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Hyperbaric Oxygen Treatment is Associated with Lipid Inflammatory Response Assessed Uding Serum Platelet Activating Factor. POLISH HYPERBARIC RESEARCH 2019. [DOI: 10.2478/phr-2019-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Abstract
Hyperbaric oxygen (HBO) treatment is generally a relatively safe therapy for various conditions. However, there are some adverse side effects. For example HBO tratment has been reported to increase the production of free oxygen radicals(FRs). Furthermore, to our knowledge, no previous clinical research has been carried out to study the involvement of platelet-activating factor(PAF)as the lipid oxidative stressor in patients undergoing HBO treatment. A total of 45 patients included in this study were first given clinical assessment and laboratory measurements before starting HBO treatment and were named group baseline. After the HBO treatment, the same clinical and laboratory measurements from the same patients were repeated and this was named group sesion >20.As expected, long-term HBO treatment had no effect on oxLDL (oxidized low-density lipoprotein), a lipid oxidative stress(OS) marker. However, the mean PAF values in the second group showed a statistically significant increase compared to their pretreatment values, (P <0. 002).As this is a preliminary study, there is a need for more detailed investigations that demonstrate the association of HBO treatment with the lipid inflammatory response. Therefore, there is need for further clinical study for OS markers such as oxLDL in HBO treatment. Clinical prospective studies are required to confirm our laboratory findings.
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Bailey SJ, Gandra PG, Jones AM, Hogan MC, Nogueira L. Incubation with sodium nitrite attenuates fatigue development in intact single mouse fibres at physiological P O 2 . J Physiol 2019; 597:5429-5443. [PMID: 31541562 DOI: 10.1113/jp278494] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/20/2019] [Indexed: 12/22/2022] Open
Abstract
KEY POINTS Dietary nitrate supplementation increases plasma nitrite concentration, which provides an oxygen-independent source of nitric oxide and can delay skeletal muscle fatigue. Nitrate supplementation has been shown to increase myofibre calcium release and force production in mouse skeletal muscle during contractions at a supra-physiological oxygen tension, but it is unclear whether nitrite exposure can delay fatigue development and improve myofibre calcium handling at a near-physiological oxygen tension. Single mouse muscle fibres acutely treated with nitrite had a lower force and cytosolic calcium concentration during single non-fatiguing contractions at a near-physiological oxygen tension. Nitrite treatment delayed fatigue development during repeated fatiguing isometric contractions at near-physiological, but not at supra-physiological, oxygen tension in combination with better maintenance of myofilament calcium sensitivity and sarcoplasmic reticulum calcium pumping. These findings improve understanding of the mechanisms by which increased skeletal muscle nitrite exposure might be ergogenic and imply that this is related to improved calcium handling. ABSTRACT Dietary nitrate (NO3 - ) supplementation, which increases plasma nitrite (NO2 - ) concentration, has been reported to attenuate skeletal muscle fatigue development. Sarcoplasmic reticulum (SR) calcium (Ca2+ ) release is enhanced in isolated single skeletal muscle fibres following NO3 - supplementation or NO2 - incubation at a supra-physiological P O 2 but it is unclear whether NO2 - incubation can alter Ca2+ handling and fatigue development at a near-physiological P O 2 . We hypothesised that NO2 - treatment would improve Ca2+ handling and delay fatigue at a physiological P O 2 in intact single mouse skeletal muscle fibres. Each muscle fibre was perfused with Tyrode solution pre-equilibrated with either 20% ( P O 2 ∼150 Torr) or 2% O2 ( P O 2 = 15.6 Torr) in the absence and presence of 100 µM NaNO2 . At supra-physiological P O 2 (i.e. 20% O2 ), time to fatigue was lowered by 34% with NaNO2 (control: 257 ± 94 vs. NaNO2 : 159 ± 46 s, Cohen's d = 1.63, P < 0.05), but extended by 21% with NaNO2 at 2% O2 (control: 308 ± 217 vs. NaNO2 : 368 ± 242 s, d = 1.14, P < 0.01). During the fatiguing contraction protocol completed with NaNO2 at 2% O2 , peak cytosolic Ca2+ concentration ([Ca2+ ]c ) was not different (P > 0.05) but [Ca2+ ]c accumulation between contractions was lower, concomitant with a greater SR Ca2+ pumping rate (P < 0.05) compared to the control condition. These results demonstrate that increased exposure to NO2 - blunts fatigue development at near-physiological, but not at supra-physiological, P O 2 through enhancing SR Ca2+ pumping rate in single skeletal muscle fibres. These findings extend our understanding of the mechanisms by which increased NO2 - exposure can mitigate skeletal muscle fatigue development.
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Affiliation(s)
- Stephen J Bailey
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Paulo G Gandra
- Section of Physiology; Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA.,Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (Unicamp), Campinas, Brazil
| | - Andrew M Jones
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Michael C Hogan
- Section of Physiology; Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Leonardo Nogueira
- Section of Physiology; Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA.,Instituto de Bioquímica Médica Leopoldo de Meis (Medical Biochemistry Institute Leopoldo de Meis), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Schjørring OL, Perner A, Wetterslev J, Lange T, Keus F, Laake JH, Okkonen M, Siegemund M, Morgan M, Thormar KM, Rasmussen BS. Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU)-Protocol for a randomised clinical trial comparing a lower vs a higher oxygenation target in adults with acute hypoxaemic respiratory failure. Acta Anaesthesiol Scand 2019; 63:956-965. [PMID: 30883686 DOI: 10.1111/aas.13356] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/22/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acutely ill adults with hypoxaemic respiratory failure are at risk of life-threatening hypoxia, and thus oxygen is often administered liberally. Excessive oxygen use may, however, increase the number of serious adverse events, including death. Establishing the optimal oxygenation level is important as existing evidence is of low quality. We hypothesise that targeting an arterial partial pressure of oxygen (PaO2 ) of 8 kPa is superior to targeting a PaO2 of 12 kPa in adult intensive care unit (ICU) patients with acute hypoxaemic respiratory failure. METHODS The Handling Oxygenation Targets in the ICU (HOT-ICU) trial is an outcome assessment blinded, multicentre, randomised, parallel-group trial targeting PaO2 in acutely ill adults with hypoxaemic respiratory failure within 12 hours after ICU admission. Patients are randomised 1:1 to one of the two PaO2 targets throughout ICU stay until a maximum of 90 days. The primary outcome is 90-day mortality. Secondary outcomes are serious adverse events in the ICU, days alive without organ support and days alive out of hospital in the 90-day period; mortality, health-related quality-of-life at 1-year follow-up as well as 1-year cognitive and pulmonary function in a subgroup; and an overall health economic analysis. To detect or reject a 20% relative risk reduction, we aim to include 2928 patients. An interim analysis is planned after 90-day follow-up of 1464 patients. CONCLUSION The HOT-ICU trial will test the hypothesis that a lower oxygenation target reduces 90-day mortality compared with a higher oxygenation target in adult ICU patients with acute hypoxaemic respiratory failure.
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Affiliation(s)
- Olav L. Schjørring
- Department of Anaesthesia and Intensive Care Medicine Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Anders Perner
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Jørn Wetterslev
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Theis Lange
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
- Section of Biostatistics University of Copenhagen Copenhagen Denmark
- Center for Statistical Science Peking University Peking China
| | - Frederik Keus
- Department of Critical Care University Medical Centre Groningen, University of Groningen Groningen The Netherlands
| | - Jon H. Laake
- Division of Emergencies and Critical Care Oslo University Hospital RikshospitaletOslo Norway
| | - Marjatta Okkonen
- Department of Perioperative, Intensive Care and Pain Medicine Helsinki University Hospital Helsinki Finland
| | - Martin Siegemund
- Department of Anaesthesia and Intensive Care University Hospital Basel Basel Switzerland
| | - Matthew Morgan
- Critical Care Research University Hospital of Wales Cardiff UK
- Cardiff University School of Medicine Wales UK
| | - Katrin M. Thormar
- Department of Anaesthesia and Intensive Care University Hospital Reykjavik Landspitali Reykjavik Iceland
| | - Bodil S. Rasmussen
- Department of Anaesthesia and Intensive Care Medicine 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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54
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Rasmussen BS, Frei D, Schjørring OL, Meyhoff CS, Young PJ. Perioperative Oxygenation Targets in Adults. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00326-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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55
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The unique role of the trigeminal autonomic reflex and its modulation in primary headache disorders. Curr Opin Neurol 2019; 32:438-442. [DOI: 10.1097/wco.0000000000000691] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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The Effects of Hyperbaric Oxygen at Different Pressures on Oxidative Stress and Antioxidant Status in Rats. ACTA ACUST UNITED AC 2019; 55:medicina55050205. [PMID: 31137620 PMCID: PMC6572368 DOI: 10.3390/medicina55050205] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/24/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023]
Abstract
Background: The optimal use of oxygen at greater than atmospheric pressures in any operational or therapeutic application (hyperbaric oxygen, HBO2) requires awareness of the fact that the beneficial effects of oxygen coexist with toxic effects depending on the pressure and duration of exposure. In this study, we aimed to investigate the effect of HBO2 therapy on oxidative stress and antioxidant status in commonly used protocol for acute HBO2 indications, such as carbon monoxide intoxication, central retinal artery occlusion, crush injury, gas gangrene, and to compare it with normobaric oxygen (NBO2) in healthy rats. Materials and Methods: Fifty-six male, young adult Wistar albino rats were randomly divided into seven groups and named as Group I through Group VII. Plasma malondialdehyde (MDA), superoxide dismutase (SOD), and erythrocyte glutathione (GSH) levels in control group were compared to the levels in other groups. Results: The increases in MDA levels and the decrease in SOD activities were statistically significant in HBO2 groups at the end of the first 24 h when compared to the control group, and the significant decrease in erythrocyte GSH level was only at 2.4 atmospheres absolute. Conclusions: The present study showed that pressure and frequency of exposure are important factors to consider when investigating HBO2-induced oxidative stress and antioxidant response.
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Kop M, Schroten NF, Soe-Loek-Mooi S, Tuinman PR. Less Is More for Steroids in Severe Sepsis and Oxygen for the Critically Ill, but Maybe Not When Searching for Pulmonary Embolism in Syncope. Am J Respir Crit Care Med 2019; 196:1473-1475. [PMID: 29043839 DOI: 10.1164/rccm.201701-0245rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mirjam Kop
- Critical Care Medicine Fellowship, Department of Intensive Care Medicine, Free University (VU) Medical Center, Amsterdam, the Netherlands
| | - Nicolas F Schroten
- Critical Care Medicine Fellowship, Department of Intensive Care Medicine, Free University (VU) Medical Center, Amsterdam, the Netherlands
| | - Sharon Soe-Loek-Mooi
- Critical Care Medicine Fellowship, Department of Intensive Care Medicine, Free University (VU) Medical Center, Amsterdam, the Netherlands
| | - Pieter R Tuinman
- Critical Care Medicine Fellowship, Department of Intensive Care Medicine, Free University (VU) Medical Center, Amsterdam, the Netherlands
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Benefits and risks of oxygen therapy during acute medical illness: Just a matter of dose! Rev Med Interne 2019; 40:670-676. [PMID: 31054779 DOI: 10.1016/j.revmed.2019.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/10/2019] [Indexed: 11/21/2022]
Abstract
Oxygen therapy is used to reverse hypoxemia since more than a century. Current usage is broader and includes routine oxygen administration despite normoxemia which may result in prolonged periods of hyperoxemia. While systematic oxygen therapy was expected to be of benefit in some ischemic diseases such as stroke or acute myocardial infarction, recent randomised controlled trials (RCTs) have challenged this hypothesis by showing the absence of clinical improvement. Although oxygen is known to be toxic at high inspired oxygen fractions, a recent meta-analysis of RCTs revealed the life-threatening effect of hyperoxemia, with a dose-dependent relationship. Several recommendations have therefore been updated: (i) to monitor peripheral oxygen saturation (SpO2) as a surrogate for arterial oxygen saturation (SaO2); (ii) to initiate oxygen only when the lower SpO2 threshold is crossed; (iii) to titrate the delivered oxygen fraction to maintain SpO2 within a target range; and (iv) to stop supplying oxygen when the upper limit of SpO2 is surpassed, in order to prevent hyperoxemia. The lower and upper limits of SpO2 depend on the presence of risk factors for oxygen-induced hypercapnia (Chronic obstructive pulmonary disease, asthma, and obesity-associated hypoventilation). For patients at risk, oxygen therapy should be started when SpO2 is≤88% and stopped when it is>92%. For patients without risk factors, oxygen therapy should be started when SpO2 is≤92% and stopped when it is >96%. High-flow oxygen should only be used in a few diseases such as carbon monoxide poisoning, cluster headaches, sickle cell crisis and pneumothorax.
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Eskesen TG, Baekgaard JS, Christensen RE, Lee JM, Velmahos GC, Steinmetz J, Rasmussen LS. Supplemental oxygen and hyperoxemia in trauma patients: A prospective, observational study. Acta Anaesthesiol Scand 2019; 63:531-536. [PMID: 30520014 DOI: 10.1111/aas.13301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Supplemental oxygen is recommended during the initial treatment of trauma patients according to several guidelines, but the supporting evidence is sparse. We aimed to describe the use of supplemental oxygen and occurrence of hyperoxemia in the initial phase of trauma management at two level 1 trauma centers, TC1 and TC2. METHODS In this prospective, observational study we included trauma patients ≥16 years of age. Data on pre- and in-hospital supplemental oxygen, arterial oxygen tension (PaO2 ), and outcomes (in-hospital mortality, hospital- and intensive care unit length of stay) were collected. RESULTS We included 56 patients. There were 22 (39%) females with a mean age of 49 years (SD: 18) and a median Injury Severity Score of 9 (IQR: 4-14, n = 49). A total of 23 (45%) out of 51 spontaneously breathing patients received pre-hospital supplemental oxygen, but did not differ significantly from the patients that did not receive supplemental oxygen. In-hospital, 29 (59%) out of 49 spontaneously breathing patients received supplemental oxygen. The median PaO2 was 26.5 kPa [IQR: 22.2-34.1] in four intubated patients and 12.3 kPa [IQR: 9.7-25.7] in eight patients with spontaneous respiration on supplemental oxygen. At TC1 a significantly greater proportion of spontaneously breathing patients received both pre-hospital (TC1: 18 [64%]; TC2: 5 [21%], P = 0.002) and in-hospital (TC1: 24 [92%]; TC2: 7 [30%], P < 0.001) supplemental oxygen. CONCLUSION Approximately 50% of trauma patients received supplemental oxygen during the initial treatment. Hyperoxemia was a common finding for patients treated with supplemental oxygen, and it was more pronounced in intubated patients.
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Affiliation(s)
- Trine G. Eskesen
- Department of Anesthesia, Section 4231, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Josefine S. Baekgaard
- Department of Anesthesia, Section 4231, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | | | - Jae Moo Lee
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - George C. Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Jacob Steinmetz
- Department of Anesthesia, Section 4231, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Trauma Centre, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Lars S. Rasmussen
- Department of Anesthesia, Section 4231, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Kongebro EK, Jorgensen LN, Siersma VD, Meyhoff C. Association between perioperative hyperoxia and cerebrovascular complications after laparotomy-A post-hoc follow-up study. Acta Anaesthesiol Scand 2019; 63:164-170. [PMID: 30066392 DOI: 10.1111/aas.13235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/21/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Perioperative hyperoxia has been linked to increased long-term mortality. Vasoconstrictive and cellular side effects to hyperoxia have been suggested to increase the risk of coronary and cerebral ischemia. The aim of this post-hoc analysis of a large randomized trial was to compare the effects of 80% vs 30% perioperative oxygen on the long-term risk of stroke or transient cerebral ischemia (TCI) in patients undergoing abdominal surgery. METHODS A total of 1386 patients were randomized to 80% or 30% perioperative oxygen during acute or elective open abdominal surgery. Median follow-up was 3.9 years. Primary outcome was a composite of the long-term occurrence of stroke or TCI. Secondary outcomes included long-term mortality without stroke or TCI, and incidences of neurological admission, psychiatric admission, and dementia. Outcomes were analyzed in Cox regression models. RESULTS Stroke or TCI occurred in 20 (3.0%) patients given 80% oxygen vs 22 (3.2%) patients given 30% oxygen with an adjusted hazard ratio (HR) of 0.96 [95% CI 0.52-1.76]. Composite secondary outcome of death, stroke, or TCI had a HR of 1.21 [95% CI 1.00-1.47] for 80% compared to 30% oxygen. HRs for secondary outcomes were HR 1.14 [95% CI 0.79-1.64] for neurological admission, 1.34 [95% CI 0.95-1.88] for psychiatric admission and 0.54 [95% CI 0.16-1.80] for dementia. CONCLUSION Stroke or TCI did not seem related to perioperative inspiratory oxygen fraction. Due to few events, this study cannot exclude that perioperative hyperoxia increases risk of mortality, stroke, or TCI after abdominal surgery.
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Affiliation(s)
- Emilie Katrine Kongebro
- Department of Anaesthesia and Intensive Care; Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Lars N. Jorgensen
- Digestive Disease Center; Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Volkert D. Siersma
- The Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Christian Sahlholt Meyhoff
- Department of Anaesthesia and Intensive Care; Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
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Iyer VN. Low-dose oxygen therapy in COPD patients: are there any radiation-like risks? Curr Opin Pulm Med 2019; 24:187-190. [PMID: 29232278 DOI: 10.1097/mcp.0000000000000455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Low-dose oxygen (LDO) supplementation is used by millions of COPD patients worldwide. The therapeutic benefits of LDO supplementation are well known. There are also several concerns regarding the potential for cellular harm from LDO in COPD patients. This review summarizes the current arguments and evidence pertaining to this important topic. RECENT FINDINGS LDO therapy has been used in COPD patients for more than 50 years. Over the years, data from randomized controlled trials has confirmed that LDO provides survival benefit in COPD patients with severe hypoxemia. Recent data, however, show that LDO does not provide any morality benefit for patients with a less severe degree of hypoxemia. There are several theoretical concerns regarding use of LDO in COPD patients, including radiation-like cellular risks because of oxygen toxicity. However, none of these have been validated in human clinical trials and remain somewhat peripheral to the clinician deciding whether or not to initiate LDO in a hypoxemic COPD patient. SUMMARY There is high-quality evidence that LDO is both well tolerated and highly efficacious for patients with COPD. There are several theoretical concerns regarding damage from oxygen free radicals from LDO in COPD patients. However, none of these have been validated or confirmed in human clinical trial data. Thus, the benefits of LDO clearly outweigh the risks from any theoretical concerns about oxygen toxicity.
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Affiliation(s)
- Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation(s)
- Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
| | - Diane Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
| | - Paul Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
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López-Rivera F, Cintrón Martínez HR, Castillo LaTorre C, Rivera González A, Rodríguez Vélez JG, Fonseca Ferrer V, Méndez Meléndez OF, Vázquez Vargas EJ, González Monroig HA. Treatment of Hypertensive Cardiogenic Edema with Intravenous High-Dose Nitroglycerin in a Patient Presenting with Signs of Respiratory Failure: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:83-90. [PMID: 30662059 PMCID: PMC6350673 DOI: 10.12659/ajcr.913250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pulmonary edema is the accumulation of fluid in the lung secondary to increased hydrostatic pressure. Hypertensive cardiogenic pulmonary edema presents with a sudden onset of severe dyspnea, tachycardia, and tachypnea, and can occur when the systolic blood pressure exceeds 160 mmHg in association with acute decompensated congestive cardiac failure (CCF). A case is presented of hypertensive cardiogenic pulmonary edema treated with high-dose nitroglycerin and includes a review of the literature. CASE REPORT A 63-year-old Hispanic male with a medical history of hypertension, coronary artery disease, heart failure with a reduced ejection fraction of 35%, chronic kidney disease (CKD) and diabetes mellitus, presented as an emergency with acute, severe dyspnea. The patient was initially managed with 100% oxygen supplementation and intravenous (IV) high-dose nitroglycerin (30 mcg/min), which was titrated every 3 minutes, increasing by 15 mcg/min until a dose of 120 mcg/min was reached. After 18 minutes of aggressive therapy, the patient's condition improved and he no longer required mechanical ventilation. CONCLUSIONS Hypertensive cardiogenic pulmonary edema is a challenging clinical condition that should be diagnosed and managed as early as possible, and distinguished from respiratory failure due to other causes. Although hypertensive cardiogenic pulmonary edema is usually managed acutely with high-dose diuretics, this case has highlighted the benefit of high-dose IV nitroglycerin, and review of the literature supports this treatment approach.
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Affiliation(s)
- Fermín López-Rivera
- Department of Internal Medicine, San Juan City Hospital, San Juan, Puerto Rico
| | | | | | | | | | | | - Omar F Méndez Meléndez
- Department of Pneumology and Critical Care Medicine, San Juan City Hospital, San Juan, Puerto Rico
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Affiliation(s)
- Teresa L. Mako
- Department of Chemistry, University of Rhode Island, 140 Flagg Road, Kingston, Rhode Island 02881, United States
| | - Joan M. Racicot
- Department of Chemistry, University of Rhode Island, 140 Flagg Road, Kingston, Rhode Island 02881, United States
| | - Mindy Levine
- Department of Chemistry, University of Rhode Island, 140 Flagg Road, Kingston, Rhode Island 02881, United States
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Jouffroy R, Vivien B. Bundle of care taking into account time to improve long-term outcome after cardiac arrest. Crit Care 2018; 22:192. [PMID: 30111374 PMCID: PMC6092816 DOI: 10.1186/s13054-018-2128-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022] Open
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Abstract
Oxygen administration is often assumed to be required for all patients who are acutely or critically ill. However, in many situations, this assumption is not based on evidence. Injured body tissues and cells throughout the body respond both beneficially and adversely to delivery of supplemental oxygen. Available evidence indicates that oxygen administration is not warranted for patients who are not hypoxemic, and hyperoxia may contribute to increased tissue damage and mortality. Nurses must be aware of implications related to oxygen administration for all types of acutely and critically ill patients. These implications include having knowledge of oxygenation processes and pathophysiology; assessing global, tissue, and organ oxygenation status; avoiding either hypoxia or hyperoxia; and creating partnerships with respiratory therapists. Nurses can contribute to patients' oxygen status well-being by being proficient in determining each patient's specific oxygen needs and appropriate oxygen administration.
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Affiliation(s)
- Debra Siela
- Debra Siela is an associate professor, Ball State University School of Nursing, Muncie, Indiana. .,Michelle Kidd is a critical care clinical nurse specialist, Indiana University Health, Ball Memorial Hospital, Muncie, Indiana.
| | - Michelle Kidd
- Debra Siela is an associate professor, Ball State University School of Nursing, Muncie, Indiana.,Michelle Kidd is a critical care clinical nurse specialist, Indiana University Health, Ball Memorial Hospital, Muncie, Indiana
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Barbateskovic M, Schjørring OL, Jakobsen JC, Meyhoff CS, Rasmussen BS, Perner A, Wetterslev J. Oxygen supplementation for critically ill patients-A protocol for a systematic review. Acta Anaesthesiol Scand 2018; 62:1020-1030. [PMID: 29708586 DOI: 10.1111/aas.13127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND In critically ill patients, hypoxaemia is a common clinical manifestation of inadequate gas exchange in the lungs. Supplemental oxygen is therefore given to all critically ill patients. This can result in hyperoxaemia, and some observational studies have identified harms with hyperoxia. The objective of this systematic review is to critically assess the evidence of randomised clinical trials on the effects of higher versus lower inspiratory oxygen fractions or targets of arterial oxygenation in critically ill adult patients. METHODS We will search for randomised clinical trials in major international databases. Two authors will independently screen and select references for inclusion using Covidence, extract data and assess the methodological quality of the included randomised clinical trials using the Cochrane risk of bias tool. Any disagreement will be resolved by consensus. We will analyse the extracted data using Review Manager and Trial Sequential Analysis. To assess the quality of the evidence, we will create a 'Summary of Findings' table containing our primary and secondary outcomes using the GRADE assessment. DISCUSSION Supplemental oxygen administration is widely recommended in international guidelines despite lack of robust evidence of its effectiveness. To our knowledge, no systematic review of randomised clinical trials has investigated the effects of oxygen supplementation in critically ill patients. This systematic review will provide reliable evidence to better inform future trialists and decision-makers on clinical practice on supplemental oxygen administration in critically ill patients.
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Affiliation(s)
- M. Barbateskovic
- Copenhagen Trial Unit; Centre for Clinical Intervention Research; Copenhagen University Hospital; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen University Hospital; Copenhagen Denmark
| | - O. L. Schjørring
- Centre for Research in Intensive Care; Copenhagen University Hospital; Copenhagen Denmark
- Department of Anaesthesia and Intensive Care Medicine; Aalborg University Hospital; Aalborg Denmark
| | - J. C. Jakobsen
- Centre for Research in Intensive Care; Copenhagen University Hospital; Copenhagen Denmark
- The Cochrane Hepato-Biliary Group; Copenhagen Trial Unit; Centre for Clinical Intervention Research; Copenhagen University Hospital; Copenhagen Denmark
- Department of Cardiology; Holbaek Hospital; Holbaek Denmark
| | - C. S. Meyhoff
- Department of Anaesthesia and Intensive Care; Bispebjerg and Frederiksberg Hospital; Copenhagen University Hospital; Copenhagen Denmark
| | - B. S. Rasmussen
- Centre for Research in Intensive Care; Copenhagen University Hospital; Copenhagen Denmark
- Department of Anaesthesia and Intensive Care Medicine; Aalborg University Hospital; Aalborg Denmark
| | - A. Perner
- Centre for Research in Intensive Care; Copenhagen University Hospital; Copenhagen Denmark
- Department of Intensive Care; Copenhagen University Hospital; Copenhagen Denmark
| | - J. Wetterslev
- Copenhagen Trial Unit; Centre for Clinical Intervention Research; Copenhagen University Hospital; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen University Hospital; Copenhagen Denmark
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68
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Saugel B, Belda FJ. The Oxygen Reserve Index in anesthesiology: a superfluous toy or a tool to individualize oxygen therapy? Minerva Anestesiol 2018; 84:1010-1012. [PMID: 29991226 DOI: 10.23736/s0375-9393.18.13103-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Javier Belda
- Department of Surgery, University of Valencia, Valencia, Spain - .,Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain
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69
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Grensemann J, Fuhrmann V, Kluge S. Oxygen Treatment in Intensive Care and Emergency Medicine. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:455-462. [PMID: 30064624 PMCID: PMC6111205 DOI: 10.3238/arztebl.2018.0455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/02/2017] [Accepted: 03/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oxygen treatment is often life-saving, but multiple studies in recent years have yielded evidence that the indiscriminate administration of oxygen to patients in the intensive care unit and emergency room can cause hyperoxia and thereby elevate mortality. METHODS This review is based on prospective, randomized trials concerning the optimum use of oxygen in adult medicine, which were retrieved by a selective search in PubMed, as well as on pertinent retrospective studies and guideline recommendations. RESULTS 13 prospective, randomized trials involving a total of 17 213 patients were analyzed. In patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) and in ventilated intensive-care patients, normoxia was associated with a lower mortality than hyperoxia (2% vs. 9%). In patients with myocardial infarction, restrictive oxygen administration was associated with a smaller infarct size on cardiac MRI at 6 months compared to oxygen administration at 8 L/min (13.1 g vs. 20.3 g). For patients with stroke, the currently available data do not reveal any benefit or harm from oxygen administration. None of the trials showed any benefit from the administration of oxygen to non-hypoxemic patients; in fact, this was generally associated with increased morbidity or mortality. CONCLUSION Hypoxemia should certainly be avoided, but the fact that the liberal administration of oxygen to patients in intensive care units and emergency rooms tends to increase morbidity and mortality implies the advisability of a conservative, normoxic oxygenation strategy.
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Affiliation(s)
- Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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70
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Kiers D, Wielockx B, Peters E, van Eijk LT, Gerretsen J, John A, Janssen E, Groeneveld R, Peters M, Damen L, Meneses AM, Krüger A, Langereis JD, Zomer AL, Blackburn MR, Joosten LA, Netea MG, Riksen NP, van der Hoeven JG, Scheffer GJ, Eltzschig HK, Pickkers P, Kox M. Short-Term Hypoxia Dampens Inflammation in vivo via Enhanced Adenosine Release and Adenosine 2B Receptor Stimulation. EBioMedicine 2018; 33:144-156. [PMID: 29983349 PMCID: PMC6085583 DOI: 10.1016/j.ebiom.2018.06.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 01/18/2023] Open
Abstract
Hypoxia and inflammation are closely intertwined phenomena. Critically ill patients often suffer from systemic inflammatory conditions and concurrently experience short-lived hypoxia. We evaluated the effects of short-term hypoxia on systemic inflammation, and show that it potently attenuates pro-inflammatory cytokine responses during murine endotoxemia. These effects are independent of hypoxia-inducible factors (HIFs), but involve augmented adenosine levels, in turn resulting in an adenosine 2B receptor-mediated post-transcriptional increase of interleukin (IL)-10 production. We translated our findings to humans using the experimental endotoxemia model, where short-term hypoxia resulted in enhanced plasma concentrations of adenosine, augmentation of endotoxin-induced circulating IL-10 levels, and concurrent attenuation of the pro-inflammatory cytokine response. Again, HIFs were shown not to be involved. Taken together, we demonstrate that short-term hypoxia dampens the systemic pro-inflammatory cytokine response through enhanced purinergic signaling in mice and men. These effects may contribute to outcome and provide leads for immunomodulatory treatment strategies for critically ill patients.
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Affiliation(s)
- Dorien Kiers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Anesthesiology, Radboud University Medical Centre, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ben Wielockx
- Heisenberg Research Group, Department of Clinical Pathobiochemistry, Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Esther Peters
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lucas T van Eijk
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jelle Gerretsen
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Aaron John
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Emmy Janssen
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rianne Groeneveld
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mara Peters
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lars Damen
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ana M Meneses
- Heisenberg Research Group, Department of Clinical Pathobiochemistry, Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anja Krüger
- Heisenberg Research Group, Department of Clinical Pathobiochemistry, Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jeroen D Langereis
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands; Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Aldert L Zomer
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands; Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Center, Nijmegen, the Netherlands; Centre for Molecular and Biomolecular Informatics (CMBI) Bacterial Genomics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michael R Blackburn
- Department of Biochemistry & Molecular Biology, McGovern Medical School, University of Texas, USA
| | - Leo A Joosten
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mihai G Netea
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Niels P Riksen
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gert-Jan Scheffer
- Department of Anesthesiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Holger K Eltzschig
- Center for Perioperative Medicine, Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center, Houston, USA
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands.
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71
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Dobbe ASM, Stolmeijer R, Ter Maaten JC, Ligtenberg JJM. Titration of oxygen therapy in critically ill emergency department patients: a feasibility study. BMC Emerg Med 2018; 18:17. [PMID: 29940886 PMCID: PMC6019296 DOI: 10.1186/s12873-018-0169-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background Liberal use of oxygen in an emergency situation is common. Today, most health care professionals do not adjust the amount of oxygen given when a saturation of 100% or a PaO2 which exceeds the normal range is reached- which may result in hyperoxia. There is increasing evidence for the toxic effects of hyperoxia. Therefore, it seems justified to aim for normoxia when giving oxygen. This study evaluates whether it is feasible to aim for normoxia when giving oxygen therapy to patients at the emergency department (ED). Methods A prospective cohort study was performed at the ED of the University Medical Center Groningen (UMCG). A protocol was developed, aiming for normoxia. During a 14 week period all patients > 18 years arriving at the ED between 8 a.m. and 23 p.m. requiring oxygen therapy registered for cardiology, internal medicine, emergency medicine and pulmonology were included. Statistical analysis was performed using student independent t-test, Mann–Whitney U-test, Fisher’s exact test or a Pearson’s chi-squared test. Results During the study period the study protocol was followed and normoxia was obtained after 1 h at the ED in 86,4% of the patients. Patients with COPD were more at risk for not being titrated to normal oxygen levels. Conclusions We showed that it is feasible to titrate oxygen therapy to normoxia at the ED. The study results will be used for further research assessing the potential beneficial effects of normoxia compared to hyper- or hypoxia in ED patients and for the development of guidelines.
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Affiliation(s)
- Anna S M Dobbe
- BSc of Medicine, Faculty of Medicine, University of Groningen, Groningen, The Netherlands
| | - Renate Stolmeijer
- Emergency physician, Emergency Department, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan C Ter Maaten
- Internist acute medicine, Emergency physician, Emergency Department, University Medical Center Groningen, Groningen, The Netherlands
| | - Jack J M Ligtenberg
- Emergency Department, Internal Medicine, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700, RB, Groningen, The Netherlands. .,Internist acute medicine, Emergency physician, Emergency Department, University Medical Center Groningen, Groningen, The Netherlands.
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72
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Stolmeijer R, Bouma HR, Zijlstra JG, Drost-de Klerck AM, ter Maaten JC, Ligtenberg JJM. A Systematic Review of the Effects of Hyperoxia in Acutely Ill Patients: Should We Aim for Less? BIOMED RESEARCH INTERNATIONAL 2018; 2018:7841295. [PMID: 29888278 PMCID: PMC5977014 DOI: 10.1155/2018/7841295] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/04/2018] [Accepted: 04/12/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Despite widespread and liberal use of oxygen supplementation, guidelines about rational use of oxygen are scarce. Recent data demonstrates that current protocols lead to hyperoxemia in the majority of the patients and most health care professionals are not aware of the negative effects of hyperoxemia. METHOD To investigate the effects of hyperoxemia in acutely ill patients on clinically relevant outcomes, such as neurological and functional status as well as mortality, we performed a literature review using Medline (PubMed) and Embase. We used the following terms: hyperoxemia OR hyperoxemia OR ["oxygen inhalation therapy" AND (mortality OR death OR outcome OR survival)] OR [oxygen AND (mortality OR death OR outcome OR survival)]. Original studies about the clinical effects of hyperoxemia in adult patients suffering from acute or emergency illnesses were included. RESULTS 37 articles were included, of which 31 could be divided into four large groups: cardiac arrest, traumatic brain injury (TBI), stroke, and sepsis. Although a single study demonstrated a transient protective effect of hyperoxemia after TBI, other studies revealed higher mortality rates after cardiac arrest, stroke, and TBI treated with oxygen supplementation leading to hyperoxemia. Approximately half of the studies showed no association between hyperoxemia and clinically relevant outcomes. CONCLUSION Liberal oxygen therapy leads to hyperoxemia in a majority of patients and hyperoxemia may negatively affect survival after acute illness. As a clinical consequence, aiming for normoxemia may limit negative effects of hyperoxemia in patients with acute illness.
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Affiliation(s)
- R. Stolmeijer
- Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - H. R. Bouma
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. G. Zijlstra
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - A. M. Drost-de Klerck
- Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. C. ter Maaten
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. J. M. Ligtenberg
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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73
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Llitjos JF, Cariou A. Effets de l’hyperoxie sur le pronostic après un arrêt cardiaque. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Un effet toxique de l’oxygène est aujourd’hui suspecté chez les patients pris en charge pour un arrêt cardiaque. Indispensable pendant la réanimation cardiopulmonaire (RCP), l’administration d’oxygène en quantité trop importante pourrait cependant majorer les lésions provoquées par le syndrome d’ischémie–reperfusion globale. Expérimentalement, l’exposition des animaux à une hyperoxie pendant et après la RCP augmente les phénomènes en rapport avec le stress oxydatif et semble responsable d’une aggravation du pronostic, au travers notamment des lésions cérébrales. Cependant, la transposition clinique de ces observations est incertaine : chez l’homme, les résultats de certaines études rétrospectives suggèrent un effet délétère de l’hyperoxie post-arrêt cardiaque, mais ces études sont entachées de nombreux biais méthodologiques, et leurs conclusions ont été en partie remises en question dans des études ultérieures. En attendant les résultats des investigations cliniques en cours, les recommandations internationales actuelles préconisent de titrer dès que possible l’oxygène administré pendant et après la RCP pour maintenir une saturation de l’oxygène entre 94 et 98 %.
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74
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Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials. Heart 2018; 104:1691-1698. [DOI: 10.1136/heartjnl-2018-313089] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 11/03/2022] Open
Abstract
BackgroundAlthough oxygen therapy has been used for over a century in the management of patients with suspected acute myocardial infarction (AMI), recent studies have raised concerns around the efficacy and safety of supplemental oxygen in normoxaemic patients.ObjectiveTo synthesise the evidence from randomised controlled trials (RCTs) that investigated the effects of supplemental oxygen therapy compared with room air in patients with suspected or confirmed AMI.MethodsFor this aggregate data meta-analysis, multiple databases were searched from inception to 30 September 2017. RCTs with any length of follow-up and any outcome measure were included if they studied the use of supplemental O2 therapy administered by any device at normal pressure compared with room air. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, an investigator assessed all the included studies and extracted the data. Outcomes of interests included mortality, troponin levels, infarct size, pain and hypoxaemia.ResultsEight RCTs with a total of 7998 participants (3982 and 4002 patients in O2 and air groups, respectively) were identified and pooled. In-hospital and 30-day death occurred in 135 and 149 patients, respectively. Oxygen therapy did not reduce the risk of in-hospital (OR, 1.11 (95% CI 0.69 to 1.77)) or 30-day mortality (OR, 1.09 (95% CI 0.80 to 1.50)) in patients with suspected AMI, and the results remained similar in the subgroup of patients with confirmed AMI. The infarct size (based on cardiac MRI) in a subgroup of patients was not different between groups with and without O2 therapy. O2 therapy reduced the risk of hypoxaemia (OR, 0.29 (95% CI 0.17 to 0.47)).ConclusionAlthough supplemental O2 therapy is commonly used, it was not associated with important clinical benefits. These findings from eight RCTs support departing from the usual practice of administering oxygen in normoxaemic patients.
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75
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Bullens LM, Hulsenboom ADJ, Moors S, Joshi R, van Runnard Heimel PJ, van der Hout-van der Jagt MB, van den Heuvel ER, Guid Oei S. Intrauterine resuscitation during the second stage of term labour by maternal hyperoxygenation versus conventional care: study protocol for a randomised controlled trial (INTEREST O2). Trials 2018; 19:195. [PMID: 29566729 PMCID: PMC5865381 DOI: 10.1186/s13063-018-2567-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 03/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Perinatal asphyxia is, even in developed countries, one the major causes of neonatal morbidity and mortality. Therefore, if foetal distress during labour is suspected, one should try to restore foetal oxygen levels or aim for immediate delivery. However, studies on the effect of intrauterine resuscitation during labour are scarce. We designed a randomised controlled trial to investigate the effect of maternal hyperoxygenation on the foetal condition. In this study, maternal hyperoxygenation is induced for the treatment of foetal distress during the second stage of term labour. METHODS/DESIGN This study is a single-centre randomised controlled trial being performed in a tertiary hospital in The Netherlands. From among cases of a suboptimal or abnormal foetal heart rate pattern during the second stage of term labour, a total of 116 patients will be randomised to the control group, where normal care is provided, or to the intervention group, where before normal care 100% oxygen is supplied to the mother by a non-rebreathing mask until delivery. The primary outcome is change in foetal heart rate pattern. Secondary outcomes are Apgar score, mode of delivery, admission to the neonatal intensive care unit and maternal side effects. In addition, blood gas values and malondialdehyde are determined in umbilical cord blood. DISCUSSION This study will be the first randomised controlled trial to investigate the effect of maternal hyperoxygenation for foetal distress during labour. This intervention should be recommended only as a treatment for intrapartum foetal distress, when improvement of the foetal condition is likely and outweighs maternal and neonatal side effects. TRIAL REGISTRATION EudraCT, 2015-001654-15; registered on 3 April 2015. Dutch Trial Register, NTR5461; registered on 20 October 2015.
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Affiliation(s)
- Lauren M Bullens
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands. .,Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands.
| | - Alexandra D J Hulsenboom
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands
| | - Suzanne Moors
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands
| | - Rohan Joshi
- Department of Clinical Physics, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
| | - Pieter J van Runnard Heimel
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands
| | - M Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
| | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
| | - S Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500, MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
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Brugniaux JV, Coombs GB, Barak OF, Dujic Z, Sekhon MS, Ainslie PN. Highs and lows of hyperoxia: physiological, performance, and clinical aspects. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1-R27. [PMID: 29488785 DOI: 10.1152/ajpregu.00165.2017] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Molecular oxygen (O2) is a vital element in human survival and plays a major role in a diverse range of biological and physiological processes. Although normobaric hyperoxia can increase arterial oxygen content ([Formula: see text]), it also causes vasoconstriction and hence reduces O2 delivery in various vascular beds, including the heart, skeletal muscle, and brain. Thus, a seemingly paradoxical situation exists in which the administration of oxygen may place tissues at increased risk of hypoxic stress. Nevertheless, with various degrees of effectiveness, and not without consequences, supplemental oxygen is used clinically in an attempt to correct tissue hypoxia (e.g., brain ischemia, traumatic brain injury, carbon monoxide poisoning, etc.) and chronic hypoxemia (e.g., severe COPD, etc.) and to help with wound healing, necrosis, or reperfusion injuries (e.g., compromised grafts). Hyperoxia has also been used liberally by athletes in a belief that it offers performance-enhancing benefits; such benefits also extend to hypoxemic patients both at rest and during rehabilitation. This review aims to provide a comprehensive overview of the effects of hyperoxia in humans from the "bench to bedside." The first section will focus on the basic physiological principles of partial pressure of arterial O2, [Formula: see text], and barometric pressure and how these changes lead to variation in regional O2 delivery. This review provides an overview of the evidence for and against the use of hyperoxia as an aid to enhance physical performance. The final section addresses pathophysiological concepts, clinical studies, and implications for therapy. The potential of O2 toxicity and future research directions are also considered.
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Affiliation(s)
| | - Geoff B Coombs
- Centre for Heart, Lung, and Vascular Health, University of British Columbia , Kelowna, British Columbia , Canada
| | - Otto F Barak
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Zeljko Dujic
- Department of Integrative Physiology, School of Medicine, University of Split , Split , Croatia
| | - Mypinder S Sekhon
- Centre for Heart, Lung, and Vascular Health, University of British Columbia , Kelowna, British Columbia , Canada.,Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia , Vancouver, British Columbia , Canada
| | - Philip N Ainslie
- Centre for Heart, Lung, and Vascular Health, University of British Columbia , Kelowna, British Columbia , Canada
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Buggeskov KB, Grønlykke L, Risom EC, Wei ML, Wetterslev J. Pulmonary artery perfusion versus no perfusion during cardiopulmonary bypass for open heart surgery in adults. Cochrane Database Syst Rev 2018; 2:CD011098. [PMID: 29419895 PMCID: PMC6491280 DOI: 10.1002/14651858.cd011098.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Available evidence has been inconclusive on whether pulmonary artery perfusion during cardiopulmonary bypass (CPB) is associated with decreased or increased mortality, pulmonary events, and serious adverse events (SAEs) after open heart surgery. To our knowledge, no previous systematic reviews have included meta-analyses of these interventions. OBJECTIVES To assess the benefits and harms of single-shot or continuous pulmonary artery perfusion with blood (oxygenated or deoxygenated) or a preservation solution compared with no perfusion during cardiopulmonary bypass (CPB) in terms of mortality, pulmonary events, serious adverse events (SAEs), and increased inflammatory markers for adult surgical patients. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index Expanded, and advanced Google for relevant studies. We handsearched retrieved study reports and scanned citations of included studies and relevant reviews to ensure that no relevant trials were missed. We searched for ongoing trials and unpublished trials in the World Health Organization International Clinical Trials Registry Platform (ICTRP) and at clinicaltrials.gov (4 July 2017). We contacted medicinal firms producing preservation solutions to retrieve additional studies conducted to examine relevant interventions. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared pulmonary artery perfusion versus no perfusion during CPB in adult patients (≧ 18 years). DATA COLLECTION AND ANALYSIS Two independent review authors extracted data, conducted fixed-effect and random-effects meta-analyses, and calculated risk ratios (RRs) or odds ratios (ORs) for dichotomous outcomes. For continuous data, we have presented mean differences (MDs) and 95% confidence intervals (CIs) as estimates of the intervention effect. To minimize the risk of systematic error, we assessed risk of bias of included trials. To reduce the risk of random errors caused by sparse data and repetitive updating of cumulative meta-analyses, we applied Trial Sequential Analyses (TSAs). We used GRADE principles to assess the quality of evidence. MAIN RESULTS We included in this review four RCTs (210 participants) reporting relevant outcomes. Investigators randomly assigned participants to pulmonary artery perfusion with blood versus no perfusion during CPB. Only one trial included the pulmonary artery perfusion intervention with a preservation solution; therefore we did not perform meta-analysis. Likewise, only one trial reported patient-specific data for the outcome "pulmonary events"; therefore we have provided no results from meta-analysis. Instead, review authors added two explorative secondary outcomes for this version of the review: the ratio of partial pressure of oxygen in arterial blood (PaO2) to fraction of inspired oxygen (FiO2); and intubation time. Last, review authors found no comparable data for the secondary outcome inflammatory markers.The effect of pulmonary artery perfusion on all-cause mortality was uncertain (Peto OR 1.78, 95% CI 0.43 to 7.40; TSA adjusted CI 0.01 to 493; 4 studies, 210 participants; GRADE: very low quality). Sensitivity analysis of one trial with overall low risk of bias (except for blinding of personnel during the surgical procedure) yielded no evidence of a difference for mortality (Peto OR 1.65, 95% CI 0.27 to 10.15; 1 study, 60 participants). The TSA calculated required information size was not reached and the futility boundaries did not cross; thus this analysis cannot refute a 100% increase in mortality.The effect of pulmonary artery perfusion with blood on SAEs was likewise uncertain (RR 1.12, 95% CI 0.66 to 1.89; 3 studies, 180 participants; GRADE: very low quality). Data show an association between pulmonary artery perfusion with blood during CPB and a higher postoperative PaO2/FiO2 ratio (MD 27.80, 95% CI 5.67 to 49.93; 3 studies, 119 participants; TSA adjusted CI 5.67 to 49.93; GRADE: very low quality), although TSA could not confirm or refute a 10% increase in the PaO2/FiO2 ratio, as the required information size was not reached. AUTHORS' CONCLUSIONS The effects of pulmonary artery perfusion with blood during cardiopulmonary bypass (CPB) are uncertain owing to the small numbers of participants included in meta-analyses. Risks of death and serious adverse events may be higher with pulmonary artery perfusion with blood during CPB, and robust evidence for any beneficial effects is lacking. Future randomized controlled trials (RCTs) should provide long-term follow-up and patient stratification by preoperative lung function and other documented risk factors for mortality. One study that is awaiting classification (epub abstract with preliminary results) may change the results of this review when full study details have been published.
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Affiliation(s)
- Katrine B Buggeskov
- Copenhagen University Hospital, RigshospitaletDepartment of Thoracic AnaesthesiologyBlegdamsvej 9CopenhagenDenmark2100
| | - Lars Grønlykke
- Copenhagen University Hospital, RigshospitaletDepartment of Thoracic AnaesthesiologyBlegdamsvej 9CopenhagenDenmark2100
| | - Emilie C Risom
- Copenhagen University Hospital, RigshospitaletDepartment of Thoracic AnaesthesiologyBlegdamsvej 9CopenhagenDenmark2100
| | - Mao Ling Wei
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Jørn Wetterslev
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmarkDK‐2100
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Kamran A, Chia E, Tobin C. Acute oxygen therapy: an audit of prescribing and delivery practices in a tertiary hospital in Perth, Western Australia. Intern Med J 2018; 48:151-157. [DOI: 10.1111/imj.13612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/03/2017] [Accepted: 08/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Anam Kamran
- Acute Medical Unit; Royal Perth Hospital; Perth Western Australia Australia
| | - Elisa Chia
- Acute Medical Unit; Royal Perth Hospital; Perth Western Australia Australia
| | - Claire Tobin
- Acute Medical Unit; Royal Perth Hospital; Perth Western Australia Australia
- Department of Respiratory Medicine; Royal Perth Hospital; Perth Western Australia Australia
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Nuding S, Werdan K, Prondzinsky R. Optimal course of treatment in acute cardiogenic shock complicating myocardial infarction. Expert Rev Cardiovasc Ther 2018; 16:99-112. [PMID: 29310471 DOI: 10.1080/14779072.2018.1425141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION About 5% of patients with myocardial infarction suffer from cardiogenic shock as a complication, with a mortality of ≥30%. Primary percutaneous coronary intervention as soon as possible is the most successful therapeutic approach. Prognosis depends not only on the extent of infarction, but also - and even more - on organ hypoperfusion with consequent development of multiple organ dysfunction syndrome. Areas covered: This review covers diagnostic, monitoring and treatment concepts relevant for caring patients with cardiogenic shock complicating myocardial infarction. All major clinical trials have been selected for review of the recent data. Expert commentary: For optimal care, not only primary percutaneous intervention of the occluded coronary artery is necessary, but also best intensive care medicine avoiding the development of multiple organ dysfunction syndrome and finally death. On contrary, intra-aortic balloon pump - though used for decades - is unable to reduce mortality of patients with cardiogenic shock complicating myocardial infarction.
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Affiliation(s)
- Sebastian Nuding
- a Department of Medicine III , University Hospital Halle (Saale) , Halle (Saale) , Germany
| | - Karl Werdan
- a Department of Medicine III , University Hospital Halle (Saale) , Halle (Saale) , Germany
| | - Roland Prondzinsky
- b Department of Medicine I , Carl-von-Basedow Hospital Merseburg , Germany
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81
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Lee SR, Nilius B, Han J. Gaseous Signaling Molecules in Cardiovascular Function: From Mechanisms to Clinical Translation. Rev Physiol Biochem Pharmacol 2018; 174:81-156. [PMID: 29372329 DOI: 10.1007/112_2017_7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Carbon monoxide (CO), hydrogen sulfide (H2S), and nitric oxide (NO) constitute endogenous gaseous molecules produced by specific enzymes. These gases are chemically simple, but exert multiple effects and act through shared molecular targets to control both physiology and pathophysiology in the cardiovascular system (CVS). The gases act via direct and/or indirect interactions with each other in proteins such as heme-containing enzymes, the mitochondrial respiratory complex, and ion channels, among others. Studies of the major impacts of CO, H2S, and NO on the CVS have revealed their involvement in controlling blood pressure and in reducing cardiac reperfusion injuries, although their functional roles are not limited to these conditions. In this review, the basic aspects of CO, H2S, and NO, including their production and effects on enzymes, mitochondrial respiration and biogenesis, and ion channels are briefly addressed to provide insight into their biology with respect to the CVS. Finally, potential therapeutic applications of CO, H2S, and NO with the CVS are addressed, based on the use of exogenous donors and different types of delivery systems.
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Affiliation(s)
- Sung Ryul Lee
- Department of Convergence Biomedical Science, Cardiovascular and Metabolic Disease Center, College of Medicine, Inje University, Busan, Republic of Korea
| | - Bernd Nilius
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Jin Han
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, Department of Health Sciences and Technology, BK21 Plus Project Team, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Republic of Korea.
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Attaye I, Smulders YM, de Waard MC, Oudemans-van Straaten HM, Smit B, Van Wijhe MH, Musters RJ, Koolwijk P, Spoelstra-de Man AME. The effects of hyperoxia on microvascular endothelial cell proliferation and production of vaso-active substances. Intensive Care Med Exp 2017; 5:22. [PMID: 28409476 PMCID: PMC5391371 DOI: 10.1186/s40635-017-0135-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 04/06/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hyperoxia, an arterial oxygen pressure of more than 100 mmHg or 13% O2, frequently occurs in hospitalized patients due to administration of supplemental oxygen. Increasing evidence suggests that hyperoxia induces vasoconstriction in the systemic (micro)circulation, potentially affecting organ perfusion. This study addresses effects of hyperoxia on viability, proliferative capacity, and on pathways affecting vascular tone in cultured human microvascular endothelial cells (hMVEC). METHODS hMVEC of the systemic circulation were exposed to graded oxygen fractions of 20, 30, 50, and 95% O2 for 8, 24, and 72 h. These fractions correspond to 152, 228, 380, and 722 mmHg, respectively. Cell proliferation and viability was measured via a proliferation assay, peroxynitrite formation via anti-nitrotyrosine levels, endothelial nitric oxide synthase (eNOS), and endothelin-1 (ET-1) levels via q-PCR and western blot analysis. RESULTS Exposing hMVEC to 50 and 95% O2 for more than 24 h impaired cell viability and proliferation. Hyperoxia did not significantly affect nitrotyrosine levels, nor eNOS mRNA and protein levels, regardless of the exposure time or oxygen concentration used. Phosphorylation of eNOS at the serine 1177 (S1177) residue and ET-1 mRNA levels were also not significantly affected. CONCLUSIONS Exposure of isolated human microvascular endothelial cells to marked hyperoxia for more than 24 h decreases cell viability and proliferation. Our results do not support a role of eNOS mRNA and protein or ET-1 mRNA in the potential vasoconstrictive effects of hyperoxia on isolated hMVEC.
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Affiliation(s)
- Ilias Attaye
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Yvo M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Monique C de Waard
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Bob Smit
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel H Van Wijhe
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rene J Musters
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter Koolwijk
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
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Hyperbaric Oxygen Sensitizes Anoxic Pseudomonas aeruginosa Biofilm to Ciprofloxacin. Antimicrob Agents Chemother 2017; 61:AAC.01024-17. [PMID: 28874373 PMCID: PMC5655102 DOI: 10.1128/aac.01024-17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Abstract
Chronic Pseudomonas aeruginosa lung infection is characterized by the presence of endobronchial antibiotic-tolerant biofilm, which is subject to strong oxygen (O2) depletion due to the activity of surrounding polymorphonuclear leukocytes. The exact mechanisms affecting the antibiotic susceptibility of biofilms remain unclear, but accumulating evidence suggests that the efficacy of several bactericidal antibiotics is enhanced by stimulation of aerobic respiration of pathogens, while lack of O2 increases their tolerance. In fact, the bactericidal effect of several antibiotics depends on active aerobic metabolism activity and the endogenous formation of reactive O2 radicals (ROS). In this study, we aimed to apply hyperbaric oxygen treatment (HBOT) to sensitize anoxic P. aeruginosa agarose biofilms established to mimic situations with intense O2 consumption by the host response in the cystic fibrosis (CF) lung. Application of HBOT resulted in enhanced bactericidal activity of ciprofloxacin at clinically relevant durations and was accompanied by indications of restored aerobic respiration, involvement of endogenous lethal oxidative stress, and increased bacterial growth. The findings highlight that oxygenation by HBOT improves the bactericidal activity of ciprofloxacin on P. aeruginosa biofilm and suggest that bacterial biofilms are sensitized to antibiotics by supplying hyperbaric O2.
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84
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Petit PC, Fine DH, Vásquez GB, Gamero L, Slaughter MS, Dasse KA. The Pathophysiology of Nitrogen Dioxide During Inhaled Nitric Oxide Therapy. ASAIO J 2017; 63:7-13. [PMID: 27556146 DOI: 10.1097/mat.0000000000000425] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Administration of inhaled nitric oxide (NO) with the existing compressed gas delivery systems is associated with unavoidable codelivery of nitrogen dioxide (NO2), an unwanted toxic contaminant that forms when mixed with oxygen. The NO2 is generated when NO is diluted with O2-enriched air before delivery to the patient. When NO2 is inhaled by the patient, it oxidizes protective antioxidants within the epithelial lining fluid (ELF) and triggers extracellular damage in the airways. The reaction of NO2 within the ELF triggers oxidative stress (OS), possibly leading to edema, bronchoconstriction, and a reduced forced expiratory volume in 1 second. Nitrogen dioxide has been shown to have deleterious effects on the airways of high-risk patients including neonates, patients with respiratory and heart failure, and the elderly. Minimizing co-delivery of NO2 for the next generation delivery systems will be a necessity to fully optimize the pulmonary perfusion of NO because of vasodilation, whereas minimizing the negative ventilatory and histopathological effects of NO2 exposure during inhaled NO therapy.
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Affiliation(s)
- Priscilla C Petit
- From the *Biomedical Research, GeNO LLC, Cocoa, Florida; and †Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky
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Keilhoff G, Esser T, Titze M, Ebmeyer U, Schild L. Gynostemma pentaphyllum is neuroprotective in a rat model of cardiopulmonary resuscitation. Exp Ther Med 2017; 14:6034-6046. [PMID: 29250141 PMCID: PMC5729372 DOI: 10.3892/etm.2017.5315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 10/02/2017] [Indexed: 01/11/2023] Open
Abstract
Asphyxial cardiac arrest (ACA)-induced ischemia results in acute and delayed neuronal cell death. The early reperfusion phase is critical for the outcome. Intervention strategies directed to this period are promising to reduce ACA/resuscitation-dependent impairments. This study focused on the evaluation of the protective potential of an extract from Gynostemma pentaphyllum (GP), a plant used in traditional medicine with antioxidative, glucose lowering and neuroprotective activities, in an ACA rat model. We tested the following parameters: i) Basic systemic parameters such as pCO2 and blood glucose value within the first 30 min post-ACA; ii) mitochondrial response by determining activities of citrate synthase, respiratory chain complexes I + III and II + III, and the composition of cardiolipin 6 and 24 h post-ACA; iii) neuronal vitality of the CA1 hippocampal region by immunohistochemistry 24 h and 7 days post-ACA; and iv) cognitive function by a novel object recognition test 7 days post-ACA. GP, administered after reaching spontaneous circulation, counteracted the following: i) ACA-mediated increases in arterial CO2 tension and blood glucose values; ii) transient increase in the activity of the respiratory chain complexes II + III; iii) elevation in cardiolipin content; iv) hippocampal CA1 neurodegeneration, and v) loss of normal novelty-object seeking. The protective effects of GP were accompanied by side effects of the vehicle DMSO, such as the stimulation of citrate synthase activity in control animals, inhibition of cardiolipin synthesis in ACA animals and complex II + III activity in both control and ACA animals. The results emphasize the importance of the early post-resuscitation phase for the neurological outcome after ACA/resuscitation, and demonstrated the power of GP substitution as neuroprotective intervention. Moreover, the results underline the need of a careful handling of the popular vehicle DMSO.
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Affiliation(s)
- Gerburg Keilhoff
- Institute of Biochemistry and Cell Biology, Otto-von-Guericke University Magdeburg, Leipziger, D-39120 Magdeburg, Germany
| | - Torben Esser
- Department of Anesthesiology, Otto-von-Guericke University Magdeburg, Leipziger, D-39120 Magdeburg, Germany
| | - Maximilian Titze
- Institute of Biochemistry and Cell Biology, Otto-von-Guericke University Magdeburg, Leipziger, D-39120 Magdeburg, Germany
| | - Uwe Ebmeyer
- Department of Anesthesiology, Otto-von-Guericke University Magdeburg, Leipziger, D-39120 Magdeburg, Germany
| | - Lorenz Schild
- Department of Pathological Biochemistry, Otto-von-Guericke University Magdeburg, Leipziger, D-39120 Magdeburg, Germany
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Zaidi F, Lee RS, Buchcic BA, Bracken NE, Jaffe HA, Joo M, Prieto-Centurion V, Tan AY, Krishnan JA. Evaluation and Documentation of Supplemental Oxygen Requirements is Rarely Performed in Patients Hospitalized With COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2017; 4:287-296. [PMID: 29354673 PMCID: PMC5764842 DOI: 10.15326/jcopdf.4.4.2017.0148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 01/22/2023]
Abstract
Rationale: Patients hospitalized with chronic obstructive pulmonary disease (COPD) who require supplemental oxygen (O2) are at increased risk of hospital readmissions. There is a paucity of information regarding quality of evaluation and documentation regarding the need for supplemental O2 in this population. Objective: To determine the extent to which evaluation and documentation regarding the need for supplemental O2 occurs prior to hospital discharge in patients with COPD. Methods: We conducted a two-center retrospective cohort study of hospitalized adults with a physician diagnosis of COPD. We reviewed electronic health records to ascertain whether patients underwent evaluation beyond rest oximetry documenting hypoxemia and if there was adequate documentation of supplemental O2 requirements prior to discharge. Results: Of 526 patients hospitalized with a primary or secondary discharge diagnosis of COPD, 335 patients (mean age 69 years, 78% with diagnosis of COPD exacerbation) met eligibility criteria. Overall, 1 in 5 (22%, 73/335) hospitalized patients with COPD had an evaluation beyond rest oximetry for supplemental O2 requirements during admission. Adequate documentation of supplemental O2 requirements occurred in even fewer patients (16%, 54/335). Both evaluation (26% versus 5%, p=0.002) and documentation (19% versus 4%, p=0.001) of supplemental O2 requirements were more common in patients hospitalized for a COPD exacerbation compared to those hospitalized with COPD but without an exacerbation. Conclusions: Evaluation and documentation of supplemental O2 requirements beyond rest oximetry occur infrequently in patients hospitalized with COPD.
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Affiliation(s)
- Farhan Zaidi
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
- Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
| | - Ryan S. Lee
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
| | - Bartosz A. Buchcic
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
- Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
| | - Nina E. Bracken
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
- Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
- Population Health Sciences Program, University of Illinois Hospital and Health Sciences System, Chicago
| | - H. Ari Jaffe
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
- Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
| | - Min Joo
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
- Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
| | - Valentin Prieto-Centurion
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
- Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
| | - Ai-Yui Tan
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
- Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
- Population Health Sciences Program, University of Illinois Hospital and Health Sciences System, Chicago
| | - Jerry A. Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
- Jesse Brown Veterans Administration Medical Center, Chicago, Illinois
- Population Health Sciences Program, University of Illinois Hospital and Health Sciences System, Chicago
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Hyperoxia does not directly affect vascular tone in isolated arteries from mice. PLoS One 2017; 12:e0182637. [PMID: 28796814 PMCID: PMC5552161 DOI: 10.1371/journal.pone.0182637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/22/2017] [Indexed: 01/10/2023] Open
Abstract
Hospitalized patients often receive oxygen supplementation, which can lead to a supraphysiological oxygen tension (hyperoxia). Hyperoxia can have hemodynamic effects, including an increase in systemic vascular resistance. This increase suggests hyperoxia-induced vasoconstriction, yet reported direct effects of hyperoxia on vessel tone have been inconsistent. Furthermore, hyperoxia-induced changes in vessel diameter have not been studied in mice, currently the most used mammal model of disease. In this study we set out to develop a pressure-myograph model using isolated vessels from mice for investigation of pathways involved in hyperoxic vasoconstriction. Isolated conduit and resistance arteries (femoral artery and gracilis arteriole, respectively) from C57BL/6 mice were exposed to normoxia (PO2 of 80 mmHg) and three levels of hyperoxia (PO2 of 215, 375 and 665 mmHg) in a no-flow pressure myograph setup. Under the different PO2 levels, dose-response agonist induced endothelium-dependent vasodilation (acetylcholine, arachidonic acid), endothelium-independent vasodilation (s-nitroprusside), as well as vasoconstriction (norepinephrine, prostaglandin F2α) were examined. The investigated arteries did not respond to oxygen by a change in vascular tone. In the dose-response studies, maximal responses and EC50 values to any of the aforementioned agonists were not affected by hyperoxia either. We conclude that arteries and arterioles from healthy mice are not intrinsically sensitive to hyperoxic conditions. The present ex-vivo model is therefore not suitable for further research into mechanisms of hyperoxic vasoconstriction.
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Akca O, Ball L, Belda FJ, Biro P, Cortegiani A, Eden A, Ferrando C, Gattinoni L, Goldik Z, Gregoretti C, Hachenberg T, Hedenstierna G, Hopf HW, Hunt TK, Pelosi P, Qadan M, Sessler DI, Soro M, Şentürk M. WHO Needs High FIO 2? Turk J Anaesthesiol Reanim 2017; 45:181-192. [PMID: 28868164 DOI: 10.5152/tjar.2017.250701] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
World Health Organization and the United States Center for Disease Control have recently recommended the use of 0.8 FIO2 in all adult surgical patients undergoing general anaesthesia, to prevent surgical site infections. This recommendation has arisen several discussions: As a matter of fact, there are numerous studies with different results about the effect of FIO2 on surgical site infection. Moreover, the clinical effects of FIO2 are not limited to infection control. We asked some prominent authors about their comments regarding the recent recommendations.
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Affiliation(s)
- Ozan Akca
- Department of Anesthesiology and Perioperative Medicine, Neuroscience ICU, University of Louisville, Kentucky, USA
| | - Lorenzo Ball
- IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - F Javier Belda
- Department of Anesthesiology and Critical Care, Hospital Clinico Universitario, University of Valencia, Valencia, Spain
| | - Peter Biro
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone. University of Palermo, Italy
| | - Arieh Eden
- Department of Anesthesiology, Critical Care and Pain Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clinico Universitario, University of Valencia, Valencia, Spain
| | - Luciano Gattinoni
- Department of Anesthesiology Emergency & Intensive Care Medicine, Gottingen University, Gottingen, Germany
| | - Zeev Goldik
- Department of Anesthesiology, Critical Care and Pain Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone. University of Palermo, Italy
| | - Thomas Hachenberg
- Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Harriet W Hopf
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Thomas K Hunt
- Division of General Surgery, University of California, San Francisco, USA
| | - Paolo Pelosi
- IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Motaz Qadan
- Massachusetts General Hospital, Department of Surgery, Harvard University, Massachusetts, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marina Soro
- Department of Anesthesiology and Critical Care, Hospital Clinico Universitario, University of Valencia, Valencia, Spain
| | - Mert Şentürk
- Department of Anaesthesiology and Reanimation, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Oxygen-induced impairment in arterial function is corrected by slow breathing in patients with type 1 diabetes. Sci Rep 2017; 7:6001. [PMID: 28729675 PMCID: PMC5519543 DOI: 10.1038/s41598-017-04947-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/24/2017] [Indexed: 12/28/2022] Open
Abstract
Hyperoxia and slow breathing acutely improve autonomic function in type-1 diabetes. However, their effects on arterial function may reveal different mechanisms, perhaps potentially useful. To test the effects of oxygen and slow breathing we measured arterial function (augmentation index, pulse wave velocity), baroreflex sensitivity (BRS) and oxygen saturation (SAT), during spontaneous and slow breathing (6 breaths/min), in normoxia and hyperoxia (5 L/min oxygen) in 91 type-1 diabetic and 40 age-matched control participants. During normoxic spontaneous breathing diabetic subjects had lower BRS and SAT, and worse arterial function. Hyperoxia and slow breathing increased BRS and SAT. Hyperoxia increased blood pressure and worsened arterial function. Slow breathing improved arterial function and diastolic blood pressure. Combined administration prevented the hyperoxia-induced arterial pressure and function worsening. Control subjects showed a similar pattern, but with lesser or no statistical significance. Oxygen-driven autonomic improvement could depend on transient arterial stiffening and hypertension (well-known irritative effect of free-radicals on endothelium), inducing reflex increase in BRS. Slow breathing-induced improvement in BRS may result from improved SAT, reduced sympathetic activity and improved vascular function, and/or parasympathetic-driven antioxidant effect. Lower oxidative stress could explain blunted effects in controls. Slow breathing could be a simple beneficial intervention in diabetes.
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Winkler MKL, Dengler N, Hecht N, Hartings JA, Kang EJ, Major S, Martus P, Vajkoczy P, Woitzik J, Dreier JP. Oxygen availability and spreading depolarizations provide complementary prognostic information in neuromonitoring of aneurysmal subarachnoid hemorrhage patients. J Cereb Blood Flow Metab 2017; 37:1841-1856. [PMID: 27025768 PMCID: PMC5435278 DOI: 10.1177/0271678x16641424] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/27/2015] [Accepted: 02/09/2016] [Indexed: 12/19/2022]
Abstract
Multimodal neuromonitoring in neurocritical care increasingly includes electrocorticography to measure epileptic events and spreading depolarizations. Spreading depolarization causes spreading depression of activity (=isoelectricity) in electrically active tissue. If the depression is long-lasting, further spreading depolarizations occur in still isoelectric tissue where no activity can be suppressed. Such spreading depolarizations are termed isoelectric and are assumed to indicate energy compromise. However, experimental and clinical recordings suggest that long-lasting spreading depolarization-induced depression and isoelectric spreading depolarizations are often recorded outside of the actual ischemic zones, allowing the remote diagnosis of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Here, we analyzed simultaneous electrocorticography and tissue partial pressure of oxygen recording in 33 aneurysmal subarachnoid hemorrhage patients. Multiple regression showed that both peak total depression duration per recording day and mean baseline tissue partial pressure of oxygen were independent predictors of outcome. Moreover, tissue partial pressure of oxygen preceding spreading depolarization was similar and differences in tissue partial pressure of oxygen responses to spreading depolarization were only subtle between isoelectric spreading depolarizations and spreading depressions. This further supports that, similar to clustering of spreading depolarizations, long spreading depolarization-induced periods of isoelectricity are useful to detect energy compromise remotely, which is valuable because the exact location of future developing pathology is unknown at the time when the neurosurgeon implants recording devices.
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Affiliation(s)
- Maren KL Winkler
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany
| | - Nora Dengler
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Jed A Hartings
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Eun J Kang
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany
- Department of Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany
- Department of Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Jens P Dreier
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany
- Department of Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
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92
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Barbateskovic M, Schjørring OLL, Jakobsen JC, Meyhoff CS, Dahl RM, Rasmussen BS, Perner A, Wetterslev J. Higher versus lower inspiratory oxygen fraction or targets of arterial oxygenation for adult intensive care patients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marija Barbateskovic
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark DK-2100
- Department 7831, Rigshospitalet, Copenhagen University Hospital; Centre for Research in Intensive Care; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Olav Lilleholt L Schjørring
- Department 7831, Rigshospitalet, Copenhagen University Hospital; Centre for Research in Intensive Care; Blegdamsvej 9 Copenhagen Denmark DK-2100
- Aalborg University Hospital; Department of Anaesthesia and Intensive Care Medicine; Hobrovej 18-22 Aalborg Denmark 9000
| | - Janus C Jakobsen
- Department 7831, Rigshospitalet, Copenhagen University Hospital; Centre for Research in Intensive Care; Blegdamsvej 9 Copenhagen Denmark DK-2100
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Sjaelland Denmark DK-2100
- Holbaek Hospital; Department of Cardiology; Holbaek Denmark 4300
| | - Christian S Meyhoff
- Bispebjerg Hospital, University of Copenhagen; Department of Anaesthesiology; Copenhagen NV Denmark
| | - Rikke M Dahl
- Herlev Hospital, University of Copenhagen; Department of Anaesthesiology; Herlev Ringvej 75, Pavillon 10, I65F10 Herlev Denmark 2730
| | - Bodil S Rasmussen
- Department 7831, Rigshospitalet, Copenhagen University Hospital; Centre for Research in Intensive Care; Blegdamsvej 9 Copenhagen Denmark DK-2100
- Aalborg University Hospital; Department of Anaesthesia and Intensive Care Medicine; Hobrovej 18-22 Aalborg Denmark 9000
| | - Anders Perner
- Department 7831, Rigshospitalet, Copenhagen University Hospital; Centre for Research in Intensive Care; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Jørn Wetterslev
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark DK-2100
- Department 7831, Rigshospitalet, Copenhagen University Hospital; Centre for Research in Intensive Care; Blegdamsvej 9 Copenhagen Denmark DK-2100
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93
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Lichardusova L, Tatarkova Z, Calkovska A, Mokra D, Engler I, Racay P, Lehotsky J, Kaplan P. Proteomic analysis of mitochondrial proteins in the guinea pig heart following long-term normobaric hyperoxia. Mol Cell Biochem 2017; 434:61-73. [PMID: 28432557 DOI: 10.1007/s11010-017-3037-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/12/2017] [Indexed: 01/15/2023]
Abstract
Normobaric hyperoxia is applied for the treatment of a wide variety of diseases and clinical conditions related to ischemia or hypoxia, but it can increase the risk of tissue damage and its efficiency is controversial. In the present study, we analyzed cardiac mitochondrial proteome derived from guinea pigs after 60 h exposure to 100% molecular oxygen (NBO) or O2 enriched with oxygen cation (NBO+). Two-dimensional gel electrophoresis followed by MALDI-TOF/TOF mass spectrometry identified twenty-two different proteins (among them ten nonmitochondrial) that were overexpressed in NBO and/or NBO+ group. Identified proteins were mainly involved in cellular energy metabolism (tricarboxylic acid cycle, oxidative phosphorylation, glycolysis), cardioprotection against stress, control of mitochondrial function, muscle contraction, and oxygen transport. These findings support the viewpoint that hyperoxia is associated with cellular stress and suggest complex adaptive responses which probably contribute to maintain or improve intracellular ATP levels and contractile function of cardiomyocytes. In addition, the results suggest that hyperoxia-induced cellular stress may be partially attenuated by utilization of NBO+ treatment.
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Affiliation(s)
- Lucia Lichardusova
- Department of Medical Biochemistry, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
| | - Zuzana Tatarkova
- Department of Medical Biochemistry, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
| | - Andrea Calkovska
- Department of Physiology, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Mala Hora 4D, SK-036 01, Martin, Slovakia
| | - Daniela Mokra
- Department of Physiology, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Mala Hora 4D, SK-036 01, Martin, Slovakia
| | - Ivan Engler
- Department of Physiology, PJ Safarik University, Faculty of Medicine, Kosice, Slovakia
| | - Peter Racay
- Department of Medical Biochemistry, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Mala Hora 4D, SK-036 01, Martin, Slovakia
| | - Jan Lehotsky
- Department of Medical Biochemistry, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Mala Hora 4D, SK-036 01, Martin, Slovakia
| | - Peter Kaplan
- Department of Medical Biochemistry, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia.
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Mala Hora 4D, SK-036 01, Martin, Slovakia.
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94
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Taguchi K, Yamasaki K, Sakai H, Maruyama T, Otagiri M. The Use of Hemoglobin Vesicles for Delivering Medicinal Gas for the Treatment of Intractable Disorders. J Pharm Sci 2017; 106:2392-2400. [PMID: 28414143 DOI: 10.1016/j.xphs.2017.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 01/27/2023]
Abstract
Bioactive gaseous molecules, such as oxygen (O2) and carbon monoxide (CO), are essential elements for most living organisms to maintain their homeostasis and biological activities. An accumulating body of evidence suggests that such molecules can be used in clinics as a medical gas in the treatment of various intractable disorders. Recent developments in hemoglobin-encapsulated liposomes, namely hemoglobin vesicles (HbV), possess great potential for retaining O2 and CO and could lead to strategies for the development of novel pharmacological agents as medical gas donors. HbV with either O2 or CO bound to it has been demonstrated to have therapeutic potential for treating certain intractable disorders and has the possibility to serve as diagnostic and augmenting product by virtue of unique physicochemical characteristics of HbV. The present review provides an overview of the present status of the use of O2- or CO-binding HbV in experimental animal models of intractable disorders and discusses prospective clinical applications of HbV as a medical gas donor.
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Affiliation(s)
- Kazuaki Taguchi
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
| | - Keishi Yamasaki
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan; DDS Research Institute, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
| | - Hiromi Sakai
- Department of Chemistry, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634-8521, Japan
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; Center for Clinical Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan; DDS Research Institute, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto 860-0082, Japan.
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95
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Affiliation(s)
- Megan Purvey
- Emergency Medicine, Queen Elizabeth II Jubilee Hospital, Brisbane
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96
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Affiliation(s)
- Megan Purvey
- Emergency Medicine, Queen Elizabeth II Jubilee Hospital, Brisbane
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97
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98
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Chiang IH, Tzeng YS, Chang SC. Is hyperbaric oxygen therapy indispensable for saving mutilated hand injuries? Int Wound J 2017; 14:929-936. [PMID: 28251838 DOI: 10.1111/iwj.12730] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/25/2017] [Indexed: 11/27/2022] Open
Abstract
Mutilated hand injuries are a profound challenge to the plastic surgeon, and such injuries often lead to limb loss and severe functional impairment. Hyperbaric oxygen therapy (HBOT) appears to counteract tissue hypoxia and stimulate acute wound healing. This study was performed to evaluate the efficacy of HBOT as an adjunctive therapy in patients with a mutilated hand injury. Between January 2006 and December 2014, 45 patients with a mutilated hand injury were enrolled. After reconstruction or revascularisation, patients underwent 120 minutes of HBOT with oxygen at 2·5 atmospheres absolute while breathing 100% oxygen. Outcomes such as amputee survival and surgery-related complications were recorded. The patients were 38 men and 7 women with average age of 37·2 years (range 18-62). The mean defect area was 131·5 cm2 (range 40-300). Most patients experienced a pure crush injury (53%). The average number of operations from the initial debridement to the first reconstruction was 3·8 (range 1-6). A total of 33 patients (73%) underwent replantation during the initial reconstruction. For flap coverage, most patients received a free flap using an anterolateral thigh flap (18 patients) or local flap using an abdomen/groin flap (nine patients). The average time from the first reconstruction or revascularisation to the first HBOT was 6·5 hours (range 2-12). The average number of HBOT sessions was 9·1 (range 6-14 sessions). The survival rate of the replanted fingers was 81%, and the survival rate of the palms was 100%. Most complications in the initial reconstruction involved partial loss of an avulsed flap, and most complications in the chronic stage (≥3 months) involved scar contracture. When combined with delicate microsurgery, early intervention using adjunctive HBOT was effective in preserving partially viable tissue and restoring hand function in patients with a mutilated hand injury.
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Affiliation(s)
- I-Han Chiang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shun-Cheng Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Hyperbaric Oxygen Therapy Center, Shuang-Ho Hospital, Taipei, Taiwan, Republic of China.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
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99
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Harmful Effects of Hyperoxia in Postcardiac Arrest, Sepsis, Traumatic Brain Injury, or Stroke: The Importance of Individualized Oxygen Therapy in Critically Ill Patients. Can Respir J 2017; 2017:2834956. [PMID: 28246487 PMCID: PMC5299175 DOI: 10.1155/2017/2834956] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 12/27/2016] [Indexed: 11/29/2022] Open
Abstract
The beneficial effects of oxygen are widely known, but the potentially harmful effects of high oxygenation concentrations in blood and tissues have been less widely discussed. Providing supplementary oxygen can increase oxygen delivery in hypoxaemic patients, thus supporting cell function and metabolism and limiting organ dysfunction, but, in patients who are not hypoxaemic, supplemental oxygen will increase oxygen concentrations into nonphysiological hyperoxaemic ranges and may be associated with harmful effects. Here, we discuss the potentially harmful effects of hyperoxaemia in various groups of critically ill patients, including postcardiac arrest, traumatic brain injury or stroke, and sepsis. In all these groups, there is evidence that hyperoxia can be harmful and that oxygen prescription should be individualized according to repeated assessment of ongoing oxygen requirements.
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100
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Theofanidis D, Gibbon B. Nursing interventions in stroke care delivery: An evidence-based clinical review. JOURNAL OF VASCULAR NURSING 2016; 34:144-151. [DOI: 10.1016/j.jvn.2016.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 10/20/2022]
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