Understanding the effects of oxygen administration in haemorrhagic shock

Assessment of knowledge, attitude, and factors associated with oxygen therapy for critically ill patients among nurses at the University of Gondar Comprehensive Specialized Hospital Northwest, Ethiopia, 2021

Background

Administering oxygen therapy has an essential role in preventing and managing hypoxemia in both acute and chronic conditions. The aim of this study was to assess knowledge, attitude and factors associated with oxygen therapy for critically ill patients among nurses.

Methods

An institutional-based cross-sectional study was conducted from May 23 to June 07 at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, in 2021. A self-administered, structured and validated questionnaire was used. It has socio-demographic characteristics, multiple choice questions, items that measure the possible associated factors and items that were used to assess the level of knowledge and attitude. Epi Data (“The EpiData Association” Odense, Denmark) version 4.6 was used to enter data, and SPSS (IBM) version 20 was used to analyze it. Both bivariate and multivariate logistic regression analyses were used to identify associated factors. Variables with a p value < 0.05 were considered statistically significant.

Results

The overall proportion of critically ill patients with good knowledge and a positive attitude toward oxygen therapy was 33% (95% CI: 25.8–37.8) and 53.8% (95% CI: 49–59), respectively. Age (AOR; 1.738, 95% CI: 1.034–2.921), level of education (AOR; 7.731, 95% CI: 2.507–23.846) and guideline (AOR; 4.338, 95% CI: 2.233–8.428) and good level of practice (AOR; 1.885, 95% CI: 1.173–3.030) were discovered to be significant factors associated with good knowledge towards oxygen therapy and the reading guideline was found to be a significant factor associated with a positive attitude toward oxygen therapy (AOR; 1.396, 95% CI: 0.830–2.348).

Conclusions

and recommendations: The level of knowledge was low, whereas the attitude of nurses was positive towards oxygen therapy. Reading guidelines, older aged nurses, master holder nurses, and good practice were significant factors associated with good knowledge of oxygen therapy, and reading guidelines was statistically associated with a positive attitude toward oxygen therapy. Thus, nurses need to be aware and skillful regarding the updated oxygen therapy guidelines. They should improve their level of education.

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To assess the level of knowledge and attitude of nurses on oxygen therapy in critically ill patients.

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An institutional-based cross-sectional survey study was conducted.

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The overall proportions of good knowledge and a positive attitude toward oxygen therapy were 33% and 53.8%, respectively.

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The level of knowledge was low, whereas the attitude of nurses was positive towards oxygen therapy.

Gradually Increased Oxygen Administration Improved Oxygenation and Mitigated Oxidative Stress after Resuscitation from Severe Hemorrhagic Shock

BACKGROUND

The optimal oxygen administration strategy during resuscitation from hemorrhagic shock (HS) is still controversial. Improving oxygenation and mitigating oxidative stress simultaneously seem to be contradictory goals. To maximize oxygen delivery while minimizing oxidative damage, the authors proposed the notion of gradually increased oxygen administration (GIOA), which entails making the arterial blood hypoxemic early in resuscitation and subsequently gradually increasing to hyperoxic, and compared its effects with normoxic resuscitation, hyperoxic resuscitation, and hypoxemic resuscitation in severe HS.

METHODS

Rats were subjected to HS, and on resuscitation, the rats were randomly assigned to four groups (n = 8): the normoxic, the hyperoxic, the hypoxemic, and the GIOA groups. Rats were observed for an additional 1 h. Hemodynamics, acid-base status, oxygenation, and oxidative injury were observed and evaluated.

RESULTS

Central venous oxygen saturation promptly recovered only in the hyperoxic and the GIOA groups, and the liver tissue partial pressure of oxygen was highest in the GIOA group after resuscitation. Oxidative stress in GIOA group was significantly reduced compared with the hyperoxic group as indicated by the reduced malondialdehyde content, increased catalase activity, and the lower histologic injury scores in the liver. In addition, the tumor necrosis factor-α and interleukin-6 expressions in the liver were markedly decreased in the GIOA group than in the hyperoxic and normoxic groups as shown by the immunohistochemical staining.

CONCLUSIONS

GIOA improved systemic/tissue oxygenation and mitigated oxidative stress simultaneously after resuscitation from severe HS. GIOA may be a promising strategy to improve resuscitation from HS and deserves further investigation.

Implementation of a titrated oxygen protocol in the out-of-hospital setting

Oxygen is one of the most frequently-used therapeutic agents in medicine and the most commonly administered drug by prehospital personnel. There is increasing evidence of harm with too much supplemental oxygen in certain conditions, including stroke, chronic obstructive pulmonary disease (COPD), neonatal resuscitations, and in postresuscitation care. Recent guidelines published by the British Thoracic Society (BTS) advocate titrated oxygen therapy, but these guidelines have not been widely adapted in the out-of-hospital setting where high-flow oxygen is the standard. This report is a description of the implementation of a titrated oxygen protocol in a large urban-suburban Emergency Medical Services (EMS) system and a discussion of the practical application of this out-of-hospital protocol.

Oxygen therapy: professional compliance with national guidelines

One of the major causes of critical illness in the UK is the deterioration of respiratory function (British Thoracic Society (BTS), 2008). The administration of supplemental oxygen therapy, although often lifesaving, can also have serious consequences if performed inappropriately. A literature review was carried out to establish whether oxygen therapy was prescribed and administered in acute care in accordance with both national guidelines and local policy. Four common themes were identified from the literature: prescribing, monitoring, administration and equipment. The review suggests that an educational programme ranging from pre-registration curriculum content to the practical experiences of junior doctors with regard to oxygen management would be appropriate. The authors suggest that the current practice of healthcare practitioners should undergo a planned timetable of audit to improve the prescription, administration and monitoring of supplemental oxygen therapy for the benefit of patient outcomes.

Effects of ubiquinol with fluid resuscitation following haemorrhagic shock on rat lungs, diaphragm, heart and kidneys

Haemorrhagic shock (HS) and fluid resuscitation can lead to increased reactive oxygen species (ROS), contributing to ischaemia-reperfusion injury and organ damage. Ubiquinol is a potent antioxidant that decreases ROS. This study examined the effects of ubiquinol administered with fluid resuscitation following controlled HS. Adult male Sprague-Dawley rats were randomly assigned to treatment [ubiquinol, 1 mg (100 g body weight)(-1)] or control groups. Rats were subjected to 60 min of HS by removing 40% of the total blood volume to a mean arterial pressure ∼45-55 mmHg. The animals were resuscitated with blood and lactated Ringer solution, with or without ubiquinol, and monitored for 120 min. At the end of the experiments, the rats were killed and the lungs, diaphragm, heart and kidneys harvested. Leucocytes were analysed for mitochondrial superoxide at baseline, end of shock and 120 min following fluid resuscitation using MitoSOX Red. Diaphragms were examined for hydrogen peroxide using dihydrofluorescein diacetate and confocal microscopy. The apoptosis in lungs, diaphragm, heart and kidneys was measured using fluorescence microscopy with acridine orange and ethidium bromide. Leucocyte mitochondrial superoxide levels were significantly lower in rats that received ubiquinol than in the control animals. Production of hydrogen peroxide and apoptosis were significantly reduced in the organs of rats treated with ubiquinol. These findings suggest that ubiquinol, administered with fluid resuscitation after HS, attenuates ROS production and apoptosis. Thus, ubiquinol is a potent antioxidant that may be used as a potential treatment to reduce organ injury following haemorrhagic events.

Ringer's malate solution protects against the multiple organ injury and dysfunction caused by hemorrhagic shock in rats

Malic acid, in the form of its anion malate, is a key intermediate in the major biochemical energy-producing cycle known as the citric acid or Krebs cycle. In this study, the authors investigated the protective effect of a novel crystalloid solution of Ringer's malate following fluid resuscitation of hemorrhagic shock using a rat model. Under general anesthesia, Sprague-Dawley male rats were subjected to 60 min of hemorrhagic shock (40 mmHg for 60 min) followed by crystalloid resuscitation. Groups were as follows: (1) sham shock, (2) normal saline, (3) Ringer's lactate, and (4) Ringer's malate. The experiment was terminated at 4 h after resuscitation. Mean arterial blood pressure (MAP) and blood biophysical parameters were monitored during the experiment. The alanine aminotransferase, aspartate aminotransferase, urea, creatinine, superoxide dismutase, and malondialdehyde levels in plasma were detected. The intestine, liver, lung, and renal histopathology were measured. It was found that Ringer's malate could increase MAP immediately and maintain MAP for a long time. Ringer's malate could reduce the level of alanine aminotransferase, aspartate aminotransferase, urea, and creatinine. At the same time, the activity of superoxide dismutase was increased, and the level of malondialdehyde was decreased. Histopathology indicated that Ringer's malate can protect against the multiple organ injury caused by hemorrhagic shock in rats. Ringer's malate prevented circulatory failure and alleviated multiple organ dysfunction syndrome in animals with hemorrhagic shock. The study suggests that Ringer's malate solution could be a potential novel therapeutic agent for fluid resuscitation.