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https://www.readbyqxmd.com/read/27888413/improving-manual-oxygen-titration-in-preterm-infants-by-training-and-guideline-implementation
#1
Henriëtte A van Zanten, Steffen C Pauws, Evelien C Beks, Ben J Stenson, Enrico Lopriore, Arjan B Te Pas
: To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85-95%) was calculated (%SpO2-wtr). SpO2 was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48...
November 26, 2016: European Journal of Pediatrics
https://www.readbyqxmd.com/read/27634820/development-and-preclinical-testing-of-an-adaptive-algorithm-for-automated-control-of-inspired-oxygen-in-the-preterm-infant
#2
Peter A Dargaville, Omid Sadeghi Fathabadi, Gemma K Plottier, Kathleen Lim, Kevin I Wheeler, Rohan Jayakar, Timothy J Gale
OBJECTIVE: To assess the performance of a novel algorithm for automated oxygen control using a simulation of oxygenation founded on in vivo data from preterm infants. METHODS: A proportional-integral-derivative (PID) control algorithm was enhanced by (i) compensation for the non-linear SpO2-PaO2 relationship, (ii) adaptation to the severity of lung dysfunction and (iii) error attenuation within the target range. Algorithm function with and without enhancements was evaluated by iterative linking with a computerised simulation of oxygenation...
September 15, 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/27573518/clinical-evaluation-of-a-novel-adaptive-algorithm-for-automated-control-of-oxygen-therapy-in-preterm-infants-on-non-invasive-respiratory-support
#3
Gemma K Plottier, Kevin I Wheeler, Sanoj K M Ali, Omid Sadeghi Fathabadi, Rohan Jayakar, Timothy J Gale, Peter A Dargaville
OBJECTIVE: To evaluate the performance of a novel rapidly responsive proportional-integral-derivative (PID) algorithm for automated oxygen control in preterm infants with respiratory insufficiency. DESIGN: Interventional study of a 4-hour period of automated oxygen control compared with combined data from two flanking periods of manual control (4 hours each). SETTING: Neonatal intensive care unit. PARTICIPANTS: Preterm infants (n=20) on non-invasive respiratory support and supplemental oxygen, with oxygen saturation (SpO2) target range 90%-94% (manual control) and 91%-95% (automated control)...
August 29, 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/27188964/efficiency-of-goal-directed-oxygen-delivery-in-icu-patients
#4
Sebastien Jochmans, Ly-Van Phach Vong, Nathalie Rolin, Oumar Sy, Jonathan Chelly, Olivier Ellrodt, Jean-Emmanuel Alphonsine, Jean Serbource-Goguel, Razach Idriss Abdallah, Claire-Marie Weyer, Mehran Monchi, Christophe Vinsonneau
BACKGROUND: Current clinical practice guidelines promote a goal-directed approach for oxygen delivery with respect to SpO₂ objectives. We evaluated the efficiency of a strategy based on goal-directed O₂ delivery in the ICU. METHODS: A group of 30 patients (Group 1) with a proven history of chronic obstructive pulmonary disease suffering from acute hypercarbic exacerbation was compared to 2 other groups of patients admitted for acute respiratory failure with no history of pulmonary disease: 30 patients requiring oxygen supply and/or non-invasive ventilation (Group 2) and 30 requiring invasive ventilation (Group 3)...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/26673584/pitfalls-in-haemodynamic-monitoring-in-the-postoperative-and-critical-care-setting
#5
REVIEW
K M Ho
Haemodynamic monitoring is a vital part of daily practice in anaesthesia and intensive care. Although there is evidence to suggest that goal-directed therapy may improve outcomes in the perioperative period, which haemodynamic targets we should aim at to optimise patient outcomes remain elusive and controversial. This review highlights the pitfalls in commonly used haemodynamic targets, including arterial blood pressure, central venous pressure, cardiac output, central venous oxygen saturation and dynamic haemodynamic indices...
January 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/26648631/acute-use-of-oxygen-therapy
#6
REVIEW
Janine Pilcher, Richard Beasley
A major change is needed in the entrenched culture of routinely administering high-concentration oxygen to acutely ill patients regardless of need. Oxygen is a drug that should be prescribed for specific indications. There should be a documented target range for oxygen saturation, and regular monitoring of the patient's response. There are risks from unrelieved hypoxaemia due to insufficient oxygen therapy, and from provoked hyperoxaemia due to excessive oxygen therapy. Oxygen therapy should therefore be titrated so that the saturation is within a range that avoids these risks...
June 2015: Australian Prescriber
https://www.readbyqxmd.com/read/26468116/compliance-in-oxygen-saturation-targeting-in-preterm-infants-a-systematic-review
#7
Henriëtte A van Zanten, Ratna N G B Tan, Agnes van den Hoogen, Enrico Lopriore, Arjan B te Pas
UNLABELLED: During oxygen therapy in preterm infants, targeting oxygen saturation is important for avoiding hypoxaemia and hyperoxaemia, but this can be very difficult and challenging for neonatal nurses. We systematically reviewed the qualitative and quantitative studies investigating the compliance in targeting oxygen saturation in preterm infants and factors that influence this compliance. We searched PubMed, Embase, Web of Science, Cochrane, CINAHL and ScienceDirect from 2000 to January 2015...
December 2015: European Journal of Pediatrics
https://www.readbyqxmd.com/read/26205807/the-effects-of-hyperoxaemia-on-tissue-oxygenation-in-patients-with-a-nadir-haematocrit-lower-than-20-during-cardiopulmonary-bypass
#8
Utkan Sevuk, Rojhat Altindag, Erkan Baysal, Baris Yaylak, Mehmet Sahin Adiyaman, Suleyman Akkaya, Nurettin Ay, Vahhac Alp
UNLABELLED: Excessive haemodilution and the resulting anaemia during CPB is accompanied by a decrease in the total arterial oxygen content, which may impair tissue oxygen delivery. Hyperoxic ventilation has been proven to improve tissue oxygenation in different pathophysiological states of anaemic tissue hypoxia. The aim of this study was to examine the influence of arterial hyperoxaemia on tissue oxygenation during CPB. Records of patients undergoing isolated CABG with CPB were retrospectively reviewed...
April 2016: Perfusion
https://www.readbyqxmd.com/read/26196193/ovine-platelet-function-is-unaffected-by-extracorporeal-membrane-oxygenation-within-the-first-24-h
#9
RANDOMIZED CONTROLLED TRIAL
Rylan A Hayes, Samuel Foley, Kiran Shekar, Sara Diab, Kimble R Dunster, Charles McDonald, John F Fraser
This study investigated platelet dysfunction during short-term extracorporeal membrane oxygenation (ECMO) and secondarily to determine if hyperoxaemia contributes to this dysfunction. Healthy sheep were anaesthetized and maintained on ECMO for either 2 or 24 h, with or without induction of smoke inhalation acute lung injury. A specialized animal-operating theatre was used to conduct the experimentation. Forty-three healthy female sheep were randomized into either a test or a control group. Following anaesthesia, test groups received ECMO ± smoke inhalation acute lung injury (SALI), whereas control groups were maintained with ventilation only ± SALI...
October 2015: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/26194933/automated-control-of-inspired-oxygen-in-ventilated-preterm-infants-crossover-physiological-study
#10
RANDOMIZED CONTROLLED TRIAL
Mithilesh Lal, Win Tin, Sunil Sinha
AIM: To evaluate the efficacy of automated control of the fraction of inspired oxygen (FiO2 ) in comparison with manual FiO2 control in maintaining target pulse oxygen saturation (SpO2 ) range. METHODS: Crossover physiological study involving preterm infants requiring mechanical ventilation and supplemental oxygen. Each infant was studied for two consecutive 12 hours in a random sequence. Outcome measures included the proportion of time with SpO2 within and outside the target range of 90-95%, extreme hypoxaemia (< 80%) and hyperoxaemia (≥ 98%)...
November 2015: Acta Paediatrica
https://www.readbyqxmd.com/read/24801519/permissive-hypoxaemia-versus-normoxaemia-for-mechanically-ventilated-critically-ill-patients
#11
REVIEW
Edward T Gilbert-Kawai, Kay Mitchell, Daniel Martin, John Carlisle, Michael P W Grocott
BACKGROUND: Permissive hypoxaemia describes a concept in which a lower level of arterial oxygenation (PaO2) than usual is accepted to avoid the detrimental effects of high fractional inspired oxygen and invasive mechanical ventilation. Currently however, no specific threshold is known that defines permissive hypoxaemia, and its use in adults remains formally untested. The importance of this systematic review is thus to determine whether any substantial evidence is available to support the notion that permissive hypoxaemia may improve clinical outcomes in mechanically ventilated critically ill patients...
May 7, 2014: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/24668832/the-risk-for-hyperoxaemia-after-apnoea-bradycardia-and-hypoxaemia-in-preterm-infants
#12
H A van Zanten, R N G B Tan, M Thio, J M de Man-van Ginkel, E W van Zwet, E Lopriore, A B te Pas
OBJECTIVE: To investigate the occurrence and duration of oxygen saturation (SpO₂) ≥95%, after extra oxygen for apnoea, bradycardia, cyanosis (ABC), and the relation with the duration of bradycardia and/or SpO₂ ≤80%. METHODS: All preterm infants <32 weeks' gestation supported with nasal continuous positive airway pressure (nCPAP) admitted to our centre were eligible for the study. We retrospectively identified all episodes of ABCs. In ABCs where oxygen supply was increased, duration and severity of bradycardia (<80 bpm), SpO₂ ≤80%, SpO₂ ≥95% and their correlation were investigated...
July 2014: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/24206183/the-medical-use-of-oxygen-a-time-for-critical-reappraisal
#13
REVIEW
F Sjöberg, M Singer
Oxygen treatment has been a cornerstone of acute medical care for numerous pathological states. Initially, this was supported by the assumed need to avoid hypoxaemia and tissue hypoxia. Most acute treatment algorithms, therefore, recommended the liberal use of a high fraction of inspired oxygen, often without first confirming the presence of a hypoxic insult. However, recent physiological research has underlined the vasoconstrictor effects of hyperoxia on normal vasculature and, consequently, the risk of significant blood flow reduction to the at-risk tissue...
December 2013: Journal of Internal Medicine
https://www.readbyqxmd.com/read/24062884/conditioning-the-heart-to-prevent-myocardial-reperfusion-injury-during-ppci
#14
Derek J Hausenloy
For patients presenting with a ST-segment elevation myocardial infarction (STEMI), early myocardial reperfusion by primary percutaneous coronary intervention (PPCI) remains the most effective treatment strategy for limiting myocardial infarct size, preserving left ventricular systolic function, and preventing the onset of heart failure. Recent advances in PCI technology to improve myocardial reperfusion and the introduction of novel anti-platelet and anti-thrombotic agents to maintain the patency of the infarct-related coronary artery continue to optimize PPCI procedure...
April 2012: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/23536610/myocardial-reperfusion-injury-looking-beyond-primary-pci
#15
REVIEW
Georg M Fröhlich, Pascal Meier, Steven K White, Derek M Yellon, Derek J Hausenloy
Coronary heart disease (CHD) is the leading cause of death and disability in Europe. For patients presenting with an acute ST-segment elevation myocardial infarction (STEMI), timely myocardial reperfusion using either thrombolytic therapy or primary percutaneous coronary intervention (PPCI) is the most effective therapy for limiting myocardial infarct (MI) size, preserving left-ventricular systolic function and reducing the onset of heart failure. Despite this, the morbidity and mortality of STEMI patients remain significant, and novel therapeutic interventions are required to improve clinical outcomes in this patient group...
June 2013: European Heart Journal
https://www.readbyqxmd.com/read/23457220/cerebral-desaturations-in-preterm-infants-a-crossover-trial-on-influence-of-oxygen-saturation-target-range
#16
RANDOMIZED CONTROLLED TRIAL
Manuel B Schmid, Reinhard J Hopfner, Susanne Lenhof, Helmut D Hummler, Hans Fuchs
OBJECTIVE: To test the hypothesis that a higher pulsoximetric arterial oxygen saturation (SpO2) target range is associated with reduced cerebral tissue oxygen desaturations from baseline during events of hypoxaemia or bradycardia. DESIGN: Randomised crossover trial. SETTING: Single tertiary care neonatal intensive care unit. PATIENTS: Sixteen preterm infants with severe intermittent hypoxaemia or bradycardia. INTERVENTIONS: SpO2 target was set to 80-92% and 85-96% for 4 h each in random sequence...
September 2013: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/23322670/is-hyperoxaemia-helping-or-hurting-patients-during-extracorporeal-membrane-oxygenation-review-of-a-complex-problem
#17
REVIEW
R A Hayes, K Shekar, J F Fraser
Extracorporeal membrane oxygenation (ECMO) facilitates organ support in patients with refractory cardiorespiratory failure whilst disease-modifying treatments can be administered. Improvements to the ECMO process have resulted in its increased utilisation. However, iatrogenic injuries remain, with bleeding and thrombosis the most significant concerns. Many factors contribute to the formation of thrombi, with the hyperoxaemia experienced during ECMO a potential contributor. Outside of ECMO, emerging evidence associates hyperoxaemia with increased mortality...
May 2013: Perfusion
https://www.readbyqxmd.com/read/23293275/high-inspired-oxygen-concentration-further-impairs-opioid-induced-respiratory-depression
#18
M Niesters, R P Mahajan, L Aarts, A Dahan
BACKGROUND: Hyperoxaemia depresses the output of peripheral and central chemoreceptors. Patients treated with opioids often receive supplemental oxygen to avert possible decreases in oxygen saturation (Sp(O2)).We examined the effect of a single dose of remifentanil in healthy volunteers inhaling room air vs air enriched with 50% oxygen. METHODS: Twenty healthy volunteers received i.v. 50 mg remifentanil (infused over 60 s) at anormoxic (N) or hyperoxic (FI(O2) 0...
May 2013: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/22977283/the-risk-of-serious-adverse-outcomes-associated-with-hypoxaemia-and-hyperoxaemia-in-acute-exacerbations-of-copd
#19
REVIEW
Laird Cameron, Janine Pilcher, Mark Weatherall, Richard Beasley, Kyle Perrin
BACKGROUND: Prehospital high concentration oxygen therapy leads to worse clinical outcomes in patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Less is known about the risks of hypoxaemia despite oxygen treatment. Current respiratory and ambulance guidelines recommend titration of supplemental oxygen to a target oxygen saturation range of 88%-92%. AIM: To explore the association between PaO(2) and risk of serious adverse clinical outcomes in AECOPD...
December 2012: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/22483005/improving-the-safety-of-oxygen-therapy-in-the-treatment-of-acute-myocardial-infarctions
#20
REVIEW
Maria Metcalfe
AIM: The article examines the evidence for giving oxygen routinely to patients with suspected myocardial infarction, and addresses the challenges in changing practice. BACKGROUND: It has been thought that administering oxygen to patients suffering from acute myocardial infarctions may be beneficial, but there is a lack of supporting evidence. Furthermore there is evidence that the use of oxygen in some circumstances may not improve clinical outcome. Despite conflicting evidence, guidelines in the past have recommended supplementary oxygen as part of treatment...
April 2012: International Emergency Nursing
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