Randomized Evaluation of Pulse Oximetry in 20,802 Patients; II

Møller, Jakob Møllenbach; Johannessen, N. W.; Espersen, Kurt; Ravlo, O; Pedersen, Bente D.; Jensen, Per; Rasmussen, Niels Henrik; Rasmussen, Lars S.; Pedersen, Thomas Bondo; Cooper, Jeffrey B.; Gravenstein, J. S.; Chraemmer-Jørgensen, B; Djernes, M; Wiberg-Jørgensen, F.; Heslet, Lars; Johansen, Søren

doi:10.1097/00000542-199303000-00007

Cited by 340 publications

(42 citation statements)

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“…In a study of over 20,000 randomized patients, the use of pulse oximetry was found to improve the ability of the anesthesia provider to detect hypoxemia and decrease myocardial ischemic events, but was not associated with concurrent reduction of postoperative complications. 39,40 Yet the WHO, in their publication Surgical Care at the District Hospital, has advocated its wide use: "The pulse oxymeter should be the minimum standard of monitoring in every operating room where regular major surgery is carried out." 41 No one appears ready to argue on behalf of removing pulse oximetry as a standard monitoring tool either in the operating room or during recovery.…”

Section: Continuous Use Of Monitoring Equipmentmentioning

confidence: 99%

Patterns in neurosurgical adverse events: open cerebrovascular neurosurgery

Wong¹,

Ziewacz

et al. 2012

FOC

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Object As part of a project to devise evidence-based safety interventions for specialty surgery, we sought to review current evidence concerning the frequency of adverse events in open cerebrovascular neurosurgery and the state of knowledge regarding methods for their reduction. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. Methods The authors performed a PubMed search using search terms “cerebral aneurysm”, “cerebral arteriovenous malformation”, “intracerebral hemorrhage”, “intracranial hemorrhage”, “subarachnoid hemorrhage”, and “complications” or “adverse events.” Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to be included to maximize the range of rates of occurrence for the reported adverse events. Results The review revealed hemorrhage-related hyperglycemia (incidence rates ranging from 27% to 71%) and cerebral salt-wasting syndromes (34%–57%) to be the most common perioperative adverse events related to subarachnoid hemorrhage (SAH). Next in terms of frequency was new cerebral infarction associated with SAH, with a rate estimated at 40%. Many techniques are advocated for use during surgery to minimize risk of this development, including intraoperative neurophysiological monitoring, but are not universally used due to surgeon preference and variable availability of appropriate staffing and equipment. The comparative effectiveness of using or omitting monitoring technologies has not been evaluated. The incidence of perioperative seizure related to vascular neurosurgery is unknown, but reported seizure rates from observational studies range from 4% to 42%. There are no standard guidelines for the use of seizure prophylaxis in these patients, and there remains a need for prospective studies to support such guidelines. Intraoperative rupture occurs at a rate of 7% to 35% and depends on aneurysm location and morphology, history of rupture, surgical technique, and surgeon experience. Preventive strategies include temporary vascular clipping. Technical adverse events directly involving application of the aneurysm clip include incomplete aneurysm obliteration and parent vessel occlusion. The rates of these events range from 5% to 18% for incomplete obliteration and 3% to 12% for major vessel occlusion. Intraoperative angiography is widely used to confirm clip placement; adjuncts include indocyanine green video angiography and microvascular Doppler ultrasonography. Use of these technologies varies by institution. Discussion A significant proportion of these complications may be avoidable through development and testing of standardized protocols to incorporate monitoring technologies and specific technical practices, teamwork and communication, and concentrated volume and specialization. Collaborative monitoring and evaluation of such protocols are likely necessary for the advancement of open cerebrovascular neurosurgical quality.

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Section: Continuous Use Of Monitoring Equipmentmentioning

confidence: 99%

Patterns in neurosurgical adverse events: open cerebrovascular neurosurgery

Wong¹,

Ziewacz

et al. 2012

FOC

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“…Firstly, the "outcomes" chosen would not intuitively be expected to have been influenced by the use of pulse oximetry, with the possible exceptions of cardiac arrest, postoperative coma and myocardial infarction, for which it was acknowledged the sample size was too small. 9 Secondly, incident monitoring yielded identical conclusions: with oximetry, significantly more cases were detected with hypoxaemia, endobronchial intubation, myocardial ischaemia and hypoventilation (when other "disconnect" monitors were not used) and there was a strong trend towards fewer full cardiac arrests under general anaesthesia (p=0.018). 4 Both studies have virtually identical messages for the practising anaesthetist, but neither provides outcome figures justifying oximetry that would satisfy the doctrinaire quantitative biomedical scientist.…”

mentioning

confidence: 87%

“…8 9 Because no significant differences were shown between the groups with and without oximeters for certain "outcomes", it was concluded by some observers that either pulse oximeters lacked efficacy or that the sample size was too small 10 ; however, significant differences were shown for the detection of hypoxaemia, hypoventilation, endobronchial intubation and myocardial ischaemia, with a trend towards fewer cardiac arrests. 9 Had the information published in this symposium been available at the time of designing this study, considerable time and effort could have been saved. Firstly, the "outcomes" chosen would not intuitively be expected to have been influenced by the use of pulse oximetry, with the possible exceptions of cardiac arrest, postoperative coma and myocardial infarction, for which it was acknowledged the sample size was too small.…”

mentioning

confidence: 99%

Qualitative versus quantitative research -- balancing cost, yield and feasibility

Runciman

2002

Quality and Safety in Health Care

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“…This separation distance was determined as a good compromise between that of commercially available reflectance sensors and the upper limits of what is physically possible without placing any of the optical components in an area of the scalp that may be compromised due to either the frontal or parietal plates of the skull. The total surface area of the active footprint of the probe is approximately 36mm 2 . Figure 1 is a diagrammatic representation of the probe geometry and component placement.…”

Section: Development Of An Optoelectronic Sensor For the Investigatiomentioning

confidence: 99%

Development of an optoelectronic sensor for the investigation of photoplethysmographic signals from the anterior fontanel of the newborn

May

Kyriacou

Petros

2011

2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Abstract-There is a need for more reliable, non-invasive and alternative measurement sites for the monitoring of arterial blood oxygen saturation in critically ill newborns at times of peripheral compromise. The anterior fontanelle, a unique anatomical feature of the newborn, has been presented as an alternative site for the estimation of oxygen saturation. A multi-wavelength non-invasive optoelectronic sensor has been designed and developed for the investigation of photoplethysmographic (PPG) signals and blood oxygen saturation values from the fontanelle. In vivo thermal tests of the optical sensor show that under normal operating conditions the heating at the skin surface was negligible (<0.1°C). Good quality PPGs with large amplitudes and high signal to noise ratio were recorded at all three (red, infrared and green) wavelengths prior to clinical measurements. Permanent

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Randomized Evaluation of Pulse Oximetry in 20,802 Patients; II

Cited by 340 publications

References 0 publications

Patterns in neurosurgical adverse events: open cerebrovascular neurosurgery

Patterns in neurosurgical adverse events: open cerebrovascular neurosurgery

Qualitative versus quantitative research -- balancing cost, yield and feasibility

Development of an optoelectronic sensor for the investigation of photoplethysmographic signals from the anterior fontanel of the newborn

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