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Alan Leviton, Elizabeth N Allred, Robert M Joseph, T Michael O'Shea, Karl C K Kuban
Among 740 children born extremely preterm, we evaluated the relationship between the highest and lowest quartiles of the distributions of PaO2 and PaCO2, as well as the lowest quartile of pH on one day, and separately on two days, and the risk of neurocognitive, language, and behavioral dysfunctions at age 10 years. Children who had hypoxemia, hyperoxemia, hypocapnia, hypercapnia, and acidemia, sometimes on only one day, and sometimes on two or more days, were more likely than others to have a high illness severity score (within the first 12 postnatal hours), and 10 years later to have multiple dysfunctions...
April 7, 2017: Respiratory Physiology & Neurobiology
Maarit Lång, Rahul Raj, Markus Benedikt Skrifvars, Matti Reinikainen, Stepani Bendel
No abstract text is available yet for this article.
March 17, 2017: Neurosurgery
Kailei Du, Yanfei Shen
No abstract text is available yet for this article.
March 15, 2017: Neurosurgery
Nandini Raghuraman, Lorene A Temming, Molly J Stout, George A Macones, Alison G Cahill, Methodius G Tuuli
OBJECTIVE: To test the hypothesis that intrauterine hyperoxemia is associated with an increased risk of neonatal morbidity. METHODS: This was a secondary analysis of a prospective study of singleton, nonanomalous deliveries at or beyond 37 weeks of gestation at an institution with a universal umbilical cord gas policy from 2010 to 2014. The primary outcome was a composite of neonatal morbidity including neonatal death, meconium aspiration syndrome, intubation, mechanical ventilation, hypoxic-ischemic encephalopathy, and hypothermic therapy...
April 2017: Obstetrics and Gynecology
Edmund Morozoff, John A Smyth, Mehrdad Saif
BACKGROUND: Within the context of automating neonatal oxygen therapy, this article describes the transformation of an idea verified by a computer model into a device actuated by a computer model. Computer modeling of an entire neonatal oxygen therapy system can facilitate the development of closed-loop control algorithms by providing a verification platform and speeding up algorithm development. METHODS: In this article, we present a method of mathematically modeling the system's components: the oxygen transport within the patient, the oxygen blender, the controller, and the pulse oximeter...
January 2017: Anesthesia and Analgesia
J I Hagadorn, D W Sink, M E Buus-Frank, E M Edwards, K A Morrow, J D Horbar, K Ferrelli, R F Soll
OBJECTIVES: To assess progress of neonatal intensive care units (NICUs) participating in the Vermont Oxford Network iNICQ 2015: Alarm Safety Collaborative in achieving Joint Commission 2014 alarm safety goals with respect to oximeters, and to compare patient-level oxygen saturation (SpO2) and oximeter alarm data to local policies. STUDY DESIGN: Prospective multicenter audits in February and August 2015 assessed implementation of policies addressing Joint Commission 2014 Alarm Safety goals, and ascertained SpO2 targets, oximeter alarm settings and compliance with policy-specified SpO2 targets and alarms...
March 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
Daniel S Martin, Helen T McKenna, Clare M Morkane
No abstract text is available yet for this article.
December 2016: Anesthesia and Analgesia
Benedikt Nußbaum, Peter Radermacher, Pierre Asfar, Clair Hartmann
Hyperoxia is common practice in the acute management of circulatory shock, and observational studies report that it is present in more than 50 % of mechanically ventilated patients during the first 24 h after intensive care unit (ICU) admission. On the other hand, "oxygen toxicity" due to the increased formation of reactive oxygen species limits its use due to serious deleterious side effects. However, formation of reactive oxygen species to boost bacterial killing is one of the body's anti-microbial auto-defense mechanisms and, hence, O2 has been referred to as an antibiotic...
August 16, 2016: Critical Care: the Official Journal of the Critical Care Forum
Shay P McGuinness, Rachael L Parke, Kate Drummond, Tim Willcox, Michael Bailey, Cornelius Kruger, Megan Baker, Keri-Anne Cowdrey, Eileen Gilder, Lianne McCarthy, Thomas Painter
BACKGROUND: Cardiac surgery utilizing cardiopulmonary bypass (CPB) is one of the most common forms of major surgery. Cardiac surgery-associated multiorgan dysfunction (CSA-MOD) is well recognized and includes acute kidney injury (AKI), hepatic impairment, myocardial damage, and postoperative neurologic deficit. Pathophysiology of CSA-MOD involves numerous injurious pathways linked to the use of CPB including oxidative stress and formation of reactive iron species. During cardiac surgery with CPB, arterial return blood is oxygenated to supranormal levels...
September 2016: Anesthesiology
Nicholas J Johnson, Kalani Dodampahala, Babette Rosselot, Sarah M Perman, Mark E Mikkelsen, Munish Goyal, David F Gaieski, Anne V Grossestreuer
A number of observational studies have evaluated the association between arterial oxygen tensions and outcome after cardiac arrest with variable results. The objective of this study is to determine the association between arterial oxygen tension and neurological outcome after cardiac arrest. A retrospective cohort analysis was performed using the Penn Alliance for Therapeutic Hypothermia registry. Adult patients who experienced return of spontaneous circulation after in-hospital or out-of-hospital cardiac arrest (OHCA) and had a partial pressure of arterial oxygen (PaO2) recorded within 48 hours were included...
March 2017: Therapeutic Hypothermia and Temperature Management
Sophie Six, Karim Jaffal, Geoffrey Ledoux, Emmanuelle Jaillette, Frédéric Wallet, Saad Nseir
BACKGROUND: Consequences of hyperoxemia, such as acute lung injury, atelectasis, and reduced bacterial clearance, might promote ventilator-associated pneumonia (VAP). The aim of our study was to determine the relationship between hyperoxemia and VAP. METHODS: This retrospective observational study was performed in a 30-bed mixed ICU. All patients receiving invasive mechanical ventilation for more than 48 hours were eligible. VAP was defined using clinical, radiologic, and quantitative microbiological criteria...
June 22, 2016: Critical Care: the Official Journal of the Critical Care Forum
Richard H Kallet, Richard D Branson
Oxygen is both lifesaving and toxic. Appropriate use of oxygen aims to provide a balance between the two effects. Although local oxygen toxicity to the lung is well accepted, recent evidence has called into question the negative consequences of hyperoxemia in other organ beds. Hyperoxia following cardiac arrest, traumatic brain injury, and stroke has been shown to worsen outcomes. The role of hyperoxemia in mechanically ventilated patients, in the face of non-toxic inspired oxygen concentrations, is less clear...
June 2016: Respiratory Care
S Lakshminrusimha, O D Saugstad
Neonatal hypoxemic respiratory failure (HRF), a deficiency of oxygenation associated with insufficient ventilation, can occur due to a variety of etiologies. HRF can result when pulmonary vascular resistance (PVR) fails to decrease at birth, leading to persistent pulmonary hypertension of newborn (PPHN), or as a result of various lung disorders including congenital abnormalities such as diaphragmatic hernia, and disorders of transition such as respiratory distress syndrome, transient tachypnea of newborn and perinatal asphyxia...
June 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
S Lakshminrusimha, G G Konduri, R H Steinhorn
Recent advances in our understanding of neonatal pulmonary circulation and the underlying pathophysiology of hypoxemic respiratory failure (HRF)/persistent pulmonary hypertension of the newborn (PPHN) have resulted in more effective management strategies. Results from animal studies demonstrate that low alveolar oxygen tension (PAO2) causes hypoxic pulmonary vasoconstriction, whereas an increase in oxygen tension to normoxic levels (preductal arterial partial pressure of oxygen (PaO2) between 60 and 80 mm Hg and/or preductal peripheral capillary oxygen saturation between 90% and 97%) results in effective pulmonary vasodilation...
June 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
D P Smith, J A Perez
INTRODUCTION: Nitric oxide is a potent, selective pulmonary vasodilator that has been proven to decrease pulmonary vascular resistance and has been part of the treatment arsenal for persistent pulmonary hypertension of the newborn (PPHN). In 2009, the approach to the administration of inhaled nitric oxide (iNO) at Winnie Palmer Hospital for Women and Babies (WPH) changed to emphasize avoiding invasive ventilation while maintaining optimal ventilation to perfusion ratio, avoiding hyperventilation and alkalosis agents, and avoiding hyperoxemia and hyperoxia exposure...
May 19, 2016: Journal of Neonatal-perinatal Medicine
Marika Fallenius, Rahul Raj, Matti Reinikainen, Stepani Bendel, Markus B Skrifvars
OBJECTIVE: To determine the relation between high arterial oxygen tension levels (PaO2) and long-term mortality in patients with spontaneous intracerebral hemorrhage treated in the ICU. DESIGN: National observational multicenter cohort study. SETTING: Twenty-one ICUs in Finland. PATIENTS: A total of 3,033 adult patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were divided into high (> 150 mm Hg), intermediate (97...
January 2016: Critical Care Medicine
Sebastian Hafner, François Beloncle, Andreas Koch, Peter Radermacher, Pierre Asfar
This review summarizes the (patho)-physiological effects of ventilation with high FiO2 (0.8-1.0), with a special focus on the most recent clinical evidence on its use for the management of circulatory shock and during medical emergencies. Hyperoxia is a cornerstone of the acute management of circulatory shock, a concept which is based on compelling experimental evidence that compensating the imbalance between O2 supply and requirements (i.e., the oxygen dept) is crucial for survival, at least after trauma. On the other hand, "oxygen toxicity" due to the increased formation of reactive oxygen species limits its use, because it may cause serious deleterious side effects, especially in conditions of ischemia/reperfusion...
December 2015: Annals of Intensive Care
Maarit Lång, Rahul Raj, Markus Benedikt Skrifvars, Timo Koivisto, Hanna Lehto, Riku Kivisaari, Mikael von Und Zu Fraunberg, Matti Reinikainen, Stepani Bendel
BACKGROUND: Targeting hyperoxemia is common practice in neurocritical care settings, but the safety of hyperoxemia has been questioned. OBJECTIVE: To investigate the independent effect of hyperoxemia on outcome in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: We included 432 patients with aneurysmal SAH on mechanical ventilation for at least 24 hours after intensive care unit (ICU) admission. Arterial blood gas levels were calculated as time-weighted averages (TWAs) of all blood gas measurements during the first 24 hours in the ICU...
April 2016: Neurosurgery
Stephan von Düring, Stéphanie Bruchez, Laurent Suppan, Marc Niquille
Oxygen adiministration for both medical and traumatic emergencies is regarded as an essential component of resuscitation. However, many recent studies suggest that the use of oxygen should be more restrictive. Detrimental effects of normobaric oxygen therapy in patients suffering from hypercapnic respiratory diseases have been demonstrated, especially because of the suppression of the hypoxic drive. Apart from this particular situation, correction of hypoxemia is still a widely accepted treatment target, although there is growing evidence that hyperoxemia could be harmful in acute coronary syndromes and cardio-respiratory arrests...
August 12, 2015: Revue Médicale Suisse
Anton H van Kaam, Helmut D Hummler, Maria Wilinska, Janusz Swietlinski, Mithilesh K Lal, Arjan B te Pas, Gianluca Lista, Samir Gupta, Carlos A Fajardo, Wes Onland, Markus Waitz, Malgorzata Warakomska, Francesco Cavigioli, Eduardo Bancalari, Nelson Claure, Thomas E Bachman
OBJECTIVE: To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (FiO2) in maintaining arterial oxygen saturation (SpO2) within a higher (91%-95%) and a lower (89%-93%) target range in preterm infants. STUDY DESIGN: Eighty preterm infants (gestational age [median]: 26 weeks, age [median] 18 days) on noninvasive (n = 50) and invasive (n = 30) respiratory support with supplemental oxygen, were first randomized to one of the SpO2 target ranges and then treated with automated FiO2 (A-FiO2) and manual FiO2 (M-FiO2) oxygen control for 24 hours each, in random sequence...
September 2015: Journal of Pediatrics
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