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Daftary R, Kamat N, Maydeo A. Is hypoxia a metric or a surrogate in colonoscopy? Simpler alternatives to bilevel positive airway pressure. Gastrointest Endosc 2024; 99:1074. [PMID: 38762302 DOI: 10.1016/j.gie.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 05/20/2024]
Affiliation(s)
- Rajen Daftary
- Department of GI Endoscopy and Interventional Pulmonology, Gleneagles Global Hospital, Parel
| | - Nagesh Kamat
- Institute of Gastrosciences, Sir H.N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Institute of Gastrosciences, Sir H.N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
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Jayakrishnan B, Gonuguntla HK. Oxygenation during Endobronchial Ultrasound: Where do we stand? Sultan Qaboos Univ Med J 2024; 24:1-3. [PMID: 38434456 PMCID: PMC10906759 DOI: 10.18295/squmj.2.2024.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 03/05/2024] Open
Affiliation(s)
- B Jayakrishnan
- Division of Pulmonology, Head & Neck and Thoracic Program, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
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Williamson ER, Henderson MA. Gas, tubes and flow. ANAESTHESIA & INTENSIVE CARE MEDICINE 2023. [DOI: 10.1016/j.mpaic.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Thompson L, Ward P, Nixon IJ, Milligan P, McNarry AF. Optiflow™ Switch: A design modification that can extend safe apnoeic oxygenation (THRIVE) time for tubeless airway surgery. A case series. Clin Otolaryngol 2023; 48:83-87. [PMID: 36192775 DOI: 10.1111/coa.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/19/2022] [Accepted: 09/10/2022] [Indexed: 01/07/2023]
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Schutzer-Weissmann J, Wojcikiewicz T, Karmali A, Lukosiute A, Sun R, Kanji R, Ahmed AR, Purkayastha S, Brett SJ, Cousins J. Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery. Br J Anaesth 2023; 130:103-110. [PMID: 35027169 PMCID: PMC9875910 DOI: 10.1016/j.bja.2021.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/26/2021] [Accepted: 12/08/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen delivery on duration of apnoea in morbidly obese patients. METHODS Morbidly obese patients undergoing bariatric surgery were randomly allocated to receive either high-flow nasal (70 L min-1) or facemask (15 L min-1) oxygen. After induction of anaesthesia, the patients were apnoeic for 18 min or until peripheral oxygen saturation decreased to 92%. RESULTS Eighty patients were studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 min in both the High-Flow Nasal Oxygen (IQR 18-18 min) and the Facemask (inter-quartile range [IQR], 4.1-18 min) groups. Five patients in the High-Flow Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% within 18 min. The risk of desaturation was significantly lower in the High-Flow Nasal Oxygen group (hazard ratio=0.27; 95% confidence interval [CI], 0.11-0.65; P=0.007). CONCLUSIONS In experienced hands, apnoeic oxygenation is possible in morbidly obese patients, and oxygen desaturation did not occur for 18 min in the majority of patients, whether oxygen delivery was high-flow nasal or low-flow facemask. High-flow nasal oxygen may reduce desaturation risk compared with facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery. CLINICAL TRIAL REGISTRATION NCT03428256.
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Affiliation(s)
- John Schutzer-Weissmann
- Imperial College Healthcare NHS Trust, London, UK,The Royal Marsden Hospital NHS Foundation Trust, London, UK,Corresponding author.
| | - Thomas Wojcikiewicz
- Imperial College Healthcare NHS Trust, London, UK,Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Anil Karmali
- Imperial College Healthcare NHS Trust, London, UK,London North West University Healthcare NHS Trust, Harrow, UK
| | - Asta Lukosiute
- Imperial College Healthcare NHS Trust, London, UK,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruoyi Sun
- Imperial College Healthcare NHS Trust, London, UK
| | - Rafiq Kanji
- Imperial College Healthcare NHS Trust, London, UK,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ahmed R. Ahmed
- Imperial College Healthcare NHS Trust, London, UK,Department of Surgery and Cancer, Imperial College London, UK
| | - Sanjay Purkayastha
- Imperial College Healthcare NHS Trust, London, UK,Department of Surgery and Cancer, Imperial College London, UK
| | - Stephen J. Brett
- Imperial College Healthcare NHS Trust, London, UK,Department of Surgery and Cancer, Imperial College London, UK
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Wyatt KD, Goel NN, Whittle JS. Recent advances in the use of high flow nasal oxygen therapies. Front Med (Lausanne) 2022; 9:1017965. [PMID: 36300187 PMCID: PMC9589055 DOI: 10.3389/fmed.2022.1017965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
High flow nasal oxygen is a relatively new option for treating patients with respiratory failure, which decreases work of breathing, improves tidal volume, and modestly increases positive end expiratory pressure. Despite well-described physiologic benefits, the clinical impact of high flow nasal oxygen is still under investigation. In this article, we review the most recent findings on the clinical efficacy of high flow nasal oxygen in Type I, II, III, and IV respiratory failure within adult and pediatric patients. Additionally, we discuss studies across clinical settings, including emergency departments, intensive care units, outpatient, and procedural settings.
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Affiliation(s)
- Kara D. Wyatt
- Scientific Consultant, Chattanooga, TN, United States
| | - Neha N. Goel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jessica S. Whittle
- Department of Emergency Medicine, University of Tennessee, Chattanooga, TN, United States
- Vapotherm, Inc., Exeter, NH, United States
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Guy L, Christensen R, Dodd B, Pelecanos A, Wyssusek K, Van Zundert A, Eley VA. The effect of transnasal humidified rapid-insufflation ventilator exchange (THRIVE) versus nasal prongs on safe apnoea time in paralysed obese patients: a randomised controlled trial. Br J Anaesth 2021; 128:375-381. [PMID: 34895717 DOI: 10.1016/j.bja.2021.10.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evidence is lacking regarding the efficacy of Optiflow transnasal humidified rapid-insufflation ventilator exchange (THRIVE™) in obese patients. We compared the impact of this technique at 70 L min-1 with 4 L min-1 oxygen via nasal prongs on safe apnoea times of paralysed obese patients. METHODS We randomised adults with a BMI >35 kg m-2 undergoing elective bariatric surgery. While apnoeic and paralysed, Group T received 70 L min-1 oxygen via Optiflow THRIVE™. Group N received nasal prong oxygen at 4 L min-1. The primary outcome was time to SpO2 ≤95% while apnoeic, with a 360 s cut-off. This was analysed by applying a time-to-event analysis. RESULTS Forty-two patients were included. The median (inter-quartile range) BMI was 44.8 kg m-2 (40.0-50.0) in Group T and 42.0 kg m-2 (39.3-45.1) in Group N. Median (inter-quartile range) time to SpO2 ≤95% in Group T was 356 (165 to ≥360) s and in Group N, 210 (160-270) s. Using a survival analysis framework, median time-to-event in Group T was 356 s (95% confidence interval 165 s-upper limit not defined) and 210 s (95% confidence interval 160-242 s) (P=0.049) in Group N. CONCLUSIONS Compared with oxygen delivered via nasal prongs at 4 L min-1, oxygen delivery via Optiflow THRIVE™ at a flow rate of 70 L min-1 can prolong safe apnoea time, however, the results are statistically inconclusive. Optiflow THRIVE™ did decrease the rate of reduction in Pao2 during apnoea. CLINICAL TRIAL REGISTRATION ANZCTR 12618000445279.
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Affiliation(s)
- Louis Guy
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - Rebecca Christensen
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Ben Dodd
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Division of Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Anita Pelecanos
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Kerstin Wyssusek
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Andre Van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Victoria A Eley
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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Schultz MJ, Roca O, Shrestha GS. Global lessons learned from COVID-19 mass casualty incidents. Br J Anaesth 2021; 128:e97-e100. [PMID: 34865825 PMCID: PMC8590954 DOI: 10.1016/j.bja.2021.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022] Open
Abstract
With healthcare systems rapidly becoming overwhelmed and occupied by patients during a pandemic, effective and safe care for patients is easily compromised. During the course of the current pandemic, numerous treatment guidelines have been developed and published that have improved care for patients with COVID-19. Certain lessons have only been learned during the course of the outbreak, from which we can learn for future pandemics. This editorial aims to raise awareness about the importance of timely stockpiling of sufficient amounts of personal protection equipment and medications, adequate oxygen supplies, uninterrupted electricity, and fair locally adapted triage strategies.
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Affiliation(s)
- Marcus J Schultz
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Oriol Roca
- Servei de Medicina Intensiva, Hospital Vall d'Hebron, Barcelona, Spain; Ciber Enfermedades Respiratorias (CibeRes), Instituto de Salud Carlos III, Madrid, Spain
| | - Gentle S Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Patel A, El-Boghdadly K. Facemask or high-flow nasal oxygenation: time to switch? Anaesthesia 2021; 77:7-11. [PMID: 34634137 DOI: 10.1111/anae.15593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 01/13/2023]
Affiliation(s)
- A Patel
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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