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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...
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...
July 6, 2016: 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...
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
Jin Yong Jung
Traumatic brain injury (TBI) is usually combined with cervical spine (C-spine) injury. The possibility of C-spine injury is always considered when performing endotracheal intubation in these patients. Rapid sequence intubation is recommended with adequate sedative or analgesics and a muscle relaxant to prevent an increase in intracranial pressure during intubation in TBI patients. Normocapnia and mild hyperoxemia should be maintained to prevent secondary brain injury. The manual-in-line-stabilization (MILS) technique effectively lessens C-spine movement during intubation...
June 2015: Korean Journal of Anesthesiology
Pedram Niknafs, Elahe Norouzi, Bahareh Bahman Bijari, Mohammad Reza Baneshi
Neonates with respiratory distress syndrome (RDS), who are treated according to INSURE protocol; require arterial blood gas (ABG) analysis to decide on appropriate management. We conducted this study to investigate the validity of pulse oximetry instead of frequent ABG analysis in the evaluation of these patients. From a total of 193 blood samples obtained from 30 neonates <1500 grams with RDS, 7.2% were found to have one or more of the followings: acidosis, hypercapnia, or hypoxemia. We found that pulse oximetry in the detection of hyperoxemia had a good validity to appropriately manage patients without blood gas analysis...
May 2015: Iranian Journal of Medical Sciences
Fleur T Tehrani, Soraya Abbasi
The predictions of a computerized decision-support system (CDSS) are compared to clinical data obtained from a group of premature infants. The infants were suffering from respiratory distress syndrome (RDS) and were treated by the Continuous Positive Airway Pressure (CPAP) therapy. The predictions of the CDSS are found to be in general agreement with clinical measurements. The CDSS is also used to determine the effect of low level oxygen treatment on arterial oxygen pressure if the infant׳s oxygenation is low despite CPAP therapy...
July 2015: Computers in Biology and Medicine
Alexis A Topjian, Robert A Berg, Fabio Silvio Taccone
PURPOSE OF REVIEW: The purpose of this study is to review the recent literature describing how to assess and treat postcardiac arrest syndrome associated haemodynamics and manage oxygenation and ventilation derangements. RECENT FINDINGS: Postcardiac arrest syndrome is a well described entity that includes systemic ischemia-reperfusion response, myocardial dysfunction and neurologic dysfunction. Continued resuscitation in the hours to days following return of spontaneous circulation (ROSC) is important to increase the likelihood of long-term survival and neurological recovery...
June 2015: Current Opinion in Critical Care
Noah D Pavlisko, Maria Killos, Natalia Henao-Guerrero, Carolina H Riccó, Stephen Werre
OBJECTIVE: To determine the relationship between tissue oxygen saturation (StO2) and oxygen delivery (D˙O2) during hypoxemia and hyperoxemia. STUDY DESIGN: Prospective, randomized study. ANIMALS: Eight purpose-bred Beagle dogs. METHODS: Dogs were anesthetized with isoflurane, ventilated to eucapnia, and instrumented for thermodilution cardiac output, invasive mean arterial pressure (MAP), sartorius muscle StO2 and airway gas monitoring...
January 2016: Veterinary Anaesthesia and Analgesia
Nelson Claure, Eduardo Bancalari
Systems for closed-loop control of inspired oxygen have been developed to improve the maintenance of oxygenation targets in premature infants and reduce hyperoxemia, hypoxemia, and exposure to high inspired oxygen levels. This review describes some of the clinical studies that have evaluated the efficacy of these systems in oxygen targeting.
June 2015: Seminars in Fetal & Neonatal Medicine
Hayley Gershengorn
While avoiding hypoxemia has long been a goal of critical care practitioners, less attention has been paid to the potential for excessive oxygenation. Interest has mounted recently in understanding the clinical effects of hyperoxemia during critical illness, in particular its impact following cardiac arrest. In this issue of Critical Care, Dell'Anna and colleagues review available animal and human data evaluating the impact of hyperoxemia after cardiac arrest. They conclude that while hyperoxemia during cardiopulmonary resuscitation is probably desirable, it should probably be avoided during post-resuscitation care...
2014: Critical Care: the Official Journal of the Critical Care Forum
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