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Objective: To compare the transcutaneous oxygen pressure (tcpO2) measurement values and changes in compressed areas of surgical patients before and after surgery and to explore the related factors influencing the tcpO2 changes before and after surgery., Methods: Researchers selected 100 patients who underwent elective surgery in a tertiary comprehensive hospital from November 2021 to September 2022. A self-designed general information questionnaire was used to collect patient general information and disease-related data, including gender, age, smoking and drinking history, hypertension, diabetes, local skin temperature and humidity, related biochemical indicators, and activities of daily living score. Researchers used a transcutaneous oxygen pressure meter to measure and record the tcpO2 of the compressed areas (sacrococcygeal area, scapula area, and heel area) before and after surgery., Results: Among the 100 patients, 37.00 % (37/100) developed type I/II pressure ulcers after surgery, and 30 patients (81.08 %) showed regression within 2 h after surgery. There was no statistically significant difference in the preoperative tcpO2 measurement values of the scapula and heel areas between the group with and without pressure ulcers, but the preoperative tcpO2 measurement value of the sacrococcygeal area in the group without pressure ulcers was higher than that in the group with pressure ulcers (P < 0.01). The factors affecting the preoperative tcpO2 measurement value of the sacrococcygeal area were smoking and surgical type. After surgery, the tcpO2 measurement values of the three areas in the group with pressure ulcers were significantly lower than those in the group without pressure ulcers (P < 0.01). Comparing the tcpO2 values of different areas, it was found that the tcpO2 value was lowest in the sacrococcygeal area, followed by the heel area, and the tcpO2 value in the scapula area was highest both before and after surgery (P < 0.01). The main factors affecting the postoperative tcpO2 measurement value were diabetes, Glassgow score, surgical time, and intraoperative red blood cell transfusion., Conclusion: The measurement of tcpO2 is related to the incidence of surgically acquired pressure ulcers, and this technology may become an important tool for quantitative assessment of the risk of pressure ulcers., Competing Interests: Declaration of competing interest The authors declare no conflict of interest in preparing this article., (Copyright © 2024 Tissue Viability Society / Society of Tissue Viability. Published by Elsevier Ltd. All rights reserved.)

The vascular causes of lower-extremity ulcers cannot be neglected because they can directly affect treatment methods. No detailed epidemiological statistics have described vascular etiological diagnosis in China. This study aimed to explore the prevalence of clinical vascular etiological examination of lower-extremity ulcers and improve the diagnosis and treatment effectiveness of lower-extremity ulcers. Data were collected from the WoundCareLog database, which includes 2413 cases of lower-extremity ulcers from 478 hospitals nationwide. Data analysis revealed that 1698 (70.4%) lower-extremity blood flow examinations (including physical examination [PE] and assistant examinations [AE]) were performed, of which 61.7% were PE, 10.4% were AE only, and 27.9% were the combined PE and AE[PAE]. The proportion of nonexaminations was higher in the nondiabetic group than in the diabetic group (χ 2 = 34.5; P < .01). The positive rates of vascular etiological examination in the diabetic and nondiabetic groups were 69.7% and 70.7%, respectively. Among the four economic regions of China, there were statistically significant differences in the use of the different examination methods. The examination of vascular diseases in lower-extremity ulcers in China has not been fully popularized and requires improvement; there was no statistically significant difference between examination rates by doctors and nurses, which is mainly based on PE. However, PE has certain rates of misdiagnosis and missed diagnosis. The false-positive and false-negative rates were 25.7% and 57.6%, respectively. The use of an AE can compensate for this deficiency by making diagnosis more precise, while the quantitative diagnostic criteria allow disease diagnosis to transcend geographical and operator differences and maximize uniformity. The vascular B-ultrasound examination is more suitable for the medical environment in China because of its mature technology, high hospital penetration rate, and low cost., (© 2020 by the Wound Healing Society.)

Introduction: Hyperoxemia in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to adverse outcomes. It remains prevalent in the pre-hospital Emergency Medical Services (EMS) and Emergency Department (ED)., Objective: To determine the key predictors for hyperoxemia in AECOPD in EMS and ED., Methods: This was a prospective observational study of AECOPD patients in EMS and two EDs. Hyperoxemia was defined as PaO 2 > 65 mm Hg (corresponds to SpO 2 > 92%). We determined apriori candidate factors in Patient, Organization and Staff domains. Primary outcomes were the key predictors for hyperoxemia. Secondary outcomes were in-hospital mortality and mechanical ventilation rates in hyperoxemic versus non-hyperoxemic groups. We generated a logistic regression model for each domain. We reported the adjusted odds ratios (AORs), 95% CIs and p values. We selected the output factors using AOR ≥2.0 and ≥2.5 for modifiable and non-modifiable factors, respectively. These selected factors were fed into a final model with eventual factors selected based on: threshold AORs as stated above and/or 95% CIs including these AORs., Results: Three hundred and twenty-six patients were analysed; 60.7% had hyperoxemia. We found three eventual modifiable factors; first, ED SpO 2 > 95% [AOR 2.62 (95% CIs: 1.61-4.33); P < 0.001], EMS non-rebreathing mask [AOR 2.01 (95% CIs: 1.06-3.97); P = 0.04]; and ED nasal cannula [AOR 1.69 (95% CIs: 1.05-2.72); P = 0.03]. Secondary outcomes did not differ between groups., Conclusion: We identified three key modifiable predictors. We intend to conduct an interventional study using them to reduce hyperoxemia rate in AECOPD., (© 2019 John Wiley & Sons Ltd.)

Background: Widespread use of transcutaneous P CO 2 (P tcCO 2 ) monitoring is currently limited by concerns many practitioners have regarding accuracy. We compared the accuracy of P tcCO 2 with that of P aCO 2 measurements in critically ill children, and we investigated whether clinical conditions associated with low cardiac output or increased subcutaneous tissue affect this accuracy., Methods: We performed a single-center prospective study of critically ill children placed on transcutaneous monitoring., Results: There were 184 children enrolled with paired P aCO 2 and P tcCO 2 values. Subjects had a median age of 31.8 mo (interquartile range 3.5-123.3 mo). Most children were mechanically ventilated ( n = 161, 87.5%), and many had cardiac disease ( n = 76, 41.3%). The median P aCO 2 was 44 mm Hg (interquartile range 39-51 mm Hg). The mean bias between P aCO 2 and P tcCO 2 was 0.6 mm Hg with 95% limits of agreement from -13.6 to 14.7 mm Hg. The P tcCO 2 and P aCO 2 were within ±5 mm Hg in 126 (68.5%) measurements. In multivariable modeling, cyanotic heart disease (odds ratio 3.5, 95% CI 1.2-10, P = .02) and monitor number 2 (odds ratio 3.8 95% CI 1.3-10.5, P = .01) remained associated with P tcCO 2 ≥ 5 mm Hg higher than P aCO 2 . Serum lactate, fluid balance, renal failure, obesity, vasoactive-inotrope score, and acyanotic heart disease were not associated with high or low P tcCO 2 values. In 130 children with a second paired P tcCO 2 and P aCO 2 measurement, predicting the second measured P aCO 2 by subtracting the initial observed difference between the P tcCO 2 and P aCO 2 from the subsequent measured P tcCO 2 decreased the mean bias between observed and predicted P aCO 2 to 0.2 mm Hg and the 95% limits of agreement to -9.4 to 9.7 mm Hg., Conclusions: P tcCO 2 provides an acceptable estimate of P aCO 2 in many critically ill children, including those with clinical conditions that may be associated with low cardiac output or increased subcutaneous tissue, although it does not perform as well in children with cyanotic heart disease. P tcCO 2 may be a useful adjunct monitoring method, but it cannot reliably replace P aCO 2 measurement., (Copyright © 2019 by Daedalus Enterprises.)

Background: Transcutaneous monitors are utilized to monitor a patient's respiratory status. Some patients have similar values when comparing transcutaneous carbon dioxide (P tcCO 2 ) values with blood gas analysis, whereas others show extreme variability. A retrospective review of data was performed to determine how accurately P tcCO 2 correlated with CO 2 values obtained by arterial blood gas (ABG) or capillary blood gas., Methods: To determine whether P tcCO 2 values correlated with ABG or capillary blood gas values, subjects' records were retrospectively reviewed. Data collected included the P tcCO 2 value at the time of blood gas procurement and the ABG or capillary blood gas P CO 2 value. Agreement of pairs of methods (ABG vs P tcCO 2 and capillary blood gas vs P tcCO 2 ) was assessed with the Bland-Altman approach with limits of agreement estimated with a mixed model to account for serial measurements per subject., Results: A total of 912 pairs of ABG/P tcCO 2 values on 54 subjects and 307 pairs of capillary blood gas/P tcCO 2 values on 34 subjects were analyzed. The P CO 2 range for ABG was 24-106 mm Hg, and P tcCO 2 values were 27-133 mm Hg. The P CO 2 range for capillary blood gas was 29-108 mm Hg, and P tcCO 2 values were 30-103 mm Hg. For ABG/P tcCO 2 comparisons, the Pearson correlation coefficient was 0.82, 95% CI was 0.80-0.84, and P was <.001. For capillary blood gas/P tcCO 2 comparisons, the Pearson correlation coefficient was 0.77, 95% CI was 0.72-0.81, and P was <.001. For ABG/P tcCO 2 , the estimated difference ± SD was -6.79 ± 7.62 mm Hg, and limits of agreement were -22.03 to 8.45. For capillary blood gas/P tcCO 2 , the estimated difference ± SD was -1.61 ± 7.64 mm Hg, and limits of agreement were -16.88 to 13.66. The repeatability coefficient was about 30 mm Hg., Conclusions: Based on these data, capillary blood gas comparisons showed less variation and a slightly lower correlation with P tcCO 2 than did ABG comparisons. After accounting for serial measurements per patient, due to the wide limits of agreement and poor repeatability, the utility of relying on P tcCO 2 readings for this purpose is questionable., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2018 by Daedalus Enterprises.)

Objective: To investigate the effect of alveolar recruitment combined with surfactant administration on children with acute respiratory distress syndrome (ARDS)., Material and Methods: A prospective, randomized, controlled and sequential study was carried out. Group A (16 children) was treated with both the alveolar recruitment manoeuvres (ARM) and the administration of the surfactant every 8 h for 3 days; group B (15) received the usual treatment only. The alveolar recruitment was carried out by increasing positive end-expiratory pressure 2 by 2 cm H 2 O to improve the transcutaneous oxygen saturation values up to 88% and 90%. Demographic data, gasometric and ventilator parameters, chest radiography and 28-day mortality were evaluated., Results: There were no significant differences in baseline characteristics between groups. An hour after treatment, significant differences (P < 0.001) were observed in transcutaneous oxygen saturation (SaO 2 ; Group A: 94.1%, Group B: 89.9%), PaO 2 /FiO 2 (212.7 and 126.4) and oxygenation index (OI; 11.4 and 18.5). After 8 h, the differences in SaO 2 (Group A: 94.6%, Group B: 90.3%), PaO 2 /FiO 2 (225.8 and 126.9) and OI (10.8 and 18.4) were also significant (P < 0.001). From the fifth dose of the surfactant, the static compliance (P = 0.0034) and radiological images (P = 0.002) were more greatly improved in group A than in group B. Survival was significantly higher in group A (81.3%) than in group B (26.7%) (P = 0.006)., Conclusions: The combined treatment of surfactant administration and ARM resulted in a better oxygenation and survival in children with ARDS than when only recruitment was used., (© 2016 John Wiley & Sons Ltd.)

Background: Transcutaneous carbon dioxide (P(tcCO2)) monitoring is being used increasingly to assess acute respiratory failure. However, there are conflicting findings concerning its reliability when evaluating patients with high levels of P(aCO2). Our study evaluates the accuracy of this method in subjects with respiratory failure according to the severity of hypercapnia., Methods: We included subjects with respiratory failure, admitted to a respiratory intermediate care unit, who required arterial blood gas analysis. Simultaneously, P(tcCO2) was measured using a digital monitor. Relations between P(aCO2) and P(tcCO2) were assessed by the Pearson correlation coefficient. Bland-Altman analysis was used to test data dispersion, and an analysis of variance test was used to compare the differences between P(aCO2) and the corresponding P(tcCO2) at different levels (level 1, <50 mm Hg; level 2, 50-60 mm Hg; level 3, >60 mm Hg)., Results: Eighty-one subjects were analyzed. The main diagnosis was COPD exacerbation (45%). P(tcCO2) correlated well with P(aCO2) (r2 = 0.93, P < .001). Bland-Altman analysis showed a mean P(aCO2) - P(tcCO2) difference of 4.9 ± 4.4 with 95% limits of agreement ranging from -3.6 to 13.4. The difference between variables increased in line with P(aCO2) severity: level 1, 1.7 ± 3.2 mm Hg; level 2, 3.7 ± 2.8; level 3, 6.8 ± 4.7 (analysis of variance, P < .001)., Conclusions: Our study showed an acceptable agreement of P(tcCO2) monitoring with arterial blood gas analysis. However, we should consider that P(tcCO2) underestimates P(aCO2) levels, and its accuracy depends on the level of hypercapnia, so this method would not be suitable for acute patients with severe hypercapnia., (Copyright © 2016 by Daedalus Enterprises.)

Background: To survey the current practice of monitoring and management of severe traumatic brain injury (TBI) patients in the critical care units across the United Kingdom., Methods: A structured telephone interview was conducted with senior medical or nursing staff of all the adult neurocritical care units. Thirty-one neurocritical care units that managed adult patients with severe TBI were identified from the Risk Adjustment in Neurocritical Care (RAIN) study and the Society of British Neurological Surgeons., Results: Intracranial pressure (ICP) monitoring was used in all the 31 institutions. Cerebral perfusion pressure was used in 30 of the 31 units and a Cerebral perfusion pressure target of 60 to 70 mm Hg was the most widely used target (25 of 31 units). Transcranial Doppler was used in 12 units (39%); brain tissue oxygen (PbtO(2)) was used in 8 (26%); cerebral microdialysis was used in 4 (13%); jugular bulb oximetry in 1 unit; and near-infrared spectrometry was not used in any unit. Continuous capnometry was used in 28 (91%) units for mechanically ventilated patients. Mannitol was the most commonly used agent for osmotherapy to treat intracranial hypertension., Conclusions: We identified that there was no clear consensus and considerable variation in practice in the management of TBI patients in UK neurocritical care units. A protocol-based management has been shown to improve outcome in sepsis patients. Given the magnitude of the problem, we conclude that there is an urgent need for international consensus guidelines for management of TBI patients in critical care units.

Background: Prediction of the return of spontaneous circulation (ROSC) in cardiac arrest patients is a parameter for deciding when to stop cardiopulmonary resuscitation (CPR) or to start extracorporeal CPR. We investigated the change in transcutaneous PCO2 (PtcCO2) in cardiac arrest patients., Methods: This study was carried out as a retrospective chart review. Patients with out-of-hospital cardiac arrest or in-hospital cardiac arrest within the emergency department were included. PtcCO2 monitoring with a V-Sign™ combined monitor (SenTec Inc., Therwil, Switzerland) was applied to patients at the start of CPR. We divided the included patients into the ROSC group and the no ROSC group. The ROSC group was subdivided into those achieving ROSC <15 min CPR and >15 min CPR. The change in the PtcCO2 value was analyzed at 0 min, 5 min, 10 min, and 15 min from PtcCO2 stabilization and was compared among the groups., Results: A total of 42 patients were enrolled. Twenty-eight patients achieved ROSC; 13 patients achieved ROSC <15 min CPR and 15 patients achieved ROSC >15 min CPR. Fourteen patients expired without ROSC. The absolute values of PtcCO2 was lower in the ROSC group than in the no ROCS group. The PtcCO2 change over time had a tendency to decrease or to remain constant in the ROSC groups. In contrast, all patients in the no ROSC group experienced an increase in the PtcCO2 change during CPR except one case., Conclusions: PtcCO2 monitoring provides non-invasive, continuous, and useful monitoring in cardiac arrest patients.