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Watabe K, Goda A, Tobita K, Yokoyama S, Kikuchi H, Takeuchi K, Inami T, Soejima K, Kohno T. Determinants of physical quality of life in patients with chronic thromboembolic pulmonary hypertension after treatment: Insights from invasive exercise stress test. J Heart Lung Transplant 2024:S1053-2498(24)01562-6. [PMID: 38636934 DOI: 10.1016/j.healun.2024.04.001] [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: 11/22/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Impaired quality of life (QoL) is prevalent among patients with chronic thromboembolic pulmonary hypertension (CTEPH) despite improved survival due to medical advances. We clarified the physical QoL of patients with CTEPH with mildly elevated pulmonary hemodynamics and evaluated its determinants using a database of patients with CTEPH evaluated for hemodynamics during exercise. METHODS The QoL was measured in 144 patients with CTEPH (age, 66 (58-73) years; men/women, 48/96) with mildly elevated mean pulmonary artery pressure (<30 mm Hg) at rest after treatment with balloon pulmonary angioplasty and/or pulmonary endarterectomy using the Short-Form 36 (SF-36) questionnaire. The enrolled patients were divided into 2 groups: physical component summary (PCS) scores in the SF-36 over 50 as PCS-good and those under 50 as PCS-poor. RESULTS The median PCS in SF-36 score was 43.4 (IQR 32.4-49.5) points. The PCS-poor group (n = 110) was older and had lower exercise capacity and SaO2 during exercise. PCS scores were correlated with 6-minute walk distance (rs=0.40, p < 0.001), quadriceps strength (rs=0.34, p < 0.001), peak VO2 (rs=0.31, p < 0.001), SaO2 at rest (rs=0.35, p < 0.001) and peak exercise (rs=0.33, p < 0.001), home oxygen therapy usage (rs=-0.28, p = 0.001), and pulmonary vascular resistance at peak exercise (rs=-0.26, p = 0.002). CONCLUSIONS The impairment of physical QoL was common in patients with CTEPH with improved hemodynamics; exercise capacity, hypoxemia, and hemodynamic status during exercise were related to the physical QoL.
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Affiliation(s)
- Kosuke Watabe
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan.
| | - Kazuki Tobita
- Department of Rehabilitation, Kyorin University Hospital, Tokyo, Japan
| | - Sachi Yokoyama
- Department of Rehabilitation, Kyorin University Hospital, Tokyo, Japan; Nursing Department, Yumino Heart Clinic, Tokyo, Japan
| | - Hanako Kikuchi
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Kaori Takeuchi
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Takumi Inami
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan
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Oltra G, Ricciardelli M, Virgilio S, Fernandez Parmo D, Ruiz A, Liquitay CME, Garegnani L. High-flow nasal cannula during pulmonary rehabilitation for people with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Physiother Res Int 2024; 29:e2088. [PMID: 38581398 DOI: 10.1002/pri.2088] [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: 11/21/2023] [Revised: 01/22/2024] [Accepted: 03/17/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an increasingly concerning global public health issue due to its high burden of morbidity and mortality. Pulmonary rehabilitation (PR) is a comprehensive intervention to improve patients' physical and psychological conditions, commonly involving oxygen supplementation. The potential benefits of high-flow nasal cannula (HFNC) have recently sparked interest as oxygen therapy. In this context, this study aims to assess the effects of HFNC during the exercise training component of a PR program in people with COPD. METHODS Systematic review (CRD42022330929). We included randomised controlled trials (RCTs), including crossover RCTs with adults with stable COPD. We included trials using oxygen therapy with HFNC during the exercise training component of a PR programme. PRIMARY OUTCOMES disease-specific health-related quality of life (HRQoL), exercise capacity (EC) and adverse events. SECONDARY OUTCOMES treatment adherence, breathlessness and future exacerbations. RESULTS We included five studies with 300 participants with moderate to severe COPD. The certainty of the evidence was primarily low or very low for all outcomes of interest due to risk of bias, inconsistency or imprecision. HFNC has little to no difference in HRQoL (4 studies, 129 participants, MD 0.17, 95% CI -1.20 to 1.54; I2 50%). HFNC may result in little to no difference in EC (3 studies, 212 participants, mean difference 18.73, 95% CI -20.49 to 28.94; I2 56%), and we are uncertain about the effect of HFNC on breathlessness (4 studies; 244 participants, MD of -0.07, 95% CI -0.4 to 0.26; I2 63%). Only one study with 44 participants reported a participant's withdrawal because of progressive dyspnoea during lower limb exercise. CONCLUSIONS We are uncertain about the effect of HFNC during the exercise component of a PR programme in HRQoL, EC or dyspnoea compared to usual care or conventional supplementary oxygen. Non-domiciliary oxygen patients showed improvements in HRQoL, EC and dyspnoea.
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Affiliation(s)
- Gisela Oltra
- Research Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariela Ricciardelli
- School of Medicine, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sacha Virgilio
- School of Medicine, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Delfina Fernandez Parmo
- School of Medicine, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Angélica Ruiz
- School of Medicine, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Luis Garegnani
- Research Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Crescioli E, Riis JØ, Weinreich UM, Jensen JUS, Poulsen LM, Brøchner AC, Lange T, Perner A, Klitgaard TL, Schjørring OL, Rasmussen BS. Long-term cognitive and pulmonary functions following a lower versus a higher oxygenation target in the HOT-ICU and HOT-COVID trials: A protocol update. Acta Anaesthesiol Scand 2024; 68:575-578. [PMID: 38272985 DOI: 10.1111/aas.14379] [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: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND The Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial was a multicentre, randomised, parallel-group trial of a lower oxygenation target (arterial partial pressure of oxygen [PaO2 ] = 8 kPa) versus a higher oxygenation target (PaO2 = 12 kPa) in adult ICU patients with acute hypoxaemic respiratory failure; the Handling Oxygenation Targets in coronavirus disease 2019 (HOT-COVID) tested the same oxygenation targets in patients with confirmed COVID-19. In this study, we aim to evaluate the long-term effects of these oxygenation targets on cognitive and pulmonary function. We hypothesise that a lower oxygenation target throughout the ICU stay may result in cognitive impairment, whereas a higher oxygenation target may result in impaired pulmonary function. METHODS This is the updated protocol and statistical analysis plan of two pre-planned secondary outcomes, the long-term cognitive function, and long-term pulmonary function, in the HOT-ICU and HOT-COVID trials. Patients enrolled in both trials at selected Danish sites and surviving to 1 year after randomisation are eligible to participate. A Repeatable Battery for the Assessment of Neuropsychological Status score and a full-body plethysmography, including diffusion capacity for carbon monoxide, will be obtained. The last patient is expected to be included in the spring of 2024. CONCLUSION This study will provide important information on the long-term effects of a lower versus a higher oxygenation target on long-term cognitive and pulmonary functions in adult ICU patients with acute hypoxaemic respiratory failure.
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Affiliation(s)
- Elena Crescioli
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Østergaard Riis
- Department of Neurology and Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Ulrik Staehr Jensen
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Anne Craveiro Brøchner
- Department of Anaesthesia and Intensive Care, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Lass Klitgaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Olav Lilleholt Schjørring
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bodil Steen Rasmussen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Armarego M, Forde H, Wills K, Beggs SA. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database Syst Rev 2024; 3:CD009609. [PMID: 38506440 PMCID: PMC10953464 DOI: 10.1002/14651858.cd009609.pub3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Bronchiolitis is a common lower respiratory tract illness, usually of viral aetiology, affecting infants younger than 24 months of age and is the most common cause of hospitalisation of infants. It causes airway inflammation, mucus production and mucous plugging, resulting in airway obstruction. Effective pharmacotherapy is lacking and bronchiolitis is a major cause of morbidity and mortality. Conventional treatment consists of supportive therapy in the form of fluids, supplemental oxygen, and respiratory support. Traditionally, oxygen delivery is as a dry gas at 100% concentration via low-flow nasal prongs. However, the use of heated, humidified, high-flow nasal cannula (HFNC) therapy enables delivery of higher inspired gas flows of an air/oxygen blend, at 2 to 3 L/kg per minute up to 60 L/min in children. It can provide some level of continuous positive airway pressure (CPAP) to improve ventilation in a minimally invasive manner. This may reduce the need for invasive respiratory support, thus potentially lowering costs, with clinical advantages and fewer adverse effects. OBJECTIVES To assess the effects of HFNC therapy compared with conventional respiratory support in the treatment of infants with bronchiolitis. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, and Web of Science (from June 2013 to December 2022). In addition, we consulted ongoing trial registers and experts in the field to identify ongoing studies, checked reference lists of relevant articles, and searched for conference abstracts. Date restrictions were imposed such that we only searched for studies published after the original version of this review. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs that assessed the effects of HFNC (delivering oxygen or oxygen/room air blend at flow rates greater than 4 L/minute) compared to conventional treatment in infants (< 24 months) with a clinical diagnosis of bronchiolitis. DATA COLLECTION AND ANALYSIS Two review authors independently used a standard template to assess trials for inclusion and extract data on study characteristics, risk of bias elements, and outcomes. We contacted trial authors to request missing data. Outcome measures included the need for invasive respiratory support and time until discharge, clinical severity measures, oxygen saturation, duration of oxygen therapy, and adverse events. MAIN RESULTS In this update we included 15 new RCTs (2794 participants), bringing the total number of RCTs to 16 (2813 participants). Of the 16 studies, 11 compared high-flow to low-flow, and five compared high-flow to CPAP. These studies included infants less than 24 months of age as stated in our selection criteria. There were no significant differences in sex. We found that when comparing high-flow to low-flow oxygen therapy for infants with bronchiolitis there may be a reduction in the total length of hospital stay (mean difference (MD) -0.65 days, 95% confidence interval (CI) -1.23 to -0.06; P < 0.00001, I2 = 89%; 7 studies, 1951 participants; low-certainty evidence). There may also be a reduction in the duration of oxygen therapy (MD -0.59 days, 95% CI -1 to -0.18; P < 0.00001, I2 = 86%; 7 studies, 2132 participants; low-certainty evidence). We also found that there was probably an improvement in respiratory rate at one and 24 hours, and heart rate at one, four to six, and 24 hours in those receiving high-flow oxygen therapy when compared to pre-intervention baselines. There was also probably a reduced risk of treatment escalation in those receiving high-flow when compared to low-flow oxygen therapy (risk ratio (RR) 0.55, 95% CI 0.39 to 0.79; P = 0.001, I2 = 43%; 8 studies, 2215 participants; moderate-certainty evidence). We found no difference in the incidence of adverse events (RR 1.2, 95% CI 0.38 to 3.74; P = 0.76, I2 = 26%; 4 studies, 1789 participants; low-certainty evidence) between the two groups. The lack of comparable outcomes in studies comparing high-flow and CPAP, as well as the small numbers of participants, limited our ability to perform meta-analysis on this group. AUTHORS' CONCLUSIONS High-flow nasal cannula therapy may have some benefits over low-flow oxygen for infants with bronchiolitis in terms of a greater improvement in respiratory and heart rates, as well as a modest reduction in the length of hospital stay and duration of oxygen therapy, with a reduced incidence of treatment escalation. There does not appear to be a difference in the number of adverse events. Further studies comparing high-flow nasal cannula therapy and CPAP are required to demonstrate the efficacy of one modality over the other. A standardised clinical definition of bronchiolitis, as well as the use of a validated clinical severity score, would allow for greater and more accurate comparison between studies.
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Affiliation(s)
- Michael Armarego
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Hannah Forde
- School of Medicine, University of Tasmania, Hobart, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Sean A Beggs
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
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de Paula Silva-Lalucci MP, Marques DCDS, Valdés-Badilla P, Andreato LV, Magnani Branco BH. Obesity as a Risk Factor for Complications and Mortality in Individuals with SARS-CoV-2: A Systematic Review. Nutrients 2024; 16:543. [PMID: 38398867 PMCID: PMC10892776 DOI: 10.3390/nu16040543] [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: 01/22/2024] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
This systematic review aimed to analyze the available studies that identified overweight and/or obesity as a risk factor for mortality, use of respiratory support, and changes in biochemical markers in adults hospitalized with SARS-CoV-2. The PubMed, Web of Science, and Scopus databases were searched using PRISMA guidelines until January 2024. The protocol was registered with PROSPERO (code: CRD42024501551). Of the 473 articles, only 8 met the inclusion criteria (e.g., adult individuals aged 18 or over diagnosed with COVID-19 individuals with overweight and/or obesity). In addition, the Downs and Black tool was used to assess the quality of the studies. The studies analyzed totaled 9782 adults hospitalized for COVID-19, indicating that overweight and obesity are present in more than half of adults. Diseases such as diabetes mellitus and hypertension are more prevalent in adults with obesity. The systematic review also highlighted that a higher incidence of respiratory support is related to a higher incidence of hospitalization in intensive care units and that adults with overweight and obesity have a higher risk of mortality from COVID-19. Biochemical markers such as procalcitinin, C-reactive protein, and interleukin-6 are associated with the severity of COVID-19 infection. This systematic review exposed overweight and/or obesity as a risk factor for worse COVID-19 disease, as well as for the need for intensive care, respiratory support, mortality, and changes in essential blood markers.
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Affiliation(s)
- Marielle Priscila de Paula Silva-Lalucci
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology, and Innovation, Maringá 87050-390, Paraná, Brazil; (M.P.d.P.S.-L.); (D.C.d.S.M.)
- Graduate Program in Health Promotion, Cesumar University, Maringá 87050-390, Paraná, Brazil
| | - Déborah Cristina de Souza Marques
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology, and Innovation, Maringá 87050-390, Paraná, Brazil; (M.P.d.P.S.-L.); (D.C.d.S.M.)
- Graduate Program in Health Promotion, Cesumar University, Maringá 87050-390, Paraná, Brazil
| | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca 3530000, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del Mar 2520000, Chile
| | - Leonardo Vidal Andreato
- Higher School of Health Sciences, State University of Amazonas, Manaus 69065-001, Amazonas, Brazil;
| | - Braulio Henrique Magnani Branco
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology, and Innovation, Maringá 87050-390, Paraná, Brazil; (M.P.d.P.S.-L.); (D.C.d.S.M.)
- Graduate Program in Health Promotion, Cesumar University, Maringá 87050-390, Paraná, Brazil
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Fernández Ceballos I, Steinberg E, Ems J, Nuñez Silveira JM, Madorno M, Carboni Bisso I, Las Heras M, Cornejo R. Physiological effect of high flow oxygen therapy measured by electrical impedance tomography in single-lung transplantation. Medicina (B Aires) 2024; 84:148-152. [PMID: 38271942] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), single lung transplantation (SLT) is sometimes performed as an alternative to bilateral lung transplantation due to limited organ availability. However, the postoperative management of SLT presents challenges, including complications related to the distinct compliance of each lung. This case report presents the case of a 65-year-old male patient who underwent SLT and was in the weaning period from mechanical ventilation. High-flow oxygen therapy (HFOT) was administered, and the physiological effects were measured using electrical impedance tomography (EIT). The results demonstrated that the application of HFOT increased air trapping and overdistention in the native lung without benefiting the transplanted lung. HFOT through a tracheostomy tube or nasal cannula resulted in a more heterogeneous distribution of ventilation, with increased end expiratory lung impedance, prolonged expiratory time constants, and an increase in silent spaces. The drop in tidal impedance after applying HFOT did not indicate hypoventilation but rather overdistention and air trapping in the native lung, while the transplanted lung showed evidence of hypoventilation. These findings suggest that HFOT may not be beneficial for SLT patients and could potentially worsen outcomes. However, due to the limited scope of this case report, further prospective studies with larger patient cohorts are needed to confirm these results.
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Affiliation(s)
| | - Emilio Steinberg
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Argentina
| | | | | | | | | | - Marcos Las Heras
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Argentina
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Chile
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Rasmussen SB, Jeppesen KK, Kjaergaard J, Hassager C, Schmidt H, Mølstrøm S, Beske RP, Grand J, Ravn HB, Winther-Jensen M, Meyer MAS, Møller JE. Blood Pressure and Oxygen Targets on Kidney Injury After Cardiac Arrest. Circulation 2023; 148:1860-1869. [PMID: 37791480 DOI: 10.1161/circulationaha.123.066012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) represents a common and serious complication to out-of-hospital cardiac arrest. The importance of post-resuscitation care targets for blood pressure and oxygenation for the development of AKI is unknown. METHODS This is a substudy of a randomized 2-by-2 factorial trial, in which 789 comatose adult patients who had out-of-hospital cardiac arrest with presumed cardiac cause and sustained return of spontaneous circulation were randomly assigned to a target mean arterial blood pressure of either 63 or 77 mm Hg. Patients were simultaneously randomly assigned to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pao2) of 9 to 10 kPa or a liberal oxygenation target of a Pao2 of 13 to 14 kPa. The primary outcome for this study was AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) classification in patients surviving at least 48 hours (N=759). Adjusted logistic regression was performed for patients allocated to high blood pressure and liberal oxygen target as reference. RESULTS The main population characteristics at admission were: age, 64 (54-73) years; 80% male; 90% shockable rhythm; and time to return of spontaneous circulation, 18 (12-26) minutes. Patients allocated to a low blood pressure and liberal oxygen target had an increased risk of developing AKI compared with patients with high blood pressure and liberal oxygen target (84/193 [44%] versus 56/187 [30%]; adjusted odds ratio, 1.87 [95% CI, 1.21-2.89]). Multinomial logistic regression revealed that the increased risk of AKI was only related to mild-stage AKI (KDIGO stage 1). There was no difference in risk of AKI in the other groups. Plasma creatinine remained high during hospitalization in the low blood pressure and liberal oxygen target group but did not differ between groups at 6- and 12-month follow-up. CONCLUSIONS In comatose patients who had been resuscitated after out-of-hospital cardiac arrest, patients allocated to a combination of a low mean arterial blood pressure and a liberal oxygen target had a significantly increased risk of mild-stage AKI. No difference was found in terms of more severe AKI stages or other kidney-related adverse outcomes, and creatinine had normalized at 1 year after discharge. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.
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Affiliation(s)
- Sebastian Buhl Rasmussen
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
| | | | - Jesper Kjaergaard
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
- Department of Clinical Medicine, University of Copenhagen, Denmark (J.K., C.H.)
| | - Christian Hassager
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
- Department of Clinical Medicine, University of Copenhagen, Denmark (J.K., C.H.)
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense (H.S., H.B.R., J.E.M.)
| | - Simon Mølstrøm
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
| | - Rasmus Paulin Beske
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
| | - Johannes Grand
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
| | - Hanne Berg Ravn
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense (H.S., H.B.R., J.E.M.)
| | - Matilde Winther-Jensen
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
| | - Martin Abild Stengaard Meyer
- Department of Anesthesiology and Intensive Care (S.B.R., H.S., S.M., H.B.R., M.A.S.M.), Odense University Hospital, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology (K.K.J., J.E.M.), Odense University Hospital, Denmark
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark (J.K., C.H., R.P.B., J.G., M.W.-J., J.E.M.)
- Department of Clinical Research, University of Southern Denmark, Odense (H.S., H.B.R., J.E.M.)
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8
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Shikani AH, Rohayem Z, D'Adamo CR, Miller AC. Linear versus Turbulent Airflow Tracheostomy Heat and Moisture Exchangers: A Crossover Study. Laryngoscope 2023; 133:3422-3428. [PMID: 37289035 DOI: 10.1002/lary.30795] [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: 09/23/2022] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of two tracheostomy heat and moisture exchangers (HMEs), namely the Shikani Oxygen HME™ (S-O2 HME, ball type, turbulent airflow) and Mallinckrodt Tracheolife II DAR HME (M-O2 HME; flapper type, linear airflow) on tracheobronchial mucosal health, oxygenation, humidification, and patient preference. METHODS A randomized cross-over study was conducted with HME-naïve long-term tracheostomy subjects at two academic medical centers. Bronchoscopy assessments of mucosal health were performed at baseline and day 5 of HME application, along with oxygen saturation (SpO2 ) and breathed air humidity at four oxygen flow rates (1, 2, 3, and 5 lpm). Patient preference was assessed on study conclusion. RESULTS Both HMEs were associated with improved mucosal inflammation and decreased mucus production (p < 0.0002), with greater improvements in the S-O2 HME group (p < 0.007). Both HMEs improved humidity concentration at each oxygen flow rate (p < 0.0001), without significant differences between groups. SpO2 was greater for the S-O2 HME versus the M-O2 HME across all measured oxygen flow rates (p = 0.003). At low oxygen flow rates (1 or 2 lpm), the SpO2 in the S-O2 HME group was similar to that of the M-O2 HME at higher oxygen flow rates (3 or 5 lpm; p = 0.6). Ninety percent of subjects preferred the S-O2 HME. CONCLUSION Tracheostomy HME uses correlated with improved indicators of tracheobronchial mucosal health, humidity, and oxygenation. The S-O2 HME outperformed the M-O2 HME with respect to tracheobronchial inflammation, SpO2 , and patient preference. Regular HME use by tracheostomy patients is recommended to optimize pulmonary health. Newer ball-type speaking valve technology additionally allows concomitant HME and speaking valve application. LEVEL OF EVIDENCE 2 Laryngoscope, 133:3422-3428, 2023.
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Affiliation(s)
- Alan H Shikani
- Division of Otolaryngology-Head and Neck Surgery, LifeBridge Sinai Hospital, Baltimore, Maryland, USA
- Division of Otolaryngology-Head and Neck Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Ziad Rohayem
- Division of Otolaryngology-Head and Neck Surgery, LifeBridge Sinai Hospital, Baltimore, Maryland, USA
- Division of Otolaryngology-Head and Neck Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Christopher R D'Adamo
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew C Miller
- Department of Emergency Medicine, Memorial Hospital of Belleville, Belleville, Illinois, USA
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9
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Trottier M, Bouchard PA, L'Her E, Lellouche F. Automated Oxygen Titration During CPAP and Noninvasive Ventilation in Healthy Subjects With Induced Hypoxemia. Respir Care 2023; 68:1553-1560. [PMID: 37311626 PMCID: PMC10589107 DOI: 10.4187/respcare.09866] [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: 06/15/2023]
Abstract
BACKGROUND Automated oxygen titration to maintain a stable SpO2 has been developed for spontaneously breathing patients but has not been evaluated during CPAP and noninvasive ventilation (NIV). METHODS We performed a randomized controlled crossover, double-blind study on 10 healthy subjects with induced hypoxemia during 3 situations: spontaneous breathing with oxygen support, CPAP (5 cm H2O), and NIV (7/3 cm H2O). We conducted in random order 3 dynamic hypoxic challenges of 5 min (FIO2 0.08 ± 0.02, 0.11± 0.02, and 0.14 ± 0.02). For each condition, we compared automated oxygen titration and manual oxygen titration by experienced respiratory therapists (RTs), with the aim to maintain the SpO2 at 94 ± 2%. In addition, we included 2 subjects hospitalized for exacerbation of COPD under NIV and a subject managed after bariatric surgery with CPAP and automated oxygen titration. RESULTS The percentage of time in the SpO2 target was higher with automated compared with manual oxygen titration for all conditions, on average 59.6 ± 22.8% compared to 44.3 ± 23.9% (P = .004). Hyperoxemia (SpO2 > 96%) was less frequent with automated titration for each mode of oxygen administration (24.0 ± 24.4% vs 39.1 ± 25.3%, P < .001). During the manual titration periods, the RT made several changes to oxygen flow (5.1 ± 3.3 interventions that lasted 122 ± 70 s/period) compared to none during the automated titration to maintain oxygenation in the targeted SpO2 . Time in the SpO2 target was higher with stable hospitalized subjects in comparison with healthy subjects under dynamic-induced hypoxemia. CONCLUSIONS In this proof-of-concept study, automated oxygen titration was used during CPAP and NIV. The performances to maintain the SpO2 target were significantly better compared to manual oxygen titration in the setting of this study protocol. This technology may allow decreasing the number of manual interventions for oxygen titration during CPAP and NIV.
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Affiliation(s)
- Miguel Trottier
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Pierre-Alexandre Bouchard
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Erwan L'Her
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada; LATIM INSERM UMR 1101, Université de Bretagne Occidentale, Brest, France; and the Centre Hospitalier Universitaire de Brest, Brest, France
| | - François Lellouche
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada.
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10
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Munroe ES, Prevalska I, Hyer M, Meurer WJ, Mosier JM, Tidswell MA, Prescott HC, Wei L, Wang H, Fung CM. High-flow nasal cannula vs non-invasive ventilation in acute hypoxia: Propensity score matched study. medRxiv 2023:2023.09.26.23296167. [PMID: 37808723 PMCID: PMC10557810 DOI: 10.1101/2023.09.26.23296167] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
RATIONALE The optimal treatment for early hypoxemic respiratory failure is unclear, and both high-flow nasal cannula and non-invasive ventilation are used. Determining clinically relevant outcomes for evaluating non-invasive respiratory support modalities remains a challenge. OBJECTIVES To compare the effectiveness of initial treatment with high-flow nasal cannula versus non-invasive ventilation for acute hypoxemic respiratory failure. METHODS We conducted a retrospective cohort study of patients with acute hypoxemic respiratory failure treated with high-flow nasal cannula or non-invasive ventilation within 24 hours of Emergency Department arrival (1/2018-12/2022). We matched patients 1:1 using a propensity score for odds of receiving non-invasive ventilation. The primary outcome was major adverse pulmonary events (28-day mortality, ventilator-free days, non-invasive respiratory support hours) calculated using a Win Ratio. MEASUREMENTS AND MAIN RESULTS 1,265 patients met inclusion criteria. 795 (62.8%) received high-flow oxygen and 470 (37.2%) received non-invasive ventilation. We propensity score matched 736/1,265 (58.2%) patients. There was no difference between non-invasive ventilation vs high-flow nasal cannula in 28-day mortality (17.7% vs 23.1%, p=0.08) or ventilator-free days (median [Interquartile Range]: 28 [25, 28] vs 28 [13, 28], p=0.50), but patients on non-invasive ventilation required treatment for fewer hours (median 7 vs 13, p< 0.001). Win Ratio for composite major adverse pulmonary events favored non-invasive ventilation (1.26, 95%CI 1.06-1.49, p< 0.001). CONCLUSIONS In this observational study of patients with acute hypoxemic respiratory failure, initial treatment with non-invasive ventilation was superior to high-flow nasal cannula for major pulmonary adverse events. Evaluation of composite outcomes is important in the assessment of respiratory support modalities.
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Affiliation(s)
- Elizabeth S Munroe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ina Prevalska
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Madison Hyer
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jarrod M Mosier
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Mark A. Tidswell
- Division of Pulmonary and Critical Care, Department of Medicine, University of Massachusetts Chan Medical School – Baystate Medical Center, Springfield, MA
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Henry Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
| | - Christopher M Fung
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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11
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Huang Y, Zhao J, Hua X, Luo K, Shi Y, Lin Z, Tang J, Feng Z, Mu D. Guidelines for high-flow nasal cannula oxygen therapy in neonates (2022). J Evid Based Med 2023; 16:394-413. [PMID: 37674304 DOI: 10.1111/jebm.12546] [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: 02/17/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
High-flow nasal cannula (HFNC) oxygen therapy, which is important in noninvasive respiratory support, is increasingly being used in critically ill neonates with respiratory failure because it is comfortable, easy to setup, and has a low incidence of nasal trauma. The advantages, indications, and risks of HFNC have been the focus of research in recent years, resulting in the development of the application. Based on current evidence, we developed guidelines for HFNC in neonates using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The guidelines were formulated after extensive consultations with neonatologists, respiratory therapists, nurse specialists, and evidence-based medicine experts. We have proposed 24 recommendations for 9 key questions. The guidelines aim to be a source of evidence and reference of HFNC oxygen therapy in clinical practice, and so that more neonates and their families will benefit from HFNC.
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Affiliation(s)
- Yi Huang
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
| | - Jing Zhao
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Xintian Hua
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Keren Luo
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Yuan Shi
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Zhenlang Lin
- Department of Neonatology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| | - Jun Tang
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Zhichun Feng
- Department of Neonatology, Faculty of Pediatrics, Chinese PLA General Hospital, Beijing, P.R. China
| | - Dezhi Mu
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
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12
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Castro S, Pedrero S, Ruiz LA, Serrano L, Zalacain R, Pérez‐Fernández S, Iriberri M, Cabriada V. High-flow nasal cannula oxygen therapy for the treatment of acute respiratory failure secondary to SARS-CoV-2 pneumonia out of ICU. Clin Respir J 2023; 17:905-914. [PMID: 37537998 PMCID: PMC10500315 DOI: 10.1111/crj.13679] [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] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/17/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES High-flow nasal cannula oxygen therapy (HFNC) has been successfully used for the treatment of acute hypoxaemic respiratory failure (AHRF) secondary to SARS-CoV-2 pneumonia and being effective in reducing progression to invasive mechanical ventilation. The objective of this study was to assess the usefulness of HFNC on a hospital ward for the treatment of AHRF secondary to SARS-CoV-2 pneumonia and its impact on the need for intensive care unit (ICU) admission and endotracheal intubation. Other objectives include identifying potential physiological parameters and/or biomarkers for predicting treatment failure and assessing the clinical course and survival. METHODS Observational study based on data collected prospectively between March 2020 and February 2021 in a single hospital on patients diagnosed with AHRF secondary to SARS-CoV-2 pneumonia who received HFNC outside an ICU. RESULTS One hundred and seventy-one patients out of 1090 patients hospitalised for SARS-CoV-2 infection. HFNC was set as the ceiling of treatment in 44 cases; 12 survived (27.3%). Among the other 127 patients, intubation was performed in 25.9% of cases with a mortality of 11.8%. Higher creatinine levels (OR 1.942, 95% CI 1.04; 3.732; p = 0.036) and Comorbidity-Age-Lymphocyte-LDH (CALL) score (OR 1.273, 95% CI 1.033; 1.617; p = 0.033) were associated with a higher risk of intubation. High platelet count at HFNC initiation was predictive of good treatment response (OR 0.935, 95% CI 0.884; 0.983; p = 0.012). CONCLUSIONS HFNC outside an ICU is a treatment with high success rate in patients with AHRF secondary to SARS-CoV-2 pneumonia, including in patients in whom this therapy was deemed to be the ceiling of treatment.
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Affiliation(s)
- Sonia Castro
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Medicine and Surgery, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
| | - Sandra Pedrero
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Medicine and Surgery, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
| | - Luis Alberto Ruiz
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
| | - Leyre Serrano
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
| | - Rafael Zalacain
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
| | - Silvia Pérez‐Fernández
- Scientific Coordination FacilityBiocruces Bizkaia Health Research InstituteBarakaldoSpain
| | - Milagros Iriberri
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
| | - Valentín Cabriada
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Medicine and Surgery, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
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13
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Abati I, Micaglio M, Giugni D, Seravalli V, Vannucci G, Di Tommaso M. Maternal Oxygen Administration during Labor: A Controversial Practice. Children (Basel) 2023; 10:1420. [PMID: 37628419 PMCID: PMC10453930 DOI: 10.3390/children10081420] [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: 07/29/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Oxygen administration to the mother is commonly performed during labor, especially in the case of a non-reassuring fetal heart rate, aiming to increase oxygen diffusion through the placenta to fetal tissues. The benefits and potential risks are controversial, especially when the mother is not hypoxemic. Its impact on placental gas exchange and the fetal acid-base equilibrium is not fully understood and it probably affects the sensible placental oxygen equilibrium causing a time-dependent vasoconstriction of umbilical and placental vessels. Hyperoxia might also cause the generation of radical oxygen species, raising concerns for the developing fetal cells. Moreover, this practice affects the maternal cardiovascular system, causing alterations of the cardiac index, heart rate and vascular resistance, and unclear effects on uterine blood flow. In conclusion, there is no evidence that maternal oxygen administration can provide any benefit in the case of a non-reassuring fetal heart rate pattern, while possible collateral effects warn of its utilization. Oxygen administration during labor should be reserved for cases of maternal hypoxia.
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Affiliation(s)
- Isabella Abati
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (I.A.); (V.S.); (G.V.)
| | - Massimo Micaglio
- Department of Anesthesia and Intensive Care, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (M.M.); (D.G.)
| | - Dario Giugni
- Department of Anesthesia and Intensive Care, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (M.M.); (D.G.)
| | - Viola Seravalli
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (I.A.); (V.S.); (G.V.)
| | - Giulia Vannucci
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (I.A.); (V.S.); (G.V.)
| | - Mariarosaria Di Tommaso
- Department of Health Sciences, Division of Obstetrics and Gynecology, Careggi Hospital, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (I.A.); (V.S.); (G.V.)
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14
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Wang J, Zhou L, Liu K, Dou L, Wang R, Chen B. Investigation and Analysis of the Current Status of Rationality and Standardization of Oxygen Therapy in Hospitalized Adult Patients. J Multidiscip Healthc 2023; 16:1915-1926. [PMID: 37465014 PMCID: PMC10350415 DOI: 10.2147/jmdh.s404595] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/22/2023] [Indexed: 07/20/2023] Open
Abstract
Objective To investigate the rationality and standardization of oxygen therapy for hospitalized adult patients, so as to provide a basis for improving the quality of oxygen therapy care. Methods Self-designed "Inpatient Oxygen Therapy Status Questionnaire", using a cross-sectional survey, surveyed 185 oxygen inhalation patients in a tertiary general hospital from August 3-15, 2020, based on the formulation and promulgation of the Chinese Nursing Association The "Nursing care for adult patient with oxygen therapy" standard evaluates the rationality of clinical oxygen therapy implementation and the standardization of nursing measures. Results The reasonable rate of oxygen therapy for hospitalized adult patients was 19.46%, and the standardized rate of nursing measures was 54.52%. The reasonable and standardized rates of medical wards were higher than those of surgical and specialized wards, and were statistically significant (P<0.05). The incidence of complications of oxygen therapy was positively correlated with the rationality of oxygen therapy and the standardized data of nursing measures. Conclusion The clinical oxygen therapy nursing practice and the standard of "Nursing care for adult patient with oxygen therapy" are quite inadequate. There are differences in the quality of oxygen therapy in different wards. Nursing managers should strengthen training and management, standardize nursing behaviors, and improve the quality of oxygen therapy and ensure oxygen therapy for patients' safety.
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Affiliation(s)
- Jun Wang
- Department of Nursing, Leshan People’s Hospital, Leshan, 614000, People’s Republic of China
| | - Li Zhou
- Department of Intensive Care Unit, Leshan People’s Hospital, Leshan, 614000, People’s Republic of China
| | - Ke Liu
- Department of Gastrointestinal Surgical, Leshan People’s Hospital, Leshan, 614000, People’s Republic of China
| | - Luqun Dou
- Department of Cordiovascular Surgery, Leshan People’s Hospital, Leshan, 614000, People’s Republic of China
| | - Rui Wang
- Department of Intensive Care Unit, Leshan People’s Hospital, Leshan, 614000, People’s Republic of China
| | - Bing Chen
- Department of Nursing, Leshan People’s Hospital, Leshan, 614000, People’s Republic of China
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15
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Pérez-Nieto OR, Gómez-Oropeza I, Quintero-Leyra A, Kammar-García A, Zamarrón-López ÉI, Soto-Estrada M, Morgado-Villaseñor LA, Meza-Comparán HD. Hemodynamic and respiratory support in pulmonary embolism: a narrative review. Front Med (Lausanne) 2023; 10:1123793. [PMID: 37332759 PMCID: PMC10272848 DOI: 10.3389/fmed.2023.1123793] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/14/2022] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Pulmonary embolism is a common and potentially fatal disease, with a significant burden on health and survival. Right ventricular dysfunction and hemodynamic instability are considered two key determinants of mortality in pulmonary embolism, which can reach up to 65% in severe cases. Therefore, timely diagnosis and management are of paramount importance to ensure the best quality of care. However, hemodynamic and respiratory support, both major constituents of management in pulmonary embolism, associated with cardiogenic shock or cardiac arrest, have been given little attention in recent years, in favor of other novel advances such as systemic thrombolysis or direct oral anticoagulants. Moreover, it has been implied that current recommendations regarding this supportive care lack enough robustness, further complicating the problem. In this review, we critically discuss and summarize the current literature concerning the hemodynamic and respiratory support in pulmonary embolism, including fluid therapy, diuretics, pharmacological support with vasopressors, inotropes and vasodilators, oxygen therapy and ventilation, and mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation and right ventricular assist devices, while also providing some insights into contemporary research gaps.
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Affiliation(s)
| | - Irene Gómez-Oropeza
- Department of Health Science, Universidad de las Américas Puebla, San Andrés Cholula, Puebla, Mexico
| | | | - Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
| | | | - Maximiliano Soto-Estrada
- Departamento de Emergencias, Hospital General de Zona 11 IMSS Delicias, Delicias, Chihuahua, Mexico
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16
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Kim JS, Shin J, Kim NH, Lee SY, Yoo SH, Keam B, Heo DS. Use of high-flow nasal cannula oxygen therapy for patients with terminal cancer at the end of life. Cancer Med 2023. [PMID: 37162306 DOI: 10.1002/cam4.6060] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/23/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Few studies have focused on high-flow nasal cannula (HFNC) usage in the last few weeks of life. The aim of this study was to identify the status of HFNC use in patients with cancer at the end of life and the relevant clinical factors. METHODS We performed a retrospective cohort study in a tertiary hospital in the Republic of Korea. Among patients with cancer who died between 2018 and 2020, those who initiated HFNC within 14 days before death were included. Patients were categorized based on the time from HFNC initiation to death as imminent (<4 days) and non-imminent (≥4 days). RESULTS Among the 2191 deceased patients with terminal cancer, 329 (15.0%) were analyzed. The median age of the patients was 66 years, and 62.9% were male. The leading cause of respiratory failure was pneumonia (70.2%), followed by pleural effusion (30.7%) and aggravation of lung neoplasms (18.8%). Most patients were conscious (79.3%) and had resting dyspnea (76.3%) at HFNC initiation. Patients received HFNC therapy for a mean of 3.4 days in the last 2 weeks of life, and 62.6% initiated it within 4 days before death. Furthermore, female sex, no palliative care consultation, no advance statements in person on life-sustaining treatment, and no resting dyspnea were independently associated with the imminent use of HFNC. CONCLUSIONS Many patients with cancer started HFNC therapy at the point of imminent death. However, efforts toward goal-directed use of HFNC at the end-of-life stage are required.
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Affiliation(s)
- Jung Sun Kim
- Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Nam Hee Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Patient-Centered Clinical Research Coordinating Center, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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17
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Jentzer JC, Miller PE, Alviar C, Yalamuri S, Bohman JK, Tonna JE. Exposure to Arterial Hyperoxia During Extracorporeal Membrane Oxygenator Support and Mortality in Patients With Cardiogenic Shock. Circ Heart Fail 2023; 16:e010328. [PMID: 36871240 PMCID: PMC10121893 DOI: 10.1161/circheartfailure.122.010328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/11/2022] [Accepted: 03/01/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Exposure to hyperoxia, a high arterial partial pressure of oxygen (PaO2), may be associated with worse outcomes in patients receiving extracorporeal membrane oxygenator (ECMO) support. We examined hyperoxia in the Extracorporeal Life Support Organization Registry among patients receiving venoarterial ECMO for cardiogenic shock. METHODS We included Extracorporeal Life Support Organization Registry patients from 2010 to 2020 who received venoarterial ECMO for cardiogenic shock, excluding extracorporeal CPR. Patients were grouped based on PaO2 after 24 hours of ECMO: normoxia (PaO2 60-150 mmHg), mild hyperoxia (PaO2 151-300 mmHg), and severe hyperoxia (PaO2 >300 mmHg). In-hospital mortality was evaluated using multivariable logistic regression. RESULTS Among 9959 patients, 3005 (30.2%) patients had mild hyperoxia and 1972 (19.8%) had severe hyperoxia. In-hospital mortality increased across groups: normoxia, 47.8%; mild hyperoxia, 55.6% (adjusted odds ratio, 1.37 [95% CI, 1.23-1.53]; P<0.001); severe hyperoxia, 65.4% (adjusted odds ratio, 2.20 [95% CI, 1.92-2.52]; P<0.001). A higher PaO2 was incrementally associated with increased in-hospital mortality (adjusted odds ratio, 1.14 per 50 mmHg higher [95% CI, 1.12-1.16]; P<0.001). Patients with a higher PaO2 had increased in-hospital mortality in each subgroup and when stratified by ventilator settings, airway pressures, acid-base status, and other clinical variables. In the random forest model, PaO2 was the second strongest predictor of in-hospital mortality, after older age. CONCLUSIONS Exposure to hyperoxia during venoarterial ECMO support for cardiogenic shock is strongly associated with increased in-hospital mortality, independent from hemodynamic and ventilatory status. Until clinical trial data are available, we suggest targeting a normal PaO2 and avoiding hyperoxia in CS patients receiving venoarterial ECMO.
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Affiliation(s)
- Jacob C. Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - P. Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Carlos Alviar
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Suraj Yalamuri
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - J. Kyle Bohman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Joseph E. Tonna
- Divisions of Cardiothoracic Surgery and Emergency Medicine, University of Utah Health and School of Medicine, Salt Lake City, UT
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Marta Suero Domínguez, Beatriz González Vallejo, Raquel Esteban Hernández, María Nogueira López, Ana Isabel Montejo García, Mª Eugenia Muñoz Bermejo, Beatriz Kindelan Alonso, Israel John Thuissard Vasallo, Cristina Andreu Vázquez, Susana Arias Rivera. Ensayo Clínico Aleatorizado En Pacientes Covid- 19 Sobre El Efecto De La Fisioterapia Precoz En Su Acondicionamiento Físico. Fisioterapia 2023. [ DOI: 10.1016/j.ft.2023.03.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Introducción. La OMS recomienda las intervenciones tempranas de rehabilitación y movilización en pacientes hospitalizados por COVID-19. Los beneficios de la fisioterapia precoz, durante la estancia hospitalaria, no han sido probados en ensayos clínicos. Objetivo: Evaluar los efectos de la fisioterapia precoz y educación para la salud en pacientes COVID-19 hospitalizados, en relación a los síntomas descritos en estudios previos, analizando diferencias entre grupos respecto a su acondicionamiento físico, necesidad de oxigenoterapia y estancia hospitalaria. Metodología: Ensayo clínico aleatorizado con dos brazos, desarrollado en unidades de hospitalización y cuidados respiratorios intermedios, con pacientes COVID- 19. Incluidos 64 pacientes en el grupo experimental (implementación de un programa de Fisioterapia precoz tras 48-72h de ingreso) y 62 pacientes en el grupo control (tratamiento habitual del centro). Variables sociodemográficas y clínicas: mMRC, oxigenoterapia, MRC-ss, 30 s-STST, FPM, Tinetti, FRAIL Scale y PCFS. Se evaluaron al ingreso, al alta y a los dos meses del alta. Resultados: Los experimentales tuvieron menos días de ingreso y de oxigenoterapia convencional. Al alta, presentan menor riesgo de caída (72,9% vs 95,8%) y menor debilidad en MRC-ss (2,1% vs 14,6%). A los dos meses tenían menor fragilidad (5,0% vs 14,5%), mayor fuerza de prensión manual, menos disnea, mejores resultados en 30s-STST y menos limitaciones post-COVID (86,5% vs 96,4%). Conclusión: La intervención de fisioterapia precoz en pacientes COVID-19 y la educación para la salud recibida, previene la debilidad muscular durante el ingreso, mejora el acondicionamiento físico al alta y a los dos meses y disminuye los días de estancia hospitalaria.ClinicalTrials.gov (NCT 05032885).
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Stoecklin B, Choi YJ, Dassios T, Jones JG, Lockwood GG, Pillow JJ. Unstable SpO 2 in preterm infants: The key role of reduced ventilation to perfusion ratio. Front Physiol 2023; 14:1112115. [PMID: 36824465 PMCID: PMC9941664 DOI: 10.3389/fphys.2023.1112115] [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: 11/30/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction: Instability of peripheral oxyhemoglobin saturation (SpO2) in preterm infants is correlated with late disability and is poorly understood. We hypothesised that a reduced ventilation to perfusion ratio (VA/Q) is the key predisposing factor for SpO2 instability. Methods: We first used a mathematical model to compare the effects of reduced VA/Q or shunt on SaO2 stability (SaO2 and SpO2 are used for model and clinical studies respectively). Stability was inferred from the slope of the SaO2 vs. inspired oxygen pressure (P IO2) curve as it intersects the 21 kPa P IO2 line (breathing air). Then, in a tertiary neonatal intensive care unit, paired hourly readings of SpO2 and P IO2 were recorded over a 24 h period in week old extremely preterm infants. We noted SpO2 variability and used an algorithm to derive VA/Q and shunt from the paired SpO2 and P IO2 measurements. Results: Our model predicted that when VA/Q < 0.4, a 1% change in P IO2 results in >8% fluctuation in SaO2 at 21 kPa P IO2. In contrast, when a 20% intrapulmonary shunt was included in the model, a 1% change in P IO2 results in <1% fluctuation in the SaO2. Moreover, further reducing the VA/Q from 0.4 to 0.3 at 21 kPa P IO2 resulted in a 24% fall in SaO2. All 31 preterm infants [mean gestation (±standard deviation) 26.2 (±1) week] had VA/Q < 0.74 (normal >0.85) but only two infants had increased shunt at 1.1 (±0.5) weeks' postnatal age. Median (IQR) SpO2 fluctuation was 8 (7)%. The greatest SpO2 fluctuations were seen in infants with VA/Q < 0.52 (n = 10): SpO2 fluctuations ranged from 11%-17% at a constant P IO2 when VA/Q < 0.52. Two infants had reduced VA/Q and increased shunt (21% and 27%) which resolved into low VA/Q after 3-6 h. Discussion: Routine monitoring of P IO2 and SpO2 can be used to derive a hitherto elusive measure of VA/Q. Predisposition to SpO2 instability results from reduced VA/Q rather than increased intrapulmonary shunt in preterm infants with cardiorespiratory disease. SpO2 instability can be prevented by a small increase in P IO2.
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Affiliation(s)
- Benjamin Stoecklin
- Department of Neonatology, University Children’s Hospital Basel (UKBB), Basel, Switzerland,School of Human Sciences, The University of Western Australia, Crawley, WA, Australia,*Correspondence: Benjamin Stoecklin,
| | - Y. Jane Choi
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
| | - Theodore Dassios
- Neonatal Intensive Care Unit, King’s College Hospital NHS Foundation Trust Denmark Hill, London, United Kingdom
| | - J. Gareth Jones
- Cambridge University Clinical School, Cambridge, United Kingdom
| | | | - J. Jane Pillow
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
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Arruda DG, Kieling GA, Melo-Diaz LL. Effectiveness of high-flow nasal cannula therapy on clinical outcomes in adults with COVID-19: A systematic review. Can J Respir Ther 2023; 59:52-65. [PMID: 36741308 PMCID: PMC9854387 DOI: 10.29390/cjrt-2022-005] [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] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction/Background Coronavirus disease 2019 (COVID-19) has high transmissibility and mortality rates. High-flow nasal cannula therapy (HFNC) might reduce the need for orotracheal intubation, easing the burden on the health system caused by COVID-19. The objective of the present study was to examine the effectiveness of HFNC in adult patients hospitalized with COVID-19. Specifically, the present study explores the effects of HFNC on rates of mortality, intubation and intensive care units (ICU) length of stay. The present study also seeks to define predictors of success and failure of HFNC. Methods A systematic literature search was conducted in the PubMed, EMBASE and SCOPUS databases, and the study was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using the National Heart, Lung, and Blood Institute's Study Quality Assessment Tools. Results The search identified 1,476 unique titles; 95 articles received full-text reviews and 40 studies were included in this review. HFNC was associated with a reduction in the rate of orotracheal intubation, notably when compared to conventional oxygen therapy. Studies reported inconsistency in whether HFNC reduced ICU length of stay or mortality rates. Among the predictors of HFNC failure/success, a ratio of oxygen saturation index of approximately 5 or more was associated with HFNC success. Conclusion In adult patients hospitalized with COVID-19, HFNC may prove effective in reducing the rate of orotracheal intubation. The ratio of the oxygen saturation index was the parameter most examined as a predictor of HFNC success. Low-level research designs, inherent study weaknesses and inconsistent findings made it impossible to conclude whether HFNC reduces ICU length of stay or mortality. Future studies should employ higher level research designs.
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Affiliation(s)
- Daiana Gonçalves Arruda
- Multiprofessional Residency Program in Hospital Care in Adult and Elderly Health – Hospital de Clínicas – Federal University of Paraná, Curitiba, Paraná, Brazil
| | - George Alvício Kieling
- Multiprofessional Unit – Hospital de Clínicas – Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Lucélia Luna Melo-Diaz
- Multiprofessional Unit – Hospital de Clínicas – Federal University of Paraná, Curitiba, Paraná, Brazil
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Muacevic A, Adler JR, Marshall R. A Volunteer Crossover Feasibility Study to Compare Standard Oxygen Cannula Used at High-Flow to Proprietary High-Flow Humidified Nasal Oxygen Systems. Cureus 2023; 15:e33738. [PMID: 36788853 PMCID: PMC9922491 DOI: 10.7759/cureus.33738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND AIM Supplemental oxygen is routinely administered to patients prior to and during induction of general anesthesia and sedation. This increases the fraction of oxygen in the lungs, increases oxygen delivery, and increases the time to oxygen desaturation. Proprietary Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) systems, which deliver warmed and humidified oxygen, have been extensively researched in the perioperative and critical care setting and have been shown to significantly prolong time to desaturation and as a means of ventilatory support. The use of traditional nasal oxygen cannula used at maximum flow rates is currently used in short bursts as it is poorly tolerated. There is however a dearth of data examining the use of this technique. We hypothesized that traditional nasal oxygen cannulae used at maximum flow rates can deliver oxygen as effectively as THRIVE in this setting. METHODS We designed a crossover volunteer feasibility study. The participants were 10 healthy anesthetists. We compared the two methods of oxygen delivery by measuring transcutaneous oxygen measurement and pharyngeal oxygen concentration. Comfort and noise levels were recorded. The aforementioned parameters were compared between the two groups. RESULTS We observed that a standard oxygen cannula used at high flows delivers comparable oxygen delivery and tissue oxygenation performance to proprietary THRIVE systems. However, they are less comfortable and make more noise. DISCUSSION To the authors' knowledge this study is the first to study the oxygen delivery of traditional nasal oxygen cannula used at maximum flow rates and make comparisons to the well-studied THRIVE technique. While similar transcutaneous partial pressure of oxygen and pharyngeal gas concentrations were observed with both techniques, the standard cannulae were deemed to be a lot less comfortable than THRIVE and made a lot more noise which likely limit the utility of this technique outside of short bursts. CONCLUSION In this study, a standard nasal oxygen cannula used at high flows achieved similar oxygen delivery to THRIVE at the expense of poor comfort and increased noise.
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22
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Dhar M, Sharma S, Hemanthkumar K, Rao S. Assessment of the efficacy of a video-based hybrid teaching module of oxygen therapy and critical care area troubleshooting in nursing professionals managing COVID-19 patients. J Educ Health Promot 2022; 11:405. [PMID: 36824096 PMCID: PMC9942149 DOI: 10.4103/jehp.jehp_785_22] [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] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Video-based teaching has become rapidly popular during the coronavirus disease 2019 (COVID-19) pandemic. The current study aimed to assess the efficacy of a hybrid video-based teaching module of oxygen therapy and critical care troubleshooting in nursing professionals managing COVID-19 patients in our institute. MATERIALS AND METHODS A retrospective analytical study (pretest and posttest design) was conducted in our medical education department in March 2022 using the data from a workshop conducted on oxygen therapy and critical care area troubleshooting during COVID-19 patient management for 296 nursing professionals. A hybrid video-based teaching module was used. Pretest and posttest data were compared along with subgroup analysis. P value <0.05 was considered significant. RESULTS Posttest scores were significantly higher than the baseline scores in the overall group as well as in all subgroups (P < 0.001). Subgroup comparisons revealed no significant difference in mean baseline pretest and posttest scores in male versus female participants. Baseline pretest scores (P = 0.02) and posttest scores (P = 0.08) were lower in the nurses of the noncritical areas compared to critical area nurses. Mean improvement in posttest score compared to baseline score was similar between all groups. CONCLUSION Hybrid technique involving both video aspects and in-person teacher presence for demonstration or troubleshooting improves perceived knowledge in nursing professionals with some prior formal training and may be superior to the conventional only didactic/lecture-based demonstrations, especially in the context of imparting rapid training during pandemics or similar urgent situations.
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Affiliation(s)
- Mridul Dhar
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sameer Sharma
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - K Hemanthkumar
- Department of Medical Education and Advanced Center for Simulation and Skills, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shalinee Rao
- Department of Medical Education and Advanced Center for Simulation and Skills, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Nagata K, Horie T, Chohnabayashi N, Jinta T, Tsugitomi R, Shiraki A, Tokioka F, Kadowaki T, Watanabe A, Fukui M, Kitajima T, Sato S, Tsuda T, Kishimoto N, Kita H, Mori Y, Nakayama M, Takahashi K, Tsuboi T, Yoshida M, Hataji O, Fuke S, Kagajo M, Nishine H, Kobayashi H, Nakamura H, Okuda M, Tachibana S, Takata S, Osoreda H, Minami K, Nishimura T, Ishida T, Terada J, Takeuchi N, Kohashi Y, Inoue H, Nakagawa Y, Kikuchi T, Tomii K. Home High-Flow Nasal Cannula Oxygen Therapy for Stable Hypercapnic COPD: A Randomized Clinical Trial. Am J Respir Crit Care Med 2022; 206:1326-1335. [PMID: 35771533 PMCID: PMC9746854 DOI: 10.1164/rccm.202201-0199oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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] [Indexed: 12/24/2022] Open
Abstract
Rationale: The long-term effects of using a high-flow nasal cannula for chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease remain unclear. Objectives: To assess whether long-term high-flow nasal cannula use reduces the number of exacerbations and improves other physiological parameters in patients with chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease. Methods: We enrolled 104 participants (aged ⩾40 yr) with daytime hypercapnia (Global Initiative for Chronic Obstructive Lung Disease stages 2-4) receiving long-term oxygen therapy (⩾16 h/d for ⩾1 mo) and randomly assigned them to high-flow nasal cannula/long-term oxygen therapy and long-term oxygen therapy groups. The primary endpoint was the moderate or severe exacerbation rate. We compared changes from baseline in arterial blood gas values, peripheral oxygen saturation, pulmonary function, health-related quality-of-life scores, and the 6-minute-walk test. Measurements and Main Results: High-flow nasal cannula use significantly reduced the rate of moderate/severe exacerbations (unadjusted mean count 1.0 vs. 2.5, a ratio of the adjusted mean count between groups [95% confidence interval] of 2.85 [1.48-5.47]) and prolonged the duration without moderate or severe exacerbations. The median time to first moderate or severe exacerbation in the long-term oxygen therapy group was 25 (14.1-47.4) weeks; this was not reached in the high-flow nasal cannula/long-term oxygen therapy group. High-flow nasal cannula use significantly improved health-related quality of life scores, peripheral oxygen saturation, and specific pulmonary function parameters. No safety concerns were identified. Conclusions: A high-flow nasal cannula is a reasonable therapeutic option for patients with stable hypercapnic chronic obstructive pulmonary disease and a history of exacerbations. Clinical trial registered with www.umin/ac.jp (UMIN000028581) and www.clinicaltrials.gov (NCT03282019).
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Affiliation(s)
- Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Takeo Horie
- Department of Respiratory Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Naohiko Chohnabayashi
- Division of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo, Japan
| | - Torahiko Jinta
- Division of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo, Japan
| | - Ryosuke Tsugitomi
- Division of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo, Japan
| | - Akira Shiraki
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Fumiaki Tokioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Toru Kadowaki
- Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, Matsue, Shimane, Japan
| | - Akira Watanabe
- Department of Respiratory Medicine, National Hospital Organization Ehime Medical Center, Toon, Ehime, Japan
| | - Motonari Fukui
- Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Osaka, Japan
| | - Takamasa Kitajima
- Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Osaka, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Toru Tsuda
- Kirigaoka Tsuda Hospital, Kitakyushu, Fukuoka, Japan
| | - Nobuhito Kishimoto
- Department of Respiratory Medicine, Takamastu Municipal Hospital, Takamatsu, Kagawa, Japan
| | - Hideo Kita
- Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Takatsuki, Osaka, Japan
| | - Yoshihiro Mori
- Department of Respiratory Medicine, KKR Takamatsu Hospital, Takamatsu, Kagawa, Japan
| | - Masayuki Nakayama
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kenichi Takahashi
- Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Osaka, Japan
| | - Tomomasa Tsuboi
- Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, Joyo, Kyoto, Japan
| | - Makoto Yoshida
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Fukuoka, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Satoshi Fuke
- Department of Respiratory Medicine, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan
| | - Michiko Kagajo
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Hiroki Nishine
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | | | - Hiroyuki Nakamura
- Department of Respiratory Medicine, Sakaide City Hospital, Sakaide, Kagawa, Japan
| | - Miyuki Okuda
- Osaka Anti-Tuberculosis Association Osaka Hospital, Neyagawa, Osaka, Japan
| | - Sayaka Tachibana
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Shohei Takata
- Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Koga, Fukuoka, Japan
| | - Hisayuki Osoreda
- Department of Respiratory Medicine, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Yamaguchi, Japan
| | - Kenichi Minami
- Department of Respiratory Medicine, Ishikiriseiki Hospital, Higashi-osaka, Osaka, Japan
| | - Takashi Nishimura
- Department of Respiratory Medicine, Kyoto Katsura Hospital, Kyoto, Kyoto, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Jiro Terada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Naoko Takeuchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Yasuo Kohashi
- Department of Respiratory Medicine, HARUHI Respiratory Medical Hospital, Kiyosu, Aichi, Japan
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan; and
| | - Yoko Nakagawa
- Division of Medical Statistics, Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Kobe, Hyogo, Japan
| | - Takashi Kikuchi
- Division of Medical Statistics, Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Kobe, Hyogo, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Carron M, Tamburini E, Safaee Fakhr B, De Cassai A, Linassi F, Navalesi P. High-flow nasal oxygenation during gastrointestinal endoscopy. Systematic review and meta-analysis. BJA Open 2022; 4:100098. [PMID: 37588780 PMCID: PMC10430836 DOI: 10.1016/j.bjao.2022.100098] [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] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/14/2022] [Indexed: 08/18/2023]
Abstract
Background The use of high-flow nasal oxygen (HFNO) has the potential to improve patient safety by limiting hypoxaemia during gastrointestinal endoscopy. The degree of benefit is not adequately established. Methods English language literature searches of PubMed, Scopus, Web of Science, and Cochrane Library electronic databases were performed to identify randomised controlled trials comparing HFNO and conventional oxygen therapy (COT) for patients undergoing gastrointestinal endoscopy under deep sedation. The primary endpoint was the incidence of hypoxic events observed during endoscopic procedures. The secondary endpoints were the incidence of recourse to rescue manoeuvres, procedure interruption, and adverse events. A meta-analysis and a post hoc trial sequence analysis were performed. Results A total of 2867 patients from six randomised controlled trials were considered. Desaturation was observed in 5.2% and 27.2% of patients receiving HFNO and COT, respectively. Desaturation <90% was observed in 1.8% and 12.6% of the patients receiving HFNO and COT, respectively. In the subgroup analysis, desaturation occurrence was lower during HFNO than during COT in non-obese patients (2.2% vs 25.2%) and obese patients (22.9% vs 43.3%). Desaturation occurrence was lower during maximum (3.6% vs 26.9%) and minimum (15.9% vs 29.8%) HFNO therapy than during COT. HFNO showed a lower recurrence to rescue manoeuvres rate (4.7% vs 34.3%), a lower procedure interruption rate (0.4% vs 6.7%), and a lower adverse events rate (18.7% vs 21%) than COT. A high level of heterogeneity between the studies precluded confidence in drawing inference from the meta-analysis. Conclusions The evidence reviewed suggests that compared with COT, HFNO has fewer hypoxaemic events during gastrointestinal endoscopy, but this may not apply to all patients and clinical scenarios.
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Affiliation(s)
- Michele Carron
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Enrico Tamburini
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Bijan Safaee Fakhr
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Alessandro De Cassai
- Institute of Anaesthesia and Intensive Care - Azienda Ospedale Università Padova, Padua, Italy
| | - Federico Linassi
- Department of Anaesthesia and Intensive Care, Ca’ Foncello Treviso Regional Hospital, Piazzale Ospedale 1,Treviso, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
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25
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Azevedo FM, Oliveira CC, Evangelista DG, Jesus LAS, Cabral LF, Pereira AL, Santos LT, Santiago RA, Cabral LA, José A, Malaguti C. Life-Space Mobility of Subjects With COPD on Long-Term Oxygen Therapy Delivered by Non-Portable Devices. Respir Care 2022; 68:respcare.10255. [PMID: 36347565 PMCID: PMC9994281 DOI: 10.4187/respcare.10255] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mobility is human body movement in all its forms, including bed-to-chair transfer, walking, daily tasks, participating in work and social functions, exercising, and using public transport. The mobility of people living with COPD is affected negatively by the disease symptoms. However, limited data are available on the life-space mobility in people with COPD on long-term oxygen therapy (LTOT). This study aimed to explore the life-space mobility in subjects with COPD on LTOT and verify whether life-space mobility is associated with comorbidities and symptoms, activity in daily life, exercise capacity performance, and quality of life. METHODS This cross-sectional study enrolled 61 subjects with COPD on LTOT (73.0 ± 8.8 y, FEV1 41.7 ± 16.0% predicted, on LTOT for 2.8 ± 3.3 y). Life-space mobility (Life-Space Assessment), LTOT usage time, comorbidities (Charlson comorbidity index), need for support from a caregiver, exercise capacity (6-min step test), dyspnea (modified Medical Research Council scale), activities of daily living (ADLs, Katz scale), and health-related quality of life (EuroQol 5-Dimension Questionnaire) were assessed. RESULTS Mobility restriction was identified in 90% of participants. Life-space mobility was negatively associated with the number of comorbidities (rs = -0.31, P = .02), dyspnea symptom (rs = -0.60, P < .001), and positively associated with basic ADLs performance (rs = 0.59, P < .001) and exercise capacity (rs = 0.49, P < .001). Dyspnea and exercise capacity were independent predictors of vital space mobility. CONCLUSIONS Subjects with COPD on LTOT had limited life-space mobility. Interventions to reduce dyspnea and improve exercise capacity should be prioritized to increase this population's domestic and community mobility.
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Affiliation(s)
- Felipe M Azevedo
- Postgraduate Program on Rehabilitation Sciences and Physical Function Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Cristino C Oliveira
- Postgraduate Program on Rehabilitation Sciences and Physical Function Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and Department of Physiotherapy, Federal University of Juiz de Fora, Campus Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Deborah G Evangelista
- Postgraduate Program on Rehabilitation Sciences and Physical Function Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Luciana A S Jesus
- Postgraduate Program on Rehabilitation Sciences and Physical Function Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Leandro F Cabral
- Postgraduate Program on Rehabilitation Sciences and Physical Function Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and Department of Physiotherapy, Federal University of Juiz de Fora, Campus Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Adriano L Pereira
- Postgraduate Program on Rehabilitation Sciences and Physical Function Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Larissa T Santos
- Home Care Department of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Raphael A Santiago
- Home Care Department of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Laura A Cabral
- Postgraduate Program on Rehabilitation Sciences and Physical Function Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Anderson José
- Postgraduate Program on Rehabilitation Sciences and Physical Function Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Carla Malaguti
- Postgraduate Program on Rehabilitation Sciences and Physical Function Performance, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
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Jesus LA, Malaguti C, Evangelista DG, Azevedo FM, França BP, Santos LT, Reboredo MM, Lee AL, Cabral LA, Cabral LF, José A, Oliveira CC. Caregiver Burden Is Associated With the Physical Function of Individuals on Long-Term Oxygen Therapy. Respir Care 2022; 67:1413-1419. [PMID: 35764347 PMCID: PMC9993965 DOI: 10.4187/respcare.09619] [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: 11/05/2022]
Abstract
BACKGROUND The influence of physical function of individuals on long-term oxygen therapy (LTOT) on caregiver burden is underexplored. This study investigated the association of caregiver burden with physical function of individuals on LTOT and the association between caregiver's burden and quality of life. METHODS This was a cross-sectional study. Informal caregivers were assessed for burden using the Caregiver Burden Inventory (CBI), the European Quality of Life 5 Dimension questionnaire index (EQ-5D index) and its Visual Analog Scale (EQ-VAS). Physical function of subjects on LTOT was assessed by dyspnea, activities of daily living (ADLs), and mobility. Univariate and multivariate linear regression models were explored. RESULTS Fifty-four caregivers (54.7 ± 16.1 y, 74.1% female) were included. CBI total score was correlated with subject's dyspnea (r = 0.369, P = .006) and ADLs (r = 0.300, P = .03). In the multivariate regression models, subject's physical function limitation due to dyspnea explained 26.4% of the CBI total score variance (P = .005). In the CBI dimension analysis, the time-dependence caregiver burden was correlated with subject's dyspnea (r = 0.335, P = .01), ADLs (r = 0.436, P = .001), and mobility (r = -0.415, P = .002). CBI developmental and physical caregiver burden were correlated with dyspnea (r = 0.309, P = .02; r = 0.363, P = .007) and ADLs (r = 0.274, P = .045; r = 0.299, P = .03). Emotional caregiver burden was correlated with dyspnea (r = 0.333, P = .01). Higher CBI total score was correlated with worse quality of life on EQ-5D index (rs= -0.374, P = .005) and EQ-VAS (rs= -0.494, P = .001) in caregivers. CONCLUSIONS Increased caregiver burden was associated with higher physical limitation due to dyspnea and dependence in ADLs of individuals on LTOT. The increased burden was associated with a worse caregiver's quality of life.
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Affiliation(s)
- Luciana As Jesus
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Carla Malaguti
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and School of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Deborah G Evangelista
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Felipe M Azevedo
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Brena P França
- Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | | | - Maycon M Reboredo
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia; and Centre for Allied Health Research and Education, Cabrini Health, Malvern, Victoria, Australia
| | - Laura A Cabral
- Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Leandro F Cabral
- School of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Anderson José
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and School of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Cristino C Oliveira
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; and Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil.
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Annaka H, Nomura T, Moriyama H. Cognitive Function and the Ability to Operate Long-Term Oxygen Therapy Equipment: An Exploratory Study. Int J Environ Res Public Health 2022; 19:10708. [PMID: 36078424 PMCID: PMC9517874 DOI: 10.3390/ijerph191710708] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Chronic respiratory disease patients with severe hypoxia receive long-term oxygen therapy (LTOT). The proper operation of LTOT equipment is essential for continuing treatment. This exploratory study investigated the relationship between cognitive impairment as a comorbidity in patients receiving LTOT and their ability to operate the LTOT equipment. The study measured responses to questions based on the ability of participants to operate the equipment and applied the Montreal Cognitive Assessment (MoCA). The ability of groups with MoCA scores ≤ 25 and >25 to operate LTOT equipment was compared to confirm the correlation between MoCA and ability to operate the equipment. An aggregate of 60 participants receiving LTOT were recruited, of whom 45 (75%) were MoCA score ≤ 25. The group of MoCA score ≤ 25 demonstrated a lower ability to operate LTOT equipment than group of MoCA score > 25 (p = 0.012). Additionally, a correlation was found between the ability to operate LTOT equipment and MoCA (rs = 0.743, p < 0.001). The results indicated that the group of MoCA score ≤ 25 indicated a lower ability to operate LTOT equipment than that of MoCA score > 25. Cognitive impairment in patients receiving LTOT can affect their ability to operate LTOT equipment.
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Affiliation(s)
- Hiroki Annaka
- Department of Occupational Therapy, National Hospital Organization Nishiniigata Chuo Hospital, Niigata 950-2085, Japan
- Graduate School, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Tomonori Nomura
- Department of Occupational Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Hiroshi Moriyama
- Respiratory Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata 950-2085, Japan
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28
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Mo H, Chung SJ, Rozen TD, Cho SJ. Oxygen Therapy in Cluster Headache, Migraine, and Other Headache Disorders. J Clin Neurol 2022; 18:271-279. [PMID: 35589316 PMCID: PMC9163947 DOI: 10.3988/jcn.2022.18.3.271] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 09/17/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
Oxygen therapy (OT) can relieve head pain in certain primary headache disorders, including cluster headache (CH). The exact underlying mechanism is currently uncertain, but suggested mechanisms include inhibition of the trigeminoautonomic reflex, modulation of neurotransmitters, and cerebral vasoconstriction. OT is the standard for acute treatment of CH, but patients with CH often experience considerable difficulties accessing home OT due to problems with insurance coverage. Inhalation of 100% oxygen at 6–12 L/min for 15–30 min using a non-rebreather face mask is one of the most effective acute therapies for CH, but several trials have indicated the superiority of higher oxygen flow rates of up to 15 L/min and/or using a demand-valve oxygen mask that can produce very high flow rates. Two randomized controlled trials have demonstrated the efficacy of OT in migraine, but obtaining reliable evidence is considered difficult because of different inhalation protocols, varying outcome measures, and small samples. There are some reports on the efficacy of OT as an adjuvant therapy in hypnic headache, primary headache in the emergency department, and even postdural puncture headache. The goal of this review article is to expand the knowledge regarding the use of oxygen in the treatment of headache disorders.
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Affiliation(s)
- Heejung Mo
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Soo Jie Chung
- Department of Pulmonology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Todd D Rozen
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Solana-Gracia R, Modesto i Alapont V, Bueso-Inchausti L, Luna-Arana M, Möller-Díez A, Medina A, Pérez-Moneo B. Changes in Ventilation Practices for Bronchiolitis in the Hospital Ward and Need for ICU Transfer over the Last Decade. J Clin Med 2022; 11:jcm11061622. [PMID: 35329951 PMCID: PMC8950048 DOI: 10.3390/jcm11061622] [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: 12/21/2021] [Revised: 02/02/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
There is limited evidence of the potential benefits of the use of high-flow nasal cannula (HFNC) for the management of bronchiolitis in the ward. Our aim is to describe the ventilation trends for bronchiolitis in our hospital along with the introduction of an HFNC ward protocol and to determine the need for respiratory support escalation and transfer to an intensive care unit (ICU). A retrospective analytical observational study of children < 12 months old requiring admission for a first RSV bronchiolitis episode in a single centre from January 2009 to December 2018. The sample was divided into four groups according to the type of respiratory support that would ensure the clinical stability of the infants on admission. A total of 502 infants were recruited. The total number and percentage of patients admitted in the ward grew progressively over time. Simultaneously, there was an increase in HFNC and, paradoxically, an increase in ICU transfers. The risk of failure was higher for those who required HFNC or CPAP for clinical stabilisation in the first 12 h after admission. Moreover, the risk of failure was also higher in children with standard oxygen therapy promptly escalated to HFNC, especially if they had atelectasis/viral pneumonia, coinfections or a history of prematurity. Despite the limitations of a retrospective analysis, our study reflects usual clinical practice and no correlation was found between the usage of HFNC and a shorter length of hospital stay or less time spent on oxygen therapy.
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Affiliation(s)
- Ruth Solana-Gracia
- Department of Paediatrics, Hospital Universitario Infanta Leonor y Hospital Virgen de la Torre, 28031 Madrid, Spain;
- Correspondence: ; Tel.: +34-91-191-8000
| | | | - Leticia Bueso-Inchausti
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.B.-I.); (M.L.-A.); (A.M.-D.)
| | - María Luna-Arana
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.B.-I.); (M.L.-A.); (A.M.-D.)
| | - Ariadna Möller-Díez
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.B.-I.); (M.L.-A.); (A.M.-D.)
| | - Alberto Medina
- Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Begoña Pérez-Moneo
- Department of Paediatrics, Hospital Universitario Infanta Leonor y Hospital Virgen de la Torre, 28031 Madrid, Spain;
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.B.-I.); (M.L.-A.); (A.M.-D.)
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30
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Annaka H, Nomura T, Moriyama H. Sedentary Time and Cognitive Impairment in Patients Using Long-Term Oxygen Therapy: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:1726. [PMID: 35162749 DOI: 10.3390/ijerph19031726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 12/17/2022]
Abstract
Physical inactivity is a predictor of death in patients with chronic respiratory disease. Cognitive impairment is common among patients with chronic respiratory disease. However, the association between sedentary time and cognitive impairment in patients with chronic respiratory disease using long-term oxygen therapy is unclear. This study aimed to determine the relationship between sedentary time and cognitive impairment in patients on long-term oxygen therapy. This cross-sectional study included 96 patients with chronic respiratory disease on long-term oxygen therapy (mean age 77.3 years; female, 22%). The primary outcomes measured were sedentary time (Japanese version of the International Physical Activity Questionnaire Short Form), cognitive function (Montreal Cognitive Assessment), and dyspnea (modified Medical Research Council scale). The factors associated with sedentary time were confirmed by multiple regression analysis. The median sedentary time was 600.0 min. The median Montreal Cognitive Assessment score was 24.0 points, and 67 (70%) patients had mild cognitive impairment. In multiple regression analysis, sedentary time was associated with dyspnea (β = 0.397, p < 0.001) and cognitive function (β = −0.239, p = 0.020). This study indicates that sedentary time in patients on long-term oxygen therapy was associated with dyspnea and cognitive impairment.
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31
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Wong JJM, Tan HL, Sultana R, Ma YJ, Aguilan A, Lee SW, Kumar P, Mok YH, Lee JH. The longitudinal course of pediatric acute respiratory distress syndrome and its time to resolution: A prospective observational study. Front Pediatr 2022; 10:993175. [PMID: 36483473 PMCID: PMC9723458 DOI: 10.3389/fped.2022.993175] [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: 07/13/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The longitudinal course of patients with pediatric acute respiratory distress syndrome (PARDS) is not well described. In this study, we describe the oxygenation index (OI) and oxygen saturation index (OSI) in mild, moderate, and severe PARDS over 28 days and provide pilot data for the time to resolution of PARDS (T res), as a short-term respiratory-specific outcome, hypothesizing that it is associated with the severity of PARDS and clinical outcomes. METHODS This prospective observational study recruited consecutive patients with PARDS. OI and OSI were trended daily over 28 days. T res (defined as OI < 4 or OSI < 5.3 on 2 consecutive days) were described based on PARDS severity and analyzed with Poisson and logistic regression to determine its association with conventional outcomes [mechanical ventilation (MV) duration, intensive care unit (ICU) and hospital length of stay, 28-day ventilator-free days (VFD), and 28-day ICU-free days (IFD)]. RESULTS There were 121 children included in this study, 33/121(27.3%), 44/121(36.4%), and 44/121(36.4%) in the mild, moderate, and severe groups of PARDS, respectively. OI and OSI clearly differentiated mild, moderate, and severe groups in the first 7days of PARDS; however, this differentiation was no longer present after 7days. Median T res was 4 (interquartile range: 3, 6), 5 (4, 7), and 7.5 (7, 11.5) days; p < 0.001 for the mild, moderate, and severe groups of PARDS, respectively. T res was associated with increased MV duration, ICU and hospital length of stay, and decreased VFD and IFD. CONCLUSION The oxygenation defect in PARDS took progressively longer to resolve across the mild, moderate, and severe groups. T res is a potential short-term respiratory-specific outcome, which may be useful in addition to conventional clinical outcomes but needs further validation in external cohorts.
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Affiliation(s)
- Judith Ju Ming Wong
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Herng Lee Tan
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Rehena Sultana
- Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Yi-Jyun Ma
- Duke-NUS Medical School, Singapore, Singapore
| | - Apollo Aguilan
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Siew Wah Lee
- Pediatric Intensive Care Unit, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
| | - Pavanish Kumar
- Translational Immunology Institute, SingHealth/Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Yee Hui Mok
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Schjørring OL, Lange T, Krag M, Andersen‐Ranberg NC, Meyhoff TS, Marker S, Klitgaard TL, Estrup S, Møller MH, Rasmussen BS, Poulsen LM, Perner A. Interactions in clinical trials: Protocol and statistical analysis plan for an explorative study of four randomized ICU trials on use of pantoprazole, oxygenation targets, haloperidol and intravenous fluids. Acta Anaesthesiol Scand 2022; 66:156-162. [PMID: 34606090 DOI: 10.1111/aas.13990] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intensive care unit (ICU) patients receive numerous interventions, but knowledge about potential interactions between these interventions is limited. Co-enrolment in randomized clinical trials represents a unique opportunity to investigate any such interactions. We aim to assess interactions in four randomized clinical trials with overlap in inclusion periods and patient populations. METHODS This protocol and statistical analysis plan describes a secondary explorative analysis of interactions in four international ICU trials on pantoprazole, oxygenations targets, haloperidol and intravenous fluids, respectively. The primary outcome will be 90-day all-cause mortality. The secondary outcome will be days alive and out of hospital in 90 days after randomization. All patients included in the intention-to-treat populations of the four trials will be included. Four co-primary analyses will be conducted, one with each of the included trials as reference using a logistic regression model adjusted for the reference trial's stratification variables and for the co-interventions with interactions terms. The primary analytical measure of interest will be the analyses' tests of interaction. A p-value below .05 will be considered statically significant. The stratification variable- and co-intervention-adjusted effect estimates will be reported with 95% confidence intervals without adjustments for multiplicity. CONCLUSION This exploratory analysis will investigate the presence of any interactions between pantoprazole, oxygenation targets, haloperidol and amount of intravenous fluids in four international ICU trials using co-enrolment. Assessment of possible interactions represents valuable information to guide the design, statistical powering and conduct of future trials.
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Affiliation(s)
- Olav L. Schjørring
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Theis Lange
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Public Health Section of Biostatistics Copenhagen University Copenhagen Denmark
| | - Mette Krag
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care Rigshospitalet Copenhagen Denmark
- Department of Anaesthesiology and Intensive Care Holbæk Hospital Holbæk Denmark
| | - Nina Christine Andersen‐Ranberg
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Anaesthesiology Zealand University Hospital Køge Denmark
| | - Tine S. Meyhoff
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Søren Marker
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care Rigshospitalet Copenhagen Denmark
| | - Thomas L. Klitgaard
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Stine Estrup
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Anaesthesiology Zealand University Hospital Køge Denmark
| | - Morten Hylander Møller
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Bodil S. Rasmussen
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Lone M. Poulsen
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Anaesthesiology Zealand University Hospital Køge Denmark
| | - Anders Perner
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Rasmussen BS, Klitgaard TL, Perner A, Brand BA, Hildebrandt T, Siegemund M, Hollinger A, Aagaard SR, Bestle MH, Marcussen KV, Brøchner AC, Sølling CG, Poulsen LM, Laake JH, Aslam TN, Bäcklund M, Okkonen M, Morgan M, Sharman M, Lange T, Wetterslev J, Schjørring OL. Oxygenation targets in ICU patients with COVID-19: A post hoc subgroup analysis of the HOT-ICU trial. Acta Anaesthesiol Scand 2022; 66:76-84. [PMID: 34425016 PMCID: PMC8653379 DOI: 10.1111/aas.13977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/23/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 01/08/2023]
Abstract
Background Supplemental oxygen is the key intervention for severe and critical COVID‐19 patients. With the unstable supplies of oxygen in many countries, it is important to define the lowest safe dosage. Methods In spring 2020, 110 COVID‐19 patients were enrolled as part of the Handling Oxygenation Targets in the ICU trial (HOT‐ICU). Patients were allocated within 12 h of ICU admission. Oxygen therapy was titrated to a partial pressure of arterial oxygen (PaO2) of 8 kPa (lower oxygenation group) or a PaO2 of 12 kPa (higher oxygenation group) during ICU stay up to 90 days. We report key outcomes at 90 days for the subgroup of COVID‐19 patients. Results At 90 days, 22 of 54 patients (40.7%) in the lower oxygenation group and 23 of 55 patients (41.8%) in the higher oxygenation group had died (adjusted risk ratio: 0.87; 95% confidence interval, 0.58–1.32). The percentage of days alive without life support was significantly higher in the lower oxygenation group (p = 0.03). The numbers of severe ischemic events were low with no difference between the two groups. Proning and inhaled vasodilators were used more frequently, and the positive end‐expiratory pressure was higher in the higher oxygenation group. Tests for interactions with the results of the remaining HOT‐ICU population were insignificant. Conclusions Targeting a PaO2 of 8 kPa may be beneficial in ICU patients with COVID‐19. These results come with uncertainty due to the low number of patients in this unplanned subgroup analysis, and insignificant tests for interaction with the main HOT‐ICU trial. Trial registration number: ClinicalTrials.gov number, NCT03174002. Date of registration: June 2, 2017.
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Affiliation(s)
- Bodil S. Rasmussen
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine The Faculty of Medicine Aalborg University Aalborg Denmark
- Center for Research in Intensive CareRigshospitalet Copenhagen Denmark
| | - Thomas L. Klitgaard
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine The Faculty of Medicine Aalborg University Aalborg Denmark
| | - Anders Perner
- Center for Research in Intensive CareRigshospitalet Copenhagen Denmark
- Department of Intensive Care, Rigshospitalet University of Copenhagen Denmark
| | - Björn A. Brand
- Department of Intensive Care, Rigshospitalet University of Copenhagen Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care Zealand University Hospital Roskilde Denmark
| | - Martin Siegemund
- Department of Anaesthesia and Intensive Care Basel University Hospital Basel Switzerland
- Department of Clinical Research University of Basel Basel Switzerland
| | - Alexa Hollinger
- Department of Anaesthesia and Intensive Care Basel University Hospital Basel Switzerland
- Department of Clinical Research University of Basel Basel Switzerland
| | - Søren R. Aagaard
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine The Faculty of Medicine Aalborg University Aalborg Denmark
| | - Morten H. Bestle
- Department of Anaesthesia and Intensive Care Nordsjaellands Hospital Hilleroed Denmark
| | - Klaus V. Marcussen
- Department of Anaesthesia and Intensive Care Slagelse Hospital Slagelse Denmark
| | - Anne C. Brøchner
- Department of Anaesthesia and Intensive Care Kolding Hospital Kolding Denmark
| | | | - Lone M. Poulsen
- Department of Anaesthesia and Intensive Care Zealand University Hospital Køge Denmark
| | - Jon H. Laake
- Department of Anaesthesia and Intensive Care Oslo University Hospital Rikshospitalet Oslo Norway
| | - Tayyba N. Aslam
- Department of Anaesthesia and Intensive Care Oslo University Hospital Rikshospitalet Oslo Norway
| | - Minna Bäcklund
- Department of Anaesthesia and Intensive Care Helsinki University Hospital Helsinki Finland
| | - Marjatta Okkonen
- Department of Anaesthesia and Intensive Care Helsinki University Hospital Helsinki Finland
| | - Matthew Morgan
- Department of Intensive Care University Hospital of Wales Cardiff UK
| | - Mike Sharman
- Department of Intensive Care and Respiratory Medicine Manchester University NHS Foundation TrustManchester Royal Infirmary Manchester UK
| | - Theis Lange
- Section of Biostatistics Department of Public Health University of Copenhagen Copenhagen Denmark
| | | | - Olav L. Schjørring
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine The Faculty of Medicine Aalborg University Aalborg Denmark
- Center for Research in Intensive CareRigshospitalet Copenhagen Denmark
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34
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Evangelista DG, Malaguti C, Meirelles FDA, de Jesus LADS, José A, Cabral LF, Silva VC, Cabral LA, Oliveira CC. Social Participation and Associated Factors in Individuals with Chronic Obstructive Pulmonary Disease on Long-Term Oxygen Therapy. COPD 2021; 18:630-636. [PMID: 34847806 DOI: 10.1080/15412555.2021.2005012] [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] [Indexed: 10/19/2022]
Abstract
Long-term oxygen therapy (LTOT) reduces hypoxaemia and mitigate systemic alterations in chronic obstructive pulmonary disease (COPD), however, it is related to inactivity and social isolation. Social participation and its related factors remain underexplored in individuals on LTOT. This study investigated social participation in individuals with COPD on LTOT and its association with dyspnoea, exercise capacity, muscle strength, symptoms of anxiety and depression, and quality of life. The Assessment of Life Habits (LIFE-H) assessed social participation. The modified Medical Research Council dyspnoea scale, the 6-Minute Step test (6MST) and handgrip dynamometry were used for assessments. In addition, participants responded to the Hospital Anxiety and Depression Scale (HADS) and the Chronic Respiratory Questionnaire (CRQ). Correlation coefficients and multivariate linear regression analyses were applied. Fifty-seven participants with moderate to very severe COPD on LTOT were included (71 ± 8 years, FEV1: 40 ± 17%predicted). Social participation was associated with dyspnoea (rs=-0.46, p < 0.01), exercise capacity (r = 0.32, p = 0.03) and muscle strength (r = 0.25, p = 0.05). Better participation was also associated with fewer depression symptoms (rs=-0.40, p < 0.01) and a better quality of life (r = 0.32, p = 0.01). Dyspnoea was an independent predictor of social participation (p < 0.01) on regression models. Restricted social participation is associated with increased dyspnoea, reduced muscle strength and exercise capacity. Better participation is associated with fewer depression symptoms and better quality of life in individuals with COPD on LTOT.
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Affiliation(s)
- Deborah Gollner Evangelista
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Carla Malaguti
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Felipe de Azevedo Meirelles
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Luciana Angélica da Silva de Jesus
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Anderson José
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Leandro Ferracini Cabral
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Vanessa Cardoso Silva
- Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Laura Alves Cabral
- Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Cristino Carneiro Oliveira
- Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
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Caneiras C, Jácome C, Oliveira D, Moreira E, Dias CC, Mendonça L, Mayoralas-Alises S, Fonseca JA, Diaz-Lobato S, Escarrabill J, Winck JC. The Portuguese Model of Home Respiratory Care: Healthcare Professionals' Perspective. Healthcare (Basel) 2021; 9:1523. [PMID: 34828569 PMCID: PMC8623333 DOI: 10.3390/healthcare9111523] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Patients' and carers' views regarding the Portuguese model of home respiratory care were recently described, yet the complementary perspective of healthcare professionals (HCPs) is still to be investigated. Thus, this study explored HCPs experience in the management of patients needing home respiratory therapies (HRT), and their perspective about the Portuguese model. A phenomenological descriptive study, using focus groups, was carried out with 28 HCPs (median 42 y, 68% female) with distinct backgrounds (57% pulmonologists, 29% clinical physiologists, 7% physiotherapists, 7% nurses). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. HCPs have in general a positive view about the organization of the Portuguese model of home respiratory care, which was revealed in four major topics: Prescription (number of references, n = 171), Implementation and maintenance (n = 162), Carer involvement (n = 65) and Quality of healthcare (n = 247). Improvements needed were related to patients' late referral, HRT prescription (usability of the medical electronic prescription system and renewals burden), patients' education, access to hospital care team, lack of multidisciplinary work and articulation between hospital, primary and home care teams. This study describes the perspective of HCPs about the Portuguese model of home respiratory care and identifies specific points where improvements and reflections are needed. This knowledge may be useful to decision makers improve the current healthcare model.
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Affiliation(s)
- Cátia Caneiras
- Microbiology Research Laboratory on Environmental Health (EnviHealthMicro Lab), Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Institute for Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Healthcare Department, Nippon Gases Portugal, 2600-242 Vila Franca de Xira, Portugal
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Daniela Oliveira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Rheumatology Department, Centro Hospitalar Universitário São João (CHUSJ), 4200-319 Porto, Portugal
| | - Emília Moreira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Liliane Mendonça
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
| | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF Porto, 4460-188 Matosinhos, Portugal
| | - Salvador Diaz-Lobato
- Healthcare Department, Nippon Gases Spain, 28020 Madrid, Spain;
- Service of Pneumology, Hospital Universitario Moncloa, 28008 Madrid, Spain
| | - Joan Escarrabill
- Programa de Atención a la Cronicidad, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
- Master Plan for Respiratory Diseases (Ministry of Health) & Observatory of Home Respiratory Therapies (FORES), 08028 Barcelona, Spain
- REDISSEC Health Services Research on Chronic Patients Network, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - João Carlos Winck
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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Kusubae R, Hirabayashi M, Nakazaki N, Shinkoda Y. Velocity-based target flow rate for high-flow nasal cannula oxygen therapy. Pediatr Int 2021; 63:770-774. [PMID: 33190381 DOI: 10.1111/ped.14545] [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: 09/24/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to assess retrospectively whether the average inspiratory flow velocity-based initial flow rate in high-flow nasal cannula (HFNC) therapy could be well tolerated and safely used for infants and children hospitalized with moderate to severe respiratory failure. METHODS Thirty-three patients without underlying diseases (22 males; 67%), hospitalized to receive HFNC therapy for infection-related respiratory failure, were analyzed. The median age was 2 months (interquartile range, 1 month to 1 year). Patients with dyspnea and carbon dioxide partial pressure (pCO2 ) >50 mmHg or venous blood pH <7.320, combined with pulse oximetry arterial oxygen saturation <92%, were included. We set target flow rates calculated from the average inspiratory flow velocity, starting at the actual initial flow rates, and these were subsequently adjusted if necessary. RESULTS One patient could not tolerate the cannula. Of the remaining 32 patients, 81% (n = 26) had an actual initial flow rate within 1 L of the target flow rate; these patients were evaluated for changes in the fraction of inspired oxygen (FITarget flow rate tableO2 ), pH, and pCO2 values after 24 h. Three patients required a higher fraction of inspired oxygen, one showed a persistent pH < 7.320, and seven exhibited pCO2 >50 mmHg. No patient required non-invasive positive-pressure ventilation, and one required intubation. Pneumothorax was not reported in any patient. CONCLUSIONS The average inspiratory flow velocity-based initial flow rate was well-tolerated without sedation, and there were no severe complications. Starting at this flow rate would improve the use of HFNC therapy in the pediatric ward, possibly reducing the need for more invasive modes of ventilation.
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Affiliation(s)
- Ryo Kusubae
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | | | - Naho Nakazaki
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Yuichi Shinkoda
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
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Liang S, Liu Z, Qin Y, Wu Y. The effect of high flow nasal oxygen therapy in intensive care units: a systematic review and meta-analysis. Expert Rev Respir Med 2021; 15:1335-1345. [PMID: 34078218 DOI: 10.1080/17476348.2021.1937131] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND High flow nasal oxygen (HFNO) therapy has been widely used in intensive care units (ICU); however, its efficacy remains inconclusive. This systematic review and meta-analysis aimed to compare the efficacy of HFNO therapy with th at of alternative noninvasive oxygen therapies such as conventional oxygen therapy (COT) and noninvasive ventilation (NIV) in ICU. METHODS A Pubmed, Embase, Web of Science, Cochrane Library database search was performed in March 2020. Results: The meta-analysis ultimately included 17 clinical studies. Compared with the overall effect of COT and NIV, HFNO was associated with a low incidence of pneumonia (95% CI: 0.6-0.99, P = 0.04) and improvement in lowest pulse oxygen saturation (SpO₂) during oxygenation (95% CI: 0.02-1.61; P = 0.04). However, no differences were detected in the following outcomes: length of ICU stay, the rate of intubation or reintubation, mortality at day 28, hospital mortality, and SpO₂ at the end of oxygen therapy (all P > 0.05). CONCLUSIONS In adult patients in ICU, HFNO may improve oxygenation and decrease pneumonia rate without affecting the length of ICU stay, intubation or reintubation rate, mortality, and SpO₂ at the end of oxygen therapy.
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Affiliation(s)
- Sujuan Liang
- Neurosurgery Center, Department of Neurotrauma and Neurocritical Care Medicine, The National Key Clinical Specialty, The Engineering Technology Research Center of Education, Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Zhizheng Liu
- Neurosurgery Center, Department of Neurotrauma and Neurocritical Care Medicine, The National Key Clinical Specialty, The Engineering Technology Research Center of Education, Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Yueling Qin
- Neurosurgery Center, Department of Neurotrauma and Neurocritical Care Medicine, The National Key Clinical Specialty, The Engineering Technology Research Center of Education, Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Yue Wu
- Neurosurgery Center, Department of Neurotrauma and Neurocritical Care Medicine, The National Key Clinical Specialty, The Engineering Technology Research Center of Education, Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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Nguyen B, Gunaratne Y, Kemp T, Chan W, Cochrane B. The Oxygen project: a prospective study to assess the effectiveness of a targeted intervention to improve oxygen management in hospitalised patients. Intern Med J 2021; 51:660-665. [PMID: 34047037 DOI: 10.1111/imj.15249] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oxygen is commonly used in the acute care setting. However, used inappropriately, oxygen therapy can result in adverse consequences, including progressive respiratory failure and death. AIM To investigate the effectiveness of a targeted intervention to improve prescribing practice and therapeutic application of supplemental oxygen. METHODS Respiratory, Oncology and Surgery wards were targeted for the intervention. Nursing and junior medical staff from these wards undertook an education programme about safe use of oxygen. Cross-sectional data about oxygen prescribing, administration and monitoring were collected on inpatients in these wards at baseline, and at 3 and 6 months post-intervention, using a modified version of the British Thoracic Society Oxygen Audit Tool. RESULTS At baseline, there was a written prescription for oxygen in 56% of patients (n = 43) using oxygen and this increased to 75% (n = 44) at 3 months, and remained at 65% (n = 48) at 6 months. However, the increased prescription rates were not statistically significant when compared to baseline (χ2 = 3.54, df = 1, P = 0.06 and χ2 = 0.73, df = 1, P = 0.40, respectively). The observed increase in oxygen prescriptions was driven by the medical wards: Oncology ward at 3 months (χ2 = 8.24, df = 1, P = 0.004); and Respiratory ward at 3 months (χ2 = 3.31, df = 1, P = 0.069) and 6 months (χ2 = 4.98, df = 1, P = 0.026). CONCLUSION The education programme intervention to improve oxygen prescription showed promise in the medical wards but did not impact outcomes in the surgical ward setting, where different strategies may be needed.
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Affiliation(s)
- Benjamin Nguyen
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | | | - Teresa Kemp
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Wei Chan
- Department of Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Belinda Cochrane
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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Montealegre-Pomar ADP, Charpak N. Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants. Pediatr Pulmonol 2021; 56:1601-1608. [PMID: 33524247 DOI: 10.1002/ppul.25288] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care Program (KMCP) with ambulatory oxygen, strict follow-up, and oxygen weaning protocols. OBJECTIVES (1) To describe growth, morbimortality, and oxygen monitoring up to 6 months in OD preterm infants. (2) To explore associations between oxygen weaning, perinatal history, Hb levels, transfusions, feeding patterns, and growth. METHODS A prospective cohort study. Descriptive and multivariate analysis. RESULTS Recruited patients were 407 with 33 weeks median gestational age (GA). Mothers presented infections >28%, pre-eclampsia in 22%, and 80% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age, and hospital stay were 36 weeks, 21 and 17 days, respectively; 56.8% of patients had neonatal sepsis and 67.8% were admitted to the neonatal intensive care unit. At oxygen weaning, patients had a median of 54 days with oxygen, median weight 3240 g and GA 41 weeks. Median follow-up oxygen saturation was 94% with 1/64-1/2 L/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 67% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement while invasive ventilation and transfusions had the opposite effect (R2 = .49). CONCLUSIONS In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding, and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.
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Affiliation(s)
- Adriana Del Pilar Montealegre-Pomar
- Kangaroo Foundation, Bogotá, Colombia.,Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Nathalie Charpak
- Kangaroo Foundation, Bogotá, Colombia.,Pontificia Universidad Javeriana, Bogotá, Colombia
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Attaway AH, Faress J, Jacono F, Dasarathy S. Acute Responses to Oxygen Delivery via High Flow Nasal Cannula in Patients with Severe Chronic Obstructive Pulmonary Disease-HFNC and Severe COPD. J Clin Med 2021; 10:1814. [PMID: 33919322 DOI: 10.3390/jcm10091814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/20/2022] Open
Abstract
Differences in oxygen delivery methods to treat hypoxemia have the potential to worsen CO2 retention in chronic obstructive lung disease (COPD). Oxygen administration using high flow nasal cannula (HFNC) has multiple physiological benefits in treating respiratory failure including reductions in PaCO2 in a flow-dependent manner. We hypothesized that patients with COPD would develop worsening hypercapnia if oxygen fraction was increased without increasing flow rate. We evaluated the acute response to HFNC in subjects with severe COPD when flow remained constant and inspired oxygen was increased. In total, 11 subjects with severe COPD (FEV1 < 50%) on supplemental oxygen with baseline normocapnia (PaCO2 < 45 mm Hg; n = 5) and hypercapnia (PaCO2 ≥ 45 mm Hg; n = 6) were studied. Arterial blood gas responses were studied at three timepoints: Baseline, HFNC at a flow rate of 30 L/min at resting oxygen supplementation for 1 h, and FiO2 30% above baseline with the same flow rate for the next hour. The primary endpoint was the change in PaCO2 from baseline. No significant changes in PaCO2 were noted in response to HFNC applied at baseline FiO2 in the normocapnic and hypercapnic group. At HFNC with FiO2 30% above baseline, the normocapnic group did not show a change in PaCO2 (baseline: 38.9 ± 1.8 mm Hg; HFNC at higher FiO2: 38.8 ± 3.1 mm Hg; p = 0.93), but the hypercapnic group demonstrated significant increase in PaCO2 (baseline: 58.2 ± 9.3 mm Hg; HFNC at higher FiO2: 63.3 ± 10.9 mm Hg; p = 0.025). We observed worsening hypercapnia in severe COPD patients and baseline hypercapnia who received increased oxygen fraction when flow remained constant. These data show the need for careful titration of oxygen therapy in COPD patients, particularly those with baseline hypercapnia when flow rate is unchanged.
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Joosten SA, Tan M, Wong AM, Landry SA, Leong P, Sands SA, Beatty C, Thomson L, Stonehouse J, Turton A, Hamilton GS, Edwards BA. A randomized controlled trial of oxygen therapy for patients who do not respond to upper airway surgery for obstructive sleep apnea. J Clin Sleep Med 2021; 17:445-452. [PMID: 33094725 DOI: 10.5664/jcsm.8920] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVES We aimed to determine whether patients diagnosed with obstructive sleep apnea (OSA) who fail to respond to upper airway surgery may be successfully treated with supplemental oxygen and whether we could identify baseline physiologic endotypes (ie, collapsibility, loop gain, arousal threshold, and muscle compensation) that predict response to oxygen therapy. METHODS We conducted a single night, randomized double-blinded cross over trial in which patients with OSA who failed to respond to upper airway surgery were treated on separate nights with oxygen therapy (4 L/min) or placebo (medical air). Effect of oxygen/air on OSA on key polysomnography outcomes were assessed: apnea-hypopnea index (AHI), AHI without desaturation (ie, flow-based AHI), arousal index, and morning blood pressure. OSA endotypes were estimated from the polysomnography signals to determine whether baseline OSA physiology could be used to predict response to oxygen therapy. RESULTS There was a statistically significant reduction in AHI and flow-based AHI on oxygen vs placebo (flow-based AHI: 42.4 ± 21.5 vs 30.5 ± 17.1 events/h, P = .008). Arousal index was also reduced on oxygen vs placebo (41.1 ± 19.5 vs 33.0 ± 15.3 events/h, P = .006). There was no significant difference in morning blood pressure between oxygen and placebo. Although 7 of 20 individuals experienced a 50% reduction or greater in flow-based AHI on oxygen (responders), there was no difference in the baseline OSA endotypes (or clinical characteristics) between responders and nonresponders. CONCLUSIONS Our findings demonstrate that a proportion of patients who fail to respond to upper airway surgery for OSA respond acutely to treatment with supplemental oxygen. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Name: Oxygen therapy for treating patients with residual obstructive sleep apnea following upper airway surgery; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373566; Identifier: ACTRN12617001361392.
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Affiliation(s)
- Simon A Joosten
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Monash Partners-Epworth, Melbourne, Victoria, Australia.,Contributed equally
| | - Michael Tan
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Victoria, Australia.,Contributed equally
| | - Ai-Ming Wong
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shane A Landry
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Paul Leong
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts.,The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Caroline Beatty
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Luke Thomson
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Stonehouse
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Victoria, Australia
| | - Anthony Turton
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Victoria, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Monash Partners-Epworth, Melbourne, Victoria, Australia
| | - Bradley A Edwards
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
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Rodovanski GP, da Costa Aguiar S, Marchi BS, do Nascimento Oliveira P, Arcêncio L, Vieira DSR, Moran CA. Respiratory Therapeutic Strategies in Children and Adolescents with COVID-19: A Critical Review. Curr Pediatr Rev 2021; 17:2-14. [PMID: 33231148 DOI: 10.2174/1573396316999201123200936] [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: 07/30/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022]
Abstract
Evidence on the treatment strategies for the child population with critical conditions due to COVID-19 is scarce and lacks consensus. Thus, this study aimed to critically review non-pharmacological respiratory strategies for this population. Original studies were searched in six databases considering predefined inclusion criteria. Other studies and recommendations were also included after a manual search. Oxygen therapy, invasive (IMV) and non-invasive (NIV) ventilation were the most frequently addressed interventions. In general, the original studies have cited these strategies, but detailed information on the parameters used was not provided. The recommendations provided more detailed data, mainly based on experiences with other acute respiratory syndromes in childhood. In the context of oxygen therapy, the nasal catheter was the most recommended strategy for hypoxemia, followed by the high-flow nasal cannula (HFNC). However, the risks of contamination due to the dispersion of aerosols in the case of the HFNC were pointed out. Lung protective IMV with the use of bacteriological or viral filters was recommended in most documents, and there was great variation in PEEP titration. Alveolar recruitment maneuvers were mentioned in a few recommendations. NIV was not consensual among studies, and when selected, several precautions must be taken to avoid contamination. Airway suctioning with a closed-circuit was recommended to reduce aerosol spread. Information on prone positioning and physiotherapy was even more scarce. In conclusion, oxygen therapy seems to be essential in the treatment of hypoxemia. If necessary, IMV should not be delayed, and protective strategies are encouraged for adequate pulmonary ventilation. Information about techniques that are adjuvant to ventilatory support is superficial and requires further investigation.
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Affiliation(s)
| | | | | | | | - Livia Arcêncio
- Department of Health Science, Federal University of Santa Catarina, Ararangua, Brazil
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Miller DC, Pu J, Kukafka D, Bime C. Failure of High Flow Nasal Cannula and Subsequent Intubation Is Associated With Increased Mortality as Compared to Failure of Non-Invasive Ventilation and Mechanical Ventilation Alone: A Real-World Retrospective Analysis. J Intensive Care Med 2020; 37:41-45. [PMID: 33118405 DOI: 10.1177/0885066620968041] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the increasing use of high flow nasal cannula oxygenation systems (HFNC) in clinical practice, little is known about its role in all cause respiratory failure as compared to traditional non-invasive ventilation (BiPAP). Furthermore, the effect of HFNC on mortality is unknown. METHODS We conducted a retrospective analysis of 49,853 patients with respiratory failure treated with non-invasive respiratory support (HFNC or BiPAP) and/or invasive mechanical ventilation (IMV) between 2017 and 2018. RESULTS Patients initially treated with HFNC who underwent subsequent intubation and IMV had a higher mortality rate as compared to patients who were initially treated with BiPAP and underwent subsequent intubation and IMV (34.8% vs 26.3%, p < 0.0001, OR 1.49, 95% CI 1.26,1.76). Patients first treated with HFNC who underwent subsequent intubation and IMV had a significantly increased mortality compared to patients who underwent immediate intubation and IMV (34.8% vs. 21.5%, p ≤ 0.0001, OR 1.94, 95% CI 1.67, 2.27). Stratified based on ICD-10 diagnosis, patients with a diagnosis of COPD exacerbation or heart failure treated with HFNC and subsequent intubation and IMV had higher mortality as compared to those treated with immediate IMV alone. This trend did not hold true for patients with a diagnosis of pneumonia. CONCLUSION In a real-world retrospective analysis, use of HFNC was associated with increased mortality as compared to BiPAP and IMV alone. Further study is needed to confirm these associations.
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Affiliation(s)
- David C Miller
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jie Pu
- Banner Health, Phoenix, AZ, USA
| | | | - Christian Bime
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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Barrett R, Catangui E, Scott R. Acute oxygen therapy: a cross-sectional study of prescribing practices at an English hospital immediately before COVID-19 pandemic. Expert Rev Respir Med 2020; 15:277-284. [PMID: 32945710 DOI: 10.1080/17476348.2021.1826316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Approximately 14% of UK hospital in-patients receive supplemental oxygen therapy, only 57% have valid prescriptions. Oxygen must be optimally prescribed to ensure maximal therapeutic response whilst minimizing adverse outcomes (including fatality). This study investigates prescription compliance. METHODS All adults admitted to medical wards (18 February to 3 March 2020) were included. Analyses present proportions, descriptive statistics, and hypothesis testing. Ethical approval was unnecessary for this audit. RESULTS Of the 636 patients admitted, 66 (10%) were receiving oxygen therapy. Ages ranged from 34 to 100 years with 36 (54.5%) males and 30 (45.5%) females. The prescription was not documented in the oxygen section of the drug chart (n = 37, 56.1%, p = 0.389), nor did it have the physicians signature (n = 40, 60.6%, p = 0.110) nor date (n = 46, 69.7%, p = 0.002). Thirteen chronic obstructive pulmonary disease (COPD) patients (19.7%) were at risk of hypercapnic failure (p = 1.582x10-6). Target oxygen saturation (SpO2) range had been documented for 30 (45.5%) patients. A target SpO2 range of 88-92% was documented for 9 patients (13.6%), a 94-98% range documented for 11 patients (16.7%). All patients had an invalid prescription. CONCLUSION We present real-world practice in naturalistic settings, immediately before pandemic-lockdown. Enhanced compliance is advocated to reduce risks of harm and mortality.
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Affiliation(s)
- Ravina Barrett
- School of Pharmacy and Biomolecular Sciences, Cockcroft Building, University of Brighton, Moulsecoomb campus, Lewes Road , Brighton, BN2 4GJ, United Kingdom
| | - Eugene Catangui
- School of Pharmacy and Biomolecular Sciences, Cockcroft Building, University of Brighton, Moulsecoomb campus, Lewes Road , Brighton, BN2 4GJ, United Kingdom
| | - Railton Scott
- School of Pharmacy and Biomolecular Sciences, Cockcroft Building, University of Brighton, Moulsecoomb campus, Lewes Road , Brighton, BN2 4GJ, United Kingdom
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45
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Hsu JM, Clark PT, Connell LE, Welfare M. Efficacy of high-flow nasal prong therapy in trauma patients with rib fractures and high-risk features for respiratory deterioration: a randomized controlled trial. Trauma Surg Acute Care Open 2020; 5:e000460. [PMID: 32885050 PMCID: PMC7451286 DOI: 10.1136/tsaco-2020-000460] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients with rib fractures require analgesia, oxygen supplementation and physiotherapy. This combination has been shown to reduce morbidity and mortality due to rib fractures. There has been movement towards the use of high-flow nasal prong (HFNP) oxygen. However there are no studies demonstrating the effectiveness of HFNP in this population. The aim of this study was to compare HFNP to venturi mask (VM) in rib fracture patients. METHODS Randomized controlled trial. Patient population included patients with rib fractures and high-risk features (three or more rib fractures, flail segment, bilateral rib fractures, smoker or chronic obstructive pulmonary disease). Exclusion criteria included initial mechanical ventilation and contraindications to HFNP. Patients were randomized to HFNP or VM. Primary outcome was deterioration requiring mechanical invasive/non-invasive ventilation, or unplanned admission to intensive care unit. Secondary outcomes included mortality, length of stay, high dependency length of stay, comfort levels, breathing exertion levels (as measured by Borg Scale), oxygen saturation, respiratory rate, heart rate, chest X-ray and arterial blood gas parameters. RESULTS 220 patients (average age 60 years and average of four rib fractures each) were randomized to HFNP (n=113) and VM (n=107). There was no statistically significant difference in the primary outcome comparing HFNP and VM (6.2% vs. 6.5%, p=1.0). There were also no statistically significant differences in the secondary outcomes except for PaCO2 (43.6 vs. 45.5, p=0.039). CONCLUSION HFNP oxygen supplementation does not appear to be more effective than VM oxygen supplementation in patients with rib fractures.
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Affiliation(s)
- Jeremy Ming Hsu
- Trauma Service, Westmead Hospital, Westmead, New South Wales, Australia
| | - Peter Telford Clark
- Westmead Hospital Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Matthew Welfare
- Trauma Service, Westmead Hospital, Westmead, New South Wales, Australia
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Perkins GD, Couper K, Connolly B, Baillie JK, Bradley JM, Dark P, De Soyza A, Gorman E, Gray A, Hamilton L, Hart N, Ji C, Lall R, McGowan N, Regan S, Simonds AK, Skilton E, Stallard N, Stimpson E, Yeung J, McAuley DF. RECOVERY- Respiratory Support: Respiratory Strategies for patients with suspected or proven COVID-19 respiratory failure; Continuous Positive Airway Pressure, High-flow Nasal Oxygen, and standard care: A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:687. [PMID: 32727624 PMCID: PMC7388424 DOI: 10.1186/s13063-020-04617-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The trial objective is to determine if Continuous Positive Airway Pressure (CPAP) or High-Flow Nasal Oxygen (HFNO) is clinically effective compared to standard oxygen therapy in patients with confirmed or suspected COVID-19. Trial design Adaptive (group-sequential), parallel group, pragmatic, superiority randomised controlled, open-label, multi-centre, effectiveness trial. Participants The trial is being conducted across approximately 60 hospitals across England, Wales, Scotland, and Northern Ireland. Inpatients at participating hospitals are eligible to participate if they have respiratory failure with suspected or proven COVID-19, and meet all of the inclusion criteria and none of the exclusion criteria. Inclusion criteria: 1) Adults ≥ 18 years; 2) Admitted to hospital with suspected or proven COVID-19; 3) Receiving oxygen with fraction of inspired oxygen (FiO2) ≥0.4 and peripheral oxygen saturation (SpO2) ≤94%; and 4) Plan for escalation to tracheal intubation if needed. Exclusion criteria: 1) Planned tracheal intubation and mechanical ventilation imminent within 1 hour; 2) Known or clinically apparent pregnancy; 3) Any absolute contraindication to CPAP or HFNO; 4) Decision not to intubate due to ceiling of treatment or withdrawal of treatment anticipated; and 5) Equipment for both CPAP and HFNO not available. Intervention and comparator Intervention one: Continuous positive airway pressure delivered by any device. Set-up and therapy titration is not protocolised and is delivered in accordance with clinical discretion. Intervention two: High-flow nasal oxygen delivered by any device. Set-up and therapy titration is not protocolised and is delivered in accordance with clinical discretion. Comparator group: Standard care- oxygen delivered by face mask or nasal cannula (excluding the use of continuous positive airway pressure or high-flow nasal oxygen). Set-up and therapy titration is not protocolised and is delivered in accordance with clinical discretion. Intervention delivery continues up to the point of death, tracheal intubation, or clinical determination that there is no ongoing need (palliation or improvement). Main outcomes The primary outcome is a composite outcome comprising tracheal intubation or mortality within 30 days following randomisation. Secondary outcomes include tracheal intubation rate, time to tracheal intubation, duration of invasive ventilation, mortality rate, time to mortality, length of hospital stay, and length of critical care stay. Randomisation Participants are randomised in a 1:1:1 ratio to receive either continuous positive airway pressure, high-flow nasal oxygen or standard care. Due to the challenging environment of study delivery, a specific intervention may not always be available at the hospital site. The study uses two integrated randomisation systems to allow, where required, the site to randomise between all three interventions, between CPAP and standard care, and between HFNO and standard care. System integration ensures maintenance of balance between interventions. Randomisation is performed using a telephone-based interactive voice response system to maintain allocation concealment. The randomisation sequence was computer-generated using the minimisation method. Participant randomisation is stratified by site, gender (M/F), and age (<50, >=50 years). Blinding (masking) The nature of the trial interventions precludes blinding of the researcher, patient and clinical team. Primary and secondary outcomes are all objective outcomes, thereby minimising the risk of detection bias. Numbers to be randomised (sample size) 4002 participants (1334 to be randomized to each of the three study arms) Trial Status Current protocol: Version 4.0, 29th May 2020. Recruitment began on April 6, 2020 and is anticipated to be complete by April 5, 2021. The trial has been awarded Urgent Public Health status by the National Institute of Health Research on 13th April 2020. Trial registration ISRCTN, ISRCTN16912075. Registered 6th April 2020, http://www.isrctn.com/ISRCTN16912075 Full protocol The full protocol (version 4.0, 29th May 2020) is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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Affiliation(s)
- Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.,Critical care unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Keith Couper
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.,Critical care unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bronwen Connolly
- Wellcome Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science Queen's University Belfast, Belfast, UK
| | - J Kenneth Baillie
- The Roslin Institute, University of Edinburgh, Edinburgh, UK.,Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Judy M Bradley
- Wellcome Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science Queen's University Belfast, Belfast, UK
| | - Paul Dark
- Division of Infection, Immunity and Respiratory Medicine, NIHR Manchester Biomedical Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anthony De Soyza
- Institute of Cellular Medicine, NIHR Biomedical Research Centre for Ageing, Newcastle University, Newcastle, UK.,Department of Respiratory Medicine, Freeman Hospital, Newcastle, UK
| | - Ellen Gorman
- Wellcome Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science Queen's University Belfast, Belfast, UK
| | - Alasdair Gray
- Emergency Medicine Research Group of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Louisa Hamilton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nicholas Hart
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nicola McGowan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Scott Regan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anita K Simonds
- Sleep and Ventilation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Emma Skilton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nigel Stallard
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Emily Stimpson
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.,Critical care unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Daniel F McAuley
- Wellcome Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science Queen's University Belfast, Belfast, UK.
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Schjørring OL, Klitgaard TL, Perner A, Wetterslev J, Lange T, Keus F, Laake JH, Morgan M, Bäcklund M, Siegemund M, Thormar KM, Rasmussen BS. The handling oxygenation targets in the intensive care unit (HOT-ICU) trial: Detailed statistical analysis plan. Acta Anaesthesiol Scand 2020; 64:847-856. [PMID: 32068884 DOI: 10.1111/aas.13569] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND No solid evidence exists on optimal oxygenation targets in intensive care patients. The handling oxygenation targets in the intensive care unit (HOT-ICU) trial assesses the effects of a targeted arterial oxygen tension of 8 vs 12 kPa on 90-day mortality in acutely admitted adult patients with hypoxaemic respiratory failure. This article describes the detailed statistical analysis plan for the predefined outcomes and supplementary analyses in the HOT-ICU trial. METHODS The trial will include 2928 patients to be able to detect or reject a true 20% relative risk reduction in the primary outcome of 90-day all-cause mortality with an α of 5% and a β of 10%. Analyses of the primary and secondary outcomes will be conducted according to the intention-to-treat principle and adjusted for stratification variables. The primary outcome and dichotomous secondary outcomes will be analysed using a generalised linear model with a log-link and binomial error distribution. For the primary outcome, a 95% confidence interval (CI) not including 1.00 for the risk ratio will be considered statistically significant. Continuous secondary outcomes will be analysed using a generalised linear model or nonparametric test. CIs adjusted for the multiple secondary outcomes not including the null effect will be considered statistically significant. One planned interim analysis has been conducted. CONCLUSIONS The HOT-ICU trial and the pre-planned statistical analyses are designed to minimise bias and produce high quality data on the effects of a lower vs a higher oxygenation target throughout ICU admission in acutely admitted adult patients with hypoxaemic respiratory failure. REGISTRATION ClinicalTrials.gov identifier: NCT03174002, date of registration: June 2, 2017. European clinical trials database, EudraCT number 2017-000632-34.
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Affiliation(s)
- Olav L. Schjørring
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Thomas L. Klitgaard
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Anders Perner
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care 4131 Copenhagen University Hospital Rigshospitalet Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Jørn Wetterslev
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department 7812 Copenhagen Trial Unit Centre for Clinical Intervention Research Copenhagen University Hospital Rigshospitalet Denmark
| | - Theis Lange
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Biostatistics Copenhagen University Copenhagen Denmark
| | - Frederik Keus
- Department of Critical Care University Medical Centre of Groningen University of Groningen Groningen the Netherlands
| | - Jon H. Laake
- Division of Emergencies and Critical Care Rikshospitalet Oslo University Hospital Oslo Norway
| | - Matthew Morgan
- Critical Care Research University Hospital of Wales Cardiff UK
- Cardiff University School of Medicine Wales UK
| | - Minna Bäcklund
- Department of Perioperative, Intensive Care and Pain Medicine Helsinki University Hospital Helsinki Finland
| | - Martin Siegemund
- Department of Intensive Care and Department of Clinical Research University Hospital University of Basel Basel Switzerland
| | - Katrin M. Thormar
- Department of Anaesthesia and Intensive Care Landspitali University Hospital Reykjavik Iceland
| | - Bodil S. Rasmussen
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
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Abstract
BACKGROUND The use of high-flow nasal cannula (HFNC) is rapidly increasing without clear indications, creating the potential for overuse or misuse and the accompanying risk of adverse events. The purpose of this study was to determine the factors associated with HFNC failure by examining the current clinical practice of HFNC. METHODS From July 1, 2017, to June 30, 2018, in 5 university-affiliated hospitals in the Republic of Korea, a total of 1,161 admitted adult subjects who had HFNC administered were retrospectively enrolled and their medical records were reviewed. RESULTS Pulmonary diseases including pneumonia (n = 757, 65.2%) were the most common reason for use of HFNC. Subjects with do-not-resuscitate (DNR) or do-not-intubate (DNI) orders comprised 33.8% of the study population (n = 392); 563 subjects (48.5%) were escalated directly to HFNC from low-flow devices without applying reservoir or other high-flow devices. In the non-DNR/DNI subjects, arterial blood gas was not monitored in 15.2% and 14.8% of subjects before and after HFNC application, respectively, and it was not monitored in 28.0% just before HFNC weaning. The HFNC failure rate was 27.0% in non-DNR/DNI subjects, and the HFNC failure was significantly associated with the decision by residents to apply HFNC (odds ratio [OR] 2.03, 95% CI 1.29-3.18, P = .002), high breathing frequency (OR 1.07, 95% CI 1.04-1.10, P < .001) ≤ 6 h before HFNC application, low [Formula: see text] (OR 0.92, 95% CI 0.89-0.95, P < .001) ≤ 6 h before HFNC application, low [Formula: see text] (OR 0.95, 95% CI 0.93-0.98, P < .001) ≤ 6 h before HFNC application, and the ratio of [Formula: see text]/[Formula: see text] to breathing frequency (ROX index) ≤ 6 h after HFNC application (OR 0.88, 95% CI 0.84-0.92, P < .001). CONCLUSIONS HFNC was practiced without applying reservoir or other high-flow devices before application and without appropriate arterial blood gas monitoring during HFNC therapy. HFNC failure was significantly associated with the decision by the resident to use HFNC, breathing frequency, [Formula: see text], and [Formula: see text] ≤ 6 h before HFNC application, and with the ROX index ≤ 6 h after HFNC application.
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Affiliation(s)
- Beong Ki Kim
- Division of Pulmonology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sua Kim
- Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Chi Young Kim
- Division of Pulmonology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Young Seok Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Yousang Ko
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Won Gun Kwack
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - So Young Park
- Department of Pulmonary and Critical Care Medicine, Chung Nam National University Medical Center, Daejeon, Republic of Korea
| | - Je Hyeong Kim
- Division of Pulmonology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea. .,Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
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49
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Catling FJR, Wolff AH. Temporal convolutional networks allow early prediction of events in critical care. J Am Med Inform Assoc 2020; 27:355-365. [PMID: 31858114 PMCID: PMC7647248 DOI: 10.1093/jamia/ocz205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/18/2019] [Revised: 10/22/2019] [Accepted: 11/13/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Clinical interventions and death in the intensive care unit (ICU) depend on complex patterns in patients' longitudinal data. We aim to anticipate these events earlier and more consistently so that staff can consider preemptive action. MATERIALS AND METHODS We use a temporal convolutional network to encode longitudinal data and a feedforward neural network to encode demographic data from 4713 ICU admissions in 2014-2018. For each hour of each admission, we predict events in the subsequent 1-6 hours. We compare performance with other models including a recurrent neural network. RESULTS Our model performed similarly to the recurrent neural network for some events and outperformed it for others. This performance increase was more evident in a sensitivity analysis where the prediction timeframe was varied. Average positive predictive value (95% CI) was 0.786 (0.781-0.790) and 0.738 (0.732-0.743) for up- and down-titrating FiO2, 0.574 (0.519-0.625) for extubation, 0.139 (0.117-0.162) for intubation, 0.533 (0.492-0.572) for starting noradrenaline, 0.441 (0.433-0.448) for fluid challenge, and 0.315 (0.282-0.352) for death. DISCUSSION Events were better predicted where their important determinants were captured in structured electronic health data, and where they occurred in homogeneous circumstances. We produce partial dependence plots that show our model learns clinically-plausible associations between its inputs and predictions. CONCLUSION Temporal convolutional networks improve prediction of clinical events when used to represent longitudinal ICU data.
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Affiliation(s)
- Finneas J R Catling
- Division of Surgery and Allied Specialities, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Anthony H Wolff
- Division of Surgery and Allied Specialities, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK
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50
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Matsuda W, Hagiwara A, Uemura T, Sato T, Kobayashi K, Sasaki R, Okamoto T, Kimura A. High-Flow Nasal Cannula May Not Reduce the Re-Intubation Rate Compared With a Large-Volume Nebulization-Based Humidifier. Respir Care 2020; 65:610-617. [PMID: 31992669 DOI: 10.4187/respcare.07095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) therapy may reduce the re-intubation rate compared with conventional oxygen therapy. However, HFNC has not been sufficiently compared with conventional oxygen therapy with a heated humidifier, even though heated humidification is beneficial for facilitating airway clearance. METHODS This study was a single-center, open-label, randomized controlled trial. We randomized subjects with respiratory failure after extubation to either HFNC group or to a large-volume humidified nebulization-based nebulizer. The primary end point was the re-intubation rate within 7 d after extubation. RESULTS We could not recruit enough subjects for the sample size we designed, therefore, we analyzed 69 subjects (HFNC group, 30 subjects; nebulizer group, 39 subjects). The re-intubation rate within 7 d was not significantly different between the HFNC and nebulizer groups (5/30 subjects [17%] and 6/39 subjects [15%], respectively; P > .99). [Formula: see text]/set [Formula: see text] at 24 h after extubation was also not significantly different between the respective groups (264 ± 105 mm Hg in the HFNC group vs 224 ± 53 mm Hg in the nebulizer group; P = .07). CONCLUSIONS Compared with a large-volume nebulization-based humidifier, HFNC may not reduce the re-intubation rate within 7 d. However, because of insufficient statistical power, further studies are needed to reach a conclusion.
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Affiliation(s)
- Wataru Matsuda
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Akiyoshi Hagiwara
- Department of Emergency Medicine, Niizashiki Chuo General Hospital, Niiza-shi, Saitama, Japan
| | - Tatsuki Uemura
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takunori Sato
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kentaro Kobayashi
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ryo Sasaki
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tatsuya Okamoto
- Department of Intensive Care Medicine, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Akio Kimura
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
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