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Sarıtaş PU, Sarıtaş A, Poyraz MÇ, Aydın G. Assessing the incidence of hyperoxia and the effectiveness of Oxygen Reserve Index-guided FiO2 titration in hyperoxia prevention. Perioper Med (Lond) 2024; 13:99. [PMID: 39375742 DOI: 10.1186/s13741-024-00456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 09/26/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Although pulse oximetry technology, which is considered the standard of care to ensure optimum oxygenation, is indispensable in clinical practice, especially in the detection of hypoxemia, it has some limitations in the detection of hyperoxemia. Oxygen Reserve Index can provide clinicians with a crucial pathway in detecting and preventing hyperoxia, noninvasively. Our aim in this study is to determine the hyperoxia detection ability of ORi and to investigate the effectiveness of ORi and SpO2-guided FiO2 titration in preventing hyperoxia. METHODS This prospective randomized study was conducted in the operating theater of Health Sciences University İzmir Tepecik Training and Research Hospital from September 1, 2020, to December 1, 2022. Patients undergoing major abdominal surgery were divided into two groups: the control group and the SpO2 + ORi group. FiO2 titration was performed in the SpO2 + ORi group to maintain the ORi between 0.00 and 95% < SpO2 ≤ 98%. Parameters were recorded before induction, 10 min after intubation, and every hour during the operation. RESULTS A positive linear relationship of 75.8% (r = 0.758) was found between PaO2 and ORi in the ORi + SpO2 group (p < 0.001). Moderate hyperoxemia was observed in 31.6% of patients in the control group, while it was not observed in the ORi + SpO2 group at the 3rd hour. PaO2 values decreased significantly over time in the ORi + SpO2 group with FiO2 titration (p < 0.001). CONCLUSION The combined use of SpO2 and ORi has been demonstrated to successfully guide FiO2 titration for optimal oxygenation and reduce hyperoxemia.
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Affiliation(s)
- Pelin Uzun Sarıtaş
- Department of Anesthesiology and Reanimation İzmir, İzmir City Hospital, İzmir, Türkiye
| | - Aykut Sarıtaş
- Department of Anesthesiology and Reanimation İzmir, Health Sciences University İzmir Faculty of Medicine Tepecik Training and Research Hospital, İzmir, Türkiye.
| | - Merve Çetin Poyraz
- Department of Anesthesiology and Reanimation İzmir, Health Sciences University İzmir Faculty of Medicine Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Gaye Aydın
- Department of Anesthesiology and Reanimation İzmir, Health Sciences University İzmir Faculty of Medicine Tepecik Training and Research Hospital, İzmir, Türkiye
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Uslu A, Gökdemir BN, Çekmen N, Ersoy Z. An Innovative Study Focused on Reducing Unnecessary Oxygen Exposure in Pediatric Patients. J Perianesth Nurs 2024; 39:881-886. [PMID: 38864799 DOI: 10.1016/j.jopan.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 06/13/2024]
Abstract
PURPOSE In the perioperative period, fractional-inspired oxygen is used at values up to 80% to stay within the safe range, even for a short time. A clear value for the safe range has not been specified, and therefore, clinicians prefer a high oxygen value. This study aims to reduce unnecessary oxygen exposure in pediatrice patients and to provide the optimum fractional inspired oxygen value. DESIGN The study was designed as a prospective randomized controlled study, including 139 patients aged 1 to 8 years without comorbidity. METHODS Three groups were formed by adjusting the fractional inspired oxygen to 30%, 50%, or 80% intraoperatively. In the intraoperative period, a strict inspired oxygen protocol (hypoxemia threshold was SpO2 < 90) and oxygen reserve index, fractional expired oxygen value, and peripheral oxygen saturation were used to maintain the balance of hypoxemia and hyperoxemia. FINDINGS One hundred and nine children were included. The mean oxygen reserve index was significantly lower in the 30% group than in the other groups (0.09 ± 0.05, P < .0001). The mean arterial pressure in the 30% group was significantly lower than the 80% group but within the normal range (78 ± 6 mmHg, P < .003). There was no significant difference between the groups regarding delirium and pain in the recovery unit. CONCLUSIONS Due to the known and unknown harmful effects of unnecessary oxygen exposure, it may be time to use optimal oxygen and to fear unnecessary oxygen, not less oxygen. As the next step, we think studies should be conducted with patient groups with lower oxygen concentrations (eg, %21 vs %24 vs %30), more patients, and arterial blood gas monitoring.
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Affiliation(s)
- Ahmed Uslu
- Department of Anesthesiology and Reanimation, University of Baskent, Ankara, Turkey.
| | - Begüm N Gökdemir
- Department of Anesthesiology and Reanimation, University of Baskent, Ankara, Turkey
| | - Nedim Çekmen
- Department of Anesthesiology and Reanimation, University of Baskent, Ankara, Turkey
| | - Zeynep Ersoy
- Department of Anesthesiology and Reanimation, University of Baskent, Ankara, Turkey
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Hille H, Le Thuaut A, Asfar P, Quelven Q, Mercier E, Le Meur A, Quenot JP, Lemiale V, Muller G, Cour M, Ferré A, Berge A, Curtiaud A, Touron M, Plantefeve G, Chakarian JC, Ricard JD, Colin G, Orieux A, Girardie P, Jozwiak M, Rouaud M, Juhel C, Reignier J, Lascarrou JB. Impact of non-invasive oxygen reserve index versus standard SpO2 monitoring on peripheral oxygen saturation during endotracheal intubation in the intensive care unit: Protocol for the randomized controlled trial NESOI2. PLoS One 2024; 19:e0307723. [PMID: 39283873 PMCID: PMC11404791 DOI: 10.1371/journal.pone.0307723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/07/2024] [Indexed: 09/20/2024] Open
Abstract
In critically ill patients, endotracheal intubation (ETI) is lifesaving but carries a high risk of adverse events, notably hypoxemia. Preoxygenation is performed before introducing the tube to increase the safe apnea time. Oxygenation is monitored by pulse oximeter measurement of peripheral oxygen saturation (SpO2). However, SpO2 is unreliable at the high oxygenation levels produced by preoxygenation and, in the event of desaturation, may not decrease sufficiently early to allow preventive measures. The oxygen reserve index (ORI) is a dimensionless parameter that can also be measured continuously by a fingertip monitor and reflects oxygenation in the moderate hyperoxia range. The ORI ranges from 0 to 1 when arterial oxygen saturation (PaO2) varies between 100 to 200 mmHg, as occurs during preoxygenation. No trial has assessed the potential effects of ORI monitoring to guide preoxygenation for ETI in unstable patients. We designed a multicenter, two-arm, parallel-group, randomized, superiority, open trial in 950 critically ill adults requiring ETI. The intervention consists in monitoring ORI values and using an ORI target for preoxygenation of at least 0.6 for at least 1 minute. In the control group, preoxygenation is guided by SpO2 values recorded by a standard pulse oximeter, according to the standard of care, the goal being to obtain 100% SpO2 during preoxygenation, which lasts at least 3 minutes. The standard-of-care ETI technique is used in both arms. Baseline parameters, rapid-sequence induction medications, ETI devices, and physiological data are recorded. The primary outcome is the lowest SpO2 value from laryngoscopy to 2 minutes after successful ETI. Secondary outcomes include cognitive function on day 28. Assuming a 10% standard deviation for the lowest SpO2 value in the control group, no missing data, and crossover of 5% of patients, with the bilateral alpha risk set at 0.05, including 950 patients will provide 85% power for detecting a 2% between-group absolute difference in the lowest SpO2 value. Should ORI monitoring with a target of ≥0.6 be found to increase the lowest SpO2 value during ETI, then this trial may change current practice regarding preoxygenation for ETI. Trial registration: Registered on ClinicalTrials.gov (NCT05867875) on April 27, 2023.
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Affiliation(s)
- Hugo Hille
- Medecine Intensive Reanimation, Nantes University Hospital, Nantes, France
| | - Aurélie Le Thuaut
- Research and Innovation Department, Methodology and Biostatistics Platform, Nantes University Hospital, Nantes, France
| | - Pierre Asfar
- Intensive Care Unit, Angers University Hospital, Angers, France
| | - Quentin Quelven
- Intensive Care Unit, Rennes University Hospital, Rennes, France
| | | | | | | | - Virginie Lemiale
- Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Grégoire Muller
- Centre Hospitalier Universitaire (CHU) d'Orléans, Médecine Intensive Réanimation, Université de Tours, MR INSERM 1327 ISCHEMIA, Université de Tours, Tours, France
- Clinical Research in Intensive Care and Sepsis-Trial Group for Global Evaluation and Research in Sepsis (CRICS_TRIGGERSep) French Clinical Research Infrastructure Network (F-CRIN) Research Network, Orléans, France
| | - Martin Cour
- Médecine Intensive-Réanimation, Edouard Herriot Hospital, University of Lyon, Lyon, France
| | - Alexis Ferré
- Intensive Care Unit, Versailles Hospital, Le Chesnay, France
| | - Asael Berge
- Intensive Care Unit, Haguenau Hospital, Haguenau, France
| | - Anaïs Curtiaud
- Department of Intensive Care (Service de Médecine Intensive-Réanimation), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), University of Strasbourg, Strasbourg, France
| | - Maxime Touron
- Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Jean-Charles Chakarian
- Service de réanimation, Centre hospitalier de Roanne, CS 80511-42328 Roanne CEDEX, Roanne, France
| | - Jean-Damien Ricard
- Intensive Care Unit, Louis-Mourier Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France
| | - Gwenhael Colin
- Intensive Care Unit, Vendée District Hospital, La Roche-sur-Yon, France
| | - Arthur Orieux
- Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | | | - Mathieu Jozwiak
- Intensive Care Unit, Nice University Hospital, Nice, France
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Manon Rouaud
- Research and Innovation Department, Methodology and Biostatistics Platform, Nantes University Hospital, Nantes, France
| | - Camille Juhel
- Medecine Intensive Reanimation, Nantes University Hospital, Nantes, France
| | - Jean Reignier
- Nantes Université, Nantes University Hospital, Intensive Care Unit, Motion-Interactions-Performance Laboratory (MIP), UR 4334, Nantes, France
| | - Jean-Baptiste Lascarrou
- Nantes Université, Nantes University Hospital, Intensive Care Unit, Motion-Interactions-Performance Laboratory (MIP), UR 4334, Nantes, France
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Wang Z, Irving BA, Spielmann G, Johannsen N, Greenway F, Dalecki M. A single exposure to 100% normo-baric oxygen therapy appears to improve sequence learning processes by increasing prefrontal cortex oxygen saturation. Brain Res 2024; 1837:148962. [PMID: 38670479 DOI: 10.1016/j.brainres.2024.148962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/23/2024] [Accepted: 04/24/2024] [Indexed: 04/28/2024]
Abstract
Previously, we showed that a normo-baric 100 % oxygen treatment (NbOxTr) enhances motor learning processes, e.g., visuomotor adaptation (VMA) and sequence learning (SL). However, this work was limited to behavioral outcomes and did not identify the physiological mechanistic underpinnings of these improvements. Here, we expand on this research to investigate the effects of a NbOxTr on the oxygen tissue saturation index (TSI) level of the prefrontal cortex (PFC) when performing a SL task and whether potential SL improvements relate to increased TSI levels in the PFC. Twenty four right-handed young, healthy adults were randomly assigned to a NbOxTr group (normo-baric 100 % oxygen, n = 12) or a control group (normal air, n = 12). They received their respective treatments via a nasal cannula during the experiment. Oxygen TSI levels of the right and left PFC were measured via near-infrared spectroscopy (NIRS) throughout different SL task phases (Baseline, Training, Testing). The NbOxTr increased the TSI of the PFC in the Training phase (p < 0.01) and positively affected SL retention in the Testing phase (p < 0.05). We also found a positive correlation between TSI changes in the right PFC during the gas treatment phase (3.4 % increase) and response time (RT) improvements in the SL task training and retention phase (all p < 0.05). Our results suggest that a simple NbOxTr increases the oxygenated hemoglobin availability in the PFC, which appears to mediate the retention of acquired SL improvements in healthy young adults. Future studies should examine treatment-related oxygenation changes in other brain areas involved and their relation to enhanced learning processes. Whether this NbOxTr improves SL in neurologically impaired populations should also be examined.
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Affiliation(s)
- Zheng Wang
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Brian A Irving
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Guillaume Spielmann
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Neil Johannsen
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Frank Greenway
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Marc Dalecki
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; German University of Health and Sports, Berlin, Germany
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Li H, Liu J, Xiong L, Duan G, Xu Y. Oxygen concentration titration guided by oxygen reserve index during pediatric laryngeal surgery with high-flow nasal cannula oxygen: a randomized controlled trial. J Anesth 2024; 38:508-515. [PMID: 38805073 DOI: 10.1007/s00540-024-03348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The objective of this study was to evaluate whether adjusting the oxygen concentration guided by the Oxygen Reserve Index (ORI) during pediatric laryngeal surgery with High Flow Nasal Cannula Oxygen (HFNO) could achieve postoperative PaO2 close to physiological levels while ensuring adequate oxygenation in surgery. METHODS Sixty pediatric patients undergoing laryngeal surgery or examination were randomly assigned to two groups. The ORI group received oxygen concentration adjustments every 5 min to maintain a target ORI value of 0.21, whereas the control group did not undergo any adjustments. Postoperative PaO2, time weighted average fraction of inspired oxygen (FiO2), and mean Peripheral Oxygen Saturation (SpO2) were compared between groups. Finally, some analyses were conducted to examine the relationship of ORI with PaO2. RESULTS In general, the postoperative PaO2 was 164.9 ± 48.8 mmHg in ORI group and 323.0 ± 87.7 mmHg in control group (P < 0.01). The time weighted average FiO2 in the ORI group was 85.9 [81.8-92.7] %. There was no significant difference in mean SpO2 between the two groups (ORI vs. control: 98.4 [97.7-99.2] vs. 98.8 [97.7-99.5]; P = 0.36). According to the analyses, the optimal cut value for ORI was determined to be 0.195 when PaO2 was 150 mmHg. CONCLUSIONS In pediatric laryngeal surgery with HFNO, reducing oxygen concentration guided by ORI helped achieve postoperative PaO2 levels closer to physiological norms without compromising intra-operative oxygenation.
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Affiliation(s)
- Haisu Li
- Department of Anesthesiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, People's Republic of China
| | - Jianxia Liu
- Department of Anesthesiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, People's Republic of China
| | - Ling Xiong
- Department of Anesthesiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, People's Republic of China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Ying Xu
- Department of Anesthesiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China.
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, People's Republic of China.
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Min JY, Hyung SW, Jeon JP, Chung MY, Kim CJ, Kim YH. A stepwise lung recruitment maneuver using I-gel can improve respiratory parameters: A prospective observational study. Medicine (Baltimore) 2024; 103:e38718. [PMID: 38941413 DOI: 10.1097/md.0000000000038718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
I-gel has been used in various clinical situations. The study investigated alterations in respiratory parameters following a stepwise lung recruitment maneuver (LRM) using the i-gel. The research involved 60 patients classified as American Society of Anesthesiologists class I-II, aged 30 to 75 years, undergoing elective urologic surgery. Various respiratory parameters, including lung compliance, airway resistance, leak volume, airway pressure, and oxygen reserve index, were recorded at different time points: before LRM, immediately after LRM, and at 5, 15, and 30 minutes after LRM, as well as at the end of the surgery. The primary outcome was to assess an improvement in lung compliance. Dynamic lung compliance (mean ± SD) was significantly increased from 49.2 ± 1.8 to 70.15 ± 3.2 mL/cmH2O (P < .05) after LRM. Static lung compliance (mean ± SD) was increased considerably from 52.4 ± 1.7 to 65.0 ± 2.5 mL/cmH2O (P < .05) after the LRM. Both parameters maintained a statistically significant increased status for a certain period compared to baseline despite a decreased degree of increment. Airway resistance (mean ± SD) was significantly reduced after the LRM from 12.05 ± 0.56 to 10.41 ± 0.64 L/cmH2O/s (P < .05). Stepwise LRM using i-gel may improve lung compliance and airway resistance. Repeated procedures could lead to prolonged improvements in respiratory parameters.
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Affiliation(s)
- Ji Young Min
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Woo Hyung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Pyo Jeon
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee Young Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Jae Kim
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National Hospital, College of Medicine, The Chungnam National University of Korea, Daejeon, Republic of Korea
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Zanusso F, De Benedictis GM, Bellini L. Exploring oxygen reserve index for timely detection of deoxygenation in canine patients recovering from anesthesia. Res Vet Sci 2024; 173:105268. [PMID: 38631076 DOI: 10.1016/j.rvsc.2024.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
Pulse oximetry (SpO2) identifies a decrease in the partial pressure of oxygen (PaO2) when it falls below 80 mmHg, while oxygen reserve index (ORi), a dimensionless index ranging from 0 to 1, detects PaO2 changes between 100 and 200 mmHg. This study investigates the usefulness of ORi in detecting impending deoxygenation before traditional SpO2. Fifty-one dogs undergoing anesthesia were mechanically ventilated maintaining a fraction of inspired oxygen of 0.50 and an ORi of 1. Animals were classified according to their body condition score (BCS) as normal-fit (BCS 4-5/9), overweight (BCS 6-7/9), or obese (BCS 8-9/9). At the end of the procedure, dogs were placed in sternal recumbency, and after 10 min disconnected from the ventilator and maintained in apnea. ORi added warning time was determined at various ORi values as the time difference in reaching SpO2 of 95% from ORi of 0.9 and 0.5, compared to the SpO2 warning time from SpO2 of 98%. During apnea, ORi decreased before noticeable SpO2 changes. An ORi of 0.9 anticipated an SpO2 of 95% in normal-fit dogs by 87 (33-212) [median (range)] seconds or in those with a BCS ≥ 6/9 by 49 (7-161) seconds. Regardless of the BCS class, the median time from ORi of 0.5 to SpO2 of 95% was 30-35 s. ORi declined from 0.9 to 0.0 in 68 compared to 33 s between normal-fit and obese dogs (p < 0.05). In dogs, ORi added warning time could facilitate timely intervention, particularly in obese patients.
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Affiliation(s)
- Francesca Zanusso
- Department of Animal Medicine, Productions and Health, School of Agricultural Sciences and Veterinary Medicine, University of Padova, Legnaro 35020, Padova, Italy
| | - Giulia Maria De Benedictis
- Department of Animal Medicine, Productions and Health, School of Agricultural Sciences and Veterinary Medicine, University of Padova, Legnaro 35020, Padova, Italy
| | - Luca Bellini
- Department of Animal Medicine, Productions and Health, School of Agricultural Sciences and Veterinary Medicine, University of Padova, Legnaro 35020, Padova, Italy.
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Ryu JH, Jeon YT, Sim KM, Lee S, Oh AY, Koo CH. Role of oxygen reserve index monitoring in patients undergoing robot-assisted radical prostatectomy: a retrospective study. World J Urol 2024; 42:232. [PMID: 38613597 PMCID: PMC11015992 DOI: 10.1007/s00345-024-04938-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/20/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE Robot-assisted radical prostatectomy (RARP) is a common surgical procedure for the treatment of prostate cancer. Although beneficial, it can lead to intraoperative hypoxia due to high-pressure pneumoperitoneum and Trendelenburg position. This study explored the use of oxygen reserve index (ORi) to monitor and predict hypoxia during RARP. METHODS A retrospective analysis was conducted on 329 patients who underwent RARP at the Seoul National University Bundang Hospital between July 2021 and March 2023. Various pre- and intraoperative variables were collected, including ORi values. The relationship between ORi values and hypoxia occurrence was assessed using receiver operating characteristic curves and logistic regression analysis. RESULTS Intraoperative hypoxia occurred in 18.8% of the patients. The receiver operating characteristic curve showed a satisfactory area under the curve of 0.762, with the ideal ORi cut-off value for predicting hypoxia set at 0.16. Sensitivity and specificity were 64.5% and 75.7%, respectively. An ORi value of < 0.16 and a higher body mass index were identified as independent risk factors of hypoxia during RARP. CONCLUSIONS ORi monitoring provides a non-invasive approach to predict intraoperative hypoxia during RARP, enabling early management. Additionally, the significant relationship between a higher body mass index and hypoxia underscores the importance of individualized patient assessment.
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Affiliation(s)
- Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Kyu Man Sim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
| | - Soowon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Chang-Hoon Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.
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Del Santo T, DI Filippo A, Romagnoli S. Rapid sequence induction of anesthesia: works in progress and steps forward with focus to oxygenation and monitoring techniques. Minerva Anestesiol 2024; 90:181-190. [PMID: 37851418 DOI: 10.23736/s0375-9393.23.17569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The description of the main scientifically consolidated innovations in recent years on Rapid Sequence Induction have been the subject of this narrative review. Data sources were PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicaTrials.gov, searched up to March 21st, 2023; rapid sequence induction and anesthesia were used as key word for the research. In recent years at least three significant innovations which have improved the procedure: firstly the possibility of using drugs which rapidly reverse the action of the myorelaxants and which have made it possible to give up the use of succinylcholine, replaced by rocuronium; secondly, the possibility of using much more effective pre-oxygenation methods than in the past, also through apneic oxygenation techniques which allow longer apnea time, and finally new monitoring systems much more effective than pulse oximetry in identifying and predicting periprocedural hypoxemia and indicating the need for ventilation in patients at risk of hypoxemia and preventing it. The description of three main scientifically consolidated innovations in recent years, in pharmacology, oxygen method of administration and monitoring, have been the subject of this narrative review.
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Affiliation(s)
- Tommaso Del Santo
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Stefano Romagnoli
- Department of Health Sciences, University of Florence, Florence, Italy
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Watanabe T, Kanno N, Suzuki S, Yogo T, Harada Y, Hara Y. Investigation of the association between oxygen reserve index and arterial partial oxygen pressure in anesthetized dogs. Vet Anaesth Analg 2024; 51:10-15. [PMID: 37949743 DOI: 10.1016/j.vaa.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the relationship between oxygen reserve index (ORI) and arterial partial pressure of oxygen (PaO2) in anesthetized dogs. STUDY DESIGN Prospective experimental study. ANIMALS A total of eight healthy adult Beagle dogs with a median age of 38 (range 20-87) months and a median body mass of 8.6 (range 7.0-13.8) kg. METHODS After induction of general anesthesia with propofol, dogs were mechanically ventilated and anesthesia maintained with isoflurane carried in oxygen. Arterial blood samples were collected from a catheter placed in the femoral artery. ORI was measured by placing a CO-oximeter sensor on the tongue. Inspired oxygen fraction (FiO2) was increased from 21% to > 95% in increments of 5%. PaO2 and ORI were recorded and compared at different times. The relationship between ORI and PaO2 was investigated using a nonlinear function, the Hill equation, and a linear regression analysis was performed, as appropriate. RESULTS A total of 128 pairs of values were compared for all dogs. Applying the Hill equation to the relationship between ORI and PaO2 resulted in R2 = 0.80 (p < 0.001) with a Hill coefficient of 3.7. It was predicted that ORI ranged 0.1-0.9 as PaO2 ranged 127.0-417.9 mmHg and that in the more linear portion of the range, PaO2 of 127.0-289.9 mmHg ORI ranged 0.1-0.7. Linear regression analysis in the more linear portion showed a weak correlation (R2 = 0.29, p = 0.006). CONCLUSIONS AND CLINICAL RELEVANCE In the present study, the Hill equation predicted the relationship between PaO2 and ORI for PaO2 ranging 127.0-417.9 mmHg in anesthetized dogs. However, in the linear portion of the PaO2, the coefficient of determination was low, indicating that ORI is not a surrogate for PaO2.
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Affiliation(s)
- Tamaki Watanabe
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan.
| | - Nobuo Kanno
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Shuji Suzuki
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Takuya Yogo
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Yasuji Harada
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Yasusi Hara
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
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Sarıtaş A, Sarıtaş PU, Uzun U. Effectiveness of the oxygen reserve index in detecting and preventing hyperoxia in critically ill patients on mechanical ventilation: a randomized controlled trial. Croat Med J 2023; 64:404-412. [PMID: 38168521 PMCID: PMC10797238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
AIM To assess the effectiveness of fraction of inspired oxygen (FiO2) titration guided by oxygen reserve index (ORi) in preventing hyperoxia in intensive care unit (ICU) patients receiving mechanical ventilator support. METHODS Patients aged 18 years and older who were admitted to a tertiary ICU and required mechanical ventilator support were randomly divided into two groups: the control group (n=30) and the oxygen saturation (SpO2) +ORi group (n=30). In the SpO2+ORi group, the goal was to maintain SpO2 between 95% and 98% and ORi at 0.00. In both groups, SpO2, ORi, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide, positive end-expiratory pressure, FiO2, and hemodynamic parameters were recorded every six hours for two consecutive days. RESULTS A very strong positive linear correlation was found between PaO2 and ORi (r=0.937; P<0.001). In the ORi+SpO2 group, PaO2 values were significantly lower and decreased with FiO2 titration over time. Severe hyperoxia was observed in 24.8% of the control group and in only 3.3% of the ORi+SpO2 group. When PaO2>120 mm Hg, FiO2>0.40 was found in 83.5% of the control group, and in 40% of the ORi+SpO2 group. CONCLUSION FiO2 titration guided by ORi+SpO2 effectively prevents hyperoxia and reduces the exposure time to hyperoxia in critically ill patients.
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Affiliation(s)
- Aykut Sarıtaş
- Aykut Sarıtaş, Department of Anesthesiology and Reanimation, Health Sciences University, İzmir Faculty of Medicine, Tepecik Training and Research Hospital, Güney Mahallesi 1140/1 sokak no: 1 Yenişehir, 35000 Izmir, Turkey,
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12
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Bang YJ, Seong Y, Jeong H. Association between Oxygen Reserve index and arterial partial pressure of oxygen during one-lung ventilation: a retrospective cohort study. J Anesth 2023; 37:938-944. [PMID: 37787833 DOI: 10.1007/s00540-023-03259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/07/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE We aimed to investigate the association between the Oxygen Reserve index (ORi) and arterial partial pressure of oxygen (PaO2) during one-lung ventilation in patients who underwent non-cardiac thoracic surgery requiring one-lung ventilation. METHODS This retrospective study assessed the eligibility of 578 adult patients who underwent elective non-cardiac thoracic surgery requiring one-lung ventilation at a tertiary hospital, and their electronic medical records were reviewed. The ORi monitor was used in all patients during anesthesia, and arterial blood gas analysis was routinely performed 15 min after the initiation of one-lung ventilation. The primary endpoint was the association between ORi and PaO2 which were measured simultaneously during one-lung ventilation. We also investigated the risk factors for PaO2 less than 150 mmHg during one-lung ventilation. RESULTS Total of 554 patient were included in the analysis. The ORi value measured 15 min after the start of one-lung ventilation was significantly associated with PaO2 in the linear regression model (r2 = 0.5752, P < 0.001), and 0.27 of the ORi value could distinguish PaO2 ≥ 150 mmHg (sensitivity 0.909, specificity 0.932). Risk factors for PaO2 < 150 mmHg during one-lung ventilation included a lower ORi, older age, higher body mass index, left-sided one-lung ventilation, and lower hemoglobin concentrations. CONCLUSION This study suggested that ORi could provide useful information on arterial oxygenation even during one-lung ventilation for non-cardiac thoracic surgery.
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Affiliation(s)
- Yu Jeong Bang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwonro, Gangnamgu, 06351, Seoul, South Korea
| | - Youjin Seong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwonro, Gangnamgu, 06351, Seoul, South Korea
| | - Heejoon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwonro, Gangnamgu, 06351, Seoul, South Korea.
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Massari D, de Keijzer IN, Vos JJ. Perioperative monitoring of the oxygen reserve: where do we stand? J Clin Monit Comput 2023; 37:1431-1433. [PMID: 37863861 DOI: 10.1007/s10877-023-01085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023]
Abstract
The Oxygen Reserve Index (ORi) is an advanced plethysmography-derived variable that may help to quantify the degree of hyperoxia in patients receiving supplemental oxygen administration. ORi is a (relative) indicator of the actual partial pressure of oxygen dissolved in arterial blood (PaO2). As such, it may help in the titration of oxygen administration or it may help to warn the clinician of a deterioration of oxygen status of the patient.In this issue of the journal, Fadel et al. provide a 'classical' clinical validation study by assessing the correlation between ORi and PaO2 in patients about to undergo open-heart surgery. Within the moderate hyperoxic range (100-200 mmHg PaO2), there is a sound correlation between ORi and PaO2. This editorial discusses the clinical implications of this validation study and elaborates on the possible role of ORi monitoring in addition to SpO2 (peripheral arterial oxygen saturation) monitoring alone.
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Affiliation(s)
- Dario Massari
- Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands.
| | - Ilonka N de Keijzer
- Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jaap Jan Vos
- Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands
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Zanusso F, De Benedictis GM, Zemko P, Bellini L. Non-invasive assessment of oxygenation status using the oxygen reserve index in dogs. BMC Vet Res 2023; 19:241. [PMID: 37980491 PMCID: PMC10657143 DOI: 10.1186/s12917-023-03804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND The oxygen reserve index (ORi) is a real-time, continuous index measured with multi-wavelength pulse CO-oximetry technology. It estimates mild hyperoxemia in humans, which is defined as a partial pressure of oxygen (PaO2) level between 100 and 200 mmHg. The objectives of this study were to assess the correlation between ORi and PaO2, as well as to determine its ability in detecting mild hyperoxemia in dogs. METHODS This prospective observational study enrolled 37 anaesthetised and mechanically ventilated dogs undergoing elective procedures. Simultaneous measurements of ORi and PaO2 were collected, using a multi-wavelength pulse CO-oximeter with a probe placed on the dog's tongue, and a blood gas analyser, respectively. A mixed-effects model was used to calculate the correlation (r2) between simultaneous measurements of ORi and PaO2. The trending ability of ORi to identify dependable and proportional changes of PaO2 was determined. The diagnostic performances of ORi to detect PaO2 ≥ 150 mmHg and ≥ 190 mmHg were estimated using the area under the receiver operating characteristic curve (AUROC). The effects of perfusion index (PI), haemoglobin (Hb), arterial blood pH and partial pressure of carbon dioxide (PaCO2) on AUROC for PaO2 ≥ 150 mmHg were evaluated. RESULTS A total of 101 paired measurements of ORi and PaO2 were collected. PaO2 values ranged from 74 to 258 mmHg. A strong positive correlation (r2 = 0.52, p < 0.001) was found between ORi and PaO2. The trending ability ORi was 90.7%, with 92% sensitivity and 89% specificity in detecting decreasing PaO2. An ORi value ≥ 0.53 and ≥ 0.76 indicated a PaO2 ≥ 150 and ≥ 190 mmHg, respectively, with ≥ 82% sensitivity, ≥ 77% specificity and AUROC ≥ 0.75. The AUROC of ORi was not affected by PI, Hb, pH and PaCO2. CONCLUSIONS In anaesthetised dogs, ORi may detect mild hyperoxaemia, although it does not replace blood gas analysis for measuring the arterial partial pressure of oxygen. ORi monitoring could be used to non-invasively assess oxygenation in dogs receiving supplemental oxygen, limiting excessive hyperoxia.
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Affiliation(s)
- Francesca Zanusso
- Department of Animal Medicine, Productions and Health, University of Padova, Legnaro, Padova, 35020, Italy
| | - Giulia Maria De Benedictis
- Department of Animal Medicine, Productions and Health, University of Padova, Legnaro, Padova, 35020, Italy
| | - Polina Zemko
- Department of Animal Medicine, Productions and Health, University of Padova, Legnaro, Padova, 35020, Italy
| | - Luca Bellini
- Department of Animal Medicine, Productions and Health, University of Padova, Legnaro, Padova, 35020, Italy.
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Wittenmeier E, Schmidtmann I, Heese P, Müller P, Didion N, Kriege M, Komorek Y, Pirlich N. Early warning for SpO 2 decrease by the oxygen reserve index in neonates and small infants. Paediatr Anaesth 2023; 33:923-929. [PMID: 37551627 DOI: 10.1111/pan.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Continuously assessing the oxygenation levels of patients to detect and prevent hypoxemia can be advantageous for safe anesthesia, especially in neonates and small infants. The oxygen reserve index (ORI) is a new parameter that can assess oxygenation through a relationship with arterial oxygen partial pressure (PaO2 ). The aim of this study was to examine whether the ORI provides a clinically relevant warning time for an impending SpO2 (pulse oximetry hemoglobin saturation) reduction in neonates and small infants. METHODS ORI and SpO2 were measured continuously in infants aged <2 years during general anesthesia. The warning time and sensitivity of different ORI alarms for detecting impending SpO2 decrease were calculated. Subsequently, the agreement of the ORI and PaO2 with blood gas analyses was assessed. RESULTS The ORI of 100 small infants and neonates with a median age of 9 months (min-max, 0-21 months) and weight of 8.35 kg (min-max, 2-13 kg) were measured. For the ORI/PaO2 correlation, 54 blood gas analyses were performed. The warning time and sensitivity of the preset ORI alarm during the entire duration of anesthesia were 84 s (25th-75th percentile, 56-102 s) and 55% (95% CI 52%-58%), and those during anesthesia induction were 63 s (40-82 s) and 56% (44%-68%), respectively. The positive predictive value of the preset ORI alarm were 18% (95% CI 17%-20%; entire duration of anesthesia) and 27% (95% CI 21%-35%; during anesthesia induction). The agreement of PaO2 intervals with the ORI intervals was poor, with a kappa of 0.00 (95% CI = [-0.18; 0.18]). The weight (p = .0129) and height (p = .0376) of the infants and neonates were correlated to the correct classification of the PaO2 interval with the ORI interval. CONCLUSIONS The ORI provided an early warning time for detecting an impending SpO2 decrease in small infants and neonates in the defined interval in this study. However, the sensitivity of ORI to forewarn a SpO2 decrease and the agreement of the ORI with PaO2 intervals in this real-life scenario were too poor to recommend the ORI as a useful early warning indicator for this age group.
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Affiliation(s)
- Eva Wittenmeier
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Irene Schmidtmann
- Biostatistician, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - Pascal Heese
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Pascal Müller
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Nicole Didion
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Marc Kriege
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Yannick Komorek
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Nina Pirlich
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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Bellini L, De Benedictis GM. Oxygen Reserve Index as a Tool to Monitor Four Techniques of Oxygen Supplementation at Different Flow Rates in Dogs Sedated with Dexmedetomidine and an Opioid. Animals (Basel) 2023; 13:3077. [PMID: 37835683 PMCID: PMC10572064 DOI: 10.3390/ani13193077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Respiratory dysfunction often decreases arterial oxygen content. Four common oxygen delivery techniques-flow-by, nasal prongs, a tight-vented mask, and a tight mask connected to a Venturi valve-were evaluated for their effectiveness in increasing the oxygen reserve index (ORi), a dimensionless index of oxygen content that provides additional information compared to traditional pulse oximetry (SpO2) during hyperoxia (PaO2 100-200 mmHg), and that ranges from 0 to 1. Thirty-two dogs sedated with dexmedetomidine and an opioid were evenly divided into four groups based on the technique for oxygen administration. Each dog received oxygen at 1, 2, and 3 L/min by a single technique, and the amount of inhaled oxygen (FiO2) was measured at the level of the cervical trachea. At each flow rate, ORi and SpO2 were recorded. The flow-by method minimally increased the FiO2, and ORi reached its highest value only in 3 out of 8 dogs at the maximum flow rate. Other methods exhibited direct correlations between the oxygen flow rate and ORi (p < 0.001). These methods effectively increased FiO2 and ORi, with over half of the values exceeding 40% and 0.4, respectively. The tight-vented mask showed variable increases in FiO2, ranging between 22 and 90%. Despite method-dependent variations, all devices increased SpO2 > 98% as the FiO2 increased (p = 0.002). In conclusion, nasal prongs and the mask connected to the Venturi valve showed the highest correlation between the oxygen flow rate and the ORi. These results suggest that using these two techniques in conjunction with ORI can help in optimizing oxygen therapy.
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Affiliation(s)
- Luca Bellini
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell’Università 16, 35028 Legnaro, Italy;
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Maeda M, Yoshikawa Y, Oura S, Takahashi K, Ohno S, Hirata N, Yamakage M. Apnea management during WATCHMAN device deployment with apneic oxygenation: A case report of three cases. Ann Card Anaesth 2023; 26:458-460. [PMID: 37861586 PMCID: PMC10691579 DOI: 10.4103/aca.aca_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 10/21/2023] Open
Abstract
WATCHMAN is a percutaneous left atrial appendage closure device that is implanted in patients who are unsuitable for anticoagulation therapy for atrial fibrillation. During WATCHMAN implantation, inducing apnea in the patient is preferable to allow stable deployment. We present three cases in which apneic oxygenation was employed to maintain oxygenation during apnea, and oxygen reserve index (ORiTM) was measured to evaluate its safety and efficacy. Oxygen was administered continuously via the endotracheal tube during apnea. During all four apneic events in three patients (mean duration of 356 seconds), the ORi values maintained above 0.24, which is generally considered the threshold of partial pressure of arterial oxygen (PaO2) > 100 mmHg. Transcutaneous oxygen saturation and PaO2 remained above 99% and 300 mmHg, respectively. There were no respiratory or circulatory complications during or after the surgery.
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Affiliation(s)
- Makishi Maeda
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yusuke Yoshikawa
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shunsuke Oura
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kanako Takahashi
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sho Ohno
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Hirata
- Department of Anesthesiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Park S, Kim SY, Kim MS, Park WK, Byon HJ, Kim HJ. Comparison of preoxygenation efficiency measured by the oxygen reserve index between high-flow nasal oxygenation and facemask ventilation: a randomised controlled trial. BMC Anesthesiol 2023; 23:159. [PMID: 37161369 PMCID: PMC10169184 DOI: 10.1186/s12871-023-02126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND High-flow nasal oxygenation and the oxygen reserve index (ORI), which is a non-invasive and innovative modality that reflects the arterial oxygen content, are used in general anaesthesia. This study compares the preoxygenation efficiency (measured by the ORI) of high-flow nasal oxygenation and facemask ventilation during the induction process. METHODS This single-centre, two-group, randomised controlled trial included 197 patients aged ≥ 20 years who underwent orotracheal intubation for general anaesthesia for elective surgery. The patients were randomly allocated to receive preoxygenation via facemask ventilation or high-flow nasal oxygenation. The ORI was measured and compared between both groups. RESULTS The ORI increased during preoxygenation in all patients. At 1 min of preoxygenation, the ORI was significantly higher in the high-flow nasal oxygenation group (0.34 ± 0.33) than in the facemask ventilation group (0.21 ± 0.28; P = 0.003). The highest ORI was not significantly different between the two groups (0.68 ± 0.25 in the high-flow nasal oxygenation group vs. 0.70 ± 0.28 in the facemask ventilation group; P = 0.505). CONCLUSIONS High-flow nasal oxygenation results in an oxygenation status similar to that provided by facemask ventilation during the induction process of general anaesthesia; therefore, high-flow nasal oxygenation is a feasible preoxygenation method. TRIAL REGISTRATION Clinicaltrials.gov (NCT04291339).
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Affiliation(s)
- Sujung Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Effectiveness of preoxygenation by conventional face mask versus non-invasive ventilation in morbidly obese patients: measurable by the oxygen-reserve index? J Clin Monit Comput 2022; 36:1767-1774. [PMID: 35167036 PMCID: PMC9637603 DOI: 10.1007/s10877-022-00825-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/27/2022] [Indexed: 11/21/2022]
Abstract
Preoxygenation is a crucial manoeuvre for patients' safety, particularly for morbidly obese patients due to their reduced pulmonary reserve and increased risk for difficult airway situations. The oxygen reserve index (ORI™) was recently introduced as a new parameter of multiple wavelength pulse oximetry and has been advocated to allow assessment of hyperoxia [quantified by the resulting arterial oxygen partial pressure (PaO2)]. This study investigates if ORI can be used to evaluate the impact of two different preoxygenation manoeuvres on the grade of hyperoxia. Two preoxygenation manoeuvres were sequentially evaluated in 41 morbidly obese patients: First, breathing 100% oxygen for 5 min via standard face mask. Second, after achieving a second baseline, 5 min of non-invasive ventilation (NIV) with 100% oxygen. The effect of preoxygenation on ORI compared to PaO2 was evaluated and whether differences in the two preoxygenation manoeuvres can be monitored by ORI. Overall correlation of PaO2 and ORI was significant (Spearman-Rho coefficient of correlation 0.818, p < 0.001). However, ORI could not differentiate between the two preoxygenation manoeuvres although the PaO2 values for NIV preoxygenation were significantly higher compared to standard preoxygenation (median 505 mmHg (M1) vs. 550 mmHg (M3); p < 0.0001). In contrast, ORI values did not differ significantly (median 0.39 (M1) vs. 0.38 (M3); p = 0.758). Absolute values of ORI cannot be used to assess effectiveness of a preoxygenation procedure in bariatric patients, mainly because its range of discrimination is considerably lower than the high ranges of PaO2 attained by adequate preoxygenation. Trial registration German Clinical Trials Register: DRKS00025023 (retrospectively registered on April 16th, 2021).
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Ahn JH, Shim JG, Park J, Lee SH, Ryu KH, Cho EA. Oxygen reserve index guided fraction of inspired oxygen titration to reduce hyperoxemia during laparoscopic gastrectomy: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e31592. [PMID: 36401493 PMCID: PMC9678519 DOI: 10.1097/md.0000000000031592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The usefulness of the oxygen reserve index (ORi) in reducing hyperoxemia remains unclear. We designed this study to investigate whether fraction of inspired oxygen (FiO2) adjustment under a combination of ORi and peripheral oxygen saturation (SpO2) guidance can reduce intraoperative hyperoxemia compared to SpO2 alone. METHODS In this prospective, double-blind, randomized controlled study, we allocated patients scheduled for laparoscopic gastrectomy to the SpO2 group (FiO2 adjusted to target SpO2 ≥ 98%) or the ORi-SpO2 group (FiO2 adjusted to target 0 < 0 ORi < .3 and SpO2 ≥ 98%). The ORi, SpO2, FiO2, arterial partial pressure of oxygen (PaO2), and incidence of severe hyperoxemia (PaO2 ≥ 200 mm Hg) were recorded before and 1, 2, and 3 hours after surgical incision. Data from 32 and 30 subjects in the SpO2 and ORi-SpO2 groups, respectively, were analyzed. RESULTS PaO2 was higher in the SpO2 group (250.31 ± 57.39 mm Hg) than in the ORi-SpO2 group (170.07 ± 49.39 mm Hg) 1 hour after incision (P < .001). PaO2 was consistently higher in the SpO2 group than in the ORi-SpO2 group, over time (P = .045). The incidence of severe hyperoxemia was higher in the SpO2 group (84.4%) than in the ORi-SpO2 group (16.7%, P < .001) 1 hour after incision. Higher FiO2 was administered to the SpO2 group [52.5 (50-60)] than the ORi-SpO2 group [40 (35-50), P < .001] 1 hour after incision. SpO2 was not different between the 2 groups. CONCLUSION The combination of ORi and SpO2 guided FiO2 adjustment reduced hyperoxemia compared to SpO2 alone during laparoscopic gastrectomy.
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Affiliation(s)
- Jin Hee Ahn
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Geum Shim
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jiyeon Park
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Hyun Lee
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Ho Ryu
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Ah Cho
- Department of Anaesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * Correspondence: Eunah Cho, Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea (e-mail: )
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[Oxygen reserve index: a new parameter for oxygen therapy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1275-1280. [PMID: 36398556 PMCID: PMC9678064 DOI: 10.7499/j.issn.1008-8830.2206112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Oxygen reserve index (ORI) is a novel dimensionless index used for noninvasive, real-time, and continuous monitoring of oxygenation, and ORI value ranges from 0 to 1, which reflects the range of 100-200 mmHg for arterial partial pressure of oxygen. ORI combined with pulse oximetry may help to accurately adjust the concentration of inspired oxygen and prevent hyperoxemia and hypoxemia. ORI is suitable for various clinical situations, and the medical staff should master this novel parameter and use it properly to assess the oxygenation of patients. In addition, several limitations of ORI should be noticed during clinical application.
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22
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Ramos M, Tau Anzoategui S. Preoxygenation: from hardcore physiology to the operating room. J Anesth 2022; 36:770-781. [PMID: 36136165 DOI: 10.1007/s00540-022-03105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
If we define the human body by the mass of the elements that compose it, we could say that we are oxygen and other elements. Oxygen, in addition to being fundamental in our composition, is an element that we constantly need to support cellular respiration and, therefore, life. Interestingly, despite its importance, humans have not developed mechanisms that allow us to store it and, therefore, we are unable to sustain life if we are deprived of ventilation, even for brief periods. Accordingly, the ability to induce the cessation of ventilation in a patient must be accompanied by different technical and non-technical skills that allow the patient's safety to be maintained in this highly vulnerable state. Through the use of basic mathematical tools and comparative physiology, we hereby propose to review the physiological foundations of preoxygenation to understand the reasons behind the clinical recommendations in this field.
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Affiliation(s)
- Matias Ramos
- Department of Anesthesiology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina.
| | - Santiago Tau Anzoategui
- Department of Anesthesiology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
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Matsuba S, Sawai M, Higashitani S, Sawasaki F, Kida H, Takahashi K. Anesthetic management in a patient with severe tracheal stenosis by monitoring oxygen reserve index. JA Clin Rep 2022; 8:73. [PMID: 36107332 PMCID: PMC9477987 DOI: 10.1186/s40981-022-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background General anesthesia for tracheal stenting is challenging because of difficult ventilation and accompanying hypoxia. We report the use of oxygen reserve index (ORi™) during tracheal stenting. Case presentation Cauterization of an intratracheal tumor and tracheal stenting was scheduled in a patient. ORi decreased from 0.3 to 0.2 after starting cauterization using a flexible bronchoscope through a tracheal tube with 28% oxygen, while SpO2 was maintained at 100%. ORi further decreased to 0, followed by a decrease of SpO2 < 90%, and surgery was interrupted. SpO2 was increased shortly after increasing FiO2 to 1.0, but ORi remained 0 when surgery was resumed; it was increased after completion of cauterization. Both ORi and SpO2 were maintained above 0.4 and 98%, respectively, during tracheal stenting through a rigid bronchoscope under intrapulmonary percussive ventilation. Conclusion ORi was useful for predicting a decrease of SpO2 under general anesthesia for tracheal stenting.
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Yang M, Kim JA, Ahn HJ, Choi YS, Park M, Jeong H, Kim K, Lee NY. Continuous Titration of Inspired Oxygen Using Oxygen Reserve Index to Decrease Oxygen Exposure During One-Lung Ventilation: A Randomized Controlled Trial. Anesth Analg 2022; 135:91-99. [PMID: 35245224 DOI: 10.1213/ane.0000000000005967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A high fraction of inspired oxygen (Fio2) is administered during one-lung ventilation (OLV). However, a high Fio2 is not physiologic and may lead to various complications. We hypothesized that continuous titration of Fio2 using the oxygen reserve index (ORI) reduces oxygen exposure compared to conventional management during OLV. METHODS In this randomized, double-blinded trial, patients undergoing thoracic surgery were assigned to an ORI (n = 64) or a control group (n = 60). In the ORI group, ORI was continuously displayed using multiwavelength pulse co-oximetry (Masimo) between 0 and 1 (0, no reserve; 1, maximum reserve), and Fio2 was titrated for a target ORI of 0.21 at 5-minute intervals during OLV. In the control group, Fio2 was adjusted using arterial blood gas analysis measured at 15 minutes after OLV initiation. The primary end point was the time-weighted average Fio2 during OLV. RESULTS Overall, time-weighted average Fio2 did not differ between the groups (control versus ORI: median [interquartile range], 0.87 [0.73-1.00] vs 0.82 [0.68-0.93]; P = .09). However, in a subgroup analysis, the ORI group reduced time-weighted average Fio2 after pulmonary vascular ligation compared to the control group (control versus ORI: median [interquartile range], 0.75 [0.70-1.00] vs 0.72 [0.59-0.89]; P = .0261). The incidence of intraoperative hypoxia (arterial oxygen saturation [Spo2] <94%; control versus ORI: 32% [19/60; 95% confidence interval (CI), 20-45] vs 19% [12/64; 95% CI, 10-31]; P = .09), and postoperative complications within the first 7 days did not differ between the groups. CONCLUSIONS ORI-guided continuous Fio2 titration does not reduce overall oxygen exposure during OLV.
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Affiliation(s)
- Mikyung Yang
- From the Departments of Anesthesiology and Pain Medicine
| | - Jie Ae Kim
- From the Departments of Anesthesiology and Pain Medicine
| | - Hyun Joo Ahn
- From the Departments of Anesthesiology and Pain Medicine
| | - Young Soo Choi
- Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - MiHye Park
- From the Departments of Anesthesiology and Pain Medicine
| | - Heejoon Jeong
- From the Departments of Anesthesiology and Pain Medicine
| | - Keoungah Kim
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Dankook University, Cheon-an, South Korea
| | - Nam Young Lee
- From the Departments of Anesthesiology and Pain Medicine
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de Courson H, Julien-Laferrière T, Georges D, Boyer P, Verchère E, Biais M. The ability of Oxygen Reserve Index® to detect hyperoxia in critically ill patients. Ann Intensive Care 2022; 12:40. [PMID: 35576087 PMCID: PMC9110610 DOI: 10.1186/s13613-022-01012-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hyperoxia is associated with increased morbidity and mortality in the intensive care unit. Classical noninvasive measurements of oxygen saturation with pulse oximeters are unable to detect hyperoxia. The Oxygen Reserve Index (ORI) is a continuous noninvasive parameter provided by a multi-wave pulse oximeter that can detect hyperoxia. Primary objective was to evaluate the diagnostic accuracy of the ORI for detecting arterial oxygen tension (PaO2) > 100 mmHg in neurocritical care patients. Secondary objectives were to test the ability of ORI to detect PaO2 > 120 mmHg and the ability of pulse oximetry (SpO2) to detect PaO2 > 100 mmHg and PaO2 > 120 mmHg. Methods In this single-center study, we collected ORI and arterial blood samples every 6 h for 3 consecutive days. Diagnostic performance was estimated using the area under the receiver operating characteristic curve (AUROC). Results There were 696 simultaneous measurements of ORI and PaO2 in 62 patients. Considering the repeated measurements, the correlation between ORI and PaO2 was r = 0.13. The area under the receiver operating characteristic curve (AUROC), obtained to test the ability of ORI to detect PaO2 > 100 mmHg, was 0.567 (95% confidence interval = 0.566–0.569) with a sensitivity of 0.233 (95%CI = 0.230–0.235) and a specificity of 0.909 (95%CI = 0.907–0.910). The AUROC value obtained to test the ability of SpO2 to detect a PaO2 > 100 mmHg was 0.771 (95%CI = 0.770–0.773) with a sensitivity of 0.715 (95%CI = 0.712–0.718) and a specificity of 0.700 (95%CI = 0.697–0.703). The diagnostic performance of ORI and SpO2 for detecting PaO2 > 120 mmHg was AUROC = 0.584 (95%CI = 0.582–0.586) and 0.764 (95%CI = 0.762–0.766), respectively. The AUROC obtained for SpO2 was significantly higher than that for ORI (p < 0.01). Diagnostic performance was not affected by sedation, norepinephrine infusion, arterial partial pressure of carbon dioxide, hemoglobin level and perfusion index. Conclusion In a specific population of brain-injured patients hospitalized in a neurointensive care unit, our results suggest that the ability of ORI to diagnose hyperoxia is relatively low and that SpO2 provides better detection. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01012-w.
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Affiliation(s)
- Hugues de Courson
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, UMR 1219, Bordeaux Population Health Research Center, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Delphine Georges
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Philippe Boyer
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Eric Verchère
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Matthieu Biais
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France. .,Biology of Cardiovascular Diseases, Institut National de la Santé et de la Recherche Médicale, U1034, Pessac, France.
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Carbino B, Guy A, Durka M, Zakerzadeh R. The Effects of Geometric Features of Intraluminal Thrombus on the Vessel Wall Oxygen Deprivation. Front Bioeng Biotechnol 2022; 10:814995. [PMID: 35419349 PMCID: PMC8997837 DOI: 10.3389/fbioe.2022.814995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/21/2022] [Indexed: 12/20/2022] Open
Abstract
The objective of this paper is to analyze the association of intraluminal thrombus (ILT) presence and morphology with oxygen transport in abdominal aortic aneurysms (AAA) and local hypoxia. The biomechanical role of the ILT layer in the evolution of the aneurysm is still not fully understood. ILT has been shown to create an inflammatory environment by reducing oxygen flux to the arterial wall and therefore decreasing its strength. It has been also hypothesized that the geometry of the ILT may further affect AAA rupture. However, no previous research has attempted to explore the effect of morphological features of ILT on oxygen distributions within the AAA, in a systematic manner. In this study, we perform a comprehensive analysis to investigate how physiologically meaningful variations in ILT geometric characteristics affect oxygen transport within an AAA. We simulate twenty-seven AAA models with variable ILT dimensions and investigate the extent to which ILT attenuates oxygen concentration in the arterial wall. Geometric variations studied include ILT thickness and ILT length, as well as the bulge diameter of the aneurysm which is related to ILT curvature. Computer simulations of coupled fluid flow-mass transport between arterial wall, ILT, and blood are solved and spatial variations of oxygen concentrations within the ILT and wall are obtained. The comparison of the results for all twenty-seven simulations supports the hypothesis that the presence of ILT in AAA correlates to significantly impaired oxygen transport to the aneurysmal wall. Mainly, we observed that ILT thickness and length are the parameters that influence decreased oxygen flow and concentration values the most, and thick thrombi exacerbate hypoxic conditions in the arterial wall, which may contribute to increased tissue degradation. Conversely, we observed that the arterial wall oxygen concentration is nearly independent of the AAA bulge diameter. This confirms that consideration of ILT size and anatomy is crucial in the analysis of AAA development.
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Affiliation(s)
- Burton Carbino
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, United States
| | - Alexander Guy
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, United States
| | - Michael Durka
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, United States
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rana Zakerzadeh
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, United States
- *Correspondence: Rana Zakerzadeh,
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Gook J, Kwon JH, Kim K, Choi JW, Chung IS, Lee J. Awake craniotomy using a high-flow nasal cannula with oxygen reserve index monitoring - A report of two cases. Anesth Pain Med (Seoul) 2022; 16:338-343. [PMID: 35139614 PMCID: PMC8828626 DOI: 10.17085/apm.21022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Awake craniotomy is a well-tolerated procedure for the resection of brain tumors residing within or close to the eloquent cortical areas. Monitored anesthesia care (MAC) is a dominant anesthetic approach for awake craniotomy; however, it is associated with inherent challenges such as desaturation and hypercapnia, which may lead to various complications. The prevention of respiratory insufficiency is important for successful awake craniotomy. As measures to avoid respiratory depression, the use of high-flow nasal cannula (HFNC) can improve patient oxygenation and monitor the monitoring the oxygen reserve index (ORi) can detect hypoxia earlier. CASE We report two cases of awake craniotomy with MAC using HFNC and ORi. We adjusted the fraction of inspired oxygen of the HFNC according to the ORi level. The patient underwent successful awake craniotomy without a desaturation event or additional airway intervention. CONCLUSIONS Combined HFNC and ORi monitoring may provide adequate oxygen reserves in patients undergoing awake craniotomy.
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Affiliation(s)
- Joonhee Gook
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keoungah Kim
- Department of Anesthesiology and Pain Medicine, Dankook University Dental Hospital, Cheonan, Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ik Soo Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeonjin Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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28
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Cheng HW, Yeh CY, Chang MY, Ting CK, Chang PL. How early warning with the Oxygen Reserve Index (ORi™) can improve the detection of desaturation during induction of general anesthesia? J Clin Monit Comput 2021; 36:1379-1385. [PMID: 34953137 DOI: 10.1007/s10877-021-00776-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022]
Abstract
The Oxygen Reserve Index (ORi™) is a dimensionless parameter with a value between 0 and 1. It is related to the real-time oxygenation status in the moderate hyperoxic range. The purpose of this study is to investigate the added warning time provided by different ORi alarm triggers and the continuous trends of ORi, SpO2, and PaO2. We enrolled 25 patients who were scheduled for elective surgery under general anesthesia with planned arterial catheterization before induction. The participants received standardized preoxygenation, induction, and intubation. The patients remained apneic and ventilation was resumed when the SpO2 fell below 90%. The ORi and SpO2 were recorded every ten seconds and arterial blood was sampled every minute, from preoxygenation to resumed ventilation. Alarm triggers set to the ORi peak and the ORi 0.55 values provided 300 and 145 s of significant added warning time compared to SpO2 (p < 0.0001). The coefficient of determination was 0.56 between the ORi and the PaO2 ≤ 240 mmHg and showed a positive correlation. The ORi enables the clinicians to monitor the patients' oxygen status during induction of general anesthesia and can improve the detection of impending desaturation. However, further studies are needed to assess its clinical potential in the high hyperoxic range.The protocol was retrospectively registered at ClinicalTrials.gov on July 21, 2021 (NCT04976504).
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Affiliation(s)
- Hung-Wei Cheng
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, 112, Taiwan, ROC.,Department of Anesthesiology, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, ROC.,Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, ROC
| | - Chia-Yi Yeh
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, 112, Taiwan, ROC
| | - Man-Yun Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, 112, Taiwan, ROC
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, 112, Taiwan, ROC.,Department of Anesthesiology, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, ROC
| | - Po-Lun Chang
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, ROC.
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Sagiroglu G, Baysal A, Karamustafaoglu YA. The use of oxygen reserve index in one-lung ventilation and its impact on peripheral oxygen saturation, perfusion index and, pleth variability index. BMC Anesthesiol 2021; 21:319. [PMID: 34930139 PMCID: PMC8685494 DOI: 10.1186/s12871-021-01539-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background Our goal is to investigate the use of the oxygen reserve index (ORi) to detect hypoxemia and its relation with parameters such as; peripheral oxygen saturation, perfusion index (PI), and pleth variability index (PVI) during one-lung ventilation (OLV). Methods Fifty patients undergoing general anesthesia and OLV for elective thoracic surgeries were enrolled in an observational cohort study in a tertiary care teaching hospital. All patients required OLV after a left-sided double-lumen tube insertion during intubation. The definition of hypoxemia during OLV is a peripheral oxygen saturation (SpO2) value of less than 95%, while the inspired oxygen fraction (FiO2) is higher than 50% on a pulse oximetry device. ORi, pulse oximetry, PI, and PVI values were measured continuously. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and accuracy were calculated for ORi values equal to zero in different time points during surgery to predict hypoxemia. At Clinicaltrials.gov registry, the Registration ID is NCT05050552. Results Hypoxemia was observed in 19 patients (38%). The accuracy for predicting hypoxemia during anesthesia induction at ORi value equals zero at 5 min after intubation in the supine position (DS5) showed a sensitivity of 92.3% (95% CI 84.9–99.6), specificity of 81.1% (95% CI 70.2–91.9), and an accuracy of 84.0% (95% CI 73.8–94.2). For predicting hypoxemia, ORi equals zero show good sensitivity, specificity, and statistical accuracy values for time points of DS5 until OLV30 where the sensitivity of 43.8%, specificity of 64%, and an accuracy of 56.1% were recorded. ORi and SpO2 correlation was found at DS5, 5 min after lateral position with two-lung ventilation (DL5) and at 10 min after OLV (OLV10) (p = 0.044, p = 0.039, p = 0.011, respectively). Time-dependent correlations also showed that; at a time point of DS5, ORi has a significant negative correlation with PI whereas, no correlations with PVI were noted. Conclusions During the use of OLV for thoracic surgeries, from 5 min after intubation (DS5) up to 30 min after the start of OLV, ORi provides valuable information in predicting hypoxemia defined as SpO2 less than 95% on pulse oximeter at FiO2 higher than 50%.
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Affiliation(s)
- Gonul Sagiroglu
- Department of Anesthesiology and Reanimation, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Ayse Baysal
- Pendik District Hospital, Clinic of Anesthesiology and Reanimation, Pendik, 34980, Istanbul, Turkey.
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30
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Ishida Y, Okada T, Kobayashi T, Uchino H. ORi™: a new indicator of oxygenation. J Anesth 2021; 35:734-740. [PMID: 33900455 PMCID: PMC8072303 DOI: 10.1007/s00540-021-02938-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/18/2021] [Indexed: 12/14/2022]
Abstract
In the perioperative period, hypoxemia and hyperoxia are crucial factors that require attention, because they greatly affect patient prognoses. The pulse oximeter has been the only noninvasive monitor that can be used as a reference of oxygenation in current anesthetic management; however, in recent years, a new monitoring method that uses the oxygen reserve index (ORi™) has been developed by Masimo Corp. ORi is an index that reflects the state of moderate hyperoxia (partial pressure of arterial oxygen [PaO2] between 100 and 200 mmHg) using a non-unit scale between 0.00 and 1.00. ORi monitoring performed together with percutaneous oxygen saturation (SpO2) measurements may become an important technique in the field of anesthetic management, for measuring oxygenation reserve capacity. By measuring ORi, it is possible to predict hypoxemia and to detect hyperoxia at an early stage. In this review, we summarize the method of ORi, cautions for its use, and suitable cases for its use. In the near future, the monitoring of oxygen concentrations using ORi may become increasingly common for the management of respiratory function before, after, and during surgery.
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Affiliation(s)
- Yusuke Ishida
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Toshio Okada
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Takayuki Kobayashi
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Hiroyuki Uchino
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
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Matsui Y, Takazawa T, Takemae A, Murooka Y, Kanamoto M, Saito S. Investigation of the optimal method of oxygen administration with simultaneous use of a surgical mask: a randomized control study. J Anesth 2021; 36:26-31. [PMID: 34491428 PMCID: PMC8422829 DOI: 10.1007/s00540-021-02998-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022]
Abstract
Purpose From the perspective of infection prevention during the Coronavirus disease 2019 (COVID-19) pandemic, a recommendation was made to use surgical masks after extubation in patients in the operating room. For compliance with this recommendation, anesthesiologists need to administer oxygen to the patient with an oxygen mask over the surgical mask. However, no studies have investigated whether this method allows good maintenance of oxygenation in patients. This study aimed to investigate which method of oxygen administration lends itself best to use with a surgical mask in terms of oxygenation. Method We administered oxygen to the study subjects using all the following three methods in random order: an oxygen mask over or under a surgical mask and a nasal cannula under the surgical mask. Oxygenation was assessed using the oxygen reserve index (ORi) and end-tidal oxygen concentration (EtO2). Result This study included 24 healthy volunteers. ORi values with administration of oxygen were higher in the order of a nasal cannula under the surgical mask, an oxygen mask under the surgical mask, and an oxygen mask over the surgical mask, with median values of 0.50, 0.48, and 0.43, respectively, and statistically significant differences between all groups (P < 0.001). EtO2 values were in the same order as ORi, with median values of 33.0%, 31.0%, and 25%, respectively, and statistically significant differences between all groups (P < 0.001). Conclusion Wearing a surgical mask over the nasal cannula during oxygen administration is beneficial for oxygenation and might help prevent aerosol dispersal. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-021-02998-6.
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Affiliation(s)
- Yusuke Matsui
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tomonori Takazawa
- Intensive Care Unit, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Akihito Takemae
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukie Murooka
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masafumi Kanamoto
- Intensive Care Unit, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Facilitation of delayed sequence intubation with oxygen reserve index monitoring in a child with esophageal perforation. Can J Anaesth 2021; 68:1826-1827. [PMID: 34426959 DOI: 10.1007/s12630-021-02092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022] Open
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Ishida Y, Nakazawa K, Okada T, Tsuzuki Y, Kobayashi T, Yamada R, Uchino H. Anesthetic management of a morbidly obese patient with endometrial cancer during robot-assisted laparoscopic surgery. JA Clin Rep 2021; 7:30. [PMID: 33821374 PMCID: PMC8021672 DOI: 10.1186/s40981-021-00434-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/21/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background The number of robot-assisted surgeries being performed has increased in recent years, even in patients with risk factors, such as obesity, owing to advancements in medical technologies. We here report the anesthetic management of a morbidly obese woman who underwent robot-assisted surgery. Case presentation A 44-year-old woman (height, 165 cm; weight, 147 kg; body mass index, 54 kg/m2) was scheduled to undergo robot-assisted laparoscopic hysterectomy for endometrial cancer. Preoperative weight loss and rehearsal of positioning during induction of anesthesia and surgical procedures greatly contributed to the surgical success. Monitoring of oxygen reserve index in combination with SpO2 was useful for appropriate airway and respiratory management. During anesthesia induction, the ramp position using a special commercially available cushion facilitated manual mask ventilation and tracheal intubation. Lung-protective ventilation using a limited tidal volume with moderate PEEP was applied during the robot-assisted surgical procedure. Conclusion We successfully managed anesthesia without any complications.
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Affiliation(s)
- Yusuke Ishida
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Koichi Nakazawa
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshio Okada
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yumi Tsuzuki
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takayuki Kobayashi
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Rikako Yamada
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hiroyuki Uchino
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Fleming NW, Singh A, Lee L, Applegate RL. Oxygen Reserve Index: Utility as an Early Warning for Desaturation in High-Risk Surgical Patients. Anesth Analg 2021; 132:770-776. [PMID: 32815872 DOI: 10.1213/ane.0000000000005109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Perioperative pulse oximetry hemoglobin saturation (Spo2) measurement is associated with fewer desaturation and hypoxia episodes. However, the sigmoidal nature of oxygen-hemoglobin dissociation limits the accuracy of estimation of the partial pressure of oxygen (Pao2) >80 mm Hg and correspondingly limits the ability to identify when Pao2 >80 mm Hg but falling. We hypothesized that a proxy measurement for oxygen saturation (Oxygen Reserve Index [ORI]) derived from multiwavelength pulse oximetry may allow additional warning time before critical desaturation or hypoxia. To test our hypothesis, we used a Masimo multiwavelength pulse oximeter to compare ORI and Spo2 warning times during apnea in high-risk surgical patients undergoing cardiac surgery. METHODS This institutional review board-approved prospective study (NCT03021473) enrolled American Society of Anesthesiologists physical status III or IV patients scheduled for elective surgery with planned preinduction arterial catheter placement. In addition to standard monitors, an ORI sensor was placed and patients were monitored with a pulse oximeter displaying the ORI, a nondimensional parameter that ranges from 0 to 1. Patients were then preoxygenated until ORI plateaued. Following induction of anesthesia, mask ventilation with 100% oxygen was performed until neuromuscular blockade was established. Endotracheal intubation was accomplished using videolaryngoscopy to confirm placement. The endotracheal tube was not connected to the breathing circuit, and patients were allowed to be apneic. Ventilation was resumed when Spo2 reached 94%. We defined ORI warning time as the time from when the ORI alarm registered (based on the absolute value and the rate of change) until the Spo2 decreased to 94%. We defined the Spo2 warning time as the time for Spo2 to decrease from 97% to 94%. The added warning time provided by ORI was defined as the difference between ORI warning time and Spo2 warning time. RESULTS Forty subjects were enrolled. Complete data for analysis were available from 37 patients. The ORI alarm registered before Spo2 decreasing to 97% in all patients. Median (interquartile range [IQR]) ORI warning time was 80.4 seconds (59.7-105.9 seconds). Median (IQR) Spo2 warning time was 29.0 seconds (20.5-41.0 seconds). The added warning time provided by ORI was 48.4 seconds (95% confidence interval [CI], 40.4-62.0 seconds; P < .0001). CONCLUSIONS In adult high-risk surgical patients, ORI provided clinically relevant added warning time of impending desaturation compared to Spo2. This additional time may allow modification of airway management, earlier calls for help, or assistance from other providers. The potential patient safety impact of such monitoring requires further study.
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Affiliation(s)
- Neal W Fleming
- From the Department of Anesthesiology and Pain Medicine, University of California Davis, Davis, California
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Hirata N, Nishimura M, Chaki T, Yoshikawa Y, Yamakage M. Comparison between oxygen reserve index and end-tidal oxygen concentration for estimation of oxygenation during pre-oxygenation via a tight-fitted face mask: A prospective observational study. Eur J Anaesthesiol 2021; 38:313-315. [PMID: 33538433 DOI: 10.1097/eja.0000000000001358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Naoyuki Hirata
- From the Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan (NH, MN, TC, YY, MY)
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Bellini L, Dzikiti BT, De Benedictis GM, Algarin Sepulveda FR, Maney JK. Oxygen reserve index as a noninvasive indicator of arterial partial pressure of oxygen in anaesthetized donkeys: a preliminary study. Vet Anaesth Analg 2021; 48:388-392. [PMID: 33632615 DOI: 10.1016/j.vaa.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/02/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the oxygen reserve index (ORI) as a noninvasive estimate of the PaO2 during moderate hyperoxaemia [100-200 mmHg (13.3-26.6 kPa)], and to determine ORI values identifying PaO2 > 100, > 150 (20.0 kPa) and > 200 mmHg in anaesthetized donkeys with an inspired fraction of oxygen (FiO2) > 0.95. STUDY DESIGN Prospective observational study. ANIMALS A group of 28 adult standard donkeys aged (mean ± standard deviation) 4 ± 2 years and weighing 135 ± 15 kg. METHODS Donkeys were sedated intramuscularly with xylazine and butorphanol; anaesthesia was induced with ketamine and diazepam and maintained with isoflurane in oxygen. An adhesive sensor probe was applied to the donkey's tongue and connected to a Masimo pulse co-oximeter to determine ORI values. An arterial catheter was inserted into an auricular artery. After ORI signal stabilization, the value was noted and PaO2 determined by blood gas analysis. The Pearson correlation coefficient was used to assess the relationship between ORI and PaO2 for oxygen tension < 200 mmHg (< 26.6 kPa). The Youden index was used to identify the value of ORI that detected PaO2 > 150 and 200 mmHg (20.0 and 26.6 kPa) with the highest sensitivity and specificity. RESULTS A total of 106 paired measurements were collected. A mild positive correlation was observed between ORI and PaO2 for values < 200 mmHg (26.6 kPa; r = 0.52). An ORI > 0.0, > 0.1 and > 0.3 indicated a PaO2 > 100, > 150 and > 200 mmHg (13.3, 20.0 and 26.6 kPa) with negative predictive values > 94%. CONCLUSIONS AND CLINICAL RELEVANCE ORI may provide a noninvasive indication of PaO2 > 100, > 150 and > 200 mmHg (13.3, 20.0 and 26.6 kPa) in anaesthetized donkeys with an FiO2 > 0.95, although it does not replace blood gas analysis for assessment of oxygenation.
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Affiliation(s)
- Luca Bellini
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy.
| | - Brighton T Dzikiti
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | | | - Felix R Algarin Sepulveda
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Jill K Maney
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
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Kumagai M, Kurihara H, Ishida K, Komatsu H, Suzuki K. The Oxygen Reserve Index as a determinant of the necessary amount of postoperative supplemental oxygen. Minerva Anestesiol 2020; 87:439-447. [PMID: 33319950 DOI: 10.23736/s0375-9393.20.14895-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although blood gas analysis (BGA) is important for supplemental oxygen titration, it is invasive, intermittent, costly, and burdensome for staff. We assessed whether the Oxygen Reserve Index (ORi™), a novel pulse oximeter-based index that reflects the partial pressure of oxygen (PaO<inf>2</inf>), could determine the amount of postoperative supplemental oxygen. We also evaluated the extent of hyperoxia and hypoxia. METHODS Fifty patients scheduled to undergo breast surgery were randomly assigned to receive ORi-based oxygen (group O) or conventional postoperative oxygen (group C) treatments. Postoperatively, patients were transported to the Post-Anesthesia Care Unit (PACU) and then to general wards. In group O, oxygen was administered at 4 L·min-1 in the operation room after extubation and was decreased if the ORi was >0.00 until a continuous index of 0.00 was achieved for 30 min in the PACU and wards. In group C, oxygen was administered at 4 L·min-1 throughout the evaluation period. BGA was performed 1 h after anesthesia induction (T0), after extubation (T1), before PACU exit (T2), and on the first postoperative morning (T3). Percutaneous oxygen saturation was measured every two seconds from 9 PM after surgery to 6 AM the next morning. RESULTS The supplemental oxygen amount and PaO<inf>2</inf> were significantly lower in group O than group C at T2 (1.5 [0.5-3.0] vs. 4.0 [4.0-4.0] L/min, 117.3 [26.8] vs. 170.0 [42.8] mmHg) and T3 (1.0 [0.5-3.0] vs. 4.0 [4.0-4.0] L/min, 107.5 [16.5] vs. 157.1 [28.4] mmHg; median [interquartile ranges] and mean [1 SD]; P<0.01). No patient exhibited hypoxia. CONCLUSIONS Based on our results, ORi might be useful to titrate postoperative oxygen supplementation.
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Affiliation(s)
- Motoi Kumagai
- Department of Anesthesiology, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan -
| | - Hiroto Kurihara
- Department of Anesthesiology, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan
| | - Kazushige Ishida
- Department of Surgery, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan
| | - Hideaki Komatsu
- Department of Surgery, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan
| | - Kenji Suzuki
- Department of Anesthesiology, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan
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Abstract
The oxygen reserve index (ORI) is a new technology that provides real-time, non-invasive, and continuous monitoring of patients’ oxygenation status. This review aimed to discuss its clinical utility, prospect and limitations. A systematic literature search of PubMed, MEDLINE, Google Scholar, and ScienceDirect was performed with the keywords of “oxygen reserve index,” “ORI,” “oxygenation,” “pulse oximetry,” “monitoring,” and “hyperoxia.” Original articles, reviews, case reports, and other relevant articles were reviewed. All articles on ORI were selected. ORI can provide an early warning before saturation begins to decrease and expands the ability to monitor the human body's oxygenation status noninvasively and continuously with the combination of pulse oximetry so as to avoid unnecessary hyperoxia or unanticipated hypoxia. Although the technology is so new that it is rarely known and has not been applied to routine practices in hospitals, it shows good prospects for critical care, oxygen therapy, and intraoperative monitoring.
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Tsymbal E, Ayala S, Singh A, Applegate RL, Fleming NW. Study of early warning for desaturation provided by Oxygen Reserve Index in obese patients. J Clin Monit Comput 2020; 35:749-756. [PMID: 32424516 PMCID: PMC8286939 DOI: 10.1007/s10877-020-00531-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
Acute hemoglobin desaturation can reflect rapidly decreasing PaO2. Pulse oximetry saturation (SpO2) facilitates hypoxia detection but may not significantly decrease until PaO2 < 80 mmHg. The Oxygen Reserve Index (ORI) is a unitless index that correlates with moderately hyperoxic PaO2. This study evaluated whether ORI provides added arterial desaturation warning in obese patients. This IRB approved, prospective, observational study obtained written informed consent from Obese (body mass index (BMI) kg m-2; 30 < BMI < 40) and Normal BMI (19 < BMI < 25) adult patients scheduled for elective surgery requiring general endotracheal anesthesia. Standard monitors and an ORI sensor were placed. Patient's lungs were pre-oxygenated with 100% FiO2. After ORI plateaued, general anesthesia was induced, and endotracheal intubation accomplished using a videolaryngoscope. Patients remained apneic until SpO2reached 94%. ORI and SpO2 were recorded continuously. Added warning time was defined as the difference between the time to SpO2 94% from ORI alarm start or from SpO2 97%. Data are reported as median; 95% confidence interval. Complete data were collected in 36 Obese and 36 Normal BMI patients. ORI warning time was always longer than SpO2 warning time. Added warning time provided by ORI was 46.5 (36.0-59.0) seconds in Obese and 87.0 (77.0-109.0) seconds in Normal BMI patients, and was shorter in Obese than Normal BMI patients difference 54.0 (38.0-74.0) seconds (p < 0.0001). ORI provided what was felt to be clinically significant added warning time of arterial desaturation compared to SpO2. This added time might allow earlier calls for help, assistance from other providers, or modifications of airway management.Trial registration ClinicalTrials.gov NCT03021551.
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Affiliation(s)
- Ekaterina Tsymbal
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
| | - Sebastian Ayala
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
| | - Amrik Singh
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
| | - Richard L Applegate
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA.
| | - Neal W Fleming
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
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Cavaliere F, Biancofiore G, Bignami E, De Robertis E, Giannini A, Grasso S, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2018. Critical care. Experimental and clinical studies. Minerva Anestesiol 2020; 85:95-105. [PMID: 30632731 DOI: 10.23736/s0375-9393.18.13524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Sacred Heart Catholic University, Rome, Italy -
| | - Gianni Biancofiore
- Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Ospedale dei Bambini, ASST - Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grasso
- Division of Anesthesiology and Resuscitation, Department of Emergency and Organ Transplantation (DETO), Aldo Moro University of Bari, Policlinic Hospital, Bari, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit and Trauma Center, University Policlinic A. Gemelli IRCCS Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Unit of Resuscitation, Critical Care, Anesthesia and Intensive Care, University Hospital of Siena, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital, University of Sassari, Sassari, Italy
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Alday E, Nieves JM, Planas A. Oxygen Reserve Index Predicts Hypoxemia During One-Lung Ventilation: An Observational Diagnostic Study. J Cardiothorac Vasc Anesth 2020; 34:417-422. [DOI: 10.1053/j.jvca.2019.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/16/2019] [Accepted: 06/24/2019] [Indexed: 01/10/2023]
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Burk KM, Orr JA. A procedure for determining subject-specific pulse oxygen saturation response. Med Biol Eng Comput 2020; 58:753-761. [PMID: 31989431 DOI: 10.1007/s11517-019-02105-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022]
Abstract
The oxyhemoglobin dissociation curve describes the relationship between the partial pressure of oxygen and the percent of hemoglobin saturated with oxygen and varies with chemical and physical factors that differ for every patient. If variability could be determined, patient-specific oxygen therapy could be administered. We have developed a procedure for characterizing variations in the oxygen dissociation curve. The purpose of this study was to validate this procedure in surgical patients. The procedure uses an automated system to alter oxygen therapy during surgery, within safe operational levels, and fit to Hill's equation non-invasive measurements of end-tidal oxygen and peripheral pulse oxygen saturation. The best-fit parameters for the Hill equation, estimated by iterative least squares, provide an apparent dissociation curve, meaningful of the patient-specific pulse oximeter response. Thirty-nine patients participated in this study. Using patient-specific parameter values increases correlation when compared with standard values. The procedure improved the model fit of patient saturation values significantly in 19 patients. This paper has demonstrated a procedure for determining patient-specific pulse oximeter response. This procedure determined best-fit parameters resulting in a significantly improved fit when compared with standard values. These best-fit parameters increased the coefficient of determination R2 in all cases. Graphical Abstract This patient-specific procedure improves fit significantly compared to standard estimates.
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Affiliation(s)
- Kyle M Burk
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84132, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Joseph A Orr
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84132, USA.
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, 84132, USA.
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Karnik P, Agrawal B, Dave N. Oxygen reserve index – A new paradigm in patient safety. J Anaesthesiol Clin Pharmacol 2020; 36:125-126. [PMID: 32174677 PMCID: PMC7047688 DOI: 10.4103/joacp.joacp_76_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/14/2019] [Accepted: 08/25/2019] [Indexed: 11/30/2022] Open
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Yoshida K, Isosu T, Imaizumi T, Obara S, Murakawa M. Oxygen Reserve Index (ORi TM ) as an alarm for oxygenation deterioration in pediatric tracheostomaplasty: A case report. Paediatr Anaesth 2019; 29:1151-1153. [PMID: 31677336 DOI: 10.1111/pan.13739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Keisuke Yoshida
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Tsuyoshi Isosu
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Tsuyoshi Imaizumi
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Shinju Obara
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Masahiro Murakawa
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
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Humphreys S, von Ungern-Sternberg BS, Skowno J, Williams T, Taylor J, Taverner F, Gibbons K, Burgoyne L, Sommerfield D, Stephens P, Hallett B, Vijayasekaran S, Slee N, Burns H, Sowa M, Davidson A, Schibler A. High-flow oxygen for children's airway surgery: rando mi sed controll ed trial protocol (HAMSTER). BMJ Open 2019; 9:e031873. [PMID: 31615801 PMCID: PMC6797255 DOI: 10.1136/bmjopen-2019-031873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Hypoxaemia during anaesthesia for tubeless upper airway surgery in children with abnormal airways is common due to the complexity of balancing adequate depth of anaesthesia with maintenance of spontaneous breathing and providing an uninterrupted field of view of the upper airway for the surgeon. High-flow nasal oxygenation (HIGH-FLOW) can prolong safe apnoea time and be used in children with abnormal airways but to date has not been compared with the alternative technique of low-flow nasal oxygenation (LOW-FLOW). The aim is to investigate if use of HIGH-FLOW can reduce the number of hypoxaemic events requiring rescue oxygenation compared with LOW-FLOW. METHODS AND ANALYSIS: High-flow oxygen for children's airway surgery: randomised controlled trial (HAMSTER) is a multicentre, unmasked, randomised controlled, parallel group, superiority trial comparing two oxygenation techniques during anaesthesia. Children (n=530) aged >37 weeks to 16 years presenting for elective tubeless upper airway surgery who fulfil inclusion but not exclusion criteria will be randomised prior to surgery to HIGH-FLOW or LOW-FLOW post induction of anaesthesia. Maintenance of anaesthesia with HIGH-FLOW requires Total IntraVenous Anaesthesia (TIVA) and with LOW-FLOW, either inhalational or TIVA at discretion of anaesthetist. The primary outcome is the incidence of hypoxaemic events requiring interruption of procedure for rescue oxygenation by positive pressure ventilation and the secondary outcome includes total hypoxaemia time, adverse cardiorespiratory events and unexpected paediatric intensive care admission admission. Hypoxaemia is defined as Sp02 <90%. Analysis will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethical approval has been obtained by Children's Health Queensland Human Research Ethics Committee (HREC/18/QRCH/130). The trial commenced recruitment in 2018. The primary manuscript will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER The HAMSTER is registered with the Australia and New Zealand Clinical TrialsRegistry: ACTRN12618000949280.
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Affiliation(s)
- Susan Humphreys
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Britta Sylvia von Ungern-Sternberg
- Anaesthesia, Perth Children's Hospital, Nedlands, Queensland, Australia
- University of Western Australia, Crawley, Western Australia, Australia
| | - Justin Skowno
- Department of Anaesthesia, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tara Williams
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Julia Taylor
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Fiona Taverner
- Department of Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- University of South Australia, Adelaide, South Australia, Australia
| | - Kristen Gibbons
- Statistics, Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Laura Burgoyne
- Department of Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- University of South Australia, Adelaide, South Australia, Australia
| | - David Sommerfield
- Anaesthesia, Perth Children's Hospital, Nedlands, Queensland, Australia
- University of Western Australia, Crawley, Western Australia, Australia
| | - Philip Stephens
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ben Hallett
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Shyan Vijayasekaran
- University of Western Australia, Crawley, Western Australia, Australia
- Ear, Nose and Throat Surgery, Perth Children's Hospital, Nedlands, Queensland, Australia
| | - Nicola Slee
- Department of Surgery; Ear, Nose and Throat, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Hannah Burns
- Department of Surgery; Ear, Nose and Throat, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Marcin Sowa
- Health Economics, The University of Queensland, South Brisbane, Queensland, Australia
| | - Andrew Davidson
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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ORI monitoring allows a reduction of time with hyperoxia in critically ill patients: the randomized control ORI 2 study. Intensive Care Med 2019; 45:1661-1662. [PMID: 31410497 PMCID: PMC6811688 DOI: 10.1007/s00134-019-05732-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/03/2023]
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Vos JJ, Willems CH, van Amsterdam K, van den Berg JP, Spanjersberg R, Struys MMRF, Scheeren TWL. Oxygen Reserve Index. Anesth Analg 2019; 129:409-415. [DOI: 10.1213/ane.0000000000003706] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yoshida K, Isosu T, Noji Y, Ebana H, Honda J, Sanbe N, Obara S, Murakawa M. Adjustment of oxygen reserve index (ORi™) to avoid excessive hyperoxia during general anesthesia. J Clin Monit Comput 2019; 34:509-514. [DOI: 10.1007/s10877-019-00341-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
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Oxygen reserve index (ORi™) contributes to prediction of hypoxemia and patient safety during tracheal stent insertion using rigid bronchoscopy: a case report. J Clin Monit Comput 2018; 33:1011-1014. [DOI: 10.1007/s10877-018-0232-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
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50
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Koishi W, Kumagai M, Ogawa S, Hongo S, Suzuki K. Monitoring the Oxygen Reserve Index can contribute to the early detection of deterioration in blood oxygenation during one-lung ventilation. Minerva Anestesiol 2018; 84:1063-1069. [DOI: 10.23736/s0375-9393.18.12622-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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