RESUMEN
BACKGROUND: PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS. METHODS: Children receiving mechanical ventilation and on pressure-controlled volume-guaranteed mode were prospectively assessed for inclusion. PEEP was sequentially changed to 5, 12, 10, 8 cm H2O, and again to 5 cm H2O. After 10 min at each PEEP level, hemodynamic, ventilatory, and oxygenation variables were collected. RESULTS: A total of 31 subjects were included, with median age and weight of 6 months and 6.3 kg, respectively. The main reasons for pediatric ICU admission were respiratory failure caused by acute viral bronchiolitis (45%) and community-acquired pneumonia (32%). Most subjects had mild or moderate ARDS (45% and 42%, respectively), with a median (interquartile range) oxygenation index of 8.4 (5.8-12.7). Oxygen saturation improved significantly when PEEP was increased. However, although no significant changes in blood pressure were observed, the median cardiac index at PEEP of 12 cm H2O was significantly lower than that observed at any other PEEP level (P = .001). Fourteen participants (45%) experienced a reduction in cardiac index of > 10% when PEEP was increased to 12 cm H2O. Also, the estimated oxygen delivery was significantly lower, at 12 cm H2O PEEP. Finally, respiratory system compliance significantly reduced when PEEP was increased. At a PEEP of 12 cm H2O, static compliance had a median reduction of 25% in relation to the initial assessment (PEEP of 5 cm H2O). CONCLUSIONS: Although it may improve arterial oxygen saturation, inappropriately high PEEP levels may reduce cardiac output, oxygen delivery, and respiratory system compliance in pediatric subjects with ARDS with low potential for lung recruitability.
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Hemodinámica , Respiración con Presión Positiva , Síndrome de Dificultad Respiratoria , Mecánica Respiratoria , Humanos , Respiración con Presión Positiva/métodos , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/fisiopatología , Masculino , Lactante , Femenino , Mecánica Respiratoria/fisiología , Estudios Prospectivos , Preescolar , Niño , Saturación de Oxígeno/fisiología , Oxígeno/sangreRESUMEN
Near-infrared spectroscopy combined with vascular occlusion test (NIRS-VOT) is a reactive hyperemia technique for in vivo evaluation of skeletal muscle microvascular reactivity. Previous studies using NIRS-VOT have been shown to be able to detect impairments in microvascular function in high-risk cardiovascular disease populations, such as older individuals. It has been demonstrated that older individuals have slower reactive hyperemia compared with young individuals. Importantly, older individuals also show less desaturation during ischemia compared with young individuals. Based on these findings, it has been suggested that the slower reactive hyperemia observed in older individuals is explained by the lower desaturation during blood flow occlusion (reduced ischemic stimulus). This retrospective analysis compared reactive hyperemia in 36 young and 47 older tissue desaturation-matched individuals that underwent 5-min blood flow occlusion. Overall, we showed that older individuals have impaired reactive hyperemia compared with young when matching for the degree of desaturation and blood flow occlusion time. These findings provide evidence that lower tissue desaturation during ischemia is not a major determinant of impaired reactive hyperemia in older individuals.NEW & NOTEWORTHY Previous findings have suggested that aging-related impairment in skeletal muscle reactive hyperemia is majorly influenced by a lower degree of tissue desaturation during ischemia in older individuals compared with young individuals. In a retrospective analysis including 83 tissue desaturation-matched individuals, we show that the degree of tissue desaturation is not a major determinant of aging-related impairments in reactive hyperemia.
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Envejecimiento , Hiperemia , Microcirculación , Músculo Esquelético , Flujo Sanguíneo Regional , Espectroscopía Infrarroja Corta , Hiperemia/fisiopatología , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiopatología , Humanos , Estudios Retrospectivos , Masculino , Envejecimiento/metabolismo , Envejecimiento/fisiología , Anciano , Femenino , Adulto , Adulto Joven , Persona de Mediana Edad , Factores de Edad , Isquemia/fisiopatología , Isquemia/metabolismo , Oxígeno/sangre , Oxígeno/metabolismoRESUMEN
BACKGROUND: Anemia prevalence is high in countries where high proportion of the population lives at high altitude (HA) due perhaps to the unsuitability hemoglobin correction factor proposed by the WHO. The present study has been designed to evaluate a new approach to establish thresholds of hemoglobin (Hb) when defining anemia at HA. MATERIALS & METHODS: Cross-sectional study evaluating 217 women aged 18 to 75 years-old, residents of 2 cities at low altitude (LA) (130 and 150 meters) and 2 at HA (3800 and 4300 meters). Hb, pulse oxygen saturation (SpO2), arterial oxygen content (CaO2), and inflammatory markers were measured. Three definitions of anemia diagnoses were used: uncorrected Hb, WHO-corrected Hb, and Silubonde's criteria based on ferritin as a gold standard. STATA v18.0 was use for data analysis, p<0.05 indicated significant difference. RESULTS: HA residents present higher Hb values than at LA. Likewise, the highest area under the curve (AUC) ROC (Receiver Operating Characteristic) was observed for uncorrected Hb (AUC = 0.8595; CI95% 0.858-0.86) for the diagnosis of anemia using serum ferritin as the gold standard. Anemia prevalence was higher when using WHO-corrected Hb, 27%, and Silubonde's criteria, 41% (Hb cut-off of 11.10, 12.73, 15.80 and 16.60 g/dl for altitudes of 130, 150, 3800 and 4300 meters, respectively), than using uncorrected Hb to define anemia (7.7%). Serum Ferritin and CaO2 values are lower only in the group with anemia defined with uncorrected Hb than in the groups of anemia using the WHO-corrected Hb or the Silubonde´s criteria. CONCLUSIONS: The correction factor of hemoglobin for altitude of residence overestimates the prevalence of anemia in adult women. Likewise, CaO2 could be a potential marker to determine the transport of oxygen in LA and HA populations. Further studies in adult men are required to confirm the present findings.
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Altitud , Anemia , Hemoglobinas , Humanos , Femenino , Persona de Mediana Edad , Adulto , Perú/epidemiología , Anemia/sangre , Anemia/epidemiología , Anemia/diagnóstico , Hemoglobinas/análisis , Hemoglobinas/metabolismo , Anciano , Estudios Transversales , Adolescente , Adulto Joven , Prevalencia , Ferritinas/sangre , Curva ROC , Oxígeno/sangreRESUMEN
OBJECTIVE: To define percentile charts for arterial oxygen saturation (SpO2), heart rate (HR), and cerebral oxygen saturation (crSO2) during the first 15 minutes after birth in neonates born very or extremely preterm and with favorable outcome. STUDY DESIGN: We conducted a secondary-outcome analysis of neonates born preterm included in the Cerebral regional tissue Oxygen Saturation to Guide Oxygen Delivery in preterm neonates during immediate transition after birth III (COSGOD III) trial with visible cerebral oximetry measurements and with favorable outcome, defined as survival without cerebral injuries until term age. We excluded infants with inflammatory morbidities within the first week after birth. SpO2 was obtained by pulse oximetry, and electrocardiogram or pulse oximetry were used for measurement of HR. crSO2 was assessed with near-infrared spectroscopy. Measurements were performed during the first 15 minutes after birth. Percentile charts (10th to 90th centile) were defined for each minute. RESULTS: A total of 207 neonates born preterm with a gestational age of 29.7 (23.9-31.9) weeks and a birth weight of 1200 (378-2320) g were eligible for analyses. The 10th percentile of SpO2 at minute 2, 5, 10, and 15 was 32%, 52%, 83%, and 85%, respectively. The 10th percentile of HR at minute 2, 5, 10, and 15 was 70, 109, 126, and 134 beats/min, respectively. The 10th percentile of crSO2 at minute 2, 5, 20, and 15 was 15%, 27%, 59%, and 63%, respectively. CONCLUSIONS: This study provides new centile charts for SpO2, HR, and crSO2 for neonates born extremely or very preterm with favorable outcome. Implementing these centiles in guiding interventions during the stabilization process after birth might help to more accurately target oxygenation during postnatal transition period.
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Frecuencia Cardíaca , Recien Nacido Extremadamente Prematuro , Oximetría , Saturación de Oxígeno , Humanos , Recién Nacido , Frecuencia Cardíaca/fisiología , Saturación de Oxígeno/fisiología , Femenino , Masculino , Oximetría/métodos , Valores de Referencia , Espectroscopía Infrarroja Corta , Recien Nacido Prematuro , Oxígeno/metabolismo , Oxígeno/sangre , Encéfalo/metabolismo , Edad GestacionalRESUMEN
The aim of this study was to determine the minimum anesthetic concentration of isoflurane (MACISO) and sevoflurane (MACSEVO) and evaluate the cardiorespiratory changes induced by varying fractions of inspired oxygen (FiO2) in Magellanic penguins (Spheniscus magellanicus). Twenty adult penguins (3.53 ± 0.44 kg) of undetermined sex were used. Both MACISO (n = 9) and MACSEVO (n = 13) were established using an up-and-down design. Next, twelve mechanically ventilated penguins were maintained at 1 MACISO or 1 MACSEVO (n = 6 per group) with the FiO2 initially set at 1.0. Three FiO2 values (0.6, 0.4 and 0.2) were then held constant during anesthesia for 20 minutes each. Arterial blood samples were collected for gas analysis after the 20-minute period for each FiO2. Mean ± SD MACISO was 1.93 ± 0.10% and MACSEVO was 3.53 ± 0.13%. Other than heart rate at 0.6 FiO2 (86 ± 11 beats/minute in MACISO and 132 ± 37 beats/minute in MACSEVO; p = 0.041), no significant cardiorespiratory differences were detected between groups. In both groups, decreasing the FiO2 produced increased pH values and reduced partial pressures of carbon dioxide and bicarbonate. Partial pressures of oxygen (PaO2) gradually lowered from 1.0 FiO2 through 0.2 FiO2, though hypoxemia (PaO2 < 80 mmHg) occurred only with the latter FiO2. The MACISO and the MACSEVO for the Magellanic penguin fell within the upper range of reported avian MAC estimates. To prevent hypoxemia in healthy, mechanically ventilated, either isoflurane- or sevoflurane-anesthetized Magellanic penguins, a minimum FiO2 of 0.4 should be used.
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Anestésicos por Inhalación , Isoflurano , Oxígeno , Sevoflurano , Spheniscidae , Animales , Spheniscidae/fisiología , Isoflurano/farmacología , Isoflurano/administración & dosificación , Sevoflurano/farmacología , Anestésicos por Inhalación/farmacología , Anestésicos por Inhalación/administración & dosificación , Oxígeno/sangre , Frecuencia Cardíaca/efectos de los fármacos , Masculino , Anestesia por Inhalación/veterinaria , Femenino , Análisis de los Gases de la Sangre/veterinariaRESUMEN
Monitoring intracranial pressure (ICP) is pivotal in the management of severe traumatic brain injury (TBI), but secondary brain injuries can arise despite normal ICP levels. Cerebral tissue oxygenation monitoring (PbtO2) may detect neuronal tissue infarction thresholds, enhancing neuroprotection. We performed a systematic review and meta-analysis to evaluate the effects of combined cerebral tissue oxygenation (PbtO2) and ICP compared to isolated ICP monitoring in patients with TBI. PubMed, Embase, Cochrane, and Web of Sciences databases were searched for trials published up to June 2023. A total of 16 studies comprising 37,820 patients were included. ICP monitoring was universal, with additional placement of PbtO2 in 2222 individuals (5.8%). The meta-analysis revealed a reduction in mortality (OR 0.57, 95% CI 0.37-0.89, p = 0.01), a greater likelihood of favorable outcomes (OR 2.28, 95% CI 1.66-3.14, p < 0.01), and a lower chance of poor outcomes (OR 0.51, 95% CI 0.34-0.79, p < 0.01) at 6 months for the PbtO2 plus ICP group. However, these patients experienced a longer length of hospital stay (MD 2.35, 95% CI 0.50-4.20, p = 0.01). No significant difference was found in hospital mortality rates (OR 0.81, 95% CI 0.61-1.08, p = 0.16) or intensive care unit length of stay (MD 2.46, 95% CI - 0.11-5.04, p = 0.06). The integration of PbtO2 to ICP monitoring improved mortality outcomes and functional recovery at 6 months in patients with TBI. PROSPERO (International Prospective Register of Systematic Reviews) CRD42022383937; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=383937.
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Lesiones Traumáticas del Encéfalo , Presión Intracraneal , Humanos , Lesiones Traumáticas del Encéfalo/terapia , Lesiones Traumáticas del Encéfalo/mortalidad , Lesiones Traumáticas del Encéfalo/fisiopatología , Presión Intracraneal/fisiología , Monitorización Neurofisiológica/métodos , Oxígeno/metabolismo , Oxígeno/sangre , Encéfalo/metabolismo , Encéfalo/fisiopatología , Monitoreo Fisiológico/métodosRESUMEN
La sangre normalmente transporta pequeñas cantidades de oxígeno (O2) disuelto en el plasma y altas cantidades combinadas en forma química con la hemoglobina. La presión parcial depende solo del oxígeno disuelto físicamente, lo que determina cuánto oxígeno se combinará con hemoglobina. La curva de disociación de la hemoglobina describe la reversibilidad de la reacción entre oxígeno y hemoglobina. Los factores habituales que aumentan o disminuyen la afinidad de la hemoglobina por el oxígeno son el pH, presión parcial de CO2, temperatura y 2,3 difosfoglicerato. La sangre también transporta grandes cantidades en forma de bicarbonato y bajas cantidades de CO2 disuelto en plasma y combinado con proteínas como compuestos carbamino. La desoxihemoglobina favorece la formación de compuestos carbamínicos y promueve el transporte del CO2 como bicarbonato uniéndose al hidrógeno proveniente de la disociación del ácido carbónico. A continuación se describe en forma detallada los mecanismos fisiológicos del transporte de gases en sangre.
Blood normally carries small amounts of oxygen dissolved in plasma and large amounts chemically combined with hemoglobin. Partial pressure of oxygen depends only on physically dissolved oxygen which determines how much oxygen will combine with hemoglobin. The oxygen-hemoglobin dissociation curve (or oxyhemoglobin dissociation curve) describes the reversibility of the reaction between oxygen and hemoglobin. The usual factors that increase or decrease the affinity of hemoglobin for oxygen are pH, CO2 partial pressure, temperature, and 2,3 diphosphoglycerate. Blood also carries large amounts of CO2 as bicarbonate and low amounts dissolved in plasma and combined with proteins as carbamino compounds. Deoxyhemoglobin favors the formation of carbamino compounds and promotes the transport of CO2 as bicarbonate by joining the hydrogen from the dissociation of carbonic acid. The physiological mechanisms of gas transport in blood are described in detail below.
Asunto(s)
Humanos , Oxígeno/sangre , Fenómenos Fisiológicos Respiratorios , Dióxido de Carbono/sangre , Transferencia de OxígenoRESUMEN
BACKGROUND: Hospital bed saturation has been one of the problems to solve during the SARS-CoV-2 pandemic. However, not every patient who is admitted requires close monitoring or specific therapeutics. Mild cases could be managed in the outpatient setting. OBJECTIVE: Our study aimed to analyze the accuracy of the oxygen saturation/respiratory rate (sat/RR) index, NEWS2, CURB65, and quick Sequential Organ Failure Assessment (qSOFA) scores to predict supplemental oxygen requirement and prolonged hospital stay in patients with mild coronavirus disease 2019 (COVID-19). METHODS: A prospective cohort study in an academic medical center. We compared the values of these scores according to the occurrence or not of each outcome. When differences between groups were statistically significant, the discriminatory capacity of the score for that outcome was analyzed. RESULTS: We included 271 patients. Of them, 11.07% required supplemental oxygen, showing significantly higher values of NEWS2 score and qSOFA score, and lower values of Sat/RR index. About 38% presented prolonged hospital stay, with significantly higher values of NEWS2 score and lower values of sat/RR index. The ROC curve area under the curve (AUC) of sat/RR index to discriminate the requirement of supplemental oxygen was 0.72 (CI 95% 0.61-0.84). The ROC curve of NEWS2 and qSOFA for the same outcome was 0.75 (95% [95% CI 0.65-0.85]) and 0.66 (95% CI 0.57-0.76), respectively. The ability of the Sat/RR index to discriminate the requirement of prolonged hospitalization showed an AUC of 0.67 (95% [95% CI 0.60- 0.73]). The NEWS2 score showed an AUC of 0.63 (CI 95% 0.56-0.70) for the same outcome. CONCLUSIONS: sat/RR index and NEWS2 score have a good capacity to discriminate patients at risk of clinical worsening, being the Sat/RR index simpler and easier to calculate.
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COVID-19/diagnóstico , Puntuaciones en la Disfunción de Órganos , Oxígeno/sangre , Frecuencia Respiratoria , Centros Médicos Académicos , Adulto , Anciano , Argentina , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
BACKGROUND/AIMS: Chronic kidney disease is frequently accompanied by anemia, hypoxemia, and hypoxia. It has become clear that the impaired erythropoietin production and altered iron homeostasis are not the sole causes of renal anemia. Eryptosis is a process of red blood cells (RBC) death, like apoptosis of nucleated cells, characterized by Ca2+ influx and phosphatidylserine (PS) exposure to the outer RBC membrane leaflet. Eryptosis can be induced by uremic toxins and occurs before senescence, thus shortening RBC lifespan and aggravating renal anemia. We aimed to assess eryptosis and intracellular oxygen levels of RBC from hemodialysis patients (HD-RBC) and their response to hypoxia, uremia, and uremic toxins uptake inhibition. METHODS: Using flow cytometry, RBC from healthy individuals (CON-RBC) and HD-RBC were subjected to PS (Annexin-V), intracellular Ca2+ (Fluo-3/AM) and intracellular oxygen (Hypoxia Green) measurements, at baseline and after incubation with uremic serum and/or hypoxia (5% O2), with or without ketoprofen. Baseline levels of uremic toxins were quantified in serum and cytosol by high performance liquid chromatography. RESULTS: Here, we show that HD-RBC have less intracellular oxygen and that it is further decreased post-HD. Also, incubation in 5% O2 and uremia triggered eryptosis in vitro by exposing PS. Hypoxia itself increased the PS exposure in HD-RBC and CON-RBC, and the addition of uremic serum aggravated it. Furthermore, inhibition of the organic anion transporter 2 with ketoprofen reverted eryptosis and restored the levels of intracellular oxygen. Cytosolic levels of the uremic toxins pCS and IAA were decreased after dialysis. CONCLUSION: These findings suggest the participation of uremic toxins and hypoxia in the process of eryptosis and intracellular oxygenation.
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Eriptosis , Eritrocitos/metabolismo , Oxígeno/sangre , Insuficiencia Renal Crónica/sangre , Uremia/sangre , Adolescente , Adulto , Anciano , Anexina A5/sangre , Calcio/sangre , Hipoxia de la Célula , Eritrocitos/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/patología , Uremia/patologíaRESUMEN
BACKGROUND: Combined exercise training (CET) has been associated with positive responses in the clinical status of patients with heart failure (HF). Other nonpharmacological tools, such as amino acid supplementation, may further enhance its adaptation. The aim was to test whether CET associated with supplementing carnosine precursors could present better responses in the functional capacity and biochemical variables of rats with HF. METHODS: Twenty-one male Wistar rats were subjected to myocardial infarction and allocated to three groups: sedentary (SED, n = 7), CET supplemented with placebo (CETP, n = 7), and CET with HF supplemented with ß-alanine and L-histidine (CETS, n = 7). The trained animals were submitted to a strength protocol three times per week. Aerobic training was conducted twice per week. The supplemented group received ß-alanine and L-histidine orally (250 mg/kg per day). RESULTS: Maximum oxygen uptake, running distance, time to exhaustion and maximum strength were higher in the CET-P group than that in the SED group and even higher in the CET-S group than that in the CET-P group (P < 0.01). CET-S showed lower oxidative stress and inflammation markers and higher heat shock protein 72 kDa content and mRNA expression for calcium transporters in the skeletal muscle compared to SED. CONCLUSION: CET together with ß-alanine and L-histidine supplementation in rats with HF can elicit adaptations in both maximum oxygen uptake, running distance, time to exhaustion, maximum strength, oxidative stress, inflammation and mRNA expression. Carnosine may influence beneficial adjustments in the cell stress response in the skeletal muscle and upregulate the mRNA expression of calcium transporters.
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Carnosina/farmacología , Insuficiencia Cardíaca , Oxígeno/sangre , Condicionamiento Físico Animal , Animales , Modelos Animales de Enfermedad , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Histidina/farmacología , Masculino , Ratas , Ratas Wistar , beta-Alanina/farmacologíaRESUMEN
OBJECTIVE: The aim was to determine the effects of chronic intermittent hypobaric hypoxia (CIHH) on prostate-specific antigen (PSA) levels in Chilean miners who work at different altitudes. METHODS: A cross-sectional study was conducted between April and July 2019. Miners from five mines (N=338) at different altitudes were evaluated. We recorded sociodemographic, working and altitude information. Haemoglobin oxygen saturation (SaO2) and haemoglobin (Hb) were measured in situ, while PSA and testosterone were analysed at a low level. Linear mixed-effect models were used to evaluate the association between PSA level and two CIHH exposures: composite CIHH (with four descriptors) and ChileStd-CIHH (CIHH Chilean standard; based on the Chilean technical guide for occupational exposure to CIHH). All models were adjusted by age, body mass index and day of the work the samples were taken. RESULTS: Highest and lowest PSA levels were found in mines ≥3000 m above sea level (mine 3: median=0.75, IQR=-0.45; mine 4: median=0.46, IQR=-0.35). In the multilevel models, the wider altitude difference between mining operation and camp showed lower PSA levels (model D: ßPSA=-0.93 ng/mL, ßlogPSA=-0.07, p<0001), adjusted for other CIHH descriptors, SaO2, Hb and testosterone. The descriptors of composite CIHH explained better PSA variations than ChileStd-CIHH (model D: marginal R2=0.090 vs model A: marginal R2=0.016). CONCLUSIONS: Occupational health regulations and high altitude medicine should consider these results as initial evidence on the inclusion of new descriptors for CIHH and the possible effect of this exposure on PSA levels in this male-dominated occupational sector.
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Mal de Altura/complicaciones , Mineros/estadística & datos numéricos , Enfermedades Profesionales/etiología , Antígeno Prostático Específico/sangre , Adulto , Mal de Altura/epidemiología , Mal de Altura/etiología , Chile/epidemiología , Estudios Transversales , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Minería/estadística & datos numéricos , Enfermedades Profesionales/epidemiología , Oxígeno/sangre , Adulto JovenRESUMEN
In Colombia, there are Kangaroo Mother Care Programs (KMCP) for the follow-up of premature infants discharged early from neonatal units. In Bogotá, a considerable number of these children require oxygen at home. These infants are followed in KMCP where, in addition to controlling growth and development, oxygen saturation is monitored and weaning from oxygen supplements is performed. The results obtained are particularly good. However, it is striking that more than half of the children who require oxygen at home are more than 32 weeks of gestational age, and most of them meet the criteria for bronchopulmonary dysplasia. There are several reasons that could justify this finding. On the one hand, if the hospital stay is shortened, as is the case with KMCP programs, it is more likely that some preterm infants need oxygen at discharge. On the other hand, the use of noninvasive ventilation is extremely limited and invasive ventilation continues to be used very frequently, which is associated with lung damage and the need for oxygen. Finally, we must not forget that Bogotá is 2600 m above sea level, and this can lead to a more difficult adaptation of premature infants. It is not clear how much each of the above factors contributes. It would be desirable to have more information to better understand the particularities of premature children in the city of Bogotá.
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Displasia Broncopulmonar , Método Madre-Canguro , Displasia Broncopulmonar/terapia , Niño , Colombia , Humanos , Recién Nacido , Recien Nacido Prematuro , Oxígeno/sangre , Terapia por Inhalación de OxígenoRESUMEN
OBJECTIVE: To study the impact of an oxygen management strategy incorporating oxygen saturation (SpO2) targeting and fraction of inspired oxygen monitoring on the incidence of retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and mortality. STUDY DESIGN: This retrospective cohort study analyzed the incidence of any ROP, severe ROP, ROP requiring treatment (surgery and/or bevacizumab), BPD, and mortality among 23-28 weeks of gestational age infants admitted to the neonatal intensive care unit in 3 epochs: Epoch 1 (2007-2010) before implementation of SpO2 histograms; Epoch 2 (2012-2014), with development of a software tool capable of generating automatic bedside SpO2 histograms; and Epoch 3 (2016-2019), with further software enhancements, incorporating simultaneous SpO2 and fraction of inspired oxygen measurements. RESULTS: During Epochs 1, 2, and 3, there were 601, 381, and 550 eligible infants, respectively, for a total of 1532 eligible infants. Mortality, any ROP, severe ROP, ROP needing treatment, and BPD all showed significant downward trends across the 3 epochs. The aOR of mortality was significantly lower in Epoch 3 compared with Epoch 1 (aOR 0.48). The aORs of any ROP and of BPD were significantly lower in Epochs 2 and 3 compared with Epoch 1 (respectively, ROP aORs 0.53 and 0.38; BPD aOR 0.43 and 0.43). The aOR of ROP needing treatment was significantly lower in Epoch 3 compared with Epoch 1 (aOR 0.43). CONCLUSIONS: We have demonstrated improvement in rates of mortality, any ROP, ROP requiring treatment, and BPD after implementation of a novel oxygen management strategy.
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Displasia Broncopulmonar/prevención & control , Oxígeno/sangre , Retinopatía de la Prematuridad/prevención & control , Displasia Broncopulmonar/etiología , Humanos , Lactante , Mortalidad Infantil , Recien Nacido Extremadamente Prematuro , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Oxígeno/efectos adversos , Retinopatía de la Prematuridad/etiología , Estudios RetrospectivosRESUMEN
Background: To evaluate the functional capacity in children and adolescents with cystic fibrosis (CF) through the pediatric Glittre ADL-test (TGlittre-P) and its implications for respiratory mechanics, physiological parameters and clinical markers. Methods: Impulse oscillometry system (IOS) parameters, vital signs (heart rate, respiratory rate and blood pressure), perception of dyspnea and peripheral oxygen saturation (SpO2) were assessed before and immediately after the TGlittre-P. Test performance was correlated with age, quality of life, disease severity, nutrition, spirometry and IOS parameters. Results: Twenty-six patients were included thirteen boys, mean age of 9.54 ± 1.94 and FEV1 of 71.45%±22.67%. The mean time to complete the test was 2.94 min, similar to that predicted for healthy children. There was a correlation of time with age, as well as with some IOS parameters. Disease severity, spirometric parameters, nutritional aspects and quality of life (QoL) were correlated with performance in the TGlittre-P. Immediate increase of vital signs and decline in SpO2 were observed after the test, without an impact on IOS parameters. Conclusion: Patients with CF showed similar performance and changes of vital signs at the TGlittre-P compared to reference values for healthy children. There were no immediate changes in parameters for the assessed respiratory mechanics. Also, there was no correlation of time to complete the TGLittre-P test with respiratory mechanics, physiological parameters and clinical markers.
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Actividades Cotidianas , Fibrosis Quística/fisiopatología , Disnea/fisiopatología , Calidad de Vida , Mecánica Respiratoria/fisiología , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Oxígeno/sangre , Pruebas de Función Respiratoria , Signos Vitales/fisiologíaRESUMEN
OBJECTIVE: To assess the procedural and clinical outcomes associated with the introduction of minimally invasive surfactant therapy (MIST) into standard care at 2 tertiary Australian neonatal intensive care units. STUDY DESIGN: A prospective audit was designed before the introduction of MIST in 2018, with data collected over a period of 18 months. Procedural data were completed by the clinical team performing MIST, including clinical observations, medication use, and adverse events. The audit team collected demographic data and subsequent clinical outcomes from medical records. RESULTS: There were 135 MIST procedures recorded in 122 infants. For the included infants, the median gestation was 302/7 weeks (IQR, 276/7 to 322/7 weeks) and birth weight was 1439 g (IQR, 982-1958 g). During the MIST procedure, desaturation to a peripheral oxygen saturation of <80% was common, occurring in 75.2% of procedures. Other adverse events included need for positive pressure ventilation (10.6%) and bradycardia <100 beats per minute (13.3%). The use of atropine premedication was associated with a significantly lower incidence of bradycardia: 8.6% vs 52.9% (P < .01). Senior clinicians demonstrated higher rates of procedural success. The majority of infants (63.9%) treated with MIST did not require subsequent intubation and mechanical ventilation. CONCLUSIONS: MIST can be successfully introduced in neonatal units with limited experience of this technique. The use of atropine premedication decreases the incidence of bradycardia during the procedure. Success rates can be optimized by limiting MIST to clinicians with greater competence in endotracheal intubation.
Asunto(s)
Intubación Intratraqueal , Surfactantes Pulmonares/administración & dosificación , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Antiarrítmicos/uso terapéutico , Atropina/uso terapéutico , Australia/epidemiología , Bradicardia/etiología , Bradicardia/prevención & control , Auditoría Clínica , Competencia Clínica , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Oxígeno/sangre , Respiración con Presión Positiva/estadística & datos numéricos , Premedicación , Estudios ProspectivosRESUMEN
BACKGROUND AND OBJECTIVES: Day-case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes. METHODS: We enrolled 120 patients (2-7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg-1 in addition to either propofol (1 mg.kg-1) or dexmedetomidine (0.5 µg.kg-1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored. RESULTS: There was no significant difference in hemodynamics between the groups. The Propofol-Ketamine (P-K) group showed significantly shorter recovery times than the Dexmedetomidine-Ketamine (D-K) group (21.25 and 29.75 minutes respectively, p <0.001). The P-K group showed more oxygen desaturation. Eleven and six patients experienced SpO2 <92% in groups P-K and D-K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D-K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P-K group, respectively (p=0.001). The P-K group showed less post-procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction. CONCLUSIONS: The P-K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D-K combination showed less need for additional doses. REGISTRATION NUMBER: Clinical trials.gov (NCT02863861).
Asunto(s)
Anestésicos Combinados/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Dexmedetomidina/administración & dosificación , Endoscopía Gastrointestinal , Hipnóticos y Sedantes/administración & dosificación , Propofol/administración & dosificación , Analgésicos/administración & dosificación , Periodo de Recuperación de la Anestesia , Presión Sanguínea/efectos de los fármacos , Niño , Preescolar , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipotensión/inducido químicamente , Ketamina/administración & dosificación , Masculino , Oxígeno/sangre , Factores de TiempoRESUMEN
Abstract Background and objectives Day-case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes. Methods We enrolled 120 patients (2−7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg-1 in addition to either propofol (1 mg.kg-1) or dexmedetomidine (0.5 µg.kg-1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored. Results There was no significant difference in hemodynamics between the groups. The Propofol-Ketamine (P-K) group showed significantly shorter recovery times than the Dexmedetomidine-Ketamine (D-K) group (21.25 and 29.75 minutes, respectively, p < 0.001). The P-K group showed more oxygen desaturation. Eleven and 6 patients experienced SpO2 < 92% in groups P-K and D-K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D-K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P-K group, respectively (p = 0.001). The P-K group showed less post-procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction. Conclusions The P-K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D-K combination showed less need for additional doses. Registration number Clinical trials.gov (NCT02863861).
Resumo Justificativa e objetivos A sedação ambulatorial pediátrica é um desafio. A dexmedetomidina é um analgésico sedativo que não induz à depressão respiratória. Comparamos a dexmedetomidina ao propofol quando associados à cetamina para sedação durante endoscopia pediátrica, quanto ao tempo de recuperação e às alterações hemodinâmicas. Métodos Foram recrutados 120 pacientes (2−7 anos de idade) que foram aleatoriamente alocados em dois grupos. Cada paciente recebeu cetamina IV na dose de 1 mg.kg‐1, além de propofol (1 mg.kg‐1) ou dexmedetomidina (0,5 µg.kg‐1). Comparamos o tempo de recuperação. A hemodinâmica, saturação de oxigênio, necessidade de doses adicionais, complicações pós‐operatórias e satisfação do endoscopista foram monitoradas. Resultados Não houve diferença significante entre os grupos no que diz respeito à hemodinâmica. O grupo Propofol‐Cetamina (P‐C) apresentou tempos de recuperação significantemente mais curtos do que o grupo Dexmedetomidina‐Cetamina (D‐C) (21,25 e 29,75 minutos respectivamente, p < 0,001). Observou‐se frequência maior de dessaturação de oxigênio no grupo P‐C. Onze e 6 pacientes apresentaram SpO2 < 92% nos grupos P‐C e D‐C, respectivamente. Uma diferença significante foi observada em relação à necessidade de doses adicionais; 10% dos pacientes no grupo D‐C precisaram de uma dose extra e 5% precisaram de duas doses extras, em comparação com 25% e 20% no grupo P‐C, respectivamente (p = 0,001). O grupo P‐C apresentou menos náuseas e vômitos após o procedimento. Não houve diferença estatisticamente significante entre os dois grupos em relação à satisfação do endoscopista. Conclusões A combinação P‐C foi associada a tempo mais curto de recuperação na endoscopia digestiva alta pediátrica, enquanto a combinação D‐C mostrou menor necessidade de doses adicionais. Número de registro Clinical trials.gov (NCT02863861).