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Robba C, Battaglini D, Cinotti R, Asehnoune K, Stevens R, Taccone FS, Badenes R, Pelosi P. Individualized Thresholds of Hypoxemia and Hyperoxemia and their Effect on Outcome in Acute Brain Injured Patients: A Secondary Analysis of the ENIO Study. Neurocrit Care 2024; 40:515-528. [PMID: 37322325 DOI: 10.1007/s12028-023-01761-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND In acute brain injury (ABI), the effects of hypoxemia as a potential cause of secondary brain damage and poor outcome are well documented, whereas the impact of hyperoxemia is unclear. The primary aim of this study was to assess the episodes of hypoxemia and hyperoxemia in patients with ABI during the intensive care unit (ICU) stay and to determine their association with in-hospital mortality. The secondary aim was to identify the optimal thresholds of arterial partial pressure of oxygen (PaO2) predicting in-hospital mortality. METHODS We conducted a secondary analysis of a prospective multicenter observational cohort study. Adult patients with ABI (traumatic brain injury, subarachnoid aneurysmal hemorrhage, intracranial hemorrhage, ischemic stroke) with available data on PaO2 during the ICU stay were included. Hypoxemia was defined as PaO2 < 80 mm Hg, normoxemia was defined as PaO2 between 80 and 120 mm Hg, mild/moderate hyperoxemia was defined as PaO2 between 121 and 299 mm Hg, and severe hyperoxemia was defined as PaO2 levels ≥ 300 mm Hg. RESULTS A total of 1,407 patients were included in this study. The mean age was 52 (±18) years, and 929 (66%) were male. Over the ICU stay, the fractions of patients in the study cohort who had at least one episode of hypoxemia, mild/moderate hyperoxemia, and severe hyperoxemia were 31.3%, 53.0%, and 1.7%, respectively. PaO2 values below 92 mm Hg and above 156 mm Hg were associated with an increased probability of in-hospital mortality. Differences were observed among subgroups of patients with ABI, with consistent effects only seen in patients without traumatic brain injury. CONCLUSIONS In patients with ABI, hypoxemia and mild/moderate hyperoxemia were relatively frequent. Hypoxemia and hyperoxemia during ICU stay may influence in-hospital mortality. However, the small number of oxygen values collected represents a major limitation of the study.
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Affiliation(s)
- Chiara Robba
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Science and Integrated Diagnostic, University of Genova, Genova, Italy
| | | | - Raphael Cinotti
- Department of Anesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, Nantes, France
- UMR 1246 SPHERE Methods in Patients-Centered Outcomes and Health Research, University of Nantes, University of Tours, INSERM, Nantes, France
| | - Karim Asehnoune
- Department of Anesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, Nantes, France
| | - Robert Stevens
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Rafael Badenes
- Anesthesiology and Surgical-Trauma Intensive Care, University Clinic Hospital, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
- INCLIVA Research Medical Institute, Valencia, Spain
| | - Paolo Pelosi
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Science and Integrated Diagnostic, University of Genova, Genova, Italy
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Malinverni S, Wilmin S, Stoll T, de Longueville D, Preseau T, Mohler A, Bouazza FZ, Annoni F, Gerard L, Denoel P, Boutrika I. Postresuscitation oxygen reserve index-guided oxygen titration in out-of-hospital cardiac arrest survivors: A randomised controlled trial. Resuscitation 2024; 194:110005. [PMID: 37863418 DOI: 10.1016/j.resuscitation.2023.110005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND PURPOSE Hyperoxia after return of spontaneous circulation is potentially harmful, and oxygen titration in a prehospital setting is challenging. This study aimed to compare outcomes of oxygen reserve index-supported prehospital oxygen titration during prehospital transport with those of standard oxygen titration. METHODS AND TRIAL DESIGN We enrolled patients who experienced return of spontaneous circulation after cardiac arrest in a prospective randomized study. Patients were randomly divided (1:1) to undergo oxygen titration based on the oxygen reserve index and SpO2 (intervention) or SpO2 only (control). FIO2 titration targeted SpO2 level maintenance at 94-98%. The primary outcome was the normoxia index, reflecting the proportion of both hyperoxia- and hypoxia-free time during prehospital intervention. RESULTS A total of 92 patients were included in the study. The mean normoxia index was 0.828 in the control group and 0.847 in the intervention group (difference = 0.019 [95 % CI, -0.056-0.095]), with no significant difference between the groups. No significant differences were found in the incidence of hypoxia or hyperoxia between groups. No difference was found in the mean PaO2 at hospital admission (116 mmHg [IQR: 89-168 mmHg] in the control group vs 115 mmHg [IQR: 89-195 mmHg] in the intervention group; p = 0.86). No difference was observed in serum neuron-specific enolase levels 48 h post-ROSC after adjustment for known confounders. CONCLUSION Oxygen reserve index- combined with pulse oximetry-based prehospital oxygen titration did not significantly improve the normoxia index compared with standard oxygen titration based on pulse oximetry alone (NCT03653325).
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Affiliation(s)
- Stefano Malinverni
- Emergency Department, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Brussels, Belgium.
| | - Stéphan Wilmin
- Emergency Department, Centre Hospitalier Universitaire Brugmann, Avenue Jean Joseph Crocq 1, 1020 Bruxelles, Belgium
| | - Timothée Stoll
- Emergency Department, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Brussels, Belgium
| | - Diane de Longueville
- Emergency Department, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Brussels, Belgium
| | - Thierry Preseau
- Emergency Department, Centre Hospitalier Universitaire Brugmann, Avenue Jean Joseph Crocq 1, 1020 Bruxelles, Belgium
| | - Andreas Mohler
- Emergency Department, Centre Hospitalier Universitaire Brugmann, Avenue Jean Joseph Crocq 1, 1020 Bruxelles, Belgium
| | - Fatima Zohra Bouazza
- Emergency Department, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Brussels, Belgium
| | - Filippo Annoni
- Intensive Care Unit, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
| | - Ludovic Gerard
- Intensive Care Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Clos Chapelle-aux-Champs 43, 1200 Woluwe-Saint-Lambert, Brussels, Belgium
| | - Paule Denoel
- Emergency Department, Cliniques de l'Europe, Avenue De Fré 206, 1180 Uccle, Belgium
| | - Ikram Boutrika
- Emergency Department, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Brussels, Belgium
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Wang CH, Chang WT, Huang CH, Tsai MS, Wang CC, Liu SH, Chen WJ. Optimal inhaled oxygen and carbon dioxide concentrations for post-cardiac arrest cerebral reoxygenation and neurological recovery. iScience 2023; 26:108476. [PMID: 38187189 PMCID: PMC10767205 DOI: 10.1016/j.isci.2023.108476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Prolonged cerebral hypoperfusion after the return of spontaneous circulation (ROSC) from cardiac arrest (CA) may lead to poor neurological recovery. In a 7-min asphyxia-induced CA rat model, four combinations of inhaled oxygen (iO2) and carbon dioxide (iCO2) were administered for 150 min post-ROSC and compared in a randomized animal trial. At the end of administration, the partial pressure of brain tissue oxygenation (PbtO2) monitored in the hippocampal CA1 region returned to the baseline for the 88% iO2 [ΔPbtO2, median: -0.39 (interquartile range: 5.6) mmHg] and 50% iO2 [ΔpbtO2, -2.25 (10.9) mmHg] groups; in contrast, PbtO2 increased substantially in the 88% iO2+12% iCO2 [ΔpbtO2, 35.05 (16.0) mmHg] and 50% iO2+12% iCO2 [ΔpbtO2, 42.03 (31.7) mmHg] groups. Pairwise comparisons (post hoc Dunn's test) indicated the significant role of 12% iCO2 in augmenting PbtO2 during the intervention and improving neurological recovery at 24 h post-ROSC. Facilitating brain reoxygenation may improve post-CA neurological outcomes.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chan-Chi Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shing-Hwa Liu
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
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Yamamoto R, Fujishima S, Yamakawa K, Abe T, Ogura H, Saitoh D, Gando S, Sasaki J. Hyperoxia for sepsis and development of acute lung injury with increased mortality. BMJ Open Respir Res 2023; 10:e001968. [PMID: 38097355 PMCID: PMC10729230 DOI: 10.1136/bmjresp-2023-001968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Supraphysiological oxygen administration causes unfavourable clinical outcomes in various diseases. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with severe infection. METHODS A post-hoc analysis of a nationwide multicentre prospective observational study on sepsis (SPICE Study) was conducted, including adult patients admitted to the intensive care unit with available arterial partial pressure of oxygen (PaO2) at the treatment initiation for severe infection. Hyperoxia was defined as a PaO2 level of ≥300 mm Hg and in-hospital mortality was compared between patients with and without hyperoxia. RESULTS Of the 563 patients eligible for the study, 49 had hyperoxia at treatment initiation for severe infection. The in-hospital all-cause mortality rates of patients with and without hyperoxia were 14 (29.2%) and 90 (17.6%), respectively. Inverse probability weighting analyses with propensity scores revealed the association between hyperoxia and increased in-hospital mortality rate (28.8% vs 18.8%; adjusted OR 1.75 (1.03 to 2.97); p=0.038), adjusting for patient demographics, comorbidities, site of infection, severity of infection, haemodynamic and respiratory status, laboratory data and location of patient at infection development. Acute lung injury developed more frequently in patients with hyperoxia on the following days after infection treatment, whereas sepsis-related mortality was comparable regardless of hyperoxia exposure. CONCLUSION Hyperoxia with PaO2 ≥300 mm Hg at treatment initiation of severe infection was associated with an increased in-hospital mortality rate in patients requiring intensive care. The amount of oxygen to administer to patients with severe infection should be carefully determined. TRIAL REGISTRATION NUMBER University Hospital Medical Information Network Clinical Trial Registry (UMIN000027452).
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Seitaro Fujishima
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Toshikazu Abe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
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Cheng P, Yang P, Zhang H, Wang H. Prediction Models for Return of Spontaneous Circulation in Patients with Cardiac Arrest: A Systematic Review and Critical Appraisal. Emerg Med Int 2023; 2023:6780941. [PMID: 38035124 PMCID: PMC10684323 DOI: 10.1155/2023/6780941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/23/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Prediction models for the return of spontaneous circulation (ROSC) in patients with cardiac arrest play an important role in helping physicians evaluate the survival probability and providing medical decision-making reference. Although relevant models have been developed, their methodological rigor and model applicability are still unclear. Therefore, this study aims to summarize the evidence for ROSC prediction models and provide a reference for the development, validation, and application of ROSC prediction models. Methods PubMed, Cochrane Library, Embase, Elsevier, Web of Science, SpringerLink, Ovid, CNKI, Wanfang, and SinoMed were systematically searched for studies on ROSC prediction models. The search time limit was from the establishment of the database to August 30, 2022. Two reviewers independently screened the literature and extracted the data. The PROBAST was used to evaluate the quality of the included literature. Results A total of 8 relevant prediction models were included, and 6 models reported the AUC of 0.662-0.830 in the modeling population, which showed good overall applicability but high risk of bias. The main reasons were improper handling of missing values and variable screening, lack of external validation of the model, and insufficient information of overfitting. Age, gender, etiology, initial heart rhythm, EMS arrival time/BLS intervention time, location, bystander CPR, witnessed during sudden arrest, and ACLS duration/compression duration were the most commonly included predictors. Obvious chest injury, body temperature below 33°C, and possible etiologies were predictive factors for ROSC failure in patients with TOHCA. Age, gender, initial heart rhythm, reason for the hospital visit, length of hospital stay, and the location of occurrence in hospital were the predictors of ROSC in IHCA patients. Conclusion The performance of current ROSC prediction models varies greatly and has a high risk of bias, which should be selected with caution. Future studies can further optimize and externally validate the existing models.
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Affiliation(s)
- Pengfei Cheng
- Department of Nursing, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
| | - Pengyu Yang
- School of International Nursing, Hainan Medical University, Haikou 571199, China
| | - Hua Zhang
- School of International Nursing, Hainan Medical University, Haikou 571199, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou 571199, China
| | - Haizhen Wang
- Department of Nursing, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
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Singh S, Rout A, Chaudhary R, Garg A, Tantry US, Gurbel PA. Oxygen Targets After Cardiac Arrest: A Meta-analysis of Randomized Controlled Trials. Am J Ther 2023; 30:e509-e518. [PMID: 37921678 PMCID: PMC10809880 DOI: 10.1097/mjt.0000000000001636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Optimal oxygen saturation target in patients resuscitated after cardiac arrest is unknown. Previous randomized controlled trials (RCTs) comparing restrictive oxygen therapy with liberal therapy have shown conflicting results. STUDY QUESTION We performed a meta-analysis of available RCTs to consolidate the contrasting findings regarding the oxygen targets after cardiac arrest. DATA SOURCES We searched electronic databases for RCTs comparing restrictive versus liberal oxygen targets in patients resuscitated after cardiac arrest. STUDY DESIGN End points of interest were mortality, unfavorable neurological outcomes, and rearrests. Random-effects meta-analysis was performed to estimate the risk ratio (RR) with a 95% confidence interval (CI). RESULTS Eight RCTs with 1641 patients (restrictive n = 833, liberal n = 808) were included in the analysis. The oxygen targets were defined by either saturation, partial pressure (PaO2), or supplementation rates. The mean age and male percentage were 63 years and 80%, respectively. There was no significant difference observed in the 2 groups for overall mortality (RR = 0.91, 95% CI = 0.75-1.10, P = 0.33), unfavorable neurological outcomes (RR = 0.93, 95% CI = 0.74-1.18, P = 0.56), and rearrests (RR = 0.67, 95% CI = 0.22-1.98, P = 0.47). CONCLUSIONS Overall, this meta-analysis shows no significant difference in mortality, unfavorable neurological outcomes, and rearrests when using restrictive or liberal oxygen targets in patients after cardiac arrest. The limitations in the newer trials should be kept in mind while interpreting the overall results.
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Affiliation(s)
- Sahib Singh
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Amit Rout
- Division of Cardiology, University of Louisville, Louisville, KY
| | - Rahul Chaudhary
- Division of Cardiology, University of Pittsburgh, Pittsburgh, PA
| | - Aakash Garg
- Cardiology Associates of Schenectady, St. Peter’s Health Partners, Albany, NY
| | - Udaya S. Tantry
- Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, MD
| | - Paul A. Gurbel
- Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, MD
- Division of Cardiology, Sinai Hospital of Baltimore, Baltimore, MD
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Cotter EKH, Jacobs M, Jain N, Chow J, Estimé SR. Post-cardiac arrest care in the intensive care unit. Int Anesthesiol Clin 2023; 61:71-78. [PMID: 37678200 DOI: 10.1097/aia.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Elizabeth K H Cotter
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Matthew Jacobs
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Nisha Jain
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Jarva Chow
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Stephen R Estimé
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
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Yamamoto R, Yamakawa K, Endo A, Homma K, Sato Y, Takemura R, Yamagiwa T, Shimizu K, Kaito D, Yagi M, Yonemura T, Shibusawa T, Suzuki G, Shoji T, Miura N, Takahashi J, Narita C, Kurata S, Minami K, Wada T, Fujinami Y, Tsubouchi Y, Natsukawa M, Nagayama J, Takayama W, Ishikura K, Yokokawa K, Fujita Y, Nakayama H, Tokuyama H, Shinada K, Taira T, Fukui S, Ushio N, Nakane M, Hoshiyama E, Tampo A, Sageshima H, Takami H, Iizuka S, Kikuchi H, Hagiwara J, Tagami T, Funato Y, Sasaki J, Er-Oxytrac SG. Early restricted oxygen therapy after resuscitation from cardiac arrest (ER-OXYTRAC): protocol for a stepped-wedge cluster randomised controlled trial. BMJ Open 2023; 13:e074475. [PMID: 37714682 PMCID: PMC10510872 DOI: 10.1136/bmjopen-2023-074475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Cardiac arrest is a critical condition, and patients often experience postcardiac arrest syndrome (PCAS) even after the return of spontaneous circulation (ROSC). Administering a restricted amount of oxygen in the early phase after ROSC has been suggested as a potential therapy for PCAS; however, the optimal target for arterial partial pressure of oxygen or peripheral oxygen saturation (SpO2) to safely and effectively reduce oxygen remains unclear. Therefore, we aimed to validate the efficacy of restricted oxygen treatment with 94%-95% of the target SpO2 during the initial 12 hours after ROSC for patients with PCAS. METHODS AND ANALYSIS ER-OXYTRAC (early restricted oxygen therapy after resuscitation from cardiac arrest) is a nationwide, multicentre, pragmatic, single-blind, stepped-wedge cluster randomised controlled trial targeting cases of non-traumatic cardiac arrest. This study includes adult patients with out-of-hospital or in-hospital cardiac arrest who achieved ROSC in 39 tertiary centres across Japan, with a target sample size of 1000. Patients whose circulation has returned before hospital arrival and those with cardiac arrest due to intracranial disease or intoxication are excluded. Study participants are assigned to either the restricted oxygen (titration of a fraction of inspired oxygen with 94%-95% of the target SpO2) or the control (98%-100% of the target SpO2) group based on cluster randomisation per institution. The trial intervention continues until 12 hours after ROSC. Other treatments for PCAS, including oxygen administration later than 12 hours, can be determined by the treating physicians. The primary outcome is favourable neurological function, defined as cerebral performance category 1-2 at 90 days after ROSC, to be compared using an intention-to-treat analysis. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board at Keio University School of Medicine (approval number: 20211106). Written informed consent will be obtained from all participants or their legal representatives. Results will be disseminated via publications and presentations. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000046914).
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akira Endo
- Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Koichiro Homma
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yasunori Sato
- Clinical and Translational Research Center, Keio University Hospital, Shinjuku, Tokyo, Japan
| | - Ryo Takemura
- Clinical and Translational Research Center, Keio University Hospital, Shinjuku, Tokyo, Japan
| | - Takeshi Yamagiwa
- Department of Emergency and Critical Care Medicine, Ebina General Hospital, Ebina, Kanagawa, Japan
| | - Keiki Shimizu
- Emergency Medical Center of Tokyo Metropolitan Tama Medical Center, Fuchuu, Tokyo, Japan
| | - Daiki Kaito
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masayuki Yagi
- Emergency Medicine and Acute Care Surgery, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Taku Yonemura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Takayuki Shibusawa
- Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Meguro, Tokyo, Japan
| | - Ginga Suzuki
- Critical Care Center, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan
| | - Takahiro Shoji
- Department of Emergency Medicine, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
| | - Naoya Miura
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jiro Takahashi
- Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Chihiro Narita
- Department of Emergency Medicine, Shizuoka General Hospital, Shizuoka City, Shizuoka, Japan
| | - Saori Kurata
- Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Kazunobu Minami
- Emergency and Critical Care Center, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya City, Hyogo, Japan
| | - Takeshi Wada
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Central City Hospital, Kakogawa, Hyogo, Japan
| | - Yohei Tsubouchi
- Department of Emergency and Critical Care Medicine, Subaru Health Insurance Society Ota Memorial Hospital, Ota City, Gunma, Japan
| | - Mai Natsukawa
- Department of Emergency and Critical Care Medicine, Yodogawa Christian Hospital, Osaka City, Osaka, Japan
| | - Jun Nagayama
- Japan Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ken Ishikura
- Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
| | - Kyoko Yokokawa
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Tohoku University Hospital Emergency Center, Sendai, Miyagi, Japan
| | - Yasuo Fujita
- Department of Emergency and Critical Care Center, Akita Redcross Hospital, Akita City, Akita, Japan
| | - Hirofumi Nakayama
- Department of Emergency and Disaster Medicine, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Hideki Tokuyama
- Department of Emergency and Critical Care Medicine, Fujita Medical School Bantane Hospital, Nakagawa-ku, Nagoya, Japan
| | - Kota Shinada
- Department of Emergency and Critical Care Medicine, Saga University, Saga City, Saga, Japan
| | - Takayuki Taira
- Department of Emergency and Critical Care Medicine, Ryukyu University hospital, Kunigamigun, Okinawa, Japan
| | - Shoki Fukui
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Noritaka Ushio
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Masaki Nakane
- Department of Emergency and Critical Care Medicine, Yamagata University Hospital, Yamagata City, Yamagata, Japan
| | - Eisei Hoshiyama
- Department of Neurology/Emergency and Critical Care Medicine, Dokkyomedical University, Mibu, Tochigi, Japan
| | - Akihito Tampo
- Department of Emergency Medicine, Asahikawa City Hospital, Asahikawa, Hokkaido, Japan
| | - Hisako Sageshima
- Department of Emergency Medicine, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Shinichi Iizuka
- Department of Emergency and Critical Care Medicine, Odawara Municipal Hospital, Odawara, Kanagawa, Japan
| | - Hitoshi Kikuchi
- Department of Emergency Medicine, Sagamihara Kyodo Hospital, Sagamihara City, Kanagawa, Japan
| | - Jun Hagiwara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Yumi Funato
- Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Keio University Hospital, Shinjuku-ku, Japan
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9
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Cheema HA, Shafiee A, Akhondi A, Seighali N, Shahid A, Rehman MEU, Almas T, Hadeed S, Nashwan AJ, Ahmad S. Oxygen targets following cardiac arrest: A meta-analysis of randomized controlled trials. Int J Cardiol Heart Vasc 2023; 47:101243. [PMID: 37484065 PMCID: PMC10359856 DOI: 10.1016/j.ijcha.2023.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
Introduction The appropriate oxygen target post-resuscitation in out-of-hospital cardiac arrest (OHCA) patients is uncertain. We sought to compare lower versus higher oxygen targets in patients following OHCA. Methods We searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov until January 2023 to include all randomized controlled trials (RCTs) that evaluated conservative vs. liberal oxygen therapy in OHCA patients. Our primary outcome was all-cause mortality at 90 days while our secondary outcomes were the level of neuron-specific enolase (NSE) at 48 h, ICU length of stay (LOS), and favorable neurological outcome (the proportion of patients with Cerebral Performance Category scores of 1-2 at end of follow-up). We used RevMan 5.4 to pool risk ratios (RRs) and mean differences (MDs). Results Nine trials with 1971 patients were included in our review. There was no significant difference between the conservative and liberal oxygen target groups regarding the rate of all-cause mortality (RR 0.95, 95% CI: 0.80 to 1.13; I2 = 55%). There were no significant differences between the two groups when assessing favorable neurological outcome (RR 1.01, 95% CI: 0.92 to 1.10; I2 = 4%), NSE at 48 h (MD 0.04, 95% CI: -0.67 to 0.76; I2 = 0%), and ICU length of stay (MD -2.86 days, 95% CI: -8.00 to 2.29 days; I2 = 0%). Conclusions Conservative oxygen therapy did not decrease mortality, improve neurologic recovery, or decrease ICU LOS as compared to a liberal oxygen regimen. Future large-scale RCTs comparing homogenous oxygen targets are needed to confirm these findings.
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Affiliation(s)
| | - Arman Shafiee
- Clinical Research Development Unit, Alborz University of Medical Sciences, Karaj, Iran
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Amirhossein Akhondi
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Niloofar Seighali
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Abia Shahid
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | | | - Talal Almas
- Department of Cardiovascular Medicine, Galway University Hospital, Galway, Ireland
| | - Sebastian Hadeed
- Department of Internal Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Soban Ahmad
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
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10
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Bray J, Skrifvars M, Bernard S. Oxygen targets after cardiac arrest: a narrative review. Resuscitation 2023:109899. [PMID: 37419236 DOI: 10.1016/j.resuscitation.2023.109899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
A significant focus of post-resuscitation research over the last decade has included optimising oxygenation. This has primarily occurred due to an improved understanding of the possible harmful biological effects of high oxygenation, particularly the neurotoxicity of oxygen free radicals. Animal studies and some observational research in humans suggest harm with the occurrence of severe hyperoxaemia (PaO2 >300mmHg) in the post-resuscitation phase. This early data informed in a change in treatment recommendations, with the International Liaison Committee on Resuscitation (ILCOR) recommending the avoidance of hyperoxaemia. However, the optimal oxygenation level for maximal survival has not yet been determined. Recent Phase 3 randomised control trials (RCTs) provide further insight into when oxygen titration should occur. The EXACT RCT suggested that decreasing oxygen fraction post-resuscitation in the prehospital setting, with limited ability to titrate and measure oxygenation, is too soon. The BOX RCT, suggests delaying titration to a normal level in intensive care may be too late. While further RCTs are currently underway in ICU cohorts, titration of oxygen early after arrival at hospital should be considered.
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Affiliation(s)
- Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Markus Skrifvars
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Finland
| | - Stephen Bernard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia The Intensive Care Unit, The Alfred Hospital, Melbourne, Australia
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11
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Minkove S, Dhamapurkar R, Cui X, Li Y, Sun J, Cooper D, Eichacker PQ, Torabi-Parizi P. Effect of low-to-moderate hyperoxia on lung injury in preclinical animal models: a systematic review and meta-analysis. Intensive Care Med Exp 2023; 11:22. [PMID: 37088856 PMCID: PMC10122981 DOI: 10.1186/s40635-023-00501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/13/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Extensive animal investigation informed clinical practice regarding the harmful effects of high fractional inspired oxygen concentrations (FiO2s > 0.60). Since questions persist whether lower but still supraphysiologic FiO2 ≤ 0.60 and > 0.21 (FiO2 ≤ 0.60/ > 0.21) are also harmful with inflammatory lung injury in patients, we performed a systematic review examining this question in animal models. METHODS Studies retrieved from systematic literature searches of three databases, that compared the effects of exposure to FiO2 ≤ 0.60/ > 0.21 vs. FiO2 = 0.21 for ≥ 24 h in adult in vivo animal models including an inflammatory challenge or not were analyzed. Survival, body weight and/or lung injury measures were included in meta-analysis if reported in ≥ 3 studies. RESULTS More than 600 retrieved reports investigated only FiO2s > 0.60 and were not analyzed. Ten studies with an inflammatory challenge (6 infectious and 4 noninfectious) and 14 studies without, investigated FiO2s ≤ 0.60/ > 0.21 and were analyzed separately. In seven studies with an inflammatory challenge, compared to FiO2 = 0.21, FiO2 ≤ 0.60/ > 0.21 had consistent effects across animal types on the overall odds ratio of survival (95%CI) that was on the side of harm but not significant [0.68 (0.38,1.23), p = 0.21; I2 = 0%, p = 0.57]. However, oxygen exposure times were only 1d in 4 studies and 2-4d in another. In a trend approaching significance, FiO2 ≤ 0.60/ > 0.21 with an inflammatory challenge consistently increased the standardized mean difference (95%CI) (SMD) in lung weights [0.47 (- 0.07,1.00), p = 0.09; I2 = 0%, p = 0.50; n = 4 studies] but had inconsistent effects on lung lavage protein concentrations (n = 3), lung pathology scores (n = 4) and/or arterial oxygenation (n = 4) (I2 ≥ 43%, p ≤ 0.17). Studies without an inflammatory challenge had consistent effects on lung lavage protein concentration (n = 3) SMDs on the side of being increased that was not significant [0.43 (- 0.23,1.09), p = 0.20; I2 = 0%, p = 0.40] but had inconsistent effects on body and lung weights (n = 6 and 8 studies, respectively) (I2 ≥ 71%, p < 0.01). Quality of evidence for studies was weak. INTERPRETATION Limited animal studies have investigated FiO2 ≤ 0.60/ > 0.21 with clinically relevant models and endpoints but suggest even these lower FiO2s may be injurious. Given the influence animal studies examining FiO2 > 0.60 have had on clinical practice, additional ones investigating FiO2 ≤ 0.60/ > 0.21 appear warranted, particularly in pneumonia models.
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Affiliation(s)
- Samuel Minkove
- Critical Care Medicine Department, National Institutes of Health, Building 10, Room 2C145, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Rhea Dhamapurkar
- Critical Care Medicine Department, National Institutes of Health, Building 10, Room 2C145, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Xizhong Cui
- Critical Care Medicine Department, National Institutes of Health, Building 10, Room 2C145, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Yan Li
- Critical Care Medicine Department, National Institutes of Health, Building 10, Room 2C145, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Junfeng Sun
- Critical Care Medicine Department, National Institutes of Health, Building 10, Room 2C145, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Diane Cooper
- NIH Library, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter Q Eichacker
- Critical Care Medicine Department, National Institutes of Health, Building 10, Room 2C145, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Parizad Torabi-Parizi
- Critical Care Medicine Department, National Institutes of Health, Building 10, Room 2C145, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
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12
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Reydellet L, Le Saux A, Blasco V, Nafati C, Harti-Souab K, Armand R, Lannelongue A, Gregoire E, Hardwigsen J, Albanese J, Chopinet S. Impact of Hyperoxia after Graft Reperfusion on Lactate Level and Outcomes in Adults Undergoing Orthotopic Liver Transplantation. J Clin Med 2023; 12:jcm12082940. [PMID: 37109276 PMCID: PMC10145037 DOI: 10.3390/jcm12082940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Hyperoxia is common during liver transplantation (LT), without being supported by any guidelines. Recent studies have shown the potential deleterious effect of hyperoxia in similar models of ischemia-reperfusion. Hyperoxia after graft reperfusion during orthotopic LT could increase lactate levels and worsen patient outcomes. METHODS We conducted a retrospective and monocentric pilot study. All adult patients who underwent LT from 26 July 2013 to 26 December 2017 were considered for inclusion. Patients were classified into two groups according to oxygen levels before graft reperfusion: the hyperoxic group (PaO2 > 200 mmHg) and the nonhyperoxic group (PaO2 < 200 mmHg). The primary endpoint was arterial lactatemia 15 min after graft revascularization. Secondary endpoints included postoperative clinical outcomes and laboratory data. RESULTS A total of 222 liver transplant recipients were included. Arterial lactatemia after graft revascularization was significantly higher in the hyperoxic group (6.03 ± 4 mmol/L) than in the nonhyperoxic group (4.81 ± 2 mmol/L), p < 0.01. The postoperative hepatic cytolysis peak, duration of mechanical ventilation and duration of ileus were significantly increased in the hyperoxic group. CONCLUSIONS In the hyperoxic group, the arterial lactatemia, the hepatic cytolysis peak, the mechanical ventilation and the postoperative ileus were higher than in the nonhyperoxic group, suggesting that hyperoxia worsens short-term outcomes and could lead to increase ischemia-reperfusion injury after liver transplantation. A multicenter prospective study should be performed to confirm these results.
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Affiliation(s)
- Laurent Reydellet
- Department of Anaesthesia and Intensive Care, Hôpital la Timone, 13005 Marseille, France
| | - Audrey Le Saux
- Department of Anaesthesia and Intensive Care, Hôpital la Timone, 13005 Marseille, France
| | - Valery Blasco
- Department of Anaesthesia and Intensive Care, Hôpital la Timone, 13005 Marseille, France
| | - Cyril Nafati
- Department of Anaesthesia and Intensive Care, Hôpital la Timone, 13005 Marseille, France
| | - Karim Harti-Souab
- Department of Anaesthesia and Intensive Care, Hôpital la Timone, 13005 Marseille, France
| | - Romain Armand
- Department of Anaesthesia and Intensive Care, Hôpital la Timone, 13005 Marseille, France
| | - Ariane Lannelongue
- Department of Anaesthesia and Intensive Care, Carémeau Hospital, 30029 Nîmes, France
| | - Emilie Gregoire
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 13005 Marseille, France
- European Center for Medical Imaging Research CERIMED/LIIE, Aix-Marseille Université, 13385 Marseille, France
| | - Jean Hardwigsen
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 13005 Marseille, France
- École de Médecine, Faculté des Sciences Médicales et Paramédicales, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille, France
| | - Jacques Albanese
- Department of Anaesthesia and Intensive Care, Hôpital la Timone, 13005 Marseille, France
- École de Médecine, Faculté des Sciences Médicales et Paramédicales, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille, France
| | - Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 13005 Marseille, France
- European Center for Medical Imaging Research CERIMED/LIIE, Aix-Marseille Université, 13385 Marseille, France
- École de Médecine, Faculté des Sciences Médicales et Paramédicales, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille, France
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13
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Yamamoto R, Yoshizawa J, Takauji S, Hayakawa M, Sasaki J. Hyperoxia for accidental hypothermia and increased mortality: a post-hoc analysis of a multicenter prospective observational study. Crit Care 2023; 27:131. [PMID: 37005646 PMCID: PMC10067299 DOI: 10.1186/s13054-023-04407-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Supraphysiologic oxygen administration causes unfavorable clinical outcomes in various diseases, including traumatic brain injury, post-cardiac arrest syndrome, and acute lung injury. Accidental hypothermia is a critical illness that reduces oxygen demands, and excessive oxygen is likely to emerge. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with accidental hypothermia. METHODS A post-hoc analysis of a nationwide multicenter prospective observational study (ICE-CRASH study) on patients with accidental hypothermia admitted in 2019-2022 was conducted. Adult patients without cardiac arrest whose core body temperature was < 32 °C and whose arterial partial pressure of oxygen (PaO2) was measured at the emergency department were included. Hyperoxia was defined as a PaO2 level of 300 mmHg or higher, and 28-day mortality was compared between patients with and without hyperoxia before rewarming. Inverse probability weighting (IPW) analyses with propensity scores were performed to adjust patient demographics, comorbidities, etiology and severity of hypothermia, hemodynamic status and laboratories on arrival, and institution characteristics. Subgroup analyses were conducted according to age, chronic cardiopulmonary diseases, hemodynamic instability, and severity of hypothermia. RESULTS Of the 338 patients who were eligible for the study, 65 had hyperoxia before rewarming. Patients with hyperoxia had a higher 28-day mortality rate than those without (25 (39.1%) vs. 51 (19.5%); odds ratio (OR) 2.65 (95% confidence interval 1.47-4.78); p < 0.001). IPW analyses with propensity scores revealed similar results (adjusted OR 1.65 (1.14-2.38); p = 0.008). Subgroup analyses showed that hyperoxia was harmful in the elderly and those with cardiopulmonary diseases and severe hypothermia below 28 °C, whereas hyperoxia exposure had no effect on mortality in patients with hemodynamic instability on hospital arrival. CONCLUSIONS Hyperoxia with PaO2 levels of 300 mmHg or higher before initiating rewarming was associated with increased 28-day mortality in patients with accidental hypothermia. The amount of oxygen to administer to patients with accidental hypothermia should be carefully determined. TRIAL REGISTRATION The ICE-CRASH study was registered at the University Hospital Medical Information Network Clinical Trial Registry on April 1, 2019 (UMIN-CTR ID, UMIN000036132).
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Jo Yoshizawa
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Shuhei Takauji
- Department of Emergency Medicine, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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14
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Awad A, Nordberg P, Jonsson M, Hofmann R, Ringh M, Hollenberg J, Olson J, Joelsson-Alm E. Hyperoxemia after reperfusion in cardiac arrest patients: a potential dose-response association with 30-day survival. Crit Care 2023; 27:86. [PMID: 36879330 PMCID: PMC9990272 DOI: 10.1186/s13054-023-04379-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Hyperoxemia may aggravate reperfusion brain injury after cardiac arrest. The aim of this study was to study the associations between different levels of hyperoxemia in the reperfusion period after cardiac arrest and 30-day survival. METHODS Nationwide observational study using data from four compulsory Swedish registries. Adult in- and out-of-hospital cardiac arrest patients admitted to an ICU, requiring mechanical ventilation, between January 2010 and March 2021, were included. The partial oxygen pressure (PaO2) was collected in a standardized way at ICU admission (± one hour) according to the simplified acute physiology score 3 reflecting the time interval with oxygen treatment from return of spontaneous circulation to ICU admission. Subsequently, patients were divided into groups based on the registered PaO2 at ICU admission. Hyperoxemia was categorized into mild (13.4-20 kPa), moderate (20.1-30 kPa) severe (30.1-40 kPa) and extreme (> 40 kPa), and normoxemia as PaO2 8-13.3 kPa. Hypoxemia was defined as PaO2 < 8 kPa. Primary outcome was 30-day survival and relative risks (RR) were estimated by multivariable modified Poisson regression. RESULTS In total, 9735 patients were included of which 4344 (44.6%) were hyperoxemic at ICU admission. Among these, 2217 were classified as mild, 1091 as moderate, 507 as severe, and 529 as extreme hyperoxemia. Normoxemia was present in 4366 (44.8%) patients and 1025 (10.5%) had hypoxemia. Compared to the normoxemia group, the adjusted RR for 30-day survival in the whole hyperoxemia group was 0.87 (95% CI 0.82-0.91). The corresponding results for the different hyperoxemia subgroups were; mild 0.91 (95% CI 0.85-0.97), moderate 0.88 (95% CI 0.82-0.95), severe 0.79 (95% CI 0.7-0.89), and extreme 0.68 (95% CI 0.58-0.79). Adjusted 30-day survival for the hypoxemia compared to normoxemia group was 0.83 (95% CI 0.74-0.92). Similar associations were seen in both out-of-hospital and in-hospital cardiac arrests. CONCLUSION In this nationwide observational study comprising both in- and out-of-hospital cardiac arrest patients, hyperoxemia at ICU admission was associated with lower 30-day survival.
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Affiliation(s)
- Akil Awad
- Department of Clinical Science and Education, Center for Resuscitation Sciences, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Per Nordberg
- Department of Clinical Science and Education, Center for Resuscitation Sciences, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176, Stockholm, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Center for Resuscitation Sciences, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Center for Resuscitation Sciences, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Center for Resuscitation Sciences, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jens Olson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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15
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Celińska-Spodar M, Załęska-Kocięcka M, Banaś S, Kołsut P, Kowalik I, Kuśmierczyk M, Kuśmierski K, Litwiński P, Sitkowska-Rysiak E, Szymański J, Stępińska J. ARTERIAL HYPEROXIA AND MORTALITY IN PATIENTS UNDERGOING VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION. Shock 2023; 59:20-27. [PMID: 36703274 DOI: 10.1097/shk.0000000000002038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
ABSTRACT Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can easily lead to supranormal oxygenation. The impact of hyperoxygenation beyond the early VA-ECMO support phase is unexplored. We sought to investigate its association with short- and long-term mortality. Methods: A total of 10,615 arterial blood gases of 179 patients undergoing VA-ECMO between 2013 and 2018 in our cardiosurgical tertiary center were analyzed for partial pressure of oxygen (PaO2) and its association with in-hospital, 90-day, and 1-year mortality. Patients were stratified into terciles (T) based on PaO2. Results: The median systemic PaO2 during VA-ECMO was 122 mm Hg (Q1-Q3, 111-158 mm Hg) and was significantly higher in 90-day nonsurvivors versus survivors (134 mm Hg [Q1-Q3, 114-175 mm Hg] vs. 114 mm Hg [Q1-Q3, 109-136 mm Hg]; P < 0.001). The incidence of mortality increased at all time points tested after VA-ECMO implantation along with the increasing terciles of PaO2. The lowest mortality rates were noted for patients with median PaO2 values of <115 mm Hg (T1), whereas patients with median PaO2 values of >144 mm Hg (T3) had the highest mortality rates. Bonferroni multiple testing analysis found the T3 of PaO2 to be a predictor of decreased 90-day survival in comparison with T1 (P < 0.001) and T2 (P = 0.002). Multivariable Cox regression analyses for in-hospital, 90-day, and 1-year mortality showed a significant association of the T3 compared with the T2 and the T1 of PaO2 to mortality across all endpoints. Conclusion: Hyperoxygenation during VA-ECMO might be associated with increased all-cause mortality. The results of our study further document the known toxicity of hyperoxygenation in general critical care patients and mark the need to focus specifically on VA-ECMO patients.
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Affiliation(s)
| | - Marta Załęska-Kocięcka
- Department of Anaesthesiology and Intensive Care, The National Institute of Cardiology, Warsaw, Poland
| | - Sławomir Banaś
- Department of Anaesthesiology and Intensive Care, The National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kołsut
- Department of Cardiac Surgery and Transplantation, The National Institute of Cardiology, Warsaw, Poland
| | - Ilona Kowalik
- Clinical Research Support Center, The National Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardiac Surgery and Transplantation, The National Institute of Cardiology, Warsaw, Poland
| | - Krzysztof Kuśmierski
- Department of Cardiac Surgery and Transplantation, The National Institute of Cardiology, Warsaw, Poland
| | - Paweł Litwiński
- Department of Cardiac Surgery and Transplantation, The National Institute of Cardiology, Warsaw, Poland
| | - Ewa Sitkowska-Rysiak
- Department of Anaesthesiology and Intensive Care, The National Institute of Cardiology, Warsaw, Poland
| | - Jarosław Szymański
- Department of Cardiac Surgery and Transplantation, The National Institute of Cardiology, Warsaw, Poland
| | - Janina Stępińska
- Department of Cardiac Intensive Care, The National Institute of Cardiology, Warsaw, Poland
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16
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Abdulmajeed F, Hamandi M, Malaiyandi D, Shutter L. Neurocritical Care in the General Intensive Care Unit. Crit Care Clin 2023; 39:153-169. [DOI: 10.1016/j.ccc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Battaglini D, Pelosi P, Robba C. Ten rules for optimizing ventilatory settings and targets in post-cardiac arrest patients. Crit Care 2022; 26:390. [PMID: 36527126 PMCID: PMC9758928 DOI: 10.1186/s13054-022-04268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Cardiac arrest (CA) is a major cause of morbidity and mortality frequently associated with neurological and systemic involvement. Supportive therapeutic strategies such as mechanical ventilation, hemodynamic settings, and temperature management have been implemented in the last decade in post-CA patients, aiming at protecting both the brain and the lungs and preventing systemic complications. A lung-protective ventilator strategy is currently the standard of care among critically ill patients since it demonstrated beneficial effects on mortality, ventilator-free days, and other clinical outcomes. The role of protective and personalized mechanical ventilation setting in patients without acute respiratory distress syndrome and after CA is becoming more evident. The individual effect of different parameters of lung-protective ventilation, including mechanical power as well as the optimal oxygen and carbon dioxide targets, on clinical outcomes is a matter of debate in post-CA patients. The management of hemodynamics and temperature in post-CA patients represents critical steps for obtaining clinical improvement. The aim of this review is to summarize and discuss current evidence on how to optimize mechanical ventilation in post-CA patients. We will provide ten tips and key insights to apply a lung-protective ventilator strategy in post-CA patients, considering the interplay between the lungs and other systems and organs, including the brain.
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Affiliation(s)
- Denise Battaglini
- grid.410345.70000 0004 1756 7871Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Paolo Pelosi
- grid.410345.70000 0004 1756 7871Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Chiara Robba
- grid.410345.70000 0004 1756 7871Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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Genzwürker H, Stuhr M. Akuttherapie mit Sauerstoff beim Erwachsenen - Aktuelle Leitlinienempfehlungen. NOTARZT 2022. [DOI: 10.1055/a-1954-5343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Harald Genzwürker
- Klinik für Anästhesiologie, Neckar-Odenwald-Kliniken gGmbH, Mosbach, Deutschland
- Leitende Notarztgruppe, Neckar-Odenwald-Kreis, Buchen, Deutschland
| | - Markus Stuhr
- Abteilung für Anästhesie, Intensiv-, Rettungs- und Schmerzmedizin, BG Klinikum Hamburg, Hamburg, Deutschland
- Einsatzabteilung, Leitende Notarztgruppe, Berufsfeuerwehr Hamburg, Hamburg, Deutschland
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19
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Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA 2022; 328:1818-1826. [PMID: 36286192 PMCID: PMC9608019 DOI: 10.1001/jama.2022.17701] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The administration of a high fraction of oxygen following return of spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury. OBJECTIVE To determine whether targeting a lower oxygen saturation in the early phase of postresuscitation care for out-of-hospital cardiac arrest improves survival at hospital discharge. DESIGN, SETTING, AND PARTICIPANTS This multicenter, parallel-group, randomized clinical trial included unconscious adults with return of spontaneous circulation and a peripheral oxygen saturation (Spo2) of at least 95% while receiving 100% oxygen. The trial was conducted in 2 emergency medical services and 15 hospitals in Victoria and South Australia, Australia, between December 11, 2017, and August 11, 2020, with data collection from ambulance and hospital medical records (final follow-up date, August 25, 2021). The trial enrolled 428 of a planned 1416 patients. INTERVENTIONS Patients were randomized by paramedics to receive oxygen titration to achieve an oxygen saturation of either 90% to 94% (intervention; n = 216) or 98% to 100% (standard care; n = 212) until arrival in the intensive care unit. MAIN OUTCOMES AND MEASURES The primary outcome was survival to hospital discharge. There were 9 secondary outcomes collected, including hypoxic episodes (Spo2 <90%) and prespecified serious adverse events, which included hypoxia with rearrest. RESULTS The trial was stopped early due to the COVID-19 pandemic. Of the 428 patients who were randomized, 425 were included in the primary analysis (median age, 65.5 years; 100 [23.5%] women) and all completed the trial. Overall, 82 of 214 patients (38.3%) in the intervention group survived to hospital discharge compared with 101 of 211 (47.9%) in the standard care group (difference, -9.6% [95% CI, -18.9% to -0.2%]; unadjusted odds ratio, 0.68 [95% CI, 0.46-1.00]; P = .05). Of the 9 prespecified secondary outcomes collected during hospital stay, 8 showed no significant difference. A hypoxic episode prior to intensive care was observed in 31.3% (n = 67) of participants in the intervention group and 16.1% (n = 34) in the standard care group (difference, 15.2% [95% CI, 7.2%-23.1%]; OR, 2.37 [95% CI, 1.49-3.79]; P < .001). CONCLUSIONS AND RELEVANCE Among patients achieving return of spontaneous circulation after out-of-hospital cardiac arrest, targeting an oxygen saturation of 90% to 94%, compared with 98% to 100%, until admission to the intensive care unit did not significantly improve survival to hospital discharge. Although the trial is limited by early termination due to the COVID-19 pandemic, the findings do not support use of an oxygen saturation target of 90% to 94% in the out-of-hospital setting after resuscitation from cardiac arrest. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03138005.
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Affiliation(s)
- Stephen A Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Janet E Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Stephenson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Hugh Grantham
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia
- SA Ambulance Service, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Cindy Hein
- Flinders University, Adelaide, South Australia, Australia
| | - Stacey Masters
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Natasha Dodge
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine Martin
- Monash University, Data Science and AI Platform, Melbourne, Victoria, Australia
| | | | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
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20
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Wang C, Huang C, Tsai M, Wang C, Chang W, Liu S, Chen W. Inhaled Carbon Dioxide Improves Neurological Outcomes by Downregulating Hippocampal Autophagy and Apoptosis in an Asphyxia‐Induced Cardiac Arrest and Resuscitation Rat Model. J Am Heart Assoc 2022; 11:e027685. [PMID: 36314493 PMCID: PMC9673650 DOI: 10.1161/jaha.122.027685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background Protracted cerebral hypoperfusion following cardiac arrest (CA) may cause poor neurological recovery. We hypothesized that inhaled carbon dioxide (CO2) could augment cerebral blood flow (CBF) and improve post‐CA neurological outcomes. Methods and Results After 6‐minute asphyxia‐induced CA and resuscitation, Wistar rats were randomly allocated to 4 groups (n=25/group) and administered with different inhaled CO2 concentrations, including control (0% CO2), 4% CO2, 8% CO2, and 12% CO2. Invasive monitoring was maintained for 120 minutes, and neurological outcomes were evaluated with neurological function score at 24 hours post‐CA. After the 120‐minute experiment, CBF was 242.3% (median; interquartile range, 221.1%–267.4%) of baseline in the 12% CO2 group while CBF fell to 45.8% (interquartile range, 41.2%–58.1%) of baseline in the control group (P<0.001). CBF increased along with increasing inhaled CO2 concentrations with significant linear trends (P<0.001). At 24 hours post‐CA, compared with the control group (neurological function score, 9 [interquartile range, 8–9]), neurological recovery was significantly better in the 12% CO2 group (neurological function score, 10 [interquartile range, 9.8–10]) (P<0.001) while no survival difference was observed. Brain tissue malondialdehyde (P=0.02) and serum neuron‐specific enolase (P=0.002) and S100β levels (P=0.002) were significantly lower in the 12% CO2 group. TUNEL (terminal deoxynucleotidyl transferase–mediated biotin–deoxyuridine triphosphate nick‐end labeling)‐positive cell densities in hippocampal CA1 (P<0.001) and CA3 (P<0.001) regions were also significantly reduced in the 12% CO2 group. Western blotting showed that beclin‐1 (P=0.02), p62 (P=0.02), and LAMP2 (lysosome‐associated membrane protein 2) (P=0.01) expression levels, and the LC3B‐II:LC3B‐I ratio (P=0.02) were significantly lower in the 12% CO2 group. Conclusions Administering inhaled CO2 augmented post‐CA CBF, mitigated oxidative brain injuries, ameliorated neuronal injury, and downregulated apoptosis and autophagy, thereby improving neurological outcomes.
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Affiliation(s)
- Chih‐Hung Wang
- Department of Emergency Medicine National Taiwan University Hospital Taipei Taiwan
- Department of Emergency Medicine, College of Medicine National Taiwan University Taipei Taiwan
| | - Chien‐Hua Huang
- Department of Emergency Medicine National Taiwan University Hospital Taipei Taiwan
- Department of Emergency Medicine, College of Medicine National Taiwan University Taipei Taiwan
| | - Min‐Shan Tsai
- Department of Emergency Medicine National Taiwan University Hospital Taipei Taiwan
- Department of Emergency Medicine, College of Medicine National Taiwan University Taipei Taiwan
| | - Chan‐Chi Wang
- Department of Emergency Medicine National Taiwan University Hospital Taipei Taiwan
- Department of Emergency Medicine, College of Medicine National Taiwan University Taipei Taiwan
| | - Wei‐Tien Chang
- Department of Emergency Medicine National Taiwan University Hospital Taipei Taiwan
- Department of Emergency Medicine, College of Medicine National Taiwan University Taipei Taiwan
| | - Shing‐Hwa Liu
- Institute of Toxicology, College of Medicine National Taiwan University Taipei Taiwan
- Department of Medical Research China Medical University Hospital, China Medical University Taichung Taiwan
- Department of Pediatrics National Taiwan University Hospital Taipei Taiwan
| | - Wen‐Jone Chen
- Department of Emergency Medicine National Taiwan University Hospital Taipei Taiwan
- Department of Emergency Medicine, College of Medicine National Taiwan University Taipei Taiwan
- Division of Cardiology, Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
- Division of Cardiology, Department of Internal Medicine Min‐Shen General Hospital Taoyuan Taiwan
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21
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Nyame S, Cheung PY, Lee TF, O’Reilly M, Schmölzer GM. A Randomized, Controlled Animal Study: 21% or 100% Oxygen during Cardiopulmonary Resuscitation in Asphyxiated Infant Piglets. Children (Basel) 2022; 9:children9111601. [PMID: 36360329 PMCID: PMC9688656 DOI: 10.3390/children9111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023]
Abstract
Background: During pediatric cardiopulmonary resuscitation (CPR), resuscitation guidelines recommend 100% oxygen (O2); however, the most effective O2 concentration for infants unknown. Aim: We aimed to determine if 21% O2 during CPR with either chest compression (CC) during sustained inflation (SI) (CC + SI) or continuous chest compression with asynchronized ventilation (CCaV) will reduce time to return of spontaneous circulation (ROSC) compared to 100% O2 in infant piglets with asphyxia-induced cardiac arrest. Methods: Piglets (20−23 days of age, weighing 6.2−10.2 kg) were anesthetized, intubated, instrumented, and exposed to asphyxia. Cardiac arrest was defined as mean arterial blood pressure < 25 mmHg with bradycardia. After cardiac arrest, piglets were randomized to CC + SI or CCaV with either 21% or 100% O2 or the sham. Heart rate, arterial blood pressure, carotid blood flow, and respiratory parameters were continuously recorded. Main results: Baseline parameters, duration, and degree of asphyxiation were not different. Median (interquartile range) time to ROSC was 107 (90−440) and 140 (105−200) s with CC + SI 21% and 100% O2, and 600 (50−600) and 600 (95−600) s with CCaV 21% and 100% O2 (p = 0.27). Overall, six (86%) and six (86%) piglets with CC + SI 21% and 100% O2, and three (43%) and three (43%) piglets achieved ROSC with CCaV 21% and 100% O2 (p = 0.13). Conclusions: In infant piglets resuscitated with CC + SI, time to ROSC reduced and survival improved compared to CCaV. The use of 21% O2 had similar time to ROSC, short-term survival, and hemodynamic recovery compared to 100% oxygen. Clinical studies comparing 21% with 100% O2 during infant CPR are warranted.
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Affiliation(s)
- Solomon Nyame
- Faculty of Medicine and Dentistry, Monash University, Melbourne, VIC 3000, Australia
| | - Po-Yin Cheung
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R, Canada
| | - Tez-Fun Lee
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R, Canada
| | - Megan O’Reilly
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R, Canada
| | - Georg M. Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R, Canada
- Correspondence: ; Fax: +1-780-735-4072
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22
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Robba C, Badenes R, Battaglini D, Ball L, Sanfilippo F, Brunetti I, Jakobsen JC, Lilja G, Friberg H, Wendel-Garcia PD, Young PJ, Eastwood G, Chew MS, Unden J, Thomas M, Joannidis M, Nichol A, Lundin A, Hollenberg J, Hammond N, Saxena M, Martin A, Solar M, Taccone FS, Dankiewicz J, Nielsen N, Grejs AM, Ebner F, Pelosi P. Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Crit Care 2022; 26:323. [PMID: 36271410 PMCID: PMC9585831 DOI: 10.1186/s13054-022-04186-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients' outcome. METHODS Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. RESULTS 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). CONCLUSIONS In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. TRIAL REGISTRATION clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
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Affiliation(s)
- Chiara Robba
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy
| | - Rafael Badenes
- grid.106023.60000 0004 1770 977XDepartment of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, Valencia, Spain ,grid.5338.d0000 0001 2173 938XDepartment of Surgery, University of Valencia, Valencia, Spain
| | - Denise Battaglini
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5841.80000 0004 1937 0247Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Lorenzo Ball
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. “Policlinico-San Marco”, Catania, Italy
| | - Iole Brunetti
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Janus Christian Jakobsen
- grid.475435.4Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Gisela Lilja
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41 Lund, Malmö, Sweden
| | - Hans Friberg
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Lund, Sweden
| | - Pedro David Wendel-Garcia
- grid.412004.30000 0004 0478 9977Institute of Intensive Care Medicine, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Paul J. Young
- grid.415117.70000 0004 0445 6830Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand ,grid.416979.40000 0000 8862 6892Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand ,grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Critical Care, University of Melbourne, Parkville, VIC Australia
| | - Glenn Eastwood
- grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia ,grid.414094.c0000 0001 0162 7225Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | - Michelle S. Chew
- grid.5640.70000 0001 2162 9922Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan Unden
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden ,grid.4514.40000 0001 0930 2361Department of Operation and Intensive Care, Hallands Hospital Halmstad, Lund University, Halland, Sweden
| | - Matthew Thomas
- grid.410421.20000 0004 0380 7336University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Alistair Nichol
- grid.1002.30000 0004 1936 7857Monash University, Melbourne, VIC Australia
| | - Andreas Lundin
- grid.8761.80000 0000 9919 9582Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 423 45 Gothenburg, Sweden
| | - Jacob Hollenberg
- grid.465198.7Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Solna, Sweden
| | - Naomi Hammond
- grid.1005.40000 0004 4902 0432Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Manoj Saxena
- grid.416398.10000 0004 0417 5393Intensive Care Unit, St George Hospital, Sydney, Australia
| | - Annborn Martin
- grid.4514.40000 0001 0930 2361Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
| | - Miroslav Solar
- grid.4491.80000 0004 1937 116XDepartment of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic ,grid.412539.80000 0004 0609 2284Department of Internal Medicine - Cardioangiology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Fabio Silvio Taccone
- grid.412157.40000 0000 8571 829XDepartment of Intensive Care Medicine, Université Libre de Bruxelles, Hopital Erasme, Brussels, Belgium
| | - Josef Dankiewicz
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Niklas Nielsen
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Anaesthesia and Intensive Care and Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Anders Morten Grejs
- grid.154185.c0000 0004 0512 597XDepartment of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Florian Ebner
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Helsingborg Hospital, Lund University, 251 87 Helsingborg, Sweden
| | - Paolo Pelosi
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy
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23
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Fritz C, Jaeger D, Luo Y, Lardenois E, Badat B, Roquet FE, Rigollot M, Kimmoun A, Tran N'G, Richard JCM, Chouihed T, Levy B. IMPACT OF DIFFERENT VENTILATION STRATEGIES ON GAS EXCHANGES AND CIRCULATION DURING PROLONGED MECHANICAL CARDIO-PULMONARY RESUSCITATION IN A PORCINE MODEL. Shock 2022; 58:119-127. [PMID: 34710880 DOI: 10.1097/shk.0000000000001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Background: Optimal ventilation during cardio-pulmonary resuscitation (CPR) is still controversial. Ventilation is expected to provide sufficient arterial oxygen content and adequate carbon dioxide removal, while minimizing the risk of circulatory impairment. The objective of the present study was to compare three ventilation strategies in a porcine model during mechanical continuous chest compressions (CCC) according to arterial oxygenation and hemodynamic impact. Method: Ventricular fibrillation was induced and followed by five no-flow minutes and thirty low-flow minutes resuscitation with mechanical-CCC without vasopressive drugs administration. Three groups of eight Landras pig were randomized according to the ventilation strategy: 1. Standard nonsynchronized volume-control mode (SD-group); 2. synchronized bilevel pressure-controlled ventilation (CPV-group); 3. continuous insufflation with Boussignac Cardiac-Arrest Device (BC-group). We assessed 1. arterial blood gases, 2. macro hemodynamics, 3. tissular cerebral macro and micro-circulation and 4. airway pressure, minute ventilation at baseline and every 5 minutes during the protocol. Results: Arterial PaO2 level was higher at each measurement time in SD-group (>200 mm Hg) compare to CPV-group and BC-group ( P < 0.01). In BC-group, arterial PaCO2 level was significantly higher (>90mm Hg) than in SD and CPV groups ( P < 0.01). There was no difference between groups concerning hemodynamic parameters, cerebral perfusion and microcirculation. Conclusion: Ventilation modalities in this porcine model of prolonged CPR influence oxygenation and decarboxylation without impairing circulation and cerebral perfusion. Synchronized bi-level pressure-controlled ventilation' use avoid hyperoxia and was as efficient as asynchronized volume ventilation to maintain alveolar ventilation and systemic perfusion during prolonged CPR.
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24
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Gottlieb J. Sauerstoff in der Akuttherapie. Z Pneumologie 2022. [DOI: 10.1007/s10405-022-00453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sauerstoff (O2) ist ein Arzneimittel und soll in der Akuttherapie bei Vorliegen einer Hypoxämie ärztlich verordnet und dokumentiert, regelmäßig überwacht und reevaluiert werden. Zur Überwachung dient in der Akutmedizin die Pulsoxymetrie, bei Risikopatienten sind arterielle Blutgase zu bestimmen. Sowohl eine Hypoxämie als auch eine Hyperoxämie sind bei akut Kranken zu vermeiden. Es sollten Zielbereiche der O2-Sättigung (SpO2 [pulsoxymetrisch gemessene O2-Sättigung]) festgelegt werden. Diese hängen vom Hyperkapnierisiko und vom Beatmungsstatus ab: spontan atmende Patienten ohne bzw. mit Hyperkapnierisiko: Ziel‑SpO2 = 92–96 % bzw. 88–92 %, beatmete Patienten: arterielle O2-Sättigung zwischen 92 und 96 %. Die Zielbereiche gelten bis auf wenige Ausnahmen für alle Erwachsenen unabhängig von der Diagnose. Die O2-Applikationssysteme werden nach Patientensicherheit und -komfort ausgewählt. Bei Beendigung der O2-Gabe kann es bei vulnerablen Menschen zur Reboundhypoxämie kommen.
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25
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Li J, Qi Y, Wang J, Dai C, Chen B, Li Y. Trimetazidine Alleviates Postresuscitation Myocardial Dysfunction and Improves 96-Hour Survival in a Ventricular Fibrillation Rat Model. J Am Heart Assoc 2022; 11:e023378. [PMID: 35261264 PMCID: PMC9075307 DOI: 10.1161/jaha.121.023378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
Background Myocardial dysfunction is a critical cause of post-cardiac arrest hemodynamic instability and circulatory failure that may lead to early mortality after resuscitation. Trimetazidine is a metabolic agent that has been demonstrated to provide protective effects in myocardial ischemia. However, whether trimetazidine protects against postresuscitation myocardial dysfunction is unknown. Methods and Results Cardiopulmonary resuscitation was initiated after 8 minutes of untreated ventricular fibrillation in Sprague-Dawley rats. Animals were randomized to 4 groups immediately after resuscitation (n=15/group): (1) normothermia control (NTC); (2) targeted temperature management; (3) trimetazidine-normothermia; (4) trimetazidine-targeted temperature management. TMZ was administered at a single dose of 10 mg/kg in rats with trimetazidine. The body temperature was maintained at 34.0°C for 2 hours and then rewarmed to 37.5°C in rats with targeted temperature management. Postresuscitation hemodynamics, 96-hours survival, and pathological analysis were assessed. Heart tissues and blood samples of additional rats (n=6/group) undergoing the same experimental procedure were collected to measure myocardial injury, inflammation and oxidative stress-related biomarkers with ELISA-based quantification assays. Compared with normothermia control, tumor necrosis factor-α, and cardiac troponin-I were significantly reduced, whereas the left ventricular ejection fraction and 96-hours survival rates were significantly improved in the 3 experimental groups. Furthermore, inflammation and oxidative stress-related biomarkers together with collagen volume fraction were significantly decreased in rats undergoing postresuscitation interventions. Conclusions Trimetazidine significantly alleviates postresuscitation myocardial dysfunction and improves survival by decreasing oxidative stress and inflammation in a ventricular fibrillation rat model. A single dose of trimetazidine administrated immediately after resuscitation can effectively improve cardiac function, whether used alone or combined with targeted temperature management.
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Affiliation(s)
- Jingru Li
- Department of Biomedical Engineering and Imaging MedicineArmy Medical UniversityChongqingChina
| | - Yuantong Qi
- Department of PharmaceuticsCollege of PharmacyArmy Medical UniversityChongqingChina
| | - Jianjie Wang
- Department of Biomedical Engineering and Imaging MedicineArmy Medical UniversityChongqingChina
| | - Chenxi Dai
- Department of Biomedical Engineering and Imaging MedicineArmy Medical UniversityChongqingChina
| | - Bihua Chen
- Department of Biomedical Engineering and Imaging MedicineArmy Medical UniversityChongqingChina
| | - Yongqin Li
- Department of Biomedical Engineering and Imaging MedicineArmy Medical UniversityChongqingChina
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Bernard F, Barsan W, Diaz-Arrastia R, Merck LH, Yeatts S, Shutter LA. Brain Oxygen Optimization in Severe Traumatic Brain Injury (BOOST-3): a multicentre, randomised, blinded-endpoint, comparative effectiveness study of brain tissue oxygen and intracranial pressure monitoring versus intracranial pressure alone. BMJ Open 2022; 12:e060188. [PMID: 35273066 PMCID: PMC8915289 DOI: 10.1136/bmjopen-2021-060188] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/02/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Management of traumatic brain injury (TBI) includes invasive monitoring to prevent secondary brain injuries. Intracranial pressure (ICP) monitor is the main measurement used to that intent but cerebral hypoxia can occur despite normal ICP. This study will assess whether the addition of a brain tissue oxygenation (PbtO2) monitor prevents more secondary injuries that will translate into improved functional outcome. METHODS AND ANALYSIS Multicentre, randomised, blinded-endpoint comparative effectiveness study enrolling 1094 patients with severe TBI monitored with both ICP and PbtO2. Patients will be randomised to medical management guided by ICP alone (treating team blinded to PbtO2 values) or both ICP and PbtO2. Management is protocolised according to international guidelines in a tiered approach fashion to maintain ICP <22 mm Hg and PbtO2 >20 mm Hg. ICP and PbtO2 will be continuously recorded for a minimum of 5 days. The primary outcome measure is the Glasgow Outcome Scale-Extended performed at 180 (±30) days by a blinded central examiner. Favourable outcome is defined according to a sliding dichotomy where the definition of favourable outcome varies according to baseline severity. Severity will be defined according to the probability of poor outcome predicted by the IMPACT core model. A large battery of secondary outcomes including granular neuropsychological and quality of life measures will be performed. ETHICS AND DISSEMINATION This has been approved by Advarra Ethics Committee (Pro00030585). Results will be presented at scientific meetings and published in peer-reviewed publications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03754114).
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Affiliation(s)
- Francis Bernard
- Critical Care, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- Department of Medicine, Université de Montreal, Montreal, Québec, Canada
| | - William Barsan
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ramon Diaz-Arrastia
- Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisa H Merck
- Emergency Medicine and Neurology, Neurocritical Care, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sharon Yeatts
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lori A Shutter
- Critical Care Medicine, Neurology, & Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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27
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Robba C, Nielsen N, Dankiewicz J, Badenes R, Battaglini D, Ball L, Brunetti I, Pedro David WG, Young P, Eastwood G, Chew MS, Jakobsen J, Unden J, Thomas M, Joannidis M, Nichol A, Lundin A, Hollenberg J, Lilja G, Hammond NE, Saxena M, Martin A, Solar M, Taccone FS, Friberg HA, Pelosi P. Ventilation management and outcomes in out-of-hospital cardiac arrest: a protocol for a preplanned secondary analysis of the TTM2 trial. BMJ Open 2022; 12:e058001. [PMID: 35241476 PMCID: PMC8896064 DOI: 10.1136/bmjopen-2021-058001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Mechanical ventilation is a fundamental component in the management of patients post cardiac arrest. However, the ventilator settings and the gas-exchange targets used after cardiac arrest may not be optimal to minimise post-anoxic secondary brain injury. Therefore, questions remain regarding the best ventilator management in such patients. METHODS AND ANALYSIS This is a preplanned analysis of the international randomised controlled trial, targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (OHCA)-target temperature management 2 (TTM2). The primary objective is to describe ventilatory settings and gas exchange in patients who required invasive mechanical ventilation and included in the TTM2 trial. Secondary objectives include evaluating the association of ventilator settings and gas-exchange values with 6 months mortality and neurological outcome. Adult patients after an OHCA who were included in the TTM2 trial and who received invasive mechanical ventilation will be eligible for this analysis. Data collected in the TTM2 trial that will be analysed include patients' prehospital characteristics, clinical examination, ventilator settings and arterial blood gases recorded at hospital and intensive care unit (ICU) admission and daily during ICU stay. ETHICS AND DISSEMINATION The TTM2 study has been approved by the regional ethics committee at Lund University and by all relevant ethics boards in participating countries. No further ethical committee approval is required for this secondary analysis. Data will be disseminated to the scientific community by abstracts and by original articles submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02908308.
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Affiliation(s)
- Chiara Robba
- Department of Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche, University of Genoa, Genoa, Italy
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anaesthesia and Intensive Care and Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Josef Dankiewicz
- Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital,Lund University, Lund, Lund, UK
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de València, Universitat de València, Valencia, Spain
| | - Denise Battaglini
- Department of Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche, University of Genoa, Genoa, Italy
- Department of Medicine, University of Barcelona, Barcelona, Spain, Genoa, Italy
| | - Lorenzo Ball
- Department of Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche, University of Genoa, Genoa, Italy
| | - Iole Brunetti
- Department of Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Wendel-Garcia Pedro David
- Institute of Intensive Care Medicine, Zurich, Switzerland, University Hospital of Zürich, Zürich, Switzerland
| | - Paul Young
- Department of Intensive Care, Wellington Hospital, Wellington, New Zealand
| | - Glenn Eastwood
- Department of Intensive Care, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Janus Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, UK
| | - Johan Unden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Operation and Intensive Care, Hallands Hospital Halmstad, Halland, Sweden
| | - Matthew Thomas
- Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Deptartment of Medicine, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Alistair Nichol
- Monash University, Melbourne, Victoria, Australia, Melbourne, Ireland
| | - Andreas Lundin
- Department of Anaesthesiology and Intensive Care Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jacob Hollenberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Solna, Sweden
| | - Gisela Lilja
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Naomi E Hammond
- Department of Critical Care, George Institute for Global Health, Newtown, New South Wales, Australia
| | - Manoj Saxena
- St George Hospital, Sydney, New South Wales, Australia
| | - Annborn Martin
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
| | - Miroslav Solar
- Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Prague, Czech Republic
| | - Fabio Silvio Taccone
- Department of Intensive Care Medicine, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Hans A Friberg
- Department of of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Paolo Pelosi
- Department of Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche, Università degli Studi di Genova, Genoa, Italy
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, Nothacker M, Roiter S, Volk T, Worth H, Fühner T. German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients. Respiration 2021; 101:214-252. [PMID: 34933311 DOI: 10.1159/000520294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Philipp Capetian
- Department of Neurology, University Hospital Würzburg, Wuerzburg, Germany
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St. Antonius Hospital, Eschweiler, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
| | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Nothacker
- AWMF-Institute for Medical Knowledge Management, Marburg, Germany
| | - Sabrina Roiter
- Intensive Care Unit, Israelite Hospital Hamburg, Hamburg, Germany
| | - Thomas Volk
- Department of Anesthesiology, University Hospital of Saarland, Saarland University, Homburg, Germany
| | | | - Thomas Fühner
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Siloah Hospital, Hannover, Germany
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29
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Ogiwara S, Tamura T, Sai S, Nojima M, Kawana S. Superiority of OxyMask TM with less carbon dioxide rebreathing in children. Eur J Pediatr 2021; 180:3593-3597. [PMID: 34146139 DOI: 10.1007/s00431-021-04157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
Despite the growing importance of oxygen-delivery devices worldwide, there are only a few reports of physiological data on various oxygen masks in children. The possibility of carbon dioxide (CO2) rebreathing has been a prevalent concern with the use of oxygen-delivery devices. OxyMask KidTM (Southmedic Inc. Canada; hereafter OxyMask) is expected to reduce CO2 rebreathing even at low oxygen flow rates because of its structural features. Biological data using OxyMask in children have not been well investigated. Measured respiratory parameters of OxyMask with those of a simple oxygen mask in healthy children were compared. Ten subjects were enrolled, with a median age of 5.4 years. All subjects used both OxyMask and a simple oxygen mask. The fraction of inspiratory oxygen (FIO2), partial pressure of inspiratory CO2 (PICO2), and partial pressure of end-tidal CO2 were measured using a sidestream gas-sampling monitor in all subjects. The oxygen flow rate was set at 1, 3, 5, and 10 L/min. FIO2 levels were higher with OxyMask than those with the simple oxygen mask at 3 L/min of oxygen. PICO2 levels were significantly lower with OxyMask than those with the simple oxygen mask (1.5 mmHg vs. 3.7 mmHg at 1 L/min, P = 0.005; 1.0 mmHg vs. 2.7 mmHg at 3 L/min, P = 0.005, respectively), whereas PICO2 levels were higher at low oxygen flow rates with both masks.Conclusion: Our results showed that higher FIO2 and less CO2 rebreathing were achieved with OxyMask than those with a simple oxygen mask at low flow rates of oxygen in healthy children. What is Known: • OxyMask is expected to reduce carbon dioxide rebreathing even at low oxygen flow rates because of its structural features. • Efficacy has been demonstrated in experimental models and adult data, but clinical data on the use of the OxyMask in children are limited. What is New: • Higher fraction of inspiratory oxygen and lesser carbon dioxide rebreathing were achieved with OxyMask than with a simple oxygen mask at low flow rates of oxygen in healthy children.
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Affiliation(s)
- Shigetoshi Ogiwara
- Department of Pediatrics, Teine Keijinkai Hospital, 12-1-40 Maeda-ichijo Teine-ku, Sapporo, 006-8555, Japan.
| | - Takuya Tamura
- Department of Pediatrics, Teine Keijinkai Hospital, 12-1-40 Maeda-ichijo Teine-ku, Sapporo, 006-8555, Japan
| | - Shuji Sai
- Department of Pediatrics, Teine Keijinkai Hospital, 12-1-40 Maeda-ichijo Teine-ku, Sapporo, 006-8555, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan
| | - Shin Kawana
- Department of Pediatric Anesthesiology, Miyagi Children's Hospital, Sendai, Japan
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30
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, König M, Markewitz A, Nothacker M, Roiter S, Unverzagt S, Veit W, Volk T, Witt C, Wildenauer R, Worth H, Fühner T. [Oxygen in the acute care of adults : Short version of the German S3 guideline]. Med Klin Intensivmed Notfmed 2021; 117:4-15. [PMID: 34651197 PMCID: PMC8516090 DOI: 10.1007/s00063-021-00884-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hintergrund Sauerstoff (O2) ist ein Arzneimittel mit spezifischen Eigenschaften, einem definierten Dosis-Wirkungs-Bereich und O2 hat unerwünschte Wirkungen. Im Jahr 2015 wurden 14 % einer Stichprobe von britischen Krankenhauspatienten mit Sauerstoff behandelt, davon hatten nur 42 % eine Verordnung. Gesundheitspersonal ist häufig unsicher über die Relevanz einer Hypoxämie und es besteht ein eingeschränktes Bewusstsein für die Risiken einer Hyperoxämie. In den letzten Jahren wurden zahlreiche randomisierte, kontrollierte Studien zur Sauerstofftherapie veröffentlicht. Methoden Im Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften diese S3-Leitlinie auf Basis einer Literaturrecherche bis zum 01.02.2021 entwickelt. Zur Literaturbewertung wurde das System des Oxford Centre for Evidence-Based Medicine (CEBM; „The Oxford 2011 Levels of Evidence“) verwendet. Die Bewertung der Evidenzqualität erfolgte anhand des Grading of Recommendations Assessment, Development and Evaluation (GRADE) und die Leitlinienempfehlungen wurden formal konsentiert. Ergebnisse Die Leitlinie enthält 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Überwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Indikation für Sauerstoff ist hauptsächlich die Hypoxämie. Hypoxämie und Hyperoxämie sollten aufgrund der Assoziation mit einer erhöhten Sterblichkeit vermieden werden. Die Leitlinie empfiehlt Zielbereiche der Sauerstoffsättigung für die Sauerstoff-Akuttherapie ohne Differenzierung zwischen verschiedenen Diagnosen. Zielbereiche sind abhängig vom Hyperkapnierisiko und Beatmungsstatus. Die Leitlinie bietet einen Überblick über verfügbare Sauerstoffzufuhrsysteme und enthält Empfehlungen für deren Auswahl basierend auf Patientensicherheit und -komfort. Fazit Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff außerklinisch und stationär anwendet, und ist bis zum 30.06.2024 gültig.
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Affiliation(s)
- Jens Gottlieb
- Klinik für Pneumologie OE 6870, Medizinische Hochschule Hannover, 30625, Hannover, Deutschland. .,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland.
| | - Philipp Capetian
- Klinik für Neurologie, Neurologische Intensivstation, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Uwe Hamsen
- Fachbereich für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - Uwe Janssens
- Innere Medizin und internistische Intensivmedizin, Sankt Antonius Hospital GmbH, Eschweiler, Deutschland
| | - Christian Karagiannidis
- Abteilung für Pneumologie und Beatmungsmedizin, ARDS/ECMO Zentrum, Lungenklinik Köln-Merheim, Köln, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Marco König
- Deutscher Berufsverband Rettungsdienst e. V., Lübeck, Deutschland
| | - Andreas Markewitz
- ehem. Klinik für Herz- und Gefäßchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg, Deutschland
| | - Sabrina Roiter
- Intensivstation, Israelitisches Krankenhaus Hamburg, Hamburg, Deutschland
| | - Susanne Unverzagt
- Abteilung für Allgemeinmedizin, Universität Leipzig, Leipzig, Deutschland
| | - Wolfgang Veit
- Bundesverband der Organtransplantierten e. V., Marne, Deutschland
| | - Thomas Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Christian Witt
- Seniorprofessor Innere Medizin und Pneumologie, Charité Berlin, Berlin, Deutschland
| | | | | | - Thomas Fühner
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland.,Krankenhaus Siloah, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Region Hannover, Hannover, Deutschland
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31
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, König M, Markewitz A, Nothacker M, Roiter S, Unverzagt S, Veit W, Volk T, Witt C, Wildenauer R, Worth H, Fühner T. [German S3 Guideline - Oxygen Therapy in the Acute Care of Adult Patients]. Pneumologie 2021; 76:159-216. [PMID: 34474487 DOI: 10.1055/a-1554-2625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiologic properties, a range of effective doses and may have side effects. In 2015, 14 % of over 55 000 hospital patients in the UK were using oxygen. 42 % of patients received this supplemental oxygen without a valid prescription. Healthcare professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A S3-guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. Literature search was performed until Feb 1st 2021 to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used and for assessing the quality of evidence and for grading guideline recommendation and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses healthcare professionals using oxygen in acute out-of-hospital and in-hospital settings. The guideline will be valid for 3 years until June 30, 2024.
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Affiliation(s)
- Jens Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
| | - Philipp Capetian
- Klinik für Neurologie, Neurologische Intensivstation, Universitätsklinikum Würzburg
| | - Uwe Hamsen
- Fachbereich für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | - Uwe Janssens
- Innere Medizin und internistische Intensivmedizin, Sankt Antonius Hospital GmbH, Eschweiler
| | - Christian Karagiannidis
- Abteilung für Pneumologie und Beatmungsmedizin, ARDS/ECMO Zentrum, Lungenklinik Köln-Merheim
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg
| | - Marco König
- Deutscher Berufsverband Rettungsdienst e. V., Lübeck
| | - Andreas Markewitz
- ehem. Klinik für Herz- und Gefäßchirurgie Bundeswehrzentralkrankenhaus Koblenz
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg
| | | | | | - Wolfgang Veit
- Bundesverband der Organtransplantierten e. V., Marne
| | - Thomas Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Christian Witt
- Seniorprofessor Innere Medizin und Pneumologie, Charité Berlin
| | | | | | - Thomas Fühner
- Krankenhaus Siloah, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Region Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
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Christensen MA, Steinmetz J, Velmahos G, Rasmussen LS. Supplemental oxygen therapy in trauma patients: An exploratory registry-based study. Acta Anaesthesiol Scand 2021; 65:967-978. [PMID: 33840093 DOI: 10.1111/aas.13829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/25/2021] [Accepted: 03/28/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Supplemental oxygen (SO) is one of the most commonly administered drugs in trauma patients and is recommended by guidelines. However, evidence supporting uniform administration is sparse, and excess oxygen use has been shown to be harmful in other patient populations. We hypothesized that SO may be harmful in patients with oxygen saturation > 97%. METHODS Patients with available information on SO-therapy in the American Trauma Quality Improvement Program 2017 database were included. Patients were categorized into 3 groups according to Emergency Department (ED) oxygen saturation: (1) saturation < 94%; (2) saturation 94%-97%; (3) saturation 98%-100%. Primary outcome was in-hospital mortality with comparisons made between patients who received SO or not. Secondary outcome was acute respiratory distress syndrome (ARDS). Patients were compared after propensity score matching. RESULTS Overall, 864 340 patients were identified. Mean age was 47.4 ± 24.4 years, and median injury severity score was 9. SO was associated with an increased risk of in-hospital mortality: (all patients: adjusted odds ratio [aOR] with 95% confidence interval [CI] 3.07 [2.92-3.22], ED saturation <94%: 2.63 [2.38-2.91], ED saturation 94%-97%: 2.71 [2.47-2.97], ED saturation >97%: 3.38 [3.16-3.61]. Same pattern was seen for in-hospital ARDS: (aOR 1.79, 95% CI [1.59-2.02], ED saturation <94%: aOR 1.75, 95% CI [1.37-2.24], ED saturation 94%-97%: aOR 1.81, 95% CI [1.43-2.29, ED saturation >97%: aOR 2.31, 95% CI [1.92-2.79]). CONCLUSION Based on propensity matched, registry data for trauma patients, the administration of SO was associated with a higher incidence of in-hospital mortality and ARDS. The highest risk was found in patients with an ED saturation >97%.
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Affiliation(s)
- Mathias A. Christensen
- Department of Anesthesia Center of Head and Orthopedics, RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Department of Surgery Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General HospitalHarvard Medical School Boston MA USA
| | - Jacob Steinmetz
- Department of Anesthesia Center of Head and Orthopedics, RigshospitaletUniversity of Copenhagen Copenhagen Denmark
| | - George Velmahos
- Department of Surgery Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General HospitalHarvard Medical School Boston MA USA
| | - Lars S. Rasmussen
- Department of Anesthesia Center of Head and Orthopedics, RigshospitaletUniversity of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Abstract
OBJECTIVE This systematic review aimed to describe the connection between the inspired oxygen fraction and pulmonary complications in adult patients, with the objective of determining a safe upper limit of oxygen supplementation. METHODS MEDLINE and Embase were systematically searched in August 2019 (updated July 2020) for studies fulfilling the following criteria: intubated adult patients (Population); high fractions of oxygen (Intervention) versus low fractions of (Comparison); atelectasis, acute respiratory distress syndrome (ARDS), pneumonia and/or duration of mechanical ventilation (Outcome); original studies both observational and interventional (Studies). Screening, data extraction and risk of bias assessment was done by two independent reviewers. RESULTS Out of 6120 records assessed for eligibility, 12 were included. Seven studies were conducted in the emergency setting, and five studies included patients undergoing elective surgery. Eight studies reported data on atelectasis, two on ARDS, four on pneumonia and two on duration of mechanical ventilation. There was a non-significant increased risk of atelectasis if an oxygen fraction of 0.8 or above was used, relative risk (RR): 1.37 (95% CI 0.95 to 1.96). One study showed an almost threefold higher risk of pneumonia in the high oxygen fraction group (RR: 2.83 (95% CI 2.25 to 3.56)). The two studies reporting ARDS and the two studies with data on mechanical ventilation showed no association with oxygen fraction. Four studies had a high risk of bias in one domain. CONCLUSIONS In this systematic review, we found inadequate evidence to identify a safe upper dosage of oxygen, but the identified studies suggest a benefit of keeping inspiratory oxygen fraction below 0.8 with regard to formation of atelectases. PROSPERO REGISTRATION NUMBER CRD42020154242.
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Affiliation(s)
| | - Bjarke Risgaard
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Josefine S Baekgaard
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Lars S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Douin DJ, Anderson EL, Dylla L, Rice JD, Jackson CL, Wright FL, Bebarta VS, Schauer SG, Ginde AA. Association Between Hyperoxia, Supplemental Oxygen, and Mortality in Critically Injured Patients. Crit Care Explor 2021; 3:e0418. [PMID: 34036272 DOI: 10.1097/CCE.0000000000000418] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: Hyperoxia is common among critically ill patients and may increase morbidity and mortality. However, limited evidence exists for critically injured patients. The objective of this study was to determine the association between hyperoxia and in-hospital mortality in adult trauma patients requiring ICU admission. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, retrospective cohort study was conducted at two level I trauma centers and one level II trauma center in CO between October 2015 and June 2018. All adult trauma patients requiring ICU admission within 24 hours of emergency department arrival were eligible. The primary exposure was oxygenation during the first 7 days of hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was in-hospital mortality. Secondary outcomes were hospital-free days and ventilator-free days. We included 3,464 critically injured patients with a mean age of 52.6 years. Sixty-five percent were male, and 66% had blunt trauma mechanism of injury. The primary outcome of in-hospital mortality occurred in 264 patients (7.6%). Of 226,057 patient-hours, 46% were spent in hyperoxia (oxygen saturation > 96%) and 52% in normoxia (oxygen saturation 90–96%). During periods of hyperoxia, the adjusted risk for mortality was higher with greater oxygen administration. At oxygen saturation of 100%, the adjusted risk scores for mortality (95% CI) at Fio2 of 100%, 80%, 60%, and 50% were 6.4 (3.5–11.8), 5.4 (3.4–8.6), 2.7 (1.7–4.1), and 1.5 (1.1–2.2), respectively. At oxygen saturation of 98%, the adjusted risk scores for mortality (95% CI) at Fio2 of 100%, 80%, 60%, and 50% were 7.7 (4.3–13.5), 6.3 (4.1–9.7), 3.2 (2.2–4.8), and 1.9 (1.4–2.7), respectively. CONCLUSIONS: During hyperoxia, higher oxygen administration was independently associated with a greater risk of mortality among critically injured patients. Level of evidence: Cohort study, level III.
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Yamamoto R, Fujishima S, Sasaki J, Gando S, Saitoh D, Shiraishi A, Kushimoto S, Ogura H, Abe T, Mayumi T, Kotani J, Nakada TA, Shiino Y, Tarui T, Okamoto K, Sakamoto Y, Shiraishi SI, Takuma K, Tsuruta R, Masuno T, Takeyama N, Yamashita N, Ikeda H, Ueyama M, Hifumi T, Yamakawa K, Hagiwara A, Otomo Y. Hyperoxemia during resuscitation of trauma patients and increased intensive care unit length of stay: inverse probability of treatment weighting analysis. World J Emerg Surg 2021; 16:19. [PMID: 33926507 PMCID: PMC8082221 DOI: 10.1186/s13017-021-00363-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background Information on hyperoxemia among patients with trauma has been limited, other than traumatic brain injuries. This study aimed to elucidate whether hyperoxemia during resuscitation of patients with trauma was associated with unfavorable outcomes. Methods A post hoc analysis of a prospective observational study was carried out at 39 tertiary hospitals in 2016–2018 in adult patients with trauma and injury severity score (ISS) of > 15. Hyperoxemia during resuscitation was defined as PaO2 of ≥ 300 mmHg on hospital arrival and/or 3 h after arrival. Intensive care unit (ICU)-free days were compared between patients with and without hyperoxemia. An inverse probability of treatment weighting (IPW) analysis was conducted to adjust patient characteristics including age, injury mechanism, comorbidities, vital signs on presentation, chest injury severity, and ISS. Analyses were stratified with intubation status at the emergency department (ED). The association between biomarkers and ICU length of stay were then analyzed with multivariate models. Results Among 295 severely injured trauma patients registered, 240 were eligible for analysis. Patients in the hyperoxemia group (n = 58) had shorter ICU-free days than those in the non-hyperoxemia group [17 (10–21) vs 23 (16–26), p < 0.001]. IPW analysis revealed the association between hyperoxemia and prolonged ICU stay among patients not intubated at the ED [ICU-free days = 16 (12–22) vs 23 (19–26), p = 0.004], but not among those intubated at the ED [18 (9–20) vs 15 (8–23), p = 0.777]. In the hyperoxemia group, high inflammatory markers such as soluble RAGE and HMGB-1, as well as low lung-protective proteins such as surfactant protein D and Clara cell secretory protein, were associated with prolonged ICU stay. Conclusions Hyperoxemia until 3 h after hospital arrival was associated with prolonged ICU stay among severely injured trauma patients not intubated at the ED. Trial registration UMIN-CTR, UMIN000019588. Registered on November 15, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-021-00363-2.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Gando
- Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | | | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshikazu Abe
- Department of General Medicine, Juntendo University, Tokyo, Japan.,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Joji Kotani
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasukazu Shiino
- Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Takehiko Tarui
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan
| | - Kiyotsugu Takuma
- Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Naoshi Takeyama
- Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan
| | - Norio Yamashita
- Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Akiyoshi Hagiwara
- Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
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Peng Y, Yuan X, Zhang Y, Wang L. Conservative oxygen supplementation versus usual oxygen supplementation among septic medical intensive care units patients: A before-after investigation. Sci Prog 2021; 104:368504211016953. [PMID: 34121519 PMCID: PMC10395172 DOI: 10.1177/00368504211016953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients admitted in the intensive care unit (ICU) are always managed with excessive high fraction of inspired oxygen and have hyperoxia for a significant period of time, which has potential harms. The guidelines for the management of patients in ICUs do not provide the target values for partial pressure of oxygen or arterial oxyhemoglobin saturations. The study was a before-after investigation comparing two time periods in which different oxygenation strategies were applied. Data of oxygen control, outcome measures, and mortality of a total of 273 patients (>18 years) admitted at least for 2 days in ICUs and received treatment for the sepsis were retrospectively collected and analyzed. Patients were received usual oxygen supplementation (targeted partial pressure of oxygen: 150 mmHg; a high fraction of inspired oxygen: 0.4; UOS cohort; n = 142) or conservative oxygen supplementation (targeted partial pressure of oxygen: 70-100 mmHg; a high fraction of inspired oxygen as low as possible; COS cohort; n = 131). Mechanical ventilation-free hours were significantly higher for patients of COS cohort than those of UOS cohort (77.99 ± 21.26 h/patient vs 70.01 ± 23.57 h/patient, p = 0.016). ICUs length of stays of patients of COS cohort was fewer than those of UOS cohort (7.05 ± 2.13 days/patient vs 7.69 ± 2.43 days/patients, p = 0.016). The probability of survival of patients was higher among patients of COS cohort than those of UOS cohort (p = 0.049). A higher number of patients from UOS cohort needed vasopressors than those from COS cohort (55 vs 35, p = 0.039). Conservative oxygen supplementation to maintain partial pressure of oxygen was improved outcome measures and decreases mortality as compared to that of usual oxygen supplementation.Level of Evidence: III.Technical Efficacy Stage: 4.
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Affiliation(s)
- Ying Peng
- Department of Burn Rectification, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, China
| | - Xiaoyan Yuan
- Department of Emergency Medicine, Gongli Hospital, Pudong New Area, Shanghai, China
| | - Yi Zhang
- Department of Burn Rectification, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, China
| | - Lei Wang
- Department of Emergency Medicine, Gongli Hospital, Pudong New Area, Shanghai, China
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Okuma Y, Becker LB, Hayashida K, Aoki T, Saeki K, Nishikimi M, Shoaib M, Miyara SJ, Yin T, Shinozaki K. Effects of Post-Resuscitation Normoxic Therapy on Oxygen-Sensitive Oxidative Stress in a Rat Model of Cardiac Arrest. J Am Heart Assoc 2021; 10:e018773. [PMID: 33775109 PMCID: PMC8174361 DOI: 10.1161/jaha.120.018773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Cardiac arrest (CA) can induce oxidative stress after resuscitation, which causes cellular and organ damage. We hypothesized that post‐resuscitation normoxic therapy would protect organs against oxidative stress and improve oxygen metabolism and survival. We tested the oxygen‐sensitive reactive oxygen species from mitochondria to determine the association with hyperoxia‐induced oxidative stress. Methods and Results Sprague–Dawley rats were subjected to 10‐minute asphyxia‐induced CA with a fraction of inspired O2 of 0.3 or 1.0 (normoxia versus hyperoxia, respectively) after resuscitation. The survival rate at 48 hours was higher in the normoxia group than in the hyperoxia group (77% versus 28%, P<0.01), and normoxia gave a lower neurological deficit score (359±140 versus 452±85, P<0.05) and wet to dry weight ratio (4.6±0.4 versus 5.6±0.5, P<0.01). Oxidative stress was correlated with increased oxygen levels: normoxia resulted in a significant decrease in oxidative stress across multiple organs and lower oxygen consumption resulting in normalized respiratory quotient (0.81±0.05 versus 0.58±0.03, P<0.01). After CA, mitochondrial reactive oxygen species increased by ≈2‐fold under hyperoxia. Heme oxygenase expression was also oxygen‐sensitive, but it was paradoxically low in the lung after CA. In contrast, the HMGB‐1 (high mobility group box‐1) protein was not oxygen‐sensitive and was induced by CA. Conclusions Post‐resuscitation normoxic therapy attenuated the oxidative stress in multiple organs and improved post‐CA organ injury, oxygen metabolism, and survival. Additionally, post‐CA hyperoxia increased the mitochondrial reactive oxygen species and activated the antioxidation system.
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Affiliation(s)
- Yu Okuma
- The Feinstein Institutes for Medical ResearchNorthwell Manhasset NY
| | - Lance B Becker
- The Feinstein Institutes for Medical ResearchNorthwell Manhasset NY.,Department of Emergency Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead NY
| | - Kei Hayashida
- The Feinstein Institutes for Medical ResearchNorthwell Manhasset NY
| | - Tomoaki Aoki
- The Feinstein Institutes for Medical ResearchNorthwell Manhasset NY
| | - Kota Saeki
- The Feinstein Institutes for Medical ResearchNorthwell Manhasset NY.,Nihon Kohden Innovation Center Cambridge MA
| | | | - Muhammad Shoaib
- The Feinstein Institutes for Medical ResearchNorthwell Manhasset NY
| | - Santiago J Miyara
- The Feinstein Institutes for Medical ResearchNorthwell Manhasset NY.,Elmezzi Graduate School of Molecular Medicine Manhasset NY
| | - Tai Yin
- The Feinstein Institutes for Medical ResearchNorthwell Manhasset NY
| | - Koichiro Shinozaki
- The Feinstein Institutes for Medical ResearchNorthwell Manhasset NY.,Department of Emergency Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead NY
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38
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Latif RK, Clifford SP, Byrne KR, Maggard B, Chowhan Y, Saleem J, Huang J. Hyperoxia After Return of Spontaneous Circulation in Cardiac Arrest Patients. J Cardiothorac Vasc Anesth 2021; 36:1419-1428. [PMID: 33875350 DOI: 10.1053/j.jvca.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/10/2021] [Accepted: 03/03/2021] [Indexed: 11/11/2022]
Abstract
Current guidelines emphasize the use of 100% oxygen during cardiopulmonary resuscitation after cardiac arrest. When patients are ventilated for variable periods after return of spontaneous circulation (ROSC), hyperoxia causes increased morbidity and mortality by overproduction of reactive oxygen species. Various patient, volunteer, and animal studies have shown the harmful effects of hyperoxia. This mini-review article aims to expand the potential clinical spectrum of hyperoxia on individual organ systems leading to organ dysfunction. A framework to achieve and maintain normoxia after ROSC is proposed. Despite the harmful considerations of hyperoxia in critically ill patients, additional safety studies including dose-effect, level and onset of the reactive oxygen species effect, and safe hyperoxia applicability period after ROSC, need to be performed in various animal and human models to further elucidate the role of oxygen therapy after cardiac arrest.
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Affiliation(s)
- Rana K Latif
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; Paris Simulation Center, Office of Medical Education, University of Louisville School of Medicine, Louisville, KY; Outcomes Research Consortium, Cleveland, OH.
| | - Sean P Clifford
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Keith R Byrne
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Brittany Maggard
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Yaruk Chowhan
- Xavier University School of Medicine, Oranjestad, Aruba
| | - Jawad Saleem
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY
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Bae J, Kim J, Lee S, Ju JW, Cho YJ, Kim TK, Jeon Y, Nam K. Association Between Intraoperative Hyperoxia and Acute Kidney Injury After Cardiac Surgery: A Retrospective Observational Study. J Cardiothorac Vasc Anesth 2020; 35:2405-2414. [PMID: 33342731 DOI: 10.1053/j.jvca.2020.11.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Optimal oxygen management during cardiac surgery has not been established, and studies on the effects of perioperative hyperoxia on postoperative acute kidney injury (AKI) are scarce. The association between intraoperative hyperoxia and AKI after cardiac surgery involving cardiopulmonary bypass was evaluated for the present study. DESIGN Retrospective observational study. SETTING A tertiary teaching hospital. PARTICIPANTS Adult patients who underwent cardiac surgery with cardiopulmonary bypass from November 2006-December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The area above arterial oxygen partial pressure (PaO2) threshold of 300 mmHg (AOT300, mmHg × h) was used as a metric of intraoperative hyperoxia and was associated with postoperative AKI, using the logistic regression analysis. Data also were fitted using the restricted cubic spline model. Sensitivity analyses were conducted using different PaO2 thresholds (150, 200, 250, and 350 mmHg). A total of 2,926 patients were analyzed. Intraoperative AOT300 independently was associated with the risk of AKI (odds ratio 1.0009; 95% confidence interval 1.0002-1.0015). A PaO2 increment of 100 mmHg above PaO2 300 mmHg for an hour was associated with an increased risk of AKI by 9.4% (1.0009100 ≈ 1.094). In the spline model, the log-odds of AKI increased as AOT300 increased. In the sensitivity analyses, AOT250 and AOT350 also significantly were associated with the risk of AKI, whereas AOT150 and AOT200 were not. As the PaO2 threshold increased from 150 to 350 mmHg, the odds ratio gradually increased. CONCLUSIONS Intraoperative hyperoxia significantly was associated with the risk of AKI after cardiac surgery involving cardiopulmonary bypass.
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Affiliation(s)
- Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jay Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul National University College of Medicine, Seoul, Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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40
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Mckenzie N, Finn J, Dobb G, Bailey P, Arendts G, Celenza A, Fatovich D, Jenkins I, Ball S, Bray J, Ho KM. Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study. Resuscitation 2020; 158:130-138. [PMID: 33232752 DOI: 10.1016/j.resuscitation.2020.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/25/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies to identify safe oxygenation targets after out-of-hospital cardiac arrest (OHCA) have often assumed a linear relationship between arterial oxygen tension (PaO2) and survival, or have dichotomised PaO2 at a supra-physiological level. We hypothesised that abnormalities in mean PaO2 (both high and low) would be associated with decreased survival after OHCA. METHODS We conducted a retrospective multicentre cohort study of adult OHCA patients who received mechanical ventilation on admission to the intensive care unit (ICU). The potential non-linear relationship between the mean PaO2 within the first 24 -hs of ICU admission and survival to hospital discharge (STHD) was assessed by a four-knot restricted cubic spline function with adjustment for potential confounders. RESULTS 3764 arterial blood gas results were available for 491 patients in the first 24-hs of ICU admission. The relationship between mean PaO2 over the first 24-hs and STHD was an inverted U-shape, with highest survival for those with a mean PaO2 between 100 and 180 mmHg (reference category) compared to a mean PaO2 of <100 mmHg (adjusted odds ratio [aOR] 0.50 95% confidence interval [CI] 0.30, 0.84), or >180 mmHg (aOR 0.41, 95% CI 0.18, 0.92). Mean PaO2 within 24 -hs was the third most important predictor and explained 9.1% of the variability in STHD. CONCLUSION The mean PaO2 within the first 24-hs after admission for OHCA has a non-linear association with the highest STHD seen between 100 and 180 mmHg. Randomised controlled trials are now needed to validate the optimal oxygenation targets in mechanically ventilated OHCA patients.
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Affiliation(s)
- Nicole Mckenzie
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia.
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Western Australia, Belmont, WA, Australia; School of Medicine (Emergency Medicine), University of Western Australia, Crawley, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Geoffrey Dobb
- Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia; Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Western Australia, Belmont, WA, Australia
| | - Glenn Arendts
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, Australia; Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Antonio Celenza
- School of Medicine (Emergency Medicine), University of Western Australia, Crawley, WA, Australia; Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Daniel Fatovich
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; School of Medicine (Emergency Medicine), University of Western Australia, Crawley, WA, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Ian Jenkins
- Fremantle Hospital, Fremantle, WA, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Western Australia, Belmont, WA, Australia
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kwok M Ho
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia; School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
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Li J, Wang J, Shen Y, Dai C, Chen B, Huang Y, Xu S, Wu Y, Li Y. Hyperoxygenation With Cardiopulmonary Resuscitation and Targeted Temperature Management Improves Post-Cardiac Arrest Outcomes in Rats. J Am Heart Assoc 2020; 9:e016730. [PMID: 32964774 PMCID: PMC7792384 DOI: 10.1161/jaha.120.016730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Oxygen plays a pivotal role in cardiopulmonary resuscitation (CPR) and postresuscitation intervention for cardiac arrest. However, the optimal method to reoxygenate patients has not been determined. This study investigated the effect of timing of hyperoxygenation on neurological outcomes in cardiac arrest/CPR rats treated with targeted temperature management. Methods and Results After induction of ventricular fibrillation, male Sprague-Dawley rats were randomized into 4 groups (n=16/group): (1) normoxic control; (2) O2_CPR, ventilated with 100% O2 during CPR; (3) O2_CPR+postresuscitation, ventilated with 100% O2 during CPR and the first 3 hours of postresuscitation; and (4) O2_postresuscitation, ventilated with 100% O2 during the first 3 hours of postresuscitation. Targeted temperature management was induced immediately after resuscitation and maintained for 3 hours in all animals. Postresuscitation hemodynamics, neurological recovery, and pathological analysis were assessed. Brain tissues of additional rats undergoing the same experimental procedure were harvested for ELISA-based quantification assays of oxidative stress-related biomarkers and compared with the sham-operated rats (n=6/group). We found that postresuscitation mean arterial pressure and quantitative electroencephalogram activity were significantly increased, whereas astroglial protein S100B, degenerated neurons, oxidative stress-related biomarkers, and neurologic deficit scores were significantly reduced in the O2_CPR+postresuscitation group compared with the normoxic control group. In addition, 96-hour survival rates were significantly improved in all of the hyperoxygenation groups. Conclusions In this cardiac arrest/CPR rat model, hyperoxygenation coupled with targeted temperature management attenuates ischemia/reperfusion-induced injuries and improves survival rates. The beneficial effects of high-concentration oxygen are timing and duration dependent. Hyperoxygenation commenced with CPR, which improves outcomes when administered during hypothermia.
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Affiliation(s)
- Jingru Li
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Jianjie Wang
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Yiming Shen
- Department of Emergency Chongqing Emergency Medical Center Chongqing China
| | - Chenxi Dai
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Bihua Chen
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Yuanyuan Huang
- Department of Neurology Southwest Hospital Army Medical University Chongqing China
| | - Senlin Xu
- Institute of Pathology and Southwest Cancer Center Southwest Hospital Army Medical University Chongqing China
| | - Yi Wu
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
| | - Yongqin Li
- Department of Biomedical Engineering and Imaging Medicine Army Medical University Chongqing China
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Abstract
High oxygen tension in blood and/or tissue affects clinical outcomes in several diseases. Thus, the optimal target PaO2 for patients recovering from cardiac arrest (CA) has been extensively examined. Many patients develop hypoxic brain injury after the return of spontaneous circulation (ROSC); this supports the need for oxygen administration in patients after CA. Insufficient oxygen delivery due to decreased blood flow to cerebral tissue during CA results in hypoxic brain injury. By contrast, hyperoxia may increase dissolved oxygen in the blood and, subsequently, generate reactive oxygen species that are harmful to neuronal cells. This secondary brain injury is particularly concerning. Although several clinical studies demonstrated that hyperoxia during post-CA care was associated with poor neurological outcomes, considerable debate is ongoing because of inconsistent results. Potential reasons for the conflicting results include differences in the definition of hyperoxia, the timing of exposure to hyperoxia, and PaO2 values used in analyses. Despite the conflicts, exposure to PaO2 > 300 mmHg through administration of unnecessary oxygen should be avoided because no obvious benefit has been demonstrated. The feasibility of titrating oxygen administration by targeting SpO2 at approximately 94% in patients recovering from CA has been demonstrated in pilot randomized controlled trials (RCTs). Such protocols should be further examined.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
| | - Jo Yoshizawa
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
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Abstract
Patients resuscitated from cardiac arrest require complex management. An organized approach to early postarrest care can improve patient outcomes. Priorities include completing a focused diagnostic work-up to identify and reverse the inciting cause of arrest, stabilizing cardiorespiratory instability to prevent rearrest, minimizing secondary brain injury, evaluating the risk and benefits of transfer to a specialty care center, and avoiding early neurologic prognostication.
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Douin DJ, Schauer SG, Anderson EL, Jones J, DeSanto K, Cunningham CW, Bebarta VS, Ginde AA. Systematic review of oxygenation and clinical outcomes to inform oxygen targets in critically ill trauma patients. J Trauma Acute Care Surg 2019; 87:961-77. [PMID: 31162333 DOI: 10.1097/TA.0000000000002392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Oxygen therapy is frequently administered to critically ill trauma patients to avoid hypoxia, but optimal oxygenation strategies are not clear. METHODS We conducted a systematic review of oxygen targets and clinical outcomes in trauma and critically ill patients. We searched Ovid MEDLINE, Cochrane Library, Embase, and Web of Science Core Collection from 1946 through 2017. Our initial search yielded 14,774 articles with 209 remaining after abstract review. We reviewed full text articles of human subjects with conditions of interest, an oxygen exposure or measurement, and clinical outcomes, narrowing the review to 43 articles. We assessed article quality using Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. RESULTS Of the 43 final studies meeting inclusions criteria, 17 focused on trauma and 26 studies focused on medical and/or surgical critical illness without trauma specifically. Four trauma studies supported lower oxygenation/normoxia, two supported higher oxygenation, and 11 supported neither normoxia nor higher oxygenation (five neutral and six supported avoidance of hypoxia). Fifteen critical illness studies supported lower oxygenation/normoxia, one supported higher oxygenation, and 10 supported neither normoxia nor higher oxygenation (nine neutral and one supported avoidance of hypoxia). We identified seven randomized controlled trials (four high quality, three moderate quality). Of the high-quality randomized controlled trials (none trauma-related), one supported lower oxygenation/normoxia and three were neutral. Of the moderate-quality randomized controlled trials (one trauma-related), one supported higher oxygenation, one was neutral, and one supported avoidance of hypoxia. CONCLUSION We identified few trauma-specific studies beyond traumatic brain injury; none were high quality. Extrapolating primarily from nontrauma critical illness, reduced oxygen administration targeting normoxia in critically ill trauma patients may result in better or equivalent clinical outcomes. Additional trauma-specific trials are needed to determine the optimal oxygen strategy in critically injured patients. LEVEL OF EVIDENCE Systematic review, level IV.
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Marquez AM, Morgan RW, Ko T, Landis WP, Hefti MM, Mavroudis CD, McManus MJ, Karlsson M, Starr J, Roberts AL, Lin Y, Nadkarni V, Licht DJ, Berg RA, Sutton RM, Kilbaugh TJ. Oxygen Exposure During Cardiopulmonary Resuscitation Is Associated With Cerebral Oxidative Injury in a Randomized, Blinded, Controlled, Preclinical Trial. J Am Heart Assoc 2020; 9:e015032. [PMID: 32321350 PMCID: PMC7428577 DOI: 10.1161/jaha.119.015032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Hyperoxia during cardiopulmonary resuscitation (CPR) may lead to oxidative injury from mitochondrial‐derived reactive oxygen species, despite guidelines recommending 1.0 inspired oxygen during CPR. We hypothesized exposure to 1.0 inspired oxygen during CPR would result in cerebral hyperoxia, higher mitochondrial‐derived reactive oxygen species, increased oxidative injury, and similar survival compared with those exposed to 21% oxygen. Methods and Results Four‐week‐old piglets (n=25) underwent asphyxial cardiac arrest followed by randomization and blinding to CPR with 0.21 (n=10) or 1.0 inspired oxygen (n=10) through 10 minutes post return of spontaneous circulation. Sham was n=5. Survivors received 4 hours of protocolized postarrest care, whereupon brain was obtained for mitochondrial analysis and neuropathology. Groups were compared using Kruskal‐Wallis test, Wilcoxon rank‐sum test, and generalized estimating equations regression models. Both 1.0 and 0.21 groups were similar in systemic hemodynamics and cerebral blood flow, as well as survival (8/10). The 1.0 animals had relative cerebral hyperoxia during CPR and immediately following return of spontaneous circulation (brain tissue oxygen tension, 85% [interquartile range, 72%–120%] baseline in 0.21 animals versus 697% [interquartile range, 515%–721%] baseline in 1.0 animals; P=0.001 at 10 minutes postarrest). Cerebral mitochondrial reactive oxygen species production was higher in animals treated with 1.0 compared with 0.21 (P<0.03). Exposure to 1.0 oxygen led to increased cerebral oxidative injury to proteins and lipids, as evidenced by significantly higher protein carbonyls and 4‐hydroxynoneals compared with 0.21 (P<0.05) and sham (P<0.001). Conclusions Exposure to 1.0 inspired oxygen during CPR caused cerebral hyperoxia during resuscitation, and resultant increased mitochondrial‐derived reactive oxygen species and oxidative injury following cardiac arrest.
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Affiliation(s)
- Alexandra M Marquez
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Ryan W Morgan
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Tiffany Ko
- Division of Neurology Department of Pediatrics Children's Hospital of Philadelphia PA
| | - William P Landis
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Marco M Hefti
- Department of Pathology University of Iowa Iowa City IA
| | - Constantine D Mavroudis
- Division of Cardiothoracic Surgery Department of Surgery Children's Hospital of Philadelphia PA
| | - Meagan J McManus
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | | | - Jonathan Starr
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Anna L Roberts
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Yuxi Lin
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Vinay Nadkarni
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Daniel J Licht
- Division of Neurology Department of Pediatrics Children's Hospital of Philadelphia PA
| | - Robert A Berg
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Robert M Sutton
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Todd J Kilbaugh
- Division of Critical Care Medicine Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia PA
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Ruetzler K, Cohen B, Leung S, Mascha EJ, Knotzer J, Kurz A, Sessler DI, Turan A. Supplemental Intraoperative Oxygen Does Not Promote Acute Kidney Injury or Cardiovascular Complications After Noncardiac Surgery. Anesth Analg 2020; 130:933-940. [DOI: 10.1213/ane.0000000000004359] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Sonnier M, Rittenberger JC. State-of-the-art considerations in post-arrest care. J Am Coll Emerg Physicians Open 2020; 1:107-116. [PMID: 33000021 PMCID: PMC7493544 DOI: 10.1002/emp2.12022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
Cardiac arrest has a high rate of morbidity and mortality. Several advances in post-cardiac arrest management can improve outcome, but are time-dependent, placing the emergency physician in a critical role to both recognize the need for and initiate therapy. We present a novel perspective of both the workup and therapeutic interventions geared toward the emergency physician during the first few hours of care. We describe how the immediate care of a post-cardiac arrest patient is resource intensive and requires simultaneous evaluation for the underlying cause and intensive management to prevent further end organ damage, particularly of the central nervous system. The goal of the initial focused assessment is to rapidly determine if any reversible causes of cardiac arrest are present and to intervene when possible. Interventions performed in this acute period are aimed at preventing additional brain injury through optimizing hemodynamics, providing ventilatory support, and by using therapeutic hypothermia when indicated. After the initial phase of care, disposition is guided by available resources and the clinician's judgment. Transfer to a specialized cardiac arrest center is prudent in centers that do not have significant support or experience in the care of these patients.
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Affiliation(s)
| | - Jon C. Rittenberger
- Guthrie Robert Packer HospitalSayrePennsylvania
- Geisinger Commonwealth Medical CollegeScrantonPennsylvania
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Zhou DW, Li ZM, Zhang SL, Wu L, Li YY, Zhou JX, Shi GZ. The optimal peripheral oxygen saturation may be 95-97% for post-cardiac arrest patients: A retrospective observational study. Am J Emerg Med 2020; 40:120-126. [PMID: 32001056 DOI: 10.1016/j.ajem.2020.01.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current post-resuscitation guidelines recommend oxygen titration in adults with the return of spontaneous circulation after cardiac arrest. However, the optimal peripheral oxygen saturation (SpO2) is still unclear for post-cardiac arrest care. METHODS We conducted a retrospective observational study of prospectively collected data of all cardiac arrest patients admitted to the intensive care units between 2014 and 2015. The main exposure was SpO2, which were interfaced from bedside vital signs monitors as 1-min averages, and archived as 5-min median values. The proportion of time spent in different SpO2 categories was included in separate multivariable regression models along with covariates. The primary outcome measure was hospital mortality and the proportion of discharged home as the secondary outcome was reported. RESULTS 2836 post-cardiac arrest patients in ICUs of 156 hospitals were included. 1235 (44%) patients died during hospitalization and 818 (29%) patients discharged home. With multivariate regression analysis, the proportion of time spent in SpO2 of ≤89%, 90%, 91%, and 92% were associated with higher hospital mortality. The proportion of time spent in SpO2 of 95%, 96%, and 97% were associated with a higher proportion of discharged home outcome, but not associated with hospital mortality. CONCLUSIONS In this retrospective observational study, the optimal SpO2 for patients admitted to the intensive care unit after cardiac arrest may be 95-97%. Further investigation is warranted to determine if targeting SpO2 of 95-97% would improve patient-centered outcomes after cardiac arrest.
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Affiliation(s)
- D W Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Z M Li
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - S L Zhang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - L Wu
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Y Y Li
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - J X Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - G Z Shi
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Ottolenghi S, Sabbatini G, Brizzolari A, Samaja M, Chiumello D. Hyperoxia and oxidative stress in anesthesia and critical care medicine. Minerva Anestesiol 2020; 86:64-75. [DOI: 10.23736/s0375-9393.19.13906-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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