Hypoxemia Clinical Trial
Official title:
Assessing the Feasibility and Effectiveness of Introducing Pulse Oximetry in IMCI Services to Manage Acute Respiratory Infections at First Level Health Facilities of Bangladesh
The purpose of the study is to assess the feasibility, acceptability and operational challenges of introducing Pulse Oximeter (PO) in IMCI services to manage acute respiratory infections at first-level primary care facilities in Bangladesh (phase 1). The investigators will also evaluate the effectiveness and cost-effectiveness of introducing PO in IMCI services at first level primary care health facilities (phase 2). This study will employ a cluster randomized controlled trial design to evaluate the effectiveness of introducing PO in IMCI services (phase-2 objective). The feasibility assessment (phase-1 objective) will be nested within the larger effectiveness trail as internal piloting; which will help in generating evidence for designing a robust phase-2 trial. First-level primary healthcare facilities providing IMCI services will be regarded as clusters and the unit of randomization. Sixteen first level primary care health facilities (UH&FWC) will be randomly assigned to comparison and intervention facilities.
Status | Recruiting |
Enrollment | 612 |
Est. completion date | December 31, 2022 |
Est. primary completion date | December 31, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 2 Months to 59 Months |
Eligibility | Inclusion Criteria: 1. Sick children aged 2 to 59 months 2. Presenting with cough or difficult breathing 3. Receiving IMCI services in the selected facilities will be enrolled Exclusion Criteria: 1. Severely ill children who need to be referred immediately 2. If the parents of the children are unwilling to participate |
Country | Name | City | State |
---|---|---|---|
Bangladesh | International Centre for Diarrhoeal Disease Research, Bangladesh | Dhaka |
Lead Sponsor | Collaborator |
---|---|
International Centre for Diarrhoeal Disease Research, Bangladesh | University of Edinburgh |
Bangladesh,
Abrams GA, Sanders MK, Fallon MB. Utility of pulse oximetry in the detection of arterial hypoxemia in liver transplant candidates. Liver Transpl. 2002 Apr;8(4):391-6. — View Citation
Addo-Yobo E, Anh DD, El-Sayed HF, Fox LM, Fox MP, MacLeod W, Saha S, Tuan TA, Thea DM, Qazi S; Multicenter Amoxicillin Severe pneumonia Study (MASS) Group. Outpatient treatment of children with severe pneumonia with oral amoxicillin in four countries: the MASS study. Trop Med Int Health. 2011 Aug;16(8):995-1006. doi: 10.1111/j.1365-3156.2011.02787.x. Epub 2011 May 4. — View Citation
Addo-Yobo E, Chisaka N, Hassan M, Hibberd P, Lozano JM, Jeena P, MacLeod WB, Maulen I, Patel A, Qazi S, Thea DM, Nguyen NT. Oral amoxicillin versus injectable penicillin for severe pneumonia in children aged 3 to 59 months: a randomised multicentre equivalency study. Lancet. 2004 Sep 25-Oct 1;364(9440):1141-8. — View Citation
AFRIcan NEonatal Sepsis Trial Group. Treatment of fast breathing in neonates and young infants with oral amoxicillin compared with penicillin-gentamicin combination: study protocol for a randomized, open-label equivalence trial. Pediatr Infect Dis J. 2013 Sep;32 Suppl 1:S33-8. doi: 10.1097/INF.0b013e31829ff7eb. — View Citation
Ahmed HM, Mitchell M, Hedt B. National implementation of Integrated Management of Childhood Illness (IMCI): policy constraints and strategies. Health Policy. 2010 Jul;96(2):128-33. doi: 10.1016/j.healthpol.2010.01.013. Epub 2010 Feb 21. Review. — View Citation
Anderson CG, Benitz WE, Madan A. Retinopathy of prematurity and pulse oximetry: a national survey of recent practices. J Perinatol. 2004 Mar;24(3):164-8. — View Citation
Arifeen SE, Hoque DM, Akter T, Rahman M, Hoque ME, Begum K, Chowdhury EK, Khan R, Blum LS, Ahmed S, Hossain MA, Siddik A, Begum N, Sadeq-ur Rahman Q, Haque TM, Billah SM, Islam M, Rumi RA, Law E, Al-Helal ZA, Baqui AH, Schellenberg J, Adam T, Moulton LH, Habicht JP, Scherpbier RW, Victora CG, Bryce J, Black RE. Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trial. Lancet. 2009 Aug 1;374(9687):393-403. doi: 10.1016/S0140-6736(09)60828-X. — View Citation
Armstrong Schellenberg JR, Adam T, Mshinda H, Masanja H, Kabadi G, Mukasa O, John T, Charles S, Nathan R, Wilczynska K, Mgalula L, Mbuya C, Mswia R, Manzi F, de Savigny D, Schellenberg D, Victora C. Effectiveness and cost of facility-based Integrated Management of Childhood Illness (IMCI) in Tanzania. Lancet. 2004 Oct 30-Nov 5;364(9445):1583-94. — View Citation
Atkinson M, Lakhanpaul M, Smyth A, Vyas H, Weston V, Sithole J, Owen V, Halliday K, Sammons H, Crane J, Guntupalli N, Walton L, Ninan T, Morjaria A, Stephenson T. Comparison of oral amoxicillin and intravenous benzyl penicillin for community acquired pneumonia in children (PIVOT trial): a multicentre pragmatic randomised controlled equivalence trial. Thorax. 2007 Dec;62(12):1102-6. Epub 2007 Jun 13. — View Citation
Ayieko P, English M. Case management of childhood pneumonia in developing countries. Pediatr Infect Dis J. 2007 May;26(5):432-40. — View Citation
Baqui AH, Saha SK, Ahmed AS, Shahidullah M, Quasem I, Roth DE, Samsuzzaman AK, Ahmed W, Tabib SM, Mitra DK, Begum N, Islam M, Mahmud A, Rahman MH, Moin MI, Mullany LC, Cousens S, El Arifeen S, Wall S, Brandes N, Santosham M, Black RE; Projahnmo Study Group in Bangladesh. Safety and efficacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open-label, equivalence trial. Lancet Glob Health. 2015 May;3(5):e279-87. doi: 10.1016/S2214-109X(14)70347-X. Epub 2015 Apr 1. — View Citation
Baqui AH, Saha SK, Ahmed AS, Shahidullah M, Quasem I, Roth DE, Williams EK, Mitra D, Shamsuzzaman AK, Ahmed W, Mullany LC, Cousens S, Wall S, Brandes N, Black RE. Safety and efficacy of simplified antibiotic regimens for outpatient treatment of serious infection in neonates and young infants 0-59 days of age in Bangladesh: design of a randomized controlled trial. Pediatr Infect Dis J. 2013 Sep;32 Suppl 1:S12-8. doi: 10.1097/INF.0b013e31829ff790. — View Citation
Bari A, Sadruddin S, Khan A, Khan Iu, Khan A, Lehri IA, Macleod WB, Fox MP, Thea DM, Qazi SA. Community case management of severe pneumonia with oral amoxicillin in children aged 2-59 months in Haripur district, Pakistan: a cluster randomised trial. Lancet. 2011 Nov 19;378(9805):1796-803. doi: 10.1016/S0140-6736(11)61140-9. Epub 2011 Nov 10. — View Citation
Bierman MI, Stein KL, Snyder JV. Pulse oximetry in the postoperative care of cardiac surgical patients. A randomized controlled trail. Chest. 1992 Nov;102(5):1367-70. — View Citation
Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, Fernandez M. How we design feasibility studies. Am J Prev Med. 2009 May;36(5):452-7. doi: 10.1016/j.amepre.2009.02.002. — View Citation
Brouillette RT, Morielli A, Leimanis A, Waters KA, Luciano R, Ducharme FM. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics. 2000 Feb;105(2):405-12. — View Citation
Chowdhury EK, El Arifeen S, Rahman M, Hoque DE, Hossain MA, Begum K, Siddik A, Begum N, Sadeq-ur Rahman Q, Akter T, Haque TM, Al-Helal ZM, Baqui AH, Bryce J, Black RE. Care at first-level facilities for children with severe pneumonia in Bangladesh: a cohort study. Lancet. 2008 Sep 6;372(9641):822-30. doi: 10.1016/S0140-6736(08)61166-6. Epub 2008 Aug 18. — View Citation
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M; Medical Research Council Guidance. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008 Sep 29;337:a1655. doi: 10.1136/bmj.a1655. — View Citation
Dildy GA, van den Berg PP, Katz M, Clark SL, Jongsma HW, Nijhuis JG, Loucks CA. Intrapartum fetal pulse oximetry: fetal oxygen saturation trends during labor and relation to delivery outcome. Am J Obstet Gynecol. 1994 Sep;171(3):679-84. — View Citation
Duke T, Subhi R, Peel D, Frey B. Pulse oximetry: technology to reduce child mortality in developing countries. Ann Trop Paediatr. 2009 Sep;29(3):165-75. doi: 10.1179/027249309X12467994190011. Review. — View Citation
Emdin CA, Mir F, Sultana S, Kazi AM, Zaidi AK, Dimitris MC, Roth DE. Utility and feasibility of integrating pulse oximetry into the routine assessment of young infants at primary care clinics in Karachi, Pakistan: a cross-sectional study. BMC Pediatr. 2015 Sep 30;15:141. doi: 10.1186/s12887-015-0463-z. — View Citation
Ewer AK, Middleton LJ, Furmston AT, Bhoyar A, Daniels JP, Thangaratinam S, Deeks JJ, Khan KS; PulseOx Study Group. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. Lancet. 2011 Aug 27;378(9793):785-94. doi: 10.1016/S0140-6736(11)60753-8. Epub 2011 Aug 4. — View Citation
Floyd J, Wu L, Hay Burgess D, Izadnegahdar R, Mukanga D, Ghani AC. Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings. Nature. 2015 Dec 3;528(7580):S53-9. doi: 10.1038/nature16043. — View Citation
Fox MP, Thea DM, Sadruddin S, Bari A, Bonawitz R, Hazir T, Bin Nisar Y, Qazi SA; Pneumonia Studies Group. Low rates of treatment failure in children aged 2-59 months treated for severe pneumonia: a multisite pooled analysis. Clin Infect Dis. 2013 Apr;56(7):978-87. doi: 10.1093/cid/cis1201. Epub 2012 Dec 21. — View Citation
Garde A, Zhou G, Raihana S, Dunsmuir D, Karlen W, Dekhordi P, Huda T, Arifeen SE, Larson C, Kissoon N, Dumont GA, Ansermino JM. Respiratory rate and pulse oximetry derived information as predictors of hospital admission in young children in Bangladesh: a prospective observational study. BMJ Open. 2016 Aug 17;6(8):e011094. doi: 10.1136/bmjopen-2016-011094. — View Citation
Ginsburg AS, Izadnegahdar R, Klugman KP. World Pneumonia Day 2016: pulse oximetry and oxygen. Lancet Glob Health. 2016 Dec;4(12):e893-e894. doi: 10.1016/S2214-109X(16)30296-0. Epub 2016 Nov 10. — View Citation
Ginsburg AS, Van Cleve WC, Thompson MI, English M. Oxygen and pulse oximetry in childhood pneumonia: a survey of healthcare providers in resource-limited settings. J Trop Pediatr. 2012 Oct;58(5):389-93. doi: 10.1093/tropej/fmr103. Epub 2011 Dec 14. — View Citation
Halevy A, Halpern Z, Negri M, Hod G, Weissgarten J, Averbukh Z, Modai D. Pulse oximetry in the evaluation of the painful hand after arteriovenous fistula creation. J Vasc Surg. 1991 Oct;14(4):537-9. — View Citation
Hazir T, Fox LM, Nisar YB, Fox MP, Ashraf YP, MacLeod WB, Ramzan A, Maqbool S, Masood T, Hussain W, Murtaza A, Khawar N, Tariq P, Asghar R, Simon JL, Thea DM, Qazi SA; New Outpatient Short-Course Home Oral Therapy for Severe Pneumonia Study Group. Ambulatory short-course high-dose oral amoxicillin for treatment of severe pneumonia in children: a randomised equivalency trial. Lancet. 2008 Jan 5;371(9606):49-56. doi: 10.1016/S0140-6736(08)60071-9. — View Citation
King C, Boyd N, Walker I, Zadutsa B, Baqui AH, Ahmed S, Islam M, Kainja E, Nambiar B, Wilson I, McCollum ED. Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: a qualitative evaluation from Malawi and Bangladesh. BMJ Open. 2018 Jan 30;8(1):e019177. doi: 10.1136/bmjopen-2017-019177. — View Citation
Lim YW, Steinhoff M, Girosi F, Holtzman D, Campbell H, Boer R, Black R, Mulholland K. Reducing the global burden of acute lower respiratory infections in children: the contribution of new diagnostics. Nature. 2006 Nov 23;444 Suppl 1:9-18. — View Citation
Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016 Dec 17;388(10063):3027-3035. doi: 10.1016/S0140-6736(16)31593-8. Epub 2016 Nov 11. Erratum in: Lancet. 2017 May 13;389(10082):1884. — View Citation
Mallory MD, Shay DK, Garrett J, Bordley WC. Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics. 2003 Jan;111(1):e45-51. — View Citation
McCollum ED, King C, Deula R, Zadutsa B, Mankhambo L, Nambiar B, Makwenda C, Masache G, Lufesi N, Mwansambo C, Costello A, Colbourn T. Pulse oximetry for children with pneumonia treated as outpatients in rural Malawi. Bull World Health Organ. 2016 Dec 1;94(12):893-902. Epub 2016 Oct 11. Erratum in: Bull World Health Organ. 2017 Jan 1;95(1):81. — View Citation
Mower WR, Sachs C, Nicklin EL, Safa P, Baraff LJ. Effect of routine emergency department triage pulse oximetry screening on medical management. Chest. 1995 Nov;108(5):1297-302. — View Citation
Nair H, Simões EA, Rudan I, Gessner BD, Azziz-Baumgartner E, Zhang JSF, Feikin DR, Mackenzie GA, Moiïsi JC, Roca A, Baggett HC, Zaman SM, Singleton RJ, Lucero MG, Chandran A, Gentile A, Cohen C, Krishnan A, Bhutta ZA, Arguedas A, Clara AW, Andrade AL, Ope M, Ruvinsky RO, Hortal M, McCracken JP, Madhi SA, Bruce N, Qazi SA, Morris SS, El Arifeen S, Weber MW, Scott JAG, Brooks WA, Breiman RF, Campbell H; Severe Acute Lower Respiratory Infections Working Group. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet. 2013 Apr 20;381(9875):1380-1390. doi: 10.1016/S0140-6736(12)61901-1. Epub 2013 Jan 29. Review. — View Citation
Owais A, Sultana S, Stein AD, Bashir NH, Awaldad R, Zaidi AK. Why do families of sick newborns accept hospital care? A community-based cohort study in Karachi, Pakistan. J Perinatol. 2011 Sep;31(9):586-92. doi: 10.1038/jp.2010.191. Epub 2011 Jan 27. — View Citation
Pedersen T, Dyrlund Pedersen B, Møller AM. Pulse oximetry for perioperative monitoring. Cochrane Database Syst Rev. 2003;(3):CD002013. Review. Update in: Cochrane Database Syst Rev. 2009;(4):CD002013. — View Citation
Peterson S, Nsungwa-Sabiiti J, Were W, Nsabagasani X, Magumba G, Nambooze J, Mukasa G. Coping with paediatric referral--Ugandan parents' experience. Lancet. 2004 Jun 12;363(9425):1955-6. — View Citation
Rahman AE, Iqbal A, Hoque DM, Moinuddin M, Zaman SB, Rahman QS, Begum T, Chowdhury AI, Haider R, Arifeen SE, Kissoon N, Larson CP. Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh. PLoS One. 2017 Jan 23;12(1):e0170267. doi: 10.1371/journal.pone.0170267. eCollection 2017. — View Citation
Raihana S, Dunsmuir D, Huda T, Zhou G, Rahman QS, Garde A, Moinuddin M, Karlen W, Dumont GA, Kissoon N, El Arifeen S, Larson C, Ansermino JM. Correction: Development and Internal Validation of a Predictive Model Including Pulse Oximetry for Hospitalization of Under-Five Children in Bangladesh. PLoS One. 2016 Jan 15;11(1):e0147560. doi: 10.1371/journal.pone.0147560. eCollection 2016. — View Citation
Ramanathan R, Durand M, Larrazabal C. Pulse oximetry in very low birth weight infants with acute and chronic lung disease. Pediatrics. 1987 Apr;79(4):612-7. — View Citation
Reed C, Madhi SA, Klugman KP, Kuwanda L, Ortiz JR, Finelli L, Fry AM. Development of the Respiratory Index of Severity in Children (RISC) score among young children with respiratory infections in South Africa. PLoS One. 2012;7(1):e27793. doi: 10.1371/journal.pone.0027793. Epub 2012 Jan 4. — View Citation
Reich JD, Miller S, Brogdon B, Casatelli J, Gompf TC, Huhta JC, Sullivan K. The use of pulse oximetry to detect congenital heart disease. J Pediatr. 2003 Mar;142(3):268-72. — View Citation
Resnicow K, Baranowski T, Ahluwalia JS, Braithwaite RL. Cultural sensitivity in public health: defined and demystified. Ethn Dis. 1999 Winter;9(1):10-21. Review. — View Citation
Sazawal S, Black RE; Pneumonia Case Management Trials Group. Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials. Lancet Infect Dis. 2003 Sep;3(9):547-56. Review. — View Citation
Schnapp LM, Cohen NH. Pulse oximetry. Uses and abuses. Chest. 1990 Nov;98(5):1244-50. Review. — View Citation
Schroeder AR, Marmor AK, Pantell RH, Newman TB. Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. Arch Pediatr Adolesc Med. 2004 Jun;158(6):527-30. — View Citation
Sherman B, Nisenboum JM, Jesberger BL, Morrow CA, Jesberger JA. Assessment of dysphagia with the use of pulse oximetry. Dysphagia. 1999 Summer;14(3):152-6. — View Citation
Straus WL, Qazi SA, Kundi Z, Nomani NK, Schwartz B. Antimicrobial resistance and clinical effectiveness of co-trimoxazole versus amoxycillin for pneumonia among children in Pakistan: randomised controlled trial. Pakistan Co-trimoxazole Study Group. Lancet. 1998 Jul 25;352(9124):270-4. — View Citation
Subhi R, Adamson M, Campbell H, Weber M, Smith K, Duke T; Hypoxaemia in Developing Countries Study Group. The prevalence of hypoxaemia among ill children in developing countries: a systematic review. Lancet Infect Dis. 2009 Apr;9(4):219-27. doi: 10.1016/S1473-3099(09)70071-4. Review. — View Citation
Tin W, Milligan DW, Pennefather P, Hey E. Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. Arch Dis Child Fetal Neonatal Ed. 2001 Mar;84(2):F106-10. — View Citation
Walter ND, Lyimo T, Skarbinski J, Metta E, Kahigwa E, Flannery B, Dowell SF, Abdulla S, Kachur SP. Why first-level health workers fail to follow guidelines for managing severe disease in children in the Coast Region, the United Republic of Tanzania. Bull World Health Organ. 2009 Feb;87(2):99-107. — View Citation
* Note: There are 53 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Treatment failure rate | The primary outcome of interest is treatment failure rate among those who are clinically classified as 'Pneumonia'. Operational definition of treatment failure will be finalized based on expert consultation and opinion of the caretakers of sick children through PPI. For illustrative purpose, an operational definition of the treatment failure is presented below which is based on some similar studies, i.e. SAT, AFRINEST, NO-SHOT, etc.Presence of any of the followings signs on day-6 and day-12 will be a considered as treatment failure:
Death Appearance of any of the danger signs: Inability to drink Vomits everything Lethargy or unconsciousness Convulsions or history of convulsion Persistence of Low oxygen saturation (SpO2<90%) Chest indrawing Fast breathing |
up to 12 months |
Status | Clinical Trial | Phase | |
---|---|---|---|
Suspended |
NCT03628560 -
Alternate Methodology of Pulse Oximeter Validation
|
N/A | |
Completed |
NCT02866578 -
Open Lung Protective Ventilation in Cardiac Surgery
|
N/A | |
Recruiting |
NCT06139081 -
Oxygen Delivery Methods of Nasal Catheter on the Incidence of Hypoxemia in Patients With Painless Gastroscopy
|
N/A | |
Not yet recruiting |
NCT05964309 -
Pre-oxygenation in Sitting Position and Oxygen Reserve Index
|
N/A | |
Completed |
NCT00740220 -
Reproducibility of 6 Minute Walk Tests for Oxygen Desaturation
|
N/A | |
Completed |
NCT00675415 -
Does Capnography Prevent Hypoxemia During Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound?
|
N/A | |
Completed |
NCT04557605 -
Effects of a Face Mask on Oxygenation During Exercise
|
N/A | |
Active, not recruiting |
NCT05479929 -
Work of Breathing Assessment in Triage Scale
|
||
Recruiting |
NCT05422430 -
Rebreathing-induced Hypoxia and Glucose Levels
|
N/A | |
Recruiting |
NCT03009643 -
Salvage Treatment of Inhaled Nitric Oxide in Patients With Refractory Hypoxemia After Aortic Surgery
|
N/A | |
Completed |
NCT01949012 -
Capnography Monitoring During Intravenous Conscious Sedation Sedation With Midazolam for Oral Surgery
|
N/A | |
Completed |
NCT01477450 -
Comparison of Oxygen Delivery Devices for Reversal of Altitude-Induced Hypoxemia in Normal Subjects
|
N/A | |
Completed |
NCT01470170 -
Regimen of Alfentanil in Propofol Sedative Fibro-bronchoscopy
|
Phase 4 | |
Recruiting |
NCT06085859 -
Anesthesia Endoscope Mask is Applied to Sedation Upper Gastrointestinal Endoscopic Diagnosis and Treatment
|
N/A | |
Recruiting |
NCT03969615 -
SuperNO2VA™ and General Anesthesia Postoperative Care
|
N/A | |
Completed |
NCT02554110 -
Peripheral Nerve Stimulation to Reduce Hypoxic Events
|
N/A | |
Completed |
NCT04566419 -
poStoperative Anesthesia Care: Facial Mask vs Hfnc and Thoracic Ultrasound for Reduction of Atelectasis Incidence
|
N/A | |
Completed |
NCT04998253 -
Effects in Oxygenation and Hypoxic Pulmonary Vasoconstriction in ARDS Secondary to SARS-CoV2
|
Early Phase 1 | |
Recruiting |
NCT04079465 -
Automated Oxygen Control by O2matic to Patients Admitted With Acute Hypoxemia
|
N/A | |
Recruiting |
NCT06022523 -
Accuracy of Pulse Oximeters With Profound Hypoxia
|
N/A |