Transkutánne monitorovanie parciálneho tlaku tkanivového kyslíka (tcpO2) je jednoduchou neinvazívnou metódou, ktorá pomáha pri diagnóze chronických komplikácií diabetes mellitus. Primárne je metóda monitorovania tcpO2 určená na hodnotenie mikrocirkulácie. Vhodne umiestnená a fixovaná Clarkova sonda na povrchu kože nám dáva s veľkou presnosťou informáciu o parciálnom tlaku kyslíku na podklade polarografického princípu detekcie difundujúceho kyslíku z kapilárneho nutritívneho riečiska cez tkanivá do povrchových vrstiev kože. Funkcia mikrocirkulácie je ovplyvňovaná makrocirkuláciou, čo umožňuje metódu merania tcpO2 využiť v diagnostickom procese periférneho artériového obliterujúceho ochorenia alebo inej vaskulárnej patológie. Kombinácia tcpO2 a meranie perfúzneho tlaku kože technikou laserového Dopplerovho vyšetrenia nám dáva informáciu nielen o kapilárnom riečisku, ale aj o cievach, ktoré anatomicky predchádzajú kapiláry. Článok ponúka odporučenia na meranie a hodnotenie výsledkov tcpO2 a zahŕňa výsledky najnovších štúdií, ktoré sa zaoberajú možnosťami využitia monitorovania tcpO2 u pacienta s diabetes mellitus. Kľúčové slova: diabetická mikroangiopatia – diabetická neuropatia – nehojaci sa diabetický defekt – periférne artériové obliterujúce ochorenie – transkutánne monitorovanie tkanivového kyslíka

Monitoring of transcutaneous perfusion pressure of tissue oxygen (tcpO2) is a simple, non-invasive method performed in diagnostic process of chronic diabetic complications. Primary, tcpO2 is used as an indicator of microcirculatory function. Properly placed and fixed Clark electrode is able to detect with high accuracy partial oxygen pressure on the skin surface by polarographic system of dissolved oxygen from capillary bed through tissues to upper layers of the skin. The microcirculation function is influenced by macrocirculation, thus, tcpO2 is a suitable parameter in diagnosis of peripheral arterial obliterative disease or other vascular pathologies. Combination of tcpO2 monitoring and skin perfusion pressure by laser Doppler technique gives us information not only about nutritive capillary flow, but also about vessels which precede capillary bed. The article discusses current guidelines for measurement of tcpO2 and evaluation of the results. Also reviews the results of recent studies which are interested in the use of tcpO2 in diabetic patients.

• MeSH
• Blood Gas Analysis methods   utilization   MeSH
• Diabetes Mellitus physiopathology   MeSH
• Diabetic Foot MeSH
• Diabetic Neuropathies MeSH
• Wound Healing MeSH
• Hyperbaric Oxygenation MeSH
• Diabetes Complications * diagnosis   classification   physiopathology   MeSH
• Skin blood supply   MeSH
• Laser-Doppler Flowmetry MeSH
• Humans MeSH
• Monitoring, Physiologic methods   utilization   MeSH
• Partial Pressure MeSH
• Regional Blood Flow MeSH
• Blood Gas Monitoring, Transcutaneous * utilization   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Úvod: Stanovení transkutánní tenze kyslíku (TcpO2) je neinvazivní metodou pro testování periferního kožního prokrvení na kapilární úrovni a jejich nutriční schopnost potřebnou ke zhojení ischemického defektu. Hodnoty TcpO2 pod 30 mmHg jsou specifické pro kritickou končetinovou ischemii a predikují obtížné hojení defektu. Cílem této práce bylo ověření cut-off hodnoty potřebné ke zhojení defektu u pacientů bez možnosti provedení cévně-rekonstrukční intervence a ověření možnosti použití této metody ke zhodnocení efektivity provedeného cévně-rekonstrukčního výkonu. Metody: Do souboru bylo zařazeno celkem 52 pacientů (35 mužů a 17 žen). Průměrný věk pacientů v souboru byl 66,5 roku (max. 85, min. 44). Výsledky: V našem souboru pacientů jsme potvrdili, že ve skupině úspěšně zhojených ischemických ran byla hodnota TcpO2 rovna nebo vyšší než 30 mmHg (průměrná hodnota TcpO2 na nártu byla 37,0 mmHg ?9,5 mmHg), oproti skupině nezhojených pacientů, kde byly hodnoty nižší (průměrná hodnota TcpO2 na nártu byla 9,0 mmHg ?5,3 mmHg ). Závěr: TcpO2 je tedy vhodnou metodou při predikci hojení ischemického defektu a případné potřeby angiochirurgické nebo endovaskulární revaskularizace. Díky své neinvazivitě a nenáročnosti měření jistě pomáhá lépe rozhodovat ve volbě terapeutického postupu potřebného ke zhojení defektu. Kličová slova: transkutánní tenze kyslíku − cut-off hodnota − revaskularizace

Introduction: The measurement of transcutaneous oxygen pressure (TcpO2) is a non-invasive method to quantify skin oxygenation at capillary level and their nutritive ability needed to heal the ischemic defect. TcpO2 pressure values below 30 mm Hg are specific for critical limb ischemia and predict complicated healing. The purpose of this study was to verify the cut-off pressure in patient unable to undergo vascular reconstruction, and to verify the possibility of using this method to evaluate the effectiveness of vascular reconstructive surgery. Methods: The group included 52 patients (35 men and 17 women). The mean age of patients in the group was 66.5 years (max. 85, min. 44). Results: In our group of patients we confirmed that the TcpO2 values of successfully healed ischemic wounds were equal or greater than 30 mm Hg (mean TcpO2 value at the dorsum of the foot was 37.0 mm Hg ?9.5 mm Hg), compared to the group of unsuccessfully healed patients whose values were lower (mean TcpO2 value at the dorsum of the foot was 9.0 mm Hg ?5.3 mm Hg). Conclusion: TcpO2 is a suitable method in predicting the healing of ischemic defects and any possible need for surgical or endovascular revascularization. Thanks to its non-invasive nature and undemanding measurement, it surely helps to make better decisions in choosing the therapeutic procedure needed to heal the defect.

• MeSH
• Amputation, Surgical MeSH
• Chronic Disease MeSH
• Lower Extremity * blood supply   MeSH
• Wound Healing MeSH
• Ischemia * complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Blood Gas Monitoring, Transcutaneous * utilization   MeSH
• Vascular Surgical Procedures MeSH
• Treatment Outcome MeSH
• Plastic Surgery Procedures MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH

• MeSH
• Analgesics therapeutic use   MeSH
• Unconsciousness MeSH
• Intubation, Intratracheal methods   adverse effects   MeSH
• Cardiopulmonary Resuscitation methods   utilization   MeSH
• Air Ambulances manpower   MeSH
• Humans MeSH
• Heart Massage methods   MeSH
• Young Adult MeSH
• Neuromuscular Agents therapeutic use   MeSH
• Ambulances manpower   utilization   MeSH
• Heart Arrest complications   therapy   MeSH
• Blood Gas Monitoring, Transcutaneous methods   utilization   MeSH
• Respiration, Artificial methods   utilization   MeSH
• Accidental Falls MeSH
• Emergency Medical Services methods   utilization   MeSH
• Check Tag
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Humans MeSH
• Infant, Newborn, Diseases MeSH
• Infant, Newborn MeSH
• Neonatal Screening trends   utilization   MeSH
• Oximetry methods   utilization   MeSH
• Blood Gas Monitoring, Transcutaneous methods   utilization   MeSH
• Heart Defects, Congenital diagnosis   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Introductory Journal Article MeSH

Cieľ: Overiť efektívnosť a spoľahlivosť skríningu postduktálnej saturácie pulznou oxymetriou pre včasnú diagnostiku kritickej vrodenej vývojovej chyby srdca (VCC) v regióne severného Slovenska. Metodika: Postduktálna saturácia bola sledovaná prospektívne u zdravých donosených novorodencov narodených od 15. 11. 2009 do 31. 10. 2010 v regióne perinatologického centra Martin. Prvé meranie bolo vykonané vo veku 6-12 hodín, pri saturácii viac ako 95 % bol skríning považovaný za negatívny. Pri nižších hodnotách saturácie bolo meranie opakované v 6-hodinových intervaloch do veku 30 hodín. Výsledky: Zo súboru 7280 detí bola skríningom zistená kritická VCC u 7, senzitivita vyšetrenia bola 87,5 %, špecificita 98,9 %, negatívna prediktívna hodnota 99 %. Skríning bol falošne negatívny u 1 dieťaťa s neskôr diagnostikovaným hypoplastickým ľavokomorovým syndrómom. Z náhodne vybratej podskupiny 3210 detí bez VCC bol pozitívny skríning u 77 (2,39 %). Do 24 hodín sa u 63 z nich saturácia upravila a deti boli zdravé, príčinou bola prechodná cirkulácia (saturácia 93,03 ± 1,16 %, medián 93 %). U zvyšných 14 detí bolo diagnostikované iné ochorenie a saturácia bola vo veku 24 hodín menej ako 95 % u 50 % z nich (saturácia 90,64 ± 4,38 %, medián 92 %). Pri kritickej VCC boli hodnoty saturácie 86,0 ± 5,6 %, medián 87 %. Záver: Pulzná oxymetria je účinnou skríningovou metódou pre včasnú diagnostiku kritických VCC v asymptomatickom štádiu. Ak je postduktálna saturácia vo veku 24 hodín menej ako 90 %, indikované je echokardiografické vyšetrenie. Pri hodnotách 90–94 % je potrebné meranie opakovať o 6–12 hodín, v prípade pozitívneho nálezu vykonať kardiologické a iné potrebné vyšetrenia. Porovnanie hodnôt saturácie z pravej hornej a ktorejkoľvek dolnej končatiny zvyšuje efektivitu skríningu.

Aim: To evaluate the efficacy of the routine use of pulse oximetry to detect critical congenital heart disease (CCHD) in the region of Northern Slovakia. Methods: Postductal saturation was recorded prospectively in healthy term infants born from 15.11.2009 to 31.10.2010. The first screen was performed at the age of 6–12 hours. If pulse-oximetry measured arterial oxygen saturation was lower than 95%, the screening was positive and it was repeated in 6 hours intervals until the age of 30 hours. Results: 7280 infants were included in the study. The CCHD was detected due to the screening in 7 out of the infants. The sensitivity was 87.5%, specificity 98.9% and negative predictive value 99%. The false negative result was recorded in 1 baby with the hypoplastic left heart syndrome that was diagnosed clinically at the age of 2 days. In a randomly chosen subgroup of infants without CCHD the screening was positive in 77 out of the 3210 newborns (2.39%). Up to 24 hours the saturation was normal in 63 out of them, they were healthy and the positive screening was due to the transitional circulation (mean saturation 93.03±1.16%, median 93%). In remaining 14 out of the 77 infants other disease was diagnosed and the saturation was less than 95% in 50% out of them at the age of 24 hours (saturation 90.64±4.38%, median 92%). The saturation in infants with CCHD was 86.0±5.6%, median 87%. Conclusion: Pulse oximetry is an effective screening method for early detection of CCHD at asymptomatic stage. If the postductal saturation is less than 90% at the age of 24 hours, echocardiographic examination is indicated. Babies with saturation between 90 and 94% should have a second screen 6–12 hours later. If it is positive, the cardiologic and other necessary examinations are performed. Comparison of saturation values from the right hand and either foot increases the effectiveness of the screening.

• MeSH
• Early Diagnosis MeSH
• Financing, Organized MeSH
• Humans MeSH
• Infant, Newborn, Diseases MeSH
• Infant, Newborn MeSH
• Neonatal Screening mortality   MeSH
• Oximetry utilization   MeSH
• Blood Gas Monitoring, Transcutaneous methods   utilization   MeSH
• Heart Defects, Congenital diagnosis   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Geographicals
• Slovakia MeSH

• MeSH
• Amputation, Surgical methods   MeSH
• Varicose Ulcer therapy   MeSH
• Diabetic Foot diagnosis   therapy   MeSH
• Wound Healing MeSH
• Humans MeSH
• Blood Gas Monitoring, Transcutaneous methods   utilization   MeSH
• Check Tag
• Humans MeSH

• MeSH
• Diabetic Foot therapy   MeSH
• Wound Healing physiology   MeSH
• Hyperbaric Oxygenation economics   utilization   MeSH
• Humans MeSH
• Evidence-Based Medicine MeSH
• Health Care Costs MeSH
• Blood Gas Monitoring, Transcutaneous methods   utilization   MeSH
• Patient Selection MeSH
• Treatment Outcome MeSH
• Limb Salvage methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Lecture MeSH

• MeSH
• Angiography utilization   MeSH
• Lower Extremity blood supply   ultrasonography   MeSH
• Ultrasonography, Doppler, Duplex methods   instrumentation   utilization   MeSH
• Financing, Organized MeSH
• Evaluation Studies as Topic MeSH
• Ischemia diagnosis   complications   ultrasonography   MeSH
• Diabetes Complications MeSH
• Humans MeSH
• Peripheral Vascular Diseases diagnosis   complications   ultrasonography   MeSH
• Pilot Projects MeSH
• Ankle Brachial Index utilization   MeSH
• Blood Gas Monitoring, Transcutaneous methods   utilization   MeSH
• Ulcer epidemiology   etiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Lecture MeSH

• MeSH
• Amputation, Surgical MeSH
• Diabetic Foot diagnosis   surgery   MeSH
• Lower Extremity surgery   blood supply   physiopathology   MeSH
• Ischemia diagnosis   MeSH
• Humans MeSH
• Peripheral Vascular Diseases diagnosis   MeSH
• Preoperative Period MeSH
• Blood Gas Monitoring, Transcutaneous methods   instrumentation   utilization   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Lecture MeSH

• MeSH
• Diabetes Mellitus, Type 2 complications   MeSH
• Diabetic Foot etiology   complications   therapy   MeSH
• Lower Extremity surgery   physiopathology   pathology   MeSH
• Financing, Organized MeSH
• Wound Healing MeSH
• Platelet Aggregation Inhibitors therapeutic use   MeSH
• Ischemia diagnosis   surgery   complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Factor XII Deficiency diagnosis   MeSH
• Peripheral Vascular Diseases diagnosis   surgery   complications   MeSH
• Blood Gas Monitoring, Transcutaneous utilization   MeSH
• Foot Ulcer etiology   complications   therapy   MeSH
• Vascular Surgical Procedures methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH
• Lecture MeSH