the cardiorespiratory status and monitor basic vital signs, such as pulse rate (PR) and oxygen saturation (SpO₂). In many preclinical situations, air transport of the patient by helicopter is necessary. Conventional pulse oximeters, mostly used on the patient’s finger, are prone to motion artifacts during transportation. Therefore, this study aims to determine whether simulated helicopter vibration has an impact on the photoplethysmogram (PPG) derived from an in-ear sensor at the external ear canal and whether the vibration influences the calculation of vital signs PR and SpO₂. The in-ear PPG signals of 17 participants were measured at rest and under exposure to vibration generated by a helicopter simulator. Several signal quality indicators (SQI), including perfusion index, skewness, entropy, kurtosis, omega, quality index, and valid pulse detection, were extracted from the in-ear PPG recordings during rest and vibration. An intra-subject comparison was performed to evaluate signal quality changes under exposure to vibration. The analysis revealed no significant difference in any SQI between vibration and rest (all p > 0.05). Furthermore, the vital signs PR and SpO₂ calculated using the in-ear PPG signal were compared to reference measurements by a clinical monitoring system (ECG and SpO₂ finger sensor). The results for the PR showed substantial agreement (${\mathrm{CCC}}_{rest}$ = 0.96; ${\mathrm{CCC}}_{vibration}$ = 0.96) and poor agreement for SpO₂ (${\mathrm{CCC}}_{rest}$ = 0.41; ${\mathrm{CCC}}_{vibration}$ = 0.19). The results of our study indicate that simulated helicopter vibration had no significant impact on the calculation of the SQIs, and the calculation of vital signs PR and SpO₂ did not differ between rest and vibration conditions. Full article

Hereditary Hemorrhagic Telangiectasia (HHT), also known as Rendu–Osler–Weber syndrome, is a disorder of angiogenesis characterized by mucocutaneous telangiectasias and visceral arteriovenous malformations. This rare autosomal dominant disorder is caused by pathogenic variants in the ENG and ACVRL1 genes, and only 1–3% of case variants occur in SMAD4. HHT clinical manifestations include telangiectasias, epistaxis, and arteriovenous malformations in multiple organ systems. Clinical diagnosis is based on Curaçao Criteria. Here, we describe a pauci-symptomatic 10-year-old girl with an orbital and sinus infectious disease. Her clinical history was unremarkable, except for sporadic, self-limiting epistaxis episodes. She showed finger clubbing and low oxygen saturation levels on pulse oximetry, suggesting a chronic lung disease, and a large lung arteriovenous malformation. She also developed acute neurological symptoms, with evidence of multiple cerebral abscess lesions on MRI. HHT was therefore suspected and confirmed by genetic analysis, which revealed a de novo pathogenic variant in the ENG gene [c.1183G>T p.(Glu395Ter)] found in only 15% of the reads from NGS analysis, performed on peripheral blood lymphocytes, indicating a possible mutational mosaicism. This case outlines that HHT could present with unusual clinical symptoms highlighting the importance of diagnosis using both clinical criteria and genetic test. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is diagnosed using pulse oximetry, which is less accurate in patients with darker skin. Two hypopnea definitions are in use: the American Academy of Sleep Medicine allows either (A) a 30% airflow decrease with a 3% oxygen desaturation or EEG arousal (“3% Rule”) or (B) a 30% airflow decrease with a 4% oxygen desaturation (“4% Rule”). The Centers for Medicare and Medicaid Services and many payers use only the 4% Rule. We hypothesized that patients from racial minority groups with darker skin tones would be less likely to qualify for OSA treatment using the 4% Rule compared to the 3% Rule. A secondary aim was to examine sex disparities. Methods: We reviewed records of adults undergoing overnight sleep studies at an urban academic hospital. Demographics, medical history, and comorbidities were collected. Analyses controlled for age, sex, BMI, anxiety, depression, hypertension, COPD, and smoking. Results: A total of 1354 records were analyzed. We found no racial or sex disparities in the proportion of participants who met the 3% but not the 4% Rule. After controlling for covariates, no racial group differed from White participants in meeting only the 3% Rule. However, female participants were significantly less likely than males to meet the 4% Rule. Conclusions: Despite known limitations of pulse oximetry associated with skin tone, no racial differences in the diagnosis of OSA were seen in this cohort. However, female patients had lower odds of meeting the 4% Rule, suggesting a potential barrier to treatment. Full article

Background: Hemoglobin Rothschild (Hb Rothschild), NM_000518.5(HBB):c.112T>C, is an ultra-rare low-oxygen-affinity hemoglobin variant that persistently causes reduced peripheral oxygen saturation on pulse oximetry despite normal arterial oxygenation. Fewer than ten cases have been reported worldwide, and only one involved a child—an asymptomatic carrier identified incidentally. Methods: The patient underwent clinical examination, growth assessment, blood tests, hemoglobin electrophoresis, chest CT, abdominal ultrasound, echocardiography, and pulmonary perfusion scintigraphy. Whole genome sequencing (WGS) of the proband and parents was performed, followed by bioinformatic analysis and ACMG-based variant interpretation. A PRISMA-guided PubMed literature review was conducted. Results: We report on the first pediatric case exhibiting a symptomatic clinical course. A 4-year-old boy was referred for chronically low peripheral oxygen saturation (SpO₂), 78–86%, on pulse oximetry and recurrent lower respiratory tract infections. Early developmental history revealed episodes of apnea in infancy, perioral cyanosis, poor exercise tolerance, and low weight gain. Repeated cardiopulmonary assessments, chest computed tomography (CT), echocardiography, and pulmonary perfusion scintigraphy yielded unremarkable findings. Arterial blood gas analysis consistently showed normal arterial partial pressure of oxygen (PaO₂), excluding true hypoxemia. Hemoglobin electrophoresis revealed an abnormal HbD fraction; WGS identified a heterozygous variant NM_000518.5(HBB):c.112T>C inherited from the patient’s asymptomatic father. This variant increases the partial pressure of oxygen at which hemoglobin is 50% saturated (p50), thereby decreasing hemoglobin’s oxygen affinity and shifting the oxyhemoglobin dissociation curve to the right. These alterations explain the discordance between low peripheral oxygen saturation (SpO₂) and preserved oxygen delivery to tissues. Conclusions: This case expands the clinical spectrum of Hb Rothschild and demonstrates that symptomatic presentation may occur in early childhood. Awareness of low-affinity hemoglobin variants is essential to avoid misdiagnosis and unnecessary cardiopulmonary interventions. Early genetic testing facilitates accurate diagnosis and appropriate counseling. Full article

Background: Hemodynamic management in veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is inherently complex, as extracorporeal circulation profoundly alters preload, afterload, ventriculo-arterial coupling and tissue perfusion. This review summarizes current and emerging monitoring strategies to guide initiation, maintenance and weaning. Methods: A structured literature search was performed in PubMed and Scopus (1990–2025), including clinical studies, consensus statement and expert reviews addressing hemodynamic monitoring in V-A ECMO. Results: A multiparametric framework is required. Echocardiography remains central for assessing biventricular performance, aortic valve dynamics and ventricular unloading. Pulmonary artery catheterization provides complementary data on filling pressures, cardiac output and global oxygen balance. Metabolic indices such as lactate clearance and veno-arterial CO₂ gap, together with regional oximetry (NIRS), inform the adequacy of systemic and tissue perfusion. Microcirculatory monitoring, though technically demanding, has shown prognostic value, particularly during weaning. Additional adjuncts include arterial pulse pressure, end-tidal CO₂ and waveform analysis. Phenotype oriented priorities, such as detection of differential hypoxemia, prevention of left ventricular distension or surveillance for limb ischemia, require tailored monitoring strategies. Artificial intelligence and machine learning represent future avenues for integrating multiparametric data into predictive models. Conclusions: No single modality can capture the hemodynamic complexity of V-A ECMO. Precision monitoring demands a dynamic, phenotype-specific and time-dependent approach that integrates systemic, cardiac, metabolic and microcirculatory variables. Such individualized strategies hold promise to optimize outcomes, reduce complications and align V-A ECMO management with the principles of precision medicine. Full article

Near-Infrared Spectroscopy (NIRS) is a noninvasive technology used to monitor muscle oxygenation in sports science. Since its introduction in 1977, NIRS has evolved into a valuable tool for assessing physiological responses during exercise and rehabilitation. The history of NIRS dates back to early hemoglobin studies in the 19th century, with significant advancements in pulse oximetry during World War II. By the late 1980s, NIRS had become widely used in sports science, allowing researchers to evaluate muscle perfusion and metabolic thresholds in various activities. NIRS applications in sports include determining exercise thresholds, monitoring muscle oxygenation during training, assessing asymmetries between limbs, and evaluating mitochondrial capacity. Studies have explored its use in both team and endurance sports, highlighting its role in optimizing performance and preventing injuries. Beyond sports, NIRS technology is expanding into clinical fields, aiding in rehabilitation and patient monitoring. This critical review has identified several key areas for future research, including the need to clarify methodological influences, strategies to minimize the impact of adipose tissue on NIRS measurements, the importance of conducting longitudinal studies, increased research on sex-specific effects, and a greater emphasis on field-based studies. With continued advancements, NIRS is expected to further enhance our understanding of muscle physiology and human performance, making it a crucial tool in athletic performance assessment and clinical practice. Full article

The recent rise in living standards has been accompanied by increased awareness and emphasis on oral health. Non-invasive assessment of gingival microcirculation and accurate evaluation of oxygen supply to oral tissues are critical for the early diagnosis of oral diseases. These factors also play a pivotal role in optimizing treatment planning and improving outcomes in dental implantology. In this study, we report the development and implementation of a novel pulse oximetry device based on reflective photoplethysmography technology, designed for non-invasive, real-time monitoring of gingival health through the measurement of oxygen saturation levels. A detailed description of the technology, including key aspects of sensor probe design, is provided, with particular emphasis on the calibration process and performance evaluation of the prototype. Furthermore, we present and discuss the first proof-of-concept gingival oxygen saturation measurements obtained in a clinical setting during oral rehabilitation consultations. Full article

Background: Pulse oximetry is a non-invasive method for continuous monitoring of peripheral blood oxygen saturation (SpO₂) to estimate arterial oxygen saturation. Previous studies suggested that SpO₂ measurements show variability depending on the particular finger that is used for measurement. To date, no study has compared all fingers for SpO₂ under hypoxemia and during continuous simultaneous monitoring with randomization of finger sensor placement. Objectives: The aim of this study was to assess the inter-finger variability of SpO₂ values during sequential desaturation and step resaturation. Methods: Forty-three out of forty-five healthy participants (age 23.0 ± 1.8 years, BMI 24.0 ± 4.4 kg·m^–2) completed the experimental assessment with short-term induced hypoxemia by consecutive inhalation of three prepared gas mixtures with reduced oxygen concentrations (14%, 12%, and 10%). SpO₂ was measured continuously with the Masimo Radical-97 (Masimo Corp., Irvine, CA, USA) pulse oximeters. Results: The SpO₂ measured on the thumb was lower than all other fingers by 0.6% to 0.7% SpO₂, a systematic difference that is less than the clinically accepted accuracy of oximeters. No difference in SpO₂ dynamics was found between any of the fingers during step resaturation. Conclusions: A systematic difference in measured SpO₂ exists between the thumb and the other fingers during desaturation, which should be considered at least as well as the impact of the performance of a particular oximeter, sensor placement or anatomical variability. Full article

Background: Trastuzumab deruxtecan (T-DXd), a HER2-directed antibody-drug conjugate, has significantly advanced the management of HER2-expressing malignancies. However, interstitial lung disease (ILD) remains a clinically significant adverse effect. Despite increasing clinical use of T-DXd, real-world data on ILD incidence, characteristics, and outcomes—particularly in Middle Eastern populations remain limited. Methods: This retrospective study analyzed medical records of patients who received trastuzumab deruxtecan (T-DXd) at a tertiary care hospital. Data collected included demographics, tumor characteristics, prior treatments, and interstitial lung disease (ILD)-related outcomes. ILD events were identified and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Descriptive statistics were used to summarize baseline characteristics and ILD features. Univariate logistic regression was performed to assess potential risk factors associated with ILD development. Kaplan–Meier survival analysis was used to evaluate time-to-event outcomes, including time to ILD onset and resolution. Results: Among 65 patients with advanced stage IV cancer (90.8% with breast cancer), 16 (24.6%) developed ILD following T-DXd therapy. The median time to ILD onset was 125.5 days. The most common presenting symptoms were dyspnea and cough (50%). A history of ground-glass opacities was associated with increased odds of ILD (OR 2.7; p = 0.236), though not statistically significant. Patients with Grade ≥ 3 ILD had significantly lower oxygen saturation levels compared to those with milder grades (88.3% vs. 97.7%, p = 0.049). Median time to clinical resolution was 297 days (95% CI: 77.5–516). No significant associations were observed with smoking history, pulmonary metastases, or prior thoracic radiation. Conclusions: In this real-world cohort, ILD occurred in nearly one-quarter of patients receiving T-DXd, predominantly within the first six months of treatment. The findings highlight the importance of early respiratory symptom monitoring and pulse oximetry—particularly in patients with pre-existing pulmonary abnormalities. These results underscore the need for vigilant ILD surveillance strategies and further prospective studies to validate predictive risk factors and optimize management protocols. Full article

Background: Expert guidelines recommend using pulse oximetry (PO) in the delivery room to monitor oxygen saturation (SpO₂) and heart rate (HR). Umbilical cord pulse oximetry (UCP) is a novel concept that, despite being postductal, could provide accurate measurements of SpO₂ and HR, as it overcomes barriers associated with skin pigmentation. Methods: This pilot study used NONIN pulse oximetry on an intact umbilical cord that underwent deferred cord clamping (DCC) to evaluate umbilical cord SpO₂ in a preterm asphyxiated ovine model (N of 5) with an HR of <100 bpm. The UCP HR served as a surrogate marker for umbilical vessel flow. A receiver operator characteristic (ROC) curve was used to evaluate UCP parameters with arterial saturations (SaO₂) and carotid HR between 2 and 10 min. Results: Following asphyxia, five preterm lambs underwent DCC for 4 min. A significant relationship was noted between SaO₂ and umbilical SpO₂ (area under the curve (AUC) of 0.907, CI 0.857–0.968, p < 0.0001) along with carotid and umbilical HR (AUC) of 0.842 (CI 0.663–0.902, p < 0.0001). Conclusions: In a translational preterm model, UCP accurately predicted preductal SaO₂ and carotid HR (a surrogate for umbilical flow). Using UCP in the delivery room will help guide supplemental oxygen and determine the optimal duration of clamping the umbilical cord. These proof-of-concept studies/pilot findings require validation with larger animal cohorts and newborn infants. Full article