Search Results (108)

Background and Objectives: Hypoxia is the most common adverse event in patients undergoing procedural sedation. Burn-related pain is severe and often requires high doses of opioids and anxiolytics, increasing the risk of respiratory depression. This study aimed to compare the effectiveness of high-flow nasal oxygen (HFNO) and standard nasal oxygen (SNO) in preventing hypoxia during deep sedation in patients with minor and moderate burns. Materials and Methods: This single-center prospective observational study enrolled 76 adult patients (ASA I–III) with minor to moderate burns undergoing supine-position procedures under sedation. Patients were allocated to HFNO (n = 38) or SNO (n = 38) groups according to a pre-specified, non-randomized allocation rule based on an alternating/sequential assignment by admission order. Peripheral oxygen saturation (SpO₂), Bispectral Index (BIS), and Near-Infrared Spectroscopy (NIRS) were monitored throughout. Desaturation was defined as SpO₂ ≤ 90%; severe hypoxia as SpO₂ < 75%. Sedation depth was standardized using BIS (target: 60–80). Propofol–ketamine-based induction was used in all patients. Results: Groups were comparable in demographics, comorbidities, burn characteristics, and procedural duration. SpO₂ ≤ 90% occurred in 79% of SNO patients vs. 11% in the HFNO group (p < 0.001). SpO₂ between 75 and 90% was observed in 68% of SNO vs. 0% of HFNO patients (p < 0.001), and SpO₂ < 75% in 26% vs. 0% (p < 0.001). Airway interventions—jaw thrust, flow increase, and FiO₂ increase—were significantly more frequent in the SNO group (84% vs. 2.6%, 84% vs. 11%, and 84% vs. 5.3%, respectively; all p < 0.001). No significant between-group differences were noted in procedure interruptions, laryngospasm, BIS, NIRS, or hemodynamic parameters. Conclusions: HFNO significantly reduced the incidence of hypoxia and the need for airway interventions compared with SNO during deep sedation in minor and moderate burn patients. These findings suggest that HFNO may represent a preferable oxygenation strategy in this population; given the observational design of this study, confirmation in randomized controlled trials is warranted before this can inform routine practice recommendations. Full article

Predicting pain in physical rehabilitation is challenging due to subjectivity, patient variability, and self-report bias, especially in telerehabilitation. This study aims to determine whether machine-learning models based on heart rate (HR), heart rate variability (HRV), and peripheral oxygen saturation (SpO₂) can reliably detect clinically meaningful pain during real rehabilitation sessions, including home-based settings where self-report is least reliable; we hypothesized that these low-cost, non-invasive markers carry sufficient information to flag low-to-moderate pain episodes without relying on self-report. We combined these markers with machine-learning models. These markers were selected for their association with autonomic pain responses and ease of measurement with only two low-cost, non-invasive sensors (a wearable band providing HR and HRV, and a fingertip oximeter providing SpO₂) suitable for clinical and home-based rehabilitation. We evaluated linear regression (LR), random forest (RF), and artificial neural networks (ANNs) using data from 25 participants (aged 20–50) undergoing lower-limb rehabilitation. Signals acquired at 1 Hz were processed via temporal filtering, quality screening, and three missing-value strategies (interpolation, zero imputation, deletion) before normalization and training. LR showed limited predictive power. RF achieved 97.77% accuracy in detecting low-pain episodes, and balanced per-class performance under deletion (76.64%). ANN models contributed a more balanced three-class profile on interpolated data but remained sensitive to class imbalance. Given high-pain scarcity in supervised therapy and underreporting at home, reliable detection of low-to-moderate pain enables timely therapy adjustments. Unlike prior studies using experimentally induced pain, this work captured naturally occurring pain during real rehabilitation, making findings applicable to clinical and telerehabilitation contexts. Physiology-based models with low-cost sensors show promise for personalized rehabilitation, improving adherence and enabling proactive adjustments without added complexity. Full article

High-intensity interval training (HIIT) is an efficient exercise strategy capable of eliciting acute cardiovascular and metabolic responses. Blood flow restriction (BFR) and normobaric hypoxia (NH) have been proposed as exposures to intensify physiological stress during exercise; however, comparative evidence between both strategies remains limited. The aim of this study was to compare acute physiological responses in HIIT protocols performed under BFR and NH in apparently healthy young men. Eight volunteers completed two HIIT sessions in this fixed-order within-subject repeated-measures study: one with BFR and one with NH (simulated altitude: 3536 m above sea level; FiO₂ ≈ 13.5%). Blood glucose, peripheral oxygen saturation (SpO₂), heart rate, and blood pressure were repeatedly measured during the exercise protocol. After Bayesian analysis, no evidence of differences in glycemic response was observed, while heart rate and diastolic blood pressure responses appeared broadly comparable between conditions. However, SpO₂ was consistently lower during NH, whereas systolic blood pressure values were higher under BFR. Although both BFR and NH induced acute physiological responses characteristic of HIIT, distinct physiological profiles were observed. NH was associated with greater systemic hypoxemic stress, whereas BFR showed higher systolic pressor responses. Full article

The Apennine wolf (Canis lupus italicus) is a distinct subspecies whose ongoing population recovery in Italy has progressively increased the demand for live capture protocols validated for scientific monitoring and conservation management. Despite the widespread use of mechanical and chemical immobilization in European wolf management, no study has to date systematically evaluated the combined use of the Fremont™ humane foot snare with a medetomidine-ketamine-acepromazine (MKA) protocol in this subspecies, nor characterized the associated cardiorespiratory, thermal, and hematobiochemical parameters under operational field conditions. Between June 2010 and July 2017, thirteen free-ranging Apennine wolves were captured in Maiella National Park (central Apennines, Italy) using the Fremont™ snare and immobilized with a standardized MKA protocol; only animals immobilized with this protocol are reported here, as three additional capture events employed different drug combinations. Cardiorespiratory parameters, body temperature, peripheral oxygen saturation, venous blood gas values, and a comprehensive hematological and serum biochemical panel were recorded during immobilization. Mean heart rate was 100 ± 15 bpm, respiratory rate 24 ± 13 breaths/min, body temperature 38.1 ± 1.3 °C, and mean SpO₂ 88 ± 11% (range: 66–97%; n = 12). No clinically significant hyperthermia requiring active intervention was recorded in the cohort as a whole. Hematological and biochemical values were broadly consistent with published reference ranges for the species, with condition-specific deviations identified in two individuals—one pregnant female and one juvenile presenting signs of transient capture-related myopathy—both of which resolved without clinical sequelae. No capture-related mortality occurred. All thirteen individuals survived the minimum post-capture monitoring period. Preliminary GPS observations in a subset of individuals (n = 3) suggest a transient reduction in movement activity in the immediate post-release period. These findings support the safety and operational feasibility of the combined Fremont™ snare–MKA protocol for the Apennine wolf, and provide baseline physiological and hematobiochemical reference data for Canis lupus italicus relevant to future capture and conservation management programmes. Full article

Objective: This pilot study aimed to explore how a receptive music intervention, based on musical genres reflecting maternal listening preferences during pregnancy, affects distress levels in Italian preterm infants. Specifically, it investigated the effects of soft pop/rock music, compared with classical music, on infants’ LF/HF ratio (derived from heart rate variability [HRV]) and peripheral oxygen saturation (SpO₂), which were used as physiological markers of distress. Method: This retrospective observational pilot study analyzed clinical data routinely collected between May 2014 and January 2015 from 27 preterm infants (gestational age 23–32 weeks; birth weight < 1500 g) who received receptive music therapy as part of standard family-centered care in the NICU. Maternal listening preferences during pregnancy were assessed in 30 mothers via an ad hoc questionnaire; a content analysis identified, at the group level, the three most frequently reported artists (i.e., Jovanotti, Vasco Rossi, and W. A. Mozart), which were used to create three standardized playlists. According to the internal clinical procedure, each infant underwent four sessions on consecutive days: a no-music condition on Day 1, followed by the three music conditions on Days 2–4 in randomized order. The LF/HF ratio and SpO₂ were measured at five time points per session (one pre-test, three intra-session time points, and one post-test). Wilcoxon signed-rank tests were used to compare conditions and time points, with effect sizes and a Benjamini–Hochberg (FDR) correction for multiple comparisons. Results: The LF/HF ratio did not differ significantly across music conditions or relative to the no-music condition. SpO₂ was higher during the Mozart condition than during the no-music condition at three of the five time points; this association remained significant after FDR correction, with medium-to-large effect sizes. No effect was observed for the soft pop/rock conditions on physiological indexes. Conclusions: Receptive music therapy based on maternal listening during pregnancy was not associated with changes in the LF/HF ratio. The Mozart condition was associated with higher SpO₂ than the no-music condition. Given the small sample, the single-center setting, and the retrospective observational design, these findings are preliminary and require confirmation in larger, adequately powered prospective trials. Future studies should also examine the specific musical features (e.g., tempo, harmonic structure, voice timbre) that may drive these physiological responses. Full article

Lung vibration is a chest physiotherapy technique used to facilitate sputum mobilization and improve airway clearance; however, its effectiveness may vary due to therapist-dependent factors. This study developed a lung vibration device and evaluated its effectiveness in patients with sputum retention. Twenty-five patients, aged ≥18 years with sputum retention, including those with bronchiectasis, pneumonia, and COPD-related conditions, participated in a randomized crossover trial and received two single interventions in random order: a conventional intervention (manual percussion, manual vibration, and suction) and an experimental intervention (manual vibration replaced by the device). Sputum volume and quality, rating of perceived dyspnea (RPD), peripheral oxygen saturation (SpO₂), cardiovascular dynamics, respiratory rate, and body temperature were assessed before and immediately after each intervention. Sputum volume was significantly higher following the experimental intervention compared with the conventional intervention (p = 0.010). No significant between-intervention differences were observed in sputum quality, RPD, SpO₂, cardiovascular parameters, respiratory rate, or body temperature (all p > 0.05). No potential adverse effects were reported. These findings suggest that the lung vibration device enhances sputum clearance in the short term, with no immediate adverse physiological effects observed, and may serve as a practical alternative to manual vibration. Full article

Reflective-mode photoplethysmography (PPG) potentially enables non-invasive physiological monitoring of heart rate and Peripheral Oxygen Saturation (SpO₂) from virtually any anatomical body site, but its performances are strongly affected by several parameters such as local perfusion, skin temperature, and microvascular bed and tissue optical properties. This study systematically evaluates the quality of reflective-mode PPG signals acquired at the finger, wrist, ear, nose, temple, upper lip, and lower lip, using two commercial PPG sensors. PPG signal quality was quantified via Skewness, Kurtosis, Perfusion Index, and Shannon entropy. Heart rate (HR) and pulse transit time (PTT) were also computed. Skewness and Perfusion Index were the most informative quality indices, revealing the finger as the site with the best signal quality and the wrist as the most challenging location. Several facial regions—including the lips, nose, and temple—showed signal quality comparable to the finger. HR estimation was most accurate using the GREEN wavelength, with the lower lip achieving the lowest error, followed by the upper lip and finger. PTT values reflected physiological differences in pulse propagation, being longest at the finger and wrist and shortest at the lips. These findings highlight the potential of non-conventional anatomical sites as alternatives to the finger and wrist for reflective-mode PPG acquisition. Full article

Background: The ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) is central to the classification of acute respiratory distress syndrome (ARDS). However, its assessment requires arterial blood gas analysis, which may be limited by availability, cost, and invasiveness. Consequently, the ratio of peripheral oxygen saturation to fraction of inspired oxygen (SpO₂/FiO₂) has been proposed as a non-invasive surrogate for estimating the degree of oxygenation impairment. Methods: A retrospective cross-sectional study was conducted in adult patients with COVID-19 admitted to the intensive care unit at an altitude of 2600 m above sea level (m.a.s.l.). Spearman correlation coefficients were calculated to assess the association between the SpO₂/FiO₂ and PaO₂/FiO₂ ratios and their corresponding imputation models. A generalized linear model was applied, and the diagnostic performance of the SpO₂/FiO₂ ratio and the imputation models for detecting severe and non-severe hypoxemia (PaO₂/FiO₂ cutoff value of 150) was evaluated using the area under the receiver operating characteristic curve (AUC). Results: A total of 473 patients receiving invasive mechanical ventilation were included, with a mean age of 62.4 years (SD 14.1), and a predominance of males (67.2%). An SpO₂/FiO₂ ratio cutoff value of ≥206 demonstrated excellent diagnostic performance, with an AUC of 0.983 (95% CI 0.97–0.99), high sensitivity (90.6%), high specificity (96.7%), and an overall correct classification rate of 93.9%. This performance remained consistent across multiple clinical scenarios. In patients with positive end-expiratory pressure > 10 cmH₂O, the AUC was 0.982, with a specificity of 97.7%. In the presence of hyperbilirubinemia (total bilirubin ≥ 3 mg/dL), the AUC was 0.951. Among patients with hemoglobin levels < 10 g/dL, sensitivity reached 100%, although specificity was reduced. In the subgroup with arterial partial pressure of carbon dioxide > 35 mmHg, an SpO₂/FiO₂ ratio ≥ 206 showed near-perfect specificity (99.4%) and a positive likelihood ratio of 120.9. Conclusions: The SpO₂/FiO₂ ratio is a reliable and non-invasive surrogate of the PaO₂/FiO₂ ratio in mechanically ventilated patients with COVID-19 living at high altitude, particularly for the identification of non-severe hypoxemia. Full article

Background and Clinical Significance: Acetazolamide is routinely used post-cataract surgery to prevent intraocular pressure (IOP) spikes. Rare non-cardiogenic pulmonary edema (NCPE) cases highlight its risks in elderly comorbid patients. This report details acetazolamide-induced NCPE and provides a review of current evidence from the literature. Case Presentation: A 74-year-old male with chronic kidney disease, atrial fibrillation, and aortic aneurysm repair received 250 mg oral acetazolamide post-cataract extraction. Clinical, imaging, and lab data were documented during Intensive Care Unit (ICU) stay. PubMed/Google Scholar review identified similar cases. Within 30 min, severe hypoxemia with SpO₂ (peripheral oxygen saturation) of 77%, accompanied by tachypnea and hypertension, necessitated endotracheal intubation. Echocardiography showed preserved left ventricular (LV) function; computed tomography (CT) confirmed bilateral alveolar opacities without cardiomegaly or embolism, indicating permeability-mediated NCPE. Lung-protective mechanical ventilation and vasopressor therapy resulted in hemodynamic and respiratory stabilization. On day 4, ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii resolved with targeted antibiotic therapy. The patient made a full recovery following ICU discharge. To date, nine prior cases have been reported, alongside 31 entries in EudraVigilance reflecting a 19.4% mortality rate. Conclusions: Rapid-onset NCPE from acetazolamide involves endothelial injury, distinct from cardiogenic pulmonary edema. Early recognition, drug cessation, and admission to the intensive care unit (ICU) are vital components of therapeutic intervention. Risk stratification and pharmacovigilance are recommended for perioperative safety. Full article

Background: Simplified field tests have gained increasing interest for the assessment of functional capacity in patients with post-COVID-19 condition; however, direct comparisons of functional performance and physiological responses between the 1-min sit-to-stand test (1MSTST) and the 6-min walk test (6MWT) remain limited. This study aimed to examine the associations between the two tests by evaluating functional performance, cardiopulmonary responses, oxygen desaturation, perceived exertion, and peripheral muscle strength. Furthermore, we explored whether the 1MSTST can be used as a complementary assessment, particularly within telerehabilitation pathways and in contexts where resource-intensive testing is not feasible. Methods: We conducted a cross-sectional observational study of adults recovering from moderate to severe COVID-19 between May and July 2021. Participants performed both the 1MSTST and 6MWT on the same day. Functional performance, peak heart rate, nadir peripheral oxygen saturation (SpO₂), perceived exertion, and handgrip dynamometry were recorded. Associations between test performances were assessed using correlation and partial correlation analyses, including adjustment for peripheral muscle strength. Results: Fifty-four patients were included. A moderate correlation was observed between 1MSTST repetitions and 6MWT distance (Spearman’s ρ = 0.47, p < 0.001), which was attenuated after adjustment for muscle strength and demographic variables. Peak heart rate and nadir SpO₂ responses were strongly correlated between tests (r = 0.75 and ρ = 0.83, respectively; both p < 0.001), with no significant differences in magnitude. Exercise-induced oxygen desaturation (≥4% SpO₂ drop) occurred at similar frequencies during both tests. Perceived exertion increased similarly following the 1MSTST and the 6MWT. Conclusions: In post-COVID-19 patients, the 1 min sit-to-stand test shows moderate concordance with the 6 min walk test for functional performance and strong agreement in cardiopulmonary responses. These findings suggest that the two tests assess overlapping but distinct aspects of functional capacity. This supports the use of the 1MSTST as a pragmatic complementary assessment when standard walking tests are not feasible, particularly within telerehabilitation pathways, primary care, and resource-limited settings. Full article

Background/Objectives: Post-COVID-19 fibrotic-like lung changes (PC19-FLC), which may represent persistent post-inflammatory abnormalities or early fibrotic remodeling, have emerged as an important long-term pulmonary sequela following SARS-CoV-2 infection. However, the underlying pathogenic mechanisms remain incompletely understood. This study aimed to investigate the potential association between mammalian target of rapamycin (mTOR) activity and the presence of PC19-FLC. Methods: This single-center, cross-sectional study included 70 patients who met the predefined inclusion criteria. Participants were categorized according to the presence or absence of PC19-FLC on chest computed tomography. Demographic, laboratory, and radiological data were collected. Serum mTOR levels were measured using enzyme-linked immunosorbent assay (ELISA). Results: Serum mTOR levels and modified Medical Research Council (mMRC) dyspnea scores were significantly higher in patients with PC19-FLC compared with those without fibrotic-like changes. Receiver operating characteristic (ROC) curve analysis identified a serum mTOR cut-off value of 6.15 ng/mL (sensitivity 83%, specificity 94%) for discriminating patients with PC19-FLC in this cohort. Serum mTOR levels were significantly correlated with forced vital capacity (FVC%), mMRC dyspnea score, and peripheral oxygen saturation (SpO₂). Conclusions: Increased serum mTOR levels were associated with the presence of fibrotic-like lung changes after COVID-19 and may help distinguish patients with such CT abnormalities in this cohort. Higher mTOR levels were also associated with greater dyspnea severity, lower lung volumes, and reduced peripheral oxygen saturation. These findings suggest a potential role of mTOR signaling in post-COVID-19 pulmonary sequelae and warrant further investigation in larger, multicenter studies. Full article

Background: Innovative training strategies aimed at improving physiological efficiency are of growing interest in kinesiology and sports performance. Elevation training masks (ETMs) offer a practical means of inducing hypoxia-like stress. However, evidence of their effectiveness in recreationally active populations remains limited. This pilot study examined the efficiency of a five-week progressive ETM protocol combined with high-intensity interval training (HIIT) in eliciting physiological, hematological, and body-composition adaptations relevant to endurance performance. Methods: Nine recreationally active men completed a five-week intervention consisting of three treadmill-based sessions per week: one weekly incremental Conconi test and two structured aerobic–anaerobic HIIT sessions performed with an ETM. Mask resistance was progressively increased to simulate altitudes of approximately 900–3600 m. Hematological variables (erythrocytes, hemoglobin, hematocrit, erythrocyte indices, leukocytes, and platelets), body composition, maximal heart rate (HRmax), and peripheral oxygen saturation (SpO₂) were assessed pre- and post intervention. Data were analyzed using paired-sample t-tests and repeated-measures ANOVA, with effect sizes reported (Cohen’s d, ω²). Results: A significant main effect of time on SpO₂ was observed (F(1, 8) = 130.61, p < 0.001, ω² = 0.69), along with a significant effect of training week (F(4, 32) = 17.41, p < 0.001, ω² = 0.43), and a significant Time × Week interaction (F(4, 32) = 15.20, p < 0.001, ω² = 0.42), indicating progressively greater post-exercise oxygen desaturation with increasing simulated altitude. Significant post-intervention increases were found in erythrocyte count, hemoglobin concentration, and hematocrit (p ≤ 0.009, d = 1.15–1.55), alongside increases in mean corpuscular volume and mean corpuscular hemoglobin. Platelet count increased significantly (p = 0.001, d = 1.68), while leukocyte values remained unchanged (p > 0.05). Body mass index (p = 0.049, d = 0.77) and body fat percentage (p = 0.012, d = 1.08) decreased following the intervention. HRmax tended to be lower at higher simulated altitudes. Conclusions: A five-week progressive ETM-HIIT protocol efficiently induced hematological and body-composition adaptations associated with improved oxygen transport and metabolic efficiency in recreationally active men. These findings support ETM-based training as an accessible strategy for enhancing physiological efficiency in endurance-oriented kinesiology practice, warranting confirmation in larger randomized controlled studies. Full article

Biometric authentication is widely regarded as more secure and reliable than conventional approaches like passwords and PINs. Nonetheless, many current systems rely on active user participation, such as fingerprint scanning or facial recognition, which can disrupt tasks, increase the likelihood of errors, and raise privacy concerns. To address these challenges, this study introduces a continuous, seamless authentication framework that utilizes vital signs for passive identity verification across various activities, including resting, walking, and running. The framework analyzes physiological indicators such as Heart Rate (HR), Heart Rate Variability (HRV), Skin Temperature, Peripheral Oxygen Saturation (${\mathrm{SpO}}_2$), and Breathing Rate to provide zero-effort authentication without requiring user intervention. Multiple machine learning algorithms, including Decision Tree, Random Forest, XGBoost, Gradient Boosting, and K-Nearest Neighbors, were implemented and compared to identify the most effective predictive model. The methodology involved data collection, preprocessing, model construction, evaluation, and comparison. Experimental results revealed that the XGBoost Classifier achieved the highest accuracy at 96%. Overall, the proposed framework demonstrates strong reliability, scalability, adaptability, and flexibility, making it suitable for practical deployment. By continuously verifying identity without interrupting user activity, it improves both security and usability, offering a modern and convenient alternative to traditional authentication methods. Full article

Background: During an apnea, oxygen depletion occurs at all tissue levels, so apnea duration is influenced by the mammalian dive reflex, which includes a bradycardia resulting in reduced cardiac oxygen consumption. This study aimed to examine the relationships between heart rate (HR), peripheral estimation of O₂ (SpO₂), deltoid and respiratory muscle oxygenation (SmO₂), and apnea duration. Methods: The study included 10 breath-hold divers (BHD), 39 ± 10 years of age, with body height of 184.3 ± 3.5 cm, body mass of 84.0 ± 9.2 kg, and 16.2 ± 9.7 years of apnea experience. The BHD performed three preparatory apneas followed by three maximal apneas with 5 min of supine rest between each apnea. During all apneas (duration, 115–323 s; involuntary breathing movements (IBMs), 7–35), SmO₂ (measured via NIRS on intercostals (respiratory) and deltoid (locomotor) muscles), heart rate, and SpO₂ (measured via forehead sensor) were obtained. Results: The smallest disagreement in oxygen levels was between intercostal SmO₂ and SpO₂ during the easy-going phase (no IBMs), whereas deltoid desaturation values were more variable. During the struggle phase, Intercostal SmO₂, moderately, and Deltoid SmO₂, strongly, differed from SpO₂. Correlations between apnea duration and O₂ saturation showed that only Intercostal SmO₂ (r = −0.71; p = 0.03) was significantly related to apnea duration. There was also a significant correlation between HR and SpO₂ in the struggle phase (r = −0.58; p = 0.05). Conclusions: These findings suggest that during the struggle phase, SpO₂ and SmO₂ are not highly connected and that local and systemic oxygen levels in the blood are depleted at different rates. Furthermore, the HR response during the struggle phase affected only SpO₂, which indicates that lowering the heart rate may help prevent more rapid deoxygenation. Lastly, the intercostal trend of deoxygenation could be interpreted as respiratory muscle work, suggesting that the increased work of respiratory muscles may prolong apnea duration. 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