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https://www.readbyqxmd.com/read/27908325/-using-a-high-inspiratory-oxygen-fraction-during-surgery
#1
Trine Grodum Eskesen, Jacob Steinmetz, Lars S Rasmussen
In this article we discuss the current level of evidence for using a high inspiratory oxygen fraction (0.60-0.90) during surgery. More than 7,000 patients have been included in randomized trials, but no significant beneficial effect was found in a recent meta-analysis as compared with 0.30-0.40 oxygen. A high oxygen fraction should be used to correct or prevent hypoxaemia in special situations, but the available studies do not allow a recommendation to use a high inspiratory oxygen fraction as a routine practice in surgical patients...
November 28, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/27902610/mean-apnea-hypopnea-duration-but-not-apnea-hypopnea-index-is-associated-with-worse-hypertension-in-patients-with-obstructive-sleep-apnea
#2
Hao Wu, Xiaojun Zhan, Mengneng Zhao, Yongxiang Wei
To determine which polysomnography parameters are associated with severity of hypertension.This retrospective study collected data on all patients admitted to our urban, academic center in Beijing with hypertension who had undergone polysomnograms (PSG) and were diagnosed with obstructive sleep apnea (OSA) (apnea-hyponea index [AHI] ≥5/hour). We then compared polysomnographic parameters (AHI, oxygen desaturation index [ODI], lowest oxygen saturation [LOS], and mean apnea-hypopnea duration [MAD]) by hypertension severity in this cohort...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27900922/-extracorporeal-life-support-for-legionella-pneumonia
#3
W A C Koekkoek, C Savelkoul, P R Wijnandts, M Platenkamp, D W Donker, D H T Tjan
BACKGROUND: Legionella species cause 5% of all community acquired pneumonias. However, Legionella pneumonia results relatively often in admission to the intensive care unit (ICU). A significant complication is the development of acute respiratory distress syndrome (ARDS). The ICU mortality rate for Legionella pneumonia is > 30% with conventional treatments. CASE DESCRIPTION: A 64-year-old male was admitted to the ICU with respiratory failure due to Legionella pneumonia complicated by ARDS...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27888413/improving-manual-oxygen-titration-in-preterm-infants-by-training-and-guideline-implementation
#4
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/27886372/oxygen-for-breathlessness-in-patients-with-chronic-obstructive-pulmonary-disease-who-do-not-qualify-for-home-oxygen-therapy
#5
REVIEW
Magnus Ekström, Zainab Ahmadi, Anna Bornefalk-Hermansson, Amy Abernethy, David Currow
BACKGROUND: Breathlessness is a cardinal symptom of chronic obstructive pulmonary disease (COPD). Long-term oxygen therapy (LTOT) is given to improve survival time in people with COPD and severe chronic hypoxaemia at rest. The efficacy of oxygen therapy for breathlessness and health-related quality of life (HRQOL) in people with COPD and mild or no hypoxaemia who do not meet the criteria for LTOT has not been established. OBJECTIVES: To determine the efficacy of oxygen versus air in mildly hypoxaemic or non-hypoxaemic patients with COPD in terms of (1) breathlessness; (2) HRQOL; (3) patient preference whether to continue therapy; and (4) oxygen-related adverse events...
November 25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27878796/patent-foramen-ovale-a-novel-cardiovascular-risk-factor-in-patients-with-sleep-disordered-breathing-and-high-altitude-dwellers
#6
Emrush Rexhai, Urs Scherrer, Stefano F Rimoldi
Diseases associated with chronic hypoxaemia are a leading cause of morbidity and mortality in Western countries. Epidemiological data indicate that cardiovascular diseases contribute substantially to this problem, but the underlying mechanisms are incompletely understood. Sleep disordered breathing and high altitude exposure are frequent conditions associated with hypoxaemia. Recent evidence suggests that in these conditions the concomitant presence of a patent foramen ovale plays an important pathogenic role...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27872166/consistency-of-medical-record-reporting-of-a-set-of-indicators-for-proactive-palliative-care-in-patients-with-chronic-obstructive-pulmonary-disease-a-pilot-study
#7
Ria G Duenk, Stans C Verhagen, Mireille Ae Janssen, Richard Pnr Dekhuijzen, Kris Cp Vissers, Yvonne Engels, Yvonne Heijdra
To identify patients hospitalized for an acute exacerbation of chronic obstructive pulmonary disease (COPD) who have a poor prognosis and might benefit from proactive palliative care, a set of indicators had been developed from the literature. A patient is considered eligible for proactive palliative care when meeting ≥2 criteria of the proposed set of 11 indicators. In order to develop a doctor-friendly and patient-convenient tool, our primary objective was to examine whether these indicators are documented consistently in the medical records...
November 21, 2016: Chronic Respiratory Disease
https://www.readbyqxmd.com/read/27867133/fiberoptic-bronchoscopy-and-remifentanil-target-controlled-infusion-in-critically-ill-patients-with-acute-hypoxaemic-respiratory-failure-a-descriptive-study
#8
Saïda Rezaiguia-Delclaux, Florent Laverdure, Talna Kortchinsky, Léa Lemasle, Audrey Imbert, François Stéphan
INTRODUCTION: Sedation optimizes patient comfort and ease of execution during fiberoptic bronchoscopy (FOB). Our objective was to describe the safety and efficacy of remifentanil-TCI during FOB in non-intubated, hypoxaemic, thoracic-surgery ICU patients. METHODS: Consecutive spontaneously breathing adults requiring FOB after thoracic surgery were included if they had hypoxaemia (PaO2/FiO2 < 300mmHg or need for non-invasive ventilation [NIV]) and prior FOB failure under topical anaesthesia...
November 17, 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27852705/non-treatment-of-children-with-community-health-worker-diagnosed-fast-breathing-pneumonia-in-rural-malawi-exploratory-subanalysis-of-a-prospective-cohort-study
#9
Carina King, Tim Colbourn, Limangeni Mankhambo, James Beard, Debbie C Hay Burgess, Anthony Costello, Rasa Izadnegahdar, Norman Lufesi, Charles Mwansambo, Bejoy Nambiar, Eric S Johnson, Robert W Platt, David Mukanga, Eric D McCollum
BACKGROUND: Despite recent progress, pneumonia remains the largest infectious killer of children globally. This paper describes outcomes of not treating community-diagnosed fast-breathing pneumonia on patient recovery. METHODS: We conducted an exploratory subanalysis of an observational prospective cohort study in Malawi. We recruited children (2-59 months) diagnosed by community health workers with fast-breathing pneumonia using WHO integrated community case management (iCCM) guidelines...
November 16, 2016: BMJ Open
https://www.readbyqxmd.com/read/27771739/effect-of-early-postextubation-high-flow-nasal-cannula-vs-conventional-oxygen-therapy-on-hypoxaemia-in-patients-after-major-abdominal-surgery-a-french-multicentre-randomised-controlled-trial-opera
#10
Emmanuel Futier, Catherine Paugam-Burtz, Thomas Godet, Linda Khoy-Ear, Sacha Rozencwajg, Jean-Marc Delay, Daniel Verzilli, Jeremie Dupuis, Gerald Chanques, Jean-Etienne Bazin, Jean-Michel Constantin, Bruno Pereira, Samir Jaber
PURPOSE: High-flow nasal cannula (HFNC) oxygen therapy is attracting increasing interest in acute medicine as an alternative to standard oxygen therapy; however, its use to prevent hypoxaemia after major abdominal surgery has not been evaluated. Our trial was designed to close this evidence gap. METHODS: A multicentre randomised controlled trial was carried out at three university hospitals in France. Adult patients at moderate to high risk of postoperative pulmonary complications who had undergone major abdominal surgery using lung-protective ventilation were randomly assigned using a computer-generated sequence to receive either HFNC oxygen therapy or standard oxygen therapy (low-flow oxygen delivered via nasal prongs or facemask) directly after extubation...
October 22, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27756811/risk-factors-for-hypoxemia-following-surgical-repair-of-acute-type-a-aortic-dissection
#11
Nan Liu, Wei Zhang, Weiguo Ma, Wei Shang, Jun Zheng, Lizhong Sun
OBJECTIVES: To identify the risk factors for hypoxaemia following surgical repair of acute type A aortic dissection. METHODS: This was a retrospective study of patients treated between October 2013 and December 2014 at the Department of Cardiovascular Surgery, Anzhen Hospital, China. Univariable and multivariable analyses were performed on the clinical data of 160 patients with acute type A dissection and who underwent ascending aortic and arch replacement under deep hypothermic circulatory arrest...
October 17, 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/27692868/chronic-hypoxaemia-as-a-molecular-regulator-of-fetal-lung-development-implications-for-risk-of-respiratory-complications-at-birth
#12
Erin V McGillick, Sandra Orgeig, Dino A Giussani, Janna L Morrison
Exposure to altered intrauterine conditions during pregnancy influences both fetal growth and organ development. Chronic fetal hypoxaemia is a common pregnancy complication associated with intrauterine growth restriction (IUGR) that may influence the risk of infants experiencing respiratory complications at birth. There are a variety of signalling pathways that contribute to normal fetal lung development at the molecular level. The specific molecular effects of chronic hypoxaemia associated with IUGR on lung development are likely to be dependent on the specific aetiology (maternal, placental and/or fetal factors) that can alter hormone concentrations, oxygen and nutrient transport to the fetus...
August 21, 2016: Paediatric Respiratory Reviews
https://www.readbyqxmd.com/read/27688259/pre-hospital-identification-and-post-recovery-challenges-of-intoxication-with-synthetic-cannabinoid-containing-legal-high-products-such-as-exodus-damnation
#13
David Fitzpatrick, Patrick O'Meara, Andrew Cunningham
This short report describes the case of a young adult male who had smoked a synthetic cannabinoid legal high product called 'Exodus Damnation'. The patient's presentation was atypical from that described in the literature, with hypotension and hypoxaemia. Of note was the rapid recovery after pre-hospital intervention with high-flow oxygen therapy and intravenous fluids. The patient refused on-going care, despite repeated advice to attend the Emergency Department. The distinct lack of specialist support and referral to drug treatment for this patient population, with whom ambulance services are coming into contact with increasing frequency, is reported...
November 2016: Scottish Medical Journal
https://www.readbyqxmd.com/read/27659967/short-term-effects-of-low-volume-resuscitation-with-hypertonic-saline-and-hydroxyethylstarch-in-an-experimental-model-of-lung-contusion-and-haemorrhagic-shock
#14
Bertrand Prunet, Pierre-Yves Cordier, Nicolas Prat, Sophie De Bourmont, David Couret, Dominique Lambert, Pierre Michelet
OBJECTIVES: This study aimed to assess the short-term respiratory tolerance and haemodynamic efficiency of low-volume resuscitation with hypertonic saline and hydroxyethylstarch (HS/HES) in a pig model of lung contusion and controlled haemorrhagic shock. We hypothesised that a low-volume of HS/HES after haemorrhagic shock did not impact contused lungs in terms of extravascular lung water 3hours after trauma. METHODS: A lung contusion resulting from blunt chest trauma was induced in 28 anaesthetised female pigs with five bolt-shots to the right thoracic cage, followed by haemorrhagic shock and fluid resuscitation...
September 20, 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27640202/sleep-disordered-breathing-do-we-have-to-change-gears-in-heart-failure
#15
REVIEW
Martin R Cowie
The majority of patients with heart failure have sleep-disordered breathing (SDB)-with central (rather than obstructive) sleep apnoea becoming the predominant form in those with more severe disease. Cyclical apnoeas and hypopnoeas are associated with sleep disturbance, hypoxaemia, haemodynamic changes, and sympathetic activation. Such patients have a worse prognosis than those without SDB. Mask-based therapies of positive airway pressure targeted at SDB can improve measures of sleep quality and partially normalise the sleep and respiratory physiology, but recent randomised trials of cardiovascular outcomes in central sleep apnoea have been neutral or suggested the possibility of harm, likely from increased sudden death...
October 2016: Current Heart Failure Reports
https://www.readbyqxmd.com/read/27634820/development-and-preclinical-testing-of-an-adaptive-algorithm-for-automated-control-of-inspired-oxygen-in-the-preterm-infant
#16
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/27617509/association-of-intermittent-and-continuous-hypoxaemia-with-carotid-and-brachial-arterial-intima-media-thicknesses
#17
S Asker, M Asker, M Ozgokce, B Ozbay
Objective: We hypothesized that the effect of intermittent and continuous hypoxia on carotid and brachial artery intima-media thicknesses (IMTs) may be similar. We aimed to assess the carotid and brachial arteries' IMTs in cases with intermittent [obstructive sleep apnea syndrome] (OSAS) and continuous (chronic obstructive pulmonary disease) [COPD] hypoxemia together with other confounding demographic and biochemical factors. Methods: The study was prospectively performed on 197 patients allocated in three groups: 80 patients with severe OSAS, 80 severe COPD patients and 37 healthy controls...
February 12, 2016: West Indian Medical Journal
https://www.readbyqxmd.com/read/27611719/contractile-capability-of-the-diaphragm-assessed-by-ultrasonography-predicts-nocturnal-oxygen-saturation-in-copd
#18
Kazuki Okura, Atsuyoshi Kawagoshi, Masahiro Iwakura, Keiyu Sugawara, Hitomi Takahashi, Takeshi Kashiwagura, Mitsunobu Homma, Masahiro Satake, Takanobu Shioya
BACKGROUND AND OBJECTIVE: Diaphragm function might be useful to predict nocturnal oxygen desaturation in COPD. Ultrasonography has been widely used for the assessment of the diaphragm. We aimed to investigate the relationship between the contractile capability of the diaphragm assessed by ultrasonography and the nocturnal percutaneous arterial oxygen saturation (NSpO2 ) in COPD. METHODS: Twenty-eight male patients with COPD (age, 73 ± 7 years; forced expiratory volume in 1 s (FEV1 ), 54...
September 9, 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/27610250/platypnea-orthodeoxia-syndrome-after-transcatheter-aortic-valve-implantation
#19
Andrew K Roy, Jerome Garot, Antoinette Neylon, Marco Spaziano, Fadi J Sawaya, Thierry Lefèvre
Progressive dyspnea and hypoxaemia in the subacute phase after transcatheter aortic valve implantation (TAVI) are uncommon and warrant immediate assessment of valve and prosthesis leaflet function to exclude thrombosis, as well as investigation for other causes related to the procedure, such as left ventricular dysfunction, pulmonary embolism, and respiratory sepsis. In this case, we report the observation of a patient presenting two weeks after TAVI with arterial hypoxaemia in an upright position, relieved by lying flat, and coupled with an intracardiac shunt detected on echocardiography in the absence of pulmonary hypertension, raising the suspicion of Platypnea-Orthodeoxia Syndrome (POS)...
2016: Case Reports in Cardiology
https://www.readbyqxmd.com/read/27609843/multivariable-fractional-polynomial-interaction-to-investigate-continuous-effect-modifiers-in-a-meta-analysis-on-higher-versus-lower-peep-for-patients-with-ards
#20
Benjamin Kasenda, Willi Sauerbrei, Patrick Royston, Alain Mercat, Arthur S Slutsky, Deborah Cook, Gordon H Guyatt, Laurent Brochard, Jean-Christophe M Richard, Thomas E Stewart, Maureen Meade, Matthias Briel
OBJECTIVES: A recent individual patient data (IPD) meta-analysis suggested that patients with moderate or severe acute respiratory distress syndrome (ARDS) benefit from higher positive end-expiratory pressure (PEEP) ventilation strategies. However, thresholds for continuous variables (eg, hypoxaemia) are often arbitrary and linearity assumptions in regression approaches may not hold; the multivariable fractional polynomial interaction (MFPI) approach can address both problems. The objective of this study was to apply the MFPI approach to investigate interactions between four continuous patient baseline variables and higher versus lower PEEP on clinical outcomes...
September 8, 2016: BMJ Open
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