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McGain F, Wickramarachchi K, Sheridan N, McAlister S. Carbon Footprint of Anesthesia: Reply. Anesthesiology 2022; 137:123-125. [PMID: 35507727 DOI: 10.1097/aln.0000000000004230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Forbes McGain
- Western Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; School of Public Health, University of Sydney, Sydney, Australia (F.M.).
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2
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Barnett A, Beasley R, Buchan C, Chien J, Farah CS, King G, McDonald CF, Miller B, Munsif M, Psirides A, Reid L, Roberts M, Smallwood N, Smith S. Thoracic Society of Australia and New Zealand Position Statement on Acute Oxygen Use in Adults: 'Swimming between the flags'. Respirology 2022; 27:262-276. [PMID: 35178831 PMCID: PMC9303673 DOI: 10.1111/resp.14218] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/28/2021] [Accepted: 01/03/2022] [Indexed: 12/14/2022]
Abstract
Oxygen is a life-saving therapy but, when given inappropriately, may also be hazardous. Therefore, in the acute medical setting, oxygen should only be given as treatment for hypoxaemia and requires appropriate prescription, monitoring and review. This update to the Thoracic Society of Australia and New Zealand (TSANZ) guidance on acute oxygen therapy is a brief and practical resource for all healthcare workers involved with administering oxygen therapy to adults in the acute medical setting. It does not apply to intubated or paediatric patients. Recommendations are made in the following six clinical areas: assessment of hypoxaemia (including use of arterial blood gases); prescription of oxygen; peripheral oxygen saturation targets; delivery, including non-invasive ventilation and humidified high-flow nasal cannulae; the significance of high oxygen requirements; and acute hypercapnic respiratory failure. There are three sections which provide (1) a brief summary, (2) recommendations in detail with practice points and (3) a detailed explanation of the reasoning and evidence behind the recommendations. It is anticipated that these recommendations will be disseminated widely in structured programmes across Australia and New Zealand.
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Affiliation(s)
- Adrian Barnett
- Department of Respiratory and Sleep MedicineMater Public HospitalSouth BrisbaneQueenslandAustralia
| | - Richard Beasley
- Medical Research Institute of New Zealand & Capital Coast District Health BoardWellingtonNew Zealand
| | - Catherine Buchan
- Department of Respiratory and Sleep MedicineThe Alfred HospitalMelbourneVictoriaAustralia
- Department of Immunology and Respiratory MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jimmy Chien
- Department of Respiratory and Sleep MedicineWestmead Hospital, Ludwig Engel Centre for Respiratory Research and University of SydneySydneyNew South WalesAustralia
| | - Claude S. Farah
- Department of Respiratory Medicine, Concord HospitalMacquarie University and University of SydneySydneyNew South WalesAustralia
| | - Gregory King
- Department of Respiratory and Sleep Medicine, Royal North Shore HospitalWoolcock Institute of Medical Research and University of SydneySydneyNew South WalesAustralia
| | - Christine F. McDonald
- Department of Respiratory and Sleep MedicineAustin Health and University of MelbourneMelbourneVictoriaAustralia
| | - Belinda Miller
- Department of Respiratory MedicineThe Alfred Hospital and Monash UniversityMelbourneVictoriaAustralia
| | - Maitri Munsif
- Department of Respiratory and Sleep MedicineAustin Health and University of MelbourneMelbourneVictoriaAustralia
| | - Alex Psirides
- Intensive Care UnitWellington Regional Hospital, Capital and Coast District Health BoardWellingtonNew Zealand
| | - Lynette Reid
- Respiratory MedicineRoyal Hobart HospitalHobartTasmaniaAustralia
| | - Mary Roberts
- Department of Respiratory and Sleep MedicineWestmead Hospital, Ludwig Engel Centre for Respiratory Research and University of SydneySydneyNew South WalesAustralia
| | - Natasha Smallwood
- Department of Respiratory and Sleep MedicineThe Alfred HospitalMelbourneVictoriaAustralia
- Department of Immunology and Respiratory MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sheree Smith
- School of Nursing and MidwiferyWestern Sydney UniversitySydneyNew South WalesAustralia
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Abstract
Noninvasive ventilation (NIV) provides respiratory support without the use of invasive ventilation with techniques that do not bypass the upper airway. NIV is particularly attractive given its associated reduced risk of complications associated with intubation. Available NIV modes include nasal cannula, simple mask, nonrebreather, high flow nasal cannula, continuous positive airway pressure (CPAP), and bilevel positive airway pressure. Acute exacerbation of COPD, cardiogenic pulmonary edema, and COVID-19 are conditions for which NIV has shown to be beneficial, whereas there is no consensus among the use of NIV in trauma patients and ARDS.
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Affiliation(s)
- Patrycja Popowicz
- Department of General Surgery, East Carolina University- Vidant Medical Center, 2100 Stantonsburg Road, Greenville, NC 27834, USA.
| | - Kenji Leonard
- Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, East Carolina University- Vidant Medical Center, 2100 Stantonsburg Road, Greenville, NC 27834, USA
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, Nothacker M, Roiter S, Volk T, Worth H, Fühner T. German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients. Respiration 2021; 101:214-252. [PMID: 34933311 DOI: 10.1159/000520294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Philipp Capetian
- Department of Neurology, University Hospital Würzburg, Wuerzburg, Germany
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St. Antonius Hospital, Eschweiler, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
| | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Nothacker
- AWMF-Institute for Medical Knowledge Management, Marburg, Germany
| | - Sabrina Roiter
- Intensive Care Unit, Israelite Hospital Hamburg, Hamburg, Germany
| | - Thomas Volk
- Department of Anesthesiology, University Hospital of Saarland, Saarland University, Homburg, Germany
| | | | - Thomas Fühner
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Siloah Hospital, Hannover, Germany
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5
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Ogiwara S, Tamura T, Sai S, Nojima M, Kawana S. Superiority of OxyMask TM with less carbon dioxide rebreathing in children. Eur J Pediatr 2021; 180:3593-3597. [PMID: 34146139 DOI: 10.1007/s00431-021-04157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
Despite the growing importance of oxygen-delivery devices worldwide, there are only a few reports of physiological data on various oxygen masks in children. The possibility of carbon dioxide (CO2) rebreathing has been a prevalent concern with the use of oxygen-delivery devices. OxyMask KidTM (Southmedic Inc. Canada; hereafter OxyMask) is expected to reduce CO2 rebreathing even at low oxygen flow rates because of its structural features. Biological data using OxyMask in children have not been well investigated. Measured respiratory parameters of OxyMask with those of a simple oxygen mask in healthy children were compared. Ten subjects were enrolled, with a median age of 5.4 years. All subjects used both OxyMask and a simple oxygen mask. The fraction of inspiratory oxygen (FIO2), partial pressure of inspiratory CO2 (PICO2), and partial pressure of end-tidal CO2 were measured using a sidestream gas-sampling monitor in all subjects. The oxygen flow rate was set at 1, 3, 5, and 10 L/min. FIO2 levels were higher with OxyMask than those with the simple oxygen mask at 3 L/min of oxygen. PICO2 levels were significantly lower with OxyMask than those with the simple oxygen mask (1.5 mmHg vs. 3.7 mmHg at 1 L/min, P = 0.005; 1.0 mmHg vs. 2.7 mmHg at 3 L/min, P = 0.005, respectively), whereas PICO2 levels were higher at low oxygen flow rates with both masks.Conclusion: Our results showed that higher FIO2 and less CO2 rebreathing were achieved with OxyMask than those with a simple oxygen mask at low flow rates of oxygen in healthy children. What is Known: • OxyMask is expected to reduce carbon dioxide rebreathing even at low oxygen flow rates because of its structural features. • Efficacy has been demonstrated in experimental models and adult data, but clinical data on the use of the OxyMask in children are limited. What is New: • Higher fraction of inspiratory oxygen and lesser carbon dioxide rebreathing were achieved with OxyMask than with a simple oxygen mask at low flow rates of oxygen in healthy children.
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Affiliation(s)
- Shigetoshi Ogiwara
- Department of Pediatrics, Teine Keijinkai Hospital, 12-1-40 Maeda-ichijo Teine-ku, Sapporo, 006-8555, Japan.
| | - Takuya Tamura
- Department of Pediatrics, Teine Keijinkai Hospital, 12-1-40 Maeda-ichijo Teine-ku, Sapporo, 006-8555, Japan
| | - Shuji Sai
- Department of Pediatrics, Teine Keijinkai Hospital, 12-1-40 Maeda-ichijo Teine-ku, Sapporo, 006-8555, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan
| | - Shin Kawana
- Department of Pediatric Anesthesiology, Miyagi Children's Hospital, Sendai, Japan
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, König M, Markewitz A, Nothacker M, Roiter S, Unverzagt S, Veit W, Volk T, Witt C, Wildenauer R, Worth H, Fühner T. [German S3 Guideline - Oxygen Therapy in the Acute Care of Adult Patients]. Pneumologie 2021; 76:159-216. [PMID: 34474487 DOI: 10.1055/a-1554-2625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiologic properties, a range of effective doses and may have side effects. In 2015, 14 % of over 55 000 hospital patients in the UK were using oxygen. 42 % of patients received this supplemental oxygen without a valid prescription. Healthcare professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A S3-guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. Literature search was performed until Feb 1st 2021 to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used and for assessing the quality of evidence and for grading guideline recommendation and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses healthcare professionals using oxygen in acute out-of-hospital and in-hospital settings. The guideline will be valid for 3 years until June 30, 2024.
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Affiliation(s)
- Jens Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
| | - Philipp Capetian
- Klinik für Neurologie, Neurologische Intensivstation, Universitätsklinikum Würzburg
| | - Uwe Hamsen
- Fachbereich für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | - Uwe Janssens
- Innere Medizin und internistische Intensivmedizin, Sankt Antonius Hospital GmbH, Eschweiler
| | - Christian Karagiannidis
- Abteilung für Pneumologie und Beatmungsmedizin, ARDS/ECMO Zentrum, Lungenklinik Köln-Merheim
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg
| | - Marco König
- Deutscher Berufsverband Rettungsdienst e. V., Lübeck
| | - Andreas Markewitz
- ehem. Klinik für Herz- und Gefäßchirurgie Bundeswehrzentralkrankenhaus Koblenz
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg
| | | | | | - Wolfgang Veit
- Bundesverband der Organtransplantierten e. V., Marne
| | - Thomas Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Christian Witt
- Seniorprofessor Innere Medizin und Pneumologie, Charité Berlin
| | | | | | - Thomas Fühner
- Krankenhaus Siloah, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Region Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
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Duan X, Wei N, Wei J, Zhu Y, Kang Y, He Y, Huang J, Wang S. Effect of High-Flow Nasal Cannula Oxygen Therapy on Pediatric Patients With Congenital Heart Disease in Procedural Sedation: A Prospective, Randomized Trial. J Cardiothorac Vasc Anesth 2021; 35:2913-2919. [PMID: 33934982 DOI: 10.1053/j.jvca.2021.03.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The study was conducted to compare the outcome of high-flow nasal cannula (HFNC) oxygen therapy with conventional oxygen therapy through a simple oxygen mask for pediatric patients with congenital heart disease during percutaneous intervention while under procedural sedation. DESIGN Prospective, randomized and controlled trial. SETTING A Cantonese cardiac center in China. PARTICIPANTS Two hundred American Society of Anesthesiologists classification II pediatric patients were enrolled from April 25, 2018 to November 28, 2018. INTERVENTIONS Patients scheduled for percutaneous closure of a heart defect under deep sedation with propofol, midazolam and fentanyl by an anesthesiologist were randomized (1:1) to receive oxygen therapy through a simple oxygen mask or through the HFNC system. MEASUREMENTS AND MAIN RESULTS The primary outcome was the lowest oxygen saturation (SpO2). Secondary outcomes included the incidence of hypoxia (SpO2 < 90%), requirement for noninvasive respiratory support, change in the gastric antrum area and other adverse events. Blood gas analysis results also were compared. Oxygen therapy through the HFNC system improved the lowest SpO2 (99% [94%-100%]), as compared with the mask group (99% [72%-100%]), p < 0.001. Seven patients out of 99 (7.1%) in the mask group had hypoxia or required bag-mask ventilation, whereas no such patient was reported in the HFNC group, p < 0.001. There were no differences between the groups in terms of gastric distention, procedure length, total propofol dose, atropine use or other complications. CONCLUSION When compared with simple mask oxygenation, HFNC could reduce the incidence of desaturation, the need for airway assisted ventilation and risk of carbon dioxide retention without causing hemodynamic instability or gastric distention. It is effective for pediatric patients with non-cyanotic congenital heart disease who require procedural sedation.
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Affiliation(s)
- Xuefei Duan
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Ning Wei
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Yi Zhu
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Yin Kang
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Yi He
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC.
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Arroyo JG, Seto B, Yamada K, Zeng K, Minturn R, Lemire CA. Rapid reduction of macular edema due to retinal vein occlusion with low-dose normobaric hyperoxia. Graefes Arch Clin Exp Ophthalmol 2021; 259:2113-2118. [PMID: 33616756 DOI: 10.1007/s00417-021-05128-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE We investigated the effects of a relatively inexpensive, non-invasive, short-term treatment with low-dose normobaric hyperoxia (NBH) on macular edema in patients with retinal vein occlusion (RVO). METHODS Participants with macular edema associated with RVO were treated with 5 LPM of NBH via facemask (40% fraction of inspired oxygen, FIO2) for 3 h. Patients with non-fovea involving edema who elected to be observed returned for a second treatment 1 month later to test reproducibility. RESULTS A 3-h session of NBH (n = 45) resulted in decreased maximum macular thickness (MMT) (mean 7.10%, t34=9.63 P<.001) and central macular thickness (CMT) (mean 4.64%, t34=6.90, P<.001) when compared to untreated eyes with RVO measured over the same period of time (n = 12) or their healthy fellow eye (n = 34; MMT:t34=-9.60, P<.001;CMT: t34=-6.72, P<.001). Patients who had a second NBH treatment 1 month later experienced a recurrence of their edema, but demonstrated a similar significant reduction in MMT and CMT after the second NBH treatment. CONCLUSIONS Three-hour treatment with 40% FIO2 NBH results in a significant reduction in MMT and CMT. This study supports an ischemic mechanism for macular edema associated with retinal vein occlusion. TRANSLATIONAL RELEVANCE Short-term low-dose normobaric hyperoxia is a simple, inexpensive, and ubiquitous treatment that may provide an alternate or adjunctive approach to treating macular edema in patients who are resistant to or cannot afford anti-VEGF medications.
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Affiliation(s)
- Jorge G Arroyo
- Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Shapiro 5th floor, Boston, MA, 02215, USA.
| | - Brendan Seto
- Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Shapiro 5th floor, Boston, MA, 02215, USA
| | - Keiko Yamada
- Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Shapiro 5th floor, Boston, MA, 02215, USA
| | - Ke Zeng
- Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Shapiro 5th floor, Boston, MA, 02215, USA
| | - Robert Minturn
- Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Shapiro 5th floor, Boston, MA, 02215, USA
| | - Colin A Lemire
- Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Shapiro 5th floor, Boston, MA, 02215, USA
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High-Flow Oxygen through Nasal Cannula vs. Non-Invasive Ventilation in Hypercapnic Respiratory Failure: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165994. [PMID: 32824771 PMCID: PMC7459687 DOI: 10.3390/ijerph17165994] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 01/14/2023]
Abstract
High-flow oxygen through nasal cannula (HFNC) provides adequate oxygenation and can be an alternative to noninvasive ventilation (NIV) for patients with hypoxemic respiratory failure. The aim of the present study was to assess the efficacy of HFNC versus NIV in hypercapnic respiratory failure. Patients (n = 40) who were admitted to the Emergency Department of Alexandra Hospital due to hypercapnic respiratory failure (PaCO2 ≥ 45 mmHg) were randomized assigned into two groups, i.e., an intervention group (use of HFNC, n = 20) and a control group (use of NIV, n = 20). During their hospitalization in the Intensive Care Unit, vital signs (respiratory and heart rate, arterial blood pressure) and arterial blood gases (ABG) were closely monitored on admission, after 24 h and at discharge. No difference between the two groups regarding the duration of hospitalization and the use of HFNC or NIV was observed (p > 0.05). On admission, the two groups did not differ in terms of gender, age, body mass index, APACHE score, predicted death rate, heart rate, arterial blood pressure and arterial blood gases (p > 0.05). Respiratory rate in the HFNC group was lower than in the NIV group (p = 0.023). At discharge, partial carbon dioxide arterial pressure (PaCO2) in the HFNC group was lower than in the NIV group (50.8 ± 9.4 mmHg versus 59.6 ± 13.9 mmHg, p = 0.024). The lowerPaCO2 in the HFNC group than in the NIV group indicated that HFNC was superior to NIV in the management of hypercapnic respiratory failure.
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Herren T, Achermann E, Hegi T, Reber A, Stäubli M. Carbon dioxide narcosis due to inappropriate oxygen delivery: a case report. J Med Case Rep 2017; 11:204. [PMID: 28750686 PMCID: PMC5532777 DOI: 10.1186/s13256-017-1363-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/23/2017] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Oxygen delivery to patients with chronic obstructive pulmonary disease may be challenging because of their potential hypoxic ventilatory drive. However, some oxygen delivery systems such as non-rebreathing face masks with an oxygen reservoir bag require high oxygen flow for adequate oxygenation and to avoid carbon dioxide rebreathing. CASE PRESENTATION A 72-year-old Caucasian man with severe chronic obstructive pulmonary disease was admitted to the emergency department because of worsening dyspnea and an oxygen saturation of 81% measured by pulse oximetry. Oxygen was administered using a non-rebreathing mask with an oxygen reservoir bag attached. For fear of removing the hypoxic stimulus to respiration the oxygen flow was inappropriately limited to 4L/minute. The patient developed carbon dioxide narcosis and had to be intubated and mechanically ventilated. CONCLUSIONS Non-rebreathing masks with oxygen reservoir bags must be fed with an oxygen flow exceeding the patient's minute ventilation (>6-10 L/minute.). If not, the amount of oxygen delivered will be too small to effectively increase the arterial oxygen saturation. Moreover, the risk of carbon dioxide rebreathing dramatically increases if the flow of oxygen to a non-rebreathing mask is lower than the minute ventilation, especially in patients with chronic obstructive pulmonary disease and low tidal volumes. Non-rebreathing masks (with oxygen reservoir bags) must be used cautiously by experienced medical staff and with an appropriately high oxygen flow of 10-15 L/minute. Nevertheless, arterial blood gases must be analyzed regularly for early detection of a rise in partial pressure of carbon dioxide in arterial blood in patients with chronic obstructive pulmonary disease and a hypoxic ventilatory drive. These patients are more safely managed using a nasal cannula with an oxygen flow of 1-2L/minute or a simple face mask with an oxygen flow of 5L/minute.
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Affiliation(s)
- Thomas Herren
- University of Zurich, Medical Faculty, Zurich, Switzerland
- Department of Medicine, Limmattal Hospital, 100 Urdorferstrasse, Schlieren, ZH 8952 Switzerland
| | - Eva Achermann
- University of Zurich, Medical Faculty, Zurich, Switzerland
- Department of Medicine, Limmattal Hospital, 100 Urdorferstrasse, Schlieren, ZH 8952 Switzerland
| | - Thomas Hegi
- Institute of Anesthesiology and Intensive Care, Limmattal Hospital, 100 Urdorferstrasse, Schlieren, ZH 8952 Switzerland
| | - Adrian Reber
- University of Basel, Medical Faculty, Basel, Switzerland
- Department of Anesthesiology and Intensive Care, Zollikerberg Hospital, 20 Trichtenhauser Strasse, Zollikerberg, ZH 8125 Switzerland
| | - Max Stäubli
- University of Bern, Medical Faculty, Bern, Switzerland
- Verein Komplikationenliste, Swiss Society of General Internal Medicine, 4 Lebernhöhe, Ebmatingen, ZH 8125 Switzerland
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11
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Kurhekar P, Prasad TK, Rajarathinam B, Raghuraman MS. Capnographic Analysis of Minimum Mandatory Flow Rate for Hudson Face Mask: A Randomized Double-blind Study. Anesth Essays Res 2017; 11:463-466. [PMID: 28663642 PMCID: PMC5490145 DOI: 10.4103/aer.aer_29_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Oxygen supplementation through Hudson type face mask is frequently used in perioperative settings. Hudson mask is a variable rate performance device with the risk of rebreathing. Studies using capnography to find out an actual fraction of rebreathing in spontaneously breathing patients are not available. AIMS In this study, we analyzed the effects of different flow rates through Hudson mask with capnography on fractional inspired carbon dioxide (FiCO2). SETTING AND DESIGNS Forty patients posted for minor surgeries under monitored anesthesia care were divided into four groups. They received oxygen flow rate of 3 L/min, 4 L/min, 5 L/min, and 6 L/min as per group division, through Hudson mask. MATERIALS AND METHODS Parameters such as pulse rate, noninvasive blood pressure, oxygen saturation, respiratory rate (RR), end-tidal carbon dioxide (EtCO2), and FiCO2 were noted at baseline. After starting oxygen supplementation, these parameters were monitored every minute for ten minutes. Statistical analysis was done using analysis of variance and Kruskal-Wallis test. Pearson correlation was used to establish a relation between RR and FiCO2. RESULTS AND CONCLUSIONS EtCO2 and FiCO2 were comparable in all four groups with no statistical significance. There was strong positive correlation seen between RR and FiCO2 at a flow rate of 3 L/min while negative correlation in other groups. We conclude that FiCO2 is similar at all flow rates while breathing through Hudson mask. Increase in RR can cause increase in FiCO2 at lower flow rate, which is within physiological tolerance limits.
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Affiliation(s)
- Pranjali Kurhekar
- Department of Anesthesiology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India
| | - T Krishna Prasad
- Department of Anesthesiology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India
| | - Buddhan Rajarathinam
- Department of Anesthesiology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India
| | - M S Raghuraman
- Department of Anesthesiology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India
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O'Driscoll BR, Howard LS, Earis J, Mak V. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax 2017; 72:ii1-ii90. [DOI: 10.1136/thoraxjnl-2016-209729] [Citation(s) in RCA: 316] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/03/2017] [Accepted: 02/12/2017] [Indexed: 12/15/2022]
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13
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Uygur P, Oktem S, Boran P, Tutar E, Tokuc G. Low- versus high-flow oxygen delivery systems in children with lower respiratory infection. Pediatr Int 2016; 58:49-52. [PMID: 26189844 DOI: 10.1111/ped.12750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 06/21/2013] [Accepted: 06/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delivery of supplemental oxygen is the initial vital management of hypoxemic acute lower respiratory infection (HALRI). Oxygen delivery systems include low-flow and high-flow devices. In high-flow devices such as the Venturi mask, a constant mixture of oxygen is delivered. As a result, increased rate of breathing does not affect the concentration of oxygen delivered. In this study, we compared the efficacy of oxygen masks and Venturi masks in the management of hypoxemia in pediatric patients. METHODS A total of 65 children, aged 3-36 months, diagnosed with HALRI, were enrolled. Patients were allocated into groups, via simple alternate randomization, to receive oxygen through an oxygen mask or through a Venturi mask. Respiratory rate, heart rate, retraction, blood gas parameters, oxygen saturation, length of hospitalization, and oxygenation were recorded before and after oxygen treatment. RESULTS After 24 h of treatment, respiratory rate was significantly lower among patients in the Venturi mask group compared with the oxygen mask group. Duration of supplemental oxygen and length of hospitalization were significantly lower in the Venturi mask group compared with the oxygen mask group. CONCLUSION In both groups, there was marked improvement in all measured parameters following introduction of supplemental oxygen. Oxygen was delivered more efficiently, however, by high-flow systems. The Venturi mask may decrease the total duration of oxygen usage time as well as the length of hospitalization among young children with HALRI through rapid symptom resolution.
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Affiliation(s)
- Pinar Uygur
- Second Clinic of Pediatrics, Dr Lutfi Kırdar Kartal Research and Training Hospital, Istanbul, Turkey
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14
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Beasley R, Chien J, Douglas J, Eastlake L, Farah C, King G, Moore R, Pilcher J, Richards M, Smith S, Walters H. Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: 'Swimming between the flags'. Respirology 2015; 20:1182-91. [PMID: 26486092 PMCID: PMC4654337 DOI: 10.1111/resp.12620] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/17/2015] [Indexed: 01/07/2023]
Abstract
The purpose of the Thoracic Society of Australia and New Zealand guidelines is to provide simple, practical evidence-based recommendations for the acute use of oxygen in adults in clinical practice. The intended users are all health professionals responsible for the administration and/or monitoring of oxygen therapy in the management of acute medical patients in the community and hospital settings (excluding perioperative and intensive care patients), those responsible for the training of such health professionals, and both public and private health care organizations that deliver oxygen therapy.
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Affiliation(s)
- Richard Beasley
- Medical Research Institute of New ZealandWellington, New Zealand
- Wellington Regional Hospital, Capital and Coast District Health BoardWellington, New Zealand
| | - Jimmy Chien
- Department of Respiratory and Sleep Medicine, Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, University of Sydney at Westmead HospitalSydney, New South Wales, Australia
| | - James Douglas
- Thoracic Program, The Prince Charles HospitalBrisbane, Queensland, Australia
| | - Leonie Eastlake
- Medical Research Institute of New ZealandWellington, New Zealand
| | - Claude Farah
- Department of Respiratory Medicine, Concord HospitalSydney, New South Wales, Australia
- Physiology and Imaging Group, Woolcock Institute of Medical ResearchSydney, New South Wales, Australia
- Sydney Medical School, University of SydneySydney, New South Wales, Australia
- Australian School of Advanced Medicine, Macquarie UniversitySydney, New South Wales, Australia
| | - Gregory King
- Physiology and Imaging Group, Woolcock Institute of Medical ResearchSydney, New South Wales, Australia
- Sydney Medical School, University of SydneySydney, New South Wales, Australia
- Department of Respiratory Medicine, Royal North Shore HospitalSydney, New South Wales, Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep, Austin HealthMelbourne, Victoria, Australia
| | - Janine Pilcher
- Medical Research Institute of New ZealandWellington, New Zealand
- Wellington Regional Hospital, Capital and Coast District Health BoardWellington, New Zealand
- School of Biological Sciences, Victoria University of WellingtonWellington, New Zealand
| | - Michael Richards
- Medical Research Institute of New ZealandWellington, New Zealand
| | - Sheree Smith
- School of Nursing and Midwifery, University of Western SydneySydney, New South Wales, Australia
| | - Haydn Walters
- CRE for Chronic Respiratory Disease, University of TasmaniaHobart, Tasmania, Australia
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15
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Yip YY, Kwok WH, Gomersall CD. Performance of a new oxygen delivery device for potentially infectious critically ill patients. Anaesthesia 2013; 68:1038-44. [PMID: 23902163 DOI: 10.1111/anae.12378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 11/28/2022]
Abstract
In patients with highly contagious diseases that are spread by respiratory droplets or air-borne particles, the use of high-flow oxygen may carry a significant risk of nosocomial transmission. We tested a new oxygen delivery device designed to address these problems by simulating 108 patients with sepsis and respiratory failure. The device being tested consisted of an airtight mask, a bacterial and viral filter, a T-shaped reservoir (50 and 100 ml) and oxygen delivery tubing connected directly to the mask. When tested with a 50-ml reservoir, a high fractional oxygen concentration was achieved: mean (SD) 0.83 (0.11) at a flow of 15 l.min(-1) oxygen. The 50-ml reservoir, when compared with the 100-ml reservoir, was associated with reduced carbon dioxide rebreathing (mean (SD) inspired fractional carbon dioxide concentration 2.5 (1.0) vs 3.0 (1.1), respectively, p = 0.009) and reduced inspiratory resistive work of breathing (mean (SD) 1.0 (0.6) J.l(-1) vs 1.2 (0.5) J.l(-1), respectively, p = 0.028). However, rebreathing and work of breathing were relatively high if a high respiratory rate was simulated. We conclude that the novel oxygen device we describe, equipped with the 50-ml T-shaped reservoir, is suitable for potentially infectious patients with type-1 respiratory failure but without marked tachypnoea.
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Affiliation(s)
- Y Y Yip
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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16
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Abstract
Much has been published in the medical literature concerning adverse events relating to the surgical patient. Among the notable disorders requiring the expertise of the postanesthesia care unit nurse are the diagnosis and management of respiratory dysfunction acutely attributable to the effects of surgery and anesthesia. Inhalational and/or intravenous anesthetic agents contribute to pathophysiological alterations that lend to the development of hypoxemia in the postoperative period. When patients present with preexisting respiratory disease, their care is frequently more complex and challenging. This review session will address the oxygenation component of respiration and the perioperative influences that alter it as well as treatment considerations for normalizing oxygenation.
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Affiliation(s)
- R A Marley
- Department of Anesthesia, Poudre Valley Hospital, Fort Collins, CO 80524, USA
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17
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Abstract
Currently, hyperoxia is being investigated as a method for producing contrast in magnetic resonance images of the brain, solid tumors, and the eye. However, the underlying physiological mechanisms involved in this type of contrast are still not completely understood. For example, under what conditions would dissolved plasma oxygen contribute to the hyperoxia-induced contrast? Using the eye as a model system, we varied the level of dissolved plasma oxygen and observed different patterns of contrast in the vitreous. The observed contrast changes were consistent with tissue oxygen buffering by hemoglobin at an arterial PO2 of 200 mm Hg and dissolved oxygen offloading at arterial PO2's > 350 mm Hg. These data demonstrate that dissolved plasma oxygen does not become an important contrast mechanism until the arterial oxygen tension exceeds approximately 350 mm Hg. The implication of this result to studies in other organs is discussed.
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Affiliation(s)
- B A Berkowitz
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas 48201, USA
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18
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McBrien ME, Sellers WF. A comparison of three variable performance devices for postoperative oxygen therapy. Anaesthesia 1995; 50:136-8. [PMID: 7710024 DOI: 10.1111/j.1365-2044.1995.tb15096.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Eleven patients in the intensive care unit following major abdominal surgery with a nasogastric tube in situ and receiving oxygen via facemask were allocated to receive in a random sequence oxygen at 4 l.min-1 via a Hudson mask, nasal cannulae or a nasal catheter with foam collar at the distal end. A significantly greater PaO2 was achieved using both the nasal catheter with foam collar (p < 0.01) and Hudson mask (p < 0.05) compared to the nasal cannulae. There were no significant differences in the PaCO2 or SpO2 values obtained between the devices. In the majority of postoperative patients in whom a variable performance device is indicated, nasal devices appear preferable in terms of patient comfort and compliance. The nasal catheter with foam collar produced a significantly greater PaO2 than nasal cannulae in patients with a nasogastric tube in situ.
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Affiliation(s)
- M E McBrien
- Department of Anaesthesia, Kettering and District General Hospital, Northamptonshire
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19
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Abstract
A lung model was used to study the effect of varying minute ventilation, oxygen flow and inspiratory : expiratory ratio on the rebreathing characteristics of the Hudson oxygen mask. The onset of rebreathing was detected using two different sets of criteria; those defined by Kain et al. and Humphrey. The onset of rebreathing was also quantified in terms of the inspired volume of carbon dioxide and increases in deadspace. The magnitude of rebreathing was increased by reducing oxygen inflow and increasing minute ventilation. Variation in I : E ratio between 1 : 1 and 1 : 4 had little effect on rebreathing. Using the clinical criteria of Kain et al, the onset of rebreathing was detected when oxygen inflow/minute ventilation ratio was reduced below 0.78 on average. With the other criterion, rebreathing occurred when the ratio was 0.46.
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Affiliation(s)
- N T Campkin
- Department of Anaesthetics, Westminster Hospital, London
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