Characteristics of cardiopulmonary ultrasonography in patients with reduced postoperative oxygenation index in PACU

Pulsed electromagnetic fields (PEMFs) are used as non-invasive tools to enhance microcirculation and tissue oxygenation, with a modulatory influence on the microvasculature. This study aimed to measure the acute effect of PEMF on muscle oxygenation and its influence on pulmonary oxygen kinetics during exercise. Eighteen male cyclists performed, on different days, a constant-load exercise in both active (ON) and inactive (OFF) PEMF stimulations while deoxyhemoglobin and pulmonary oxygen kinetics, total oxygenation index, and blood lactate were collected. PEMF enhanced muscle oxygenation, with higher values of deoxyhemoglobin both at the primary component and at the steady-state level. Moreover, PEMF accelerated deoxyhemoglobin on-transition kinetic, with a shorter time delay, time constant, and mean response time than the OFF condition. Lactate concentration was higher during stimulation. No differences were found for total oxygenation index and pulmonary oxygen kinetics. Local application of a precise PEMF stimulation can increase the rate of the muscle O2 extraction and utilization. These changes were not accompanied by faster oxygen kinetics, reduced oxygen slow component, or reduced blood lactate level. It seems that oxygen consumption is more influenced by exercise involving large muscle mass like cycling, whereas PEMF might only act at the local level.

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Pathogenetic and predictive value of biomarkers in patients with ALI and lower severity of illness: results from two clinical trials

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00195.2012 ◽

2012 ◽

Vol 303 (8) ◽

pp. L634-L639 ◽

Cited By ~ 42

Author(s):

Ashish Agrawal ◽

Hanjing Zhuo ◽

Sandra Brady ◽

Joseph Levitt ◽

Jay Steingrub ◽

...

Keyword(s):

Clinical Trials ◽

Clinical Outcomes ◽

Predictive Value ◽

Secondary Analysis ◽

Activated Protein C ◽

Oxygenation Index ◽

Severity Of Illness ◽

Plasminogen Activator Inhibitor ◽

High Plasma ◽

Plasminogen Activator Inhibitor 1

Plasma and bronchoalveolar lavage (BAL) biomarkers related to the pathogenesis of acute lung injury (ALI) have previously been associated with poorer clinical outcomes and increased disease severity among patients with ALI. Whether these biomarkers have predictive value in a less severely ill population that excludes septic patients with high APACHE II scores is currently unknown. We tested the association of plasma and BAL biomarkers with physiological markers of ALI severity or clinically relevant outcomes in a secondary analysis of a clinical trial of activated protein C for the treatment of ALI. Plasma plasminogen activator inhibitor-1 (PAI-1) and mini-BAL protein were both significantly associated with increased oxygenation index ( P = 0.02 and 0.01, respectively), whereas there was a trend toward an association between IL-6 and oxygenation index ( P = 0.057). High plasma IL-6, thrombomodulin, and mini-BAL protein were all significantly associated with fewer ventilator-free days (VFDs) ( P = 0.01, 0.01, and 0.05, respectively); no markers were associated with mortality, but we hypothesized that this was due to the small size of our cohort and the low death rate. To confirm these associations in a larger sample, we identified a restricted cohort of patients from the ARDS Network ALVEOLI study with similar baseline characteristics. We retested the associations of the significant biomarkers with markers of severity and clinical outcomes and studied IL-8 as an additional biomarker given its important predictive value in prior studies. In this restricted cohort, IL-6 was significantly associated with oxygenation index ( P = 0.02). Both IL-6 and IL-8 were associated with decreased VFDs and increased 28-day mortality. Future studies should be focused on examining larger numbers of patients with less severe ALI to further test the relative predictive value of plasma and mini-BAL biomarkers for clinically relevant outcomes, including VFDs and mortality, and for their prospective utility in risk stratification for future clinical trials.

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Which common NIRS variable reflects muscle estimated lactate threshold most closely?

Applied Physiology Nutrition and Metabolism ◽

10.1139/h06-069 ◽

2006 ◽

Vol 31 (5) ◽

pp. 612-620 ◽

Cited By ~ 29

Author(s):

Lixin Wang ◽

Takahiro Yoshikawa ◽

Taketaka Hara ◽

Hayato Nakao ◽

Takashi Suzuki ◽

...

Keyword(s):

Lactate Threshold ◽

Near Infrared ◽

Ventilatory Threshold ◽

Lactate Concentration ◽

Blood Lactate Concentration ◽

Oxygenation Index ◽

Muscle Lactate ◽

Tissue Oxygenation Index ◽

The Mean ◽

Tissue Hemoglobin

Various near-infrared spectroscopy (NIRS) variables have been used to estimate muscle lactate threshold (LT), but no study has determined which common NIRS variable best reflects muscle estimated LT. Establishing the inflection point of 2 regression lines for deoxyhaemoglobin (ΔHHbi.p.), oxyhaemoglobin (ΔO2Hbi.p.), and tissue oxygenation index (TOIi.p.), as well as for blood lactate concentration, we then investigated the relationships between NIRS variables and ventilatory threshold (VT), LT, or maximal tissue hemoglobin index (nTHImax) during incremental cycling exercise. ΔHHbi.p. and TOIi.p. could be determined for all 15 subjects, but ΔO2Hbi.p. was determined for only 11 subjects. The mean absolute values for the 2 measurable slopes of the 2 continuous linear regression lines exhibited increased changes in 3 NIRS variables. The workload and VO2 at ΔO2Hbi.p. and nTHImax were greater than those at VT, LT, ΔHHbi.p., and TOIi.p.. For workload and VO2, ΔHHbi.p. was correlated with VT and LT, whereas ΔO2Hbi.p. was correlated with nTHImax, and TOIi.p. with VT and nTHImax. These findings indicate that ΔO2Hb strongly corresponds with local perfusion, and TOI corresponds with both local perfusion and deoxygenation, but that ΔHHb can exactly determine deoxygenation changes and reflect O2 metabolic dynamics. The finding of strongest correlations between ΔHHb and VT or LT indicates that ΔHHb is the best variable for muscle LT estimation.

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Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Journal of Perinatal Medicine ◽

10.1515/jpm-2017-0040 ◽

2018 ◽

Vol 46 (6) ◽

pp. 657-663 ◽

Cited By ~ 6

Author(s):

Satoshi Suzuki ◽

Hajime Togari ◽

Jim L. Potenziano ◽

Michael D. Schreiber

Keyword(s):

Nitric Oxide ◽

Pulmonary Hypertension ◽

Respiratory Failure ◽

Negative Impact ◽

Survival Rates ◽

Oxygenation Index ◽

Inhaled Nitric Oxide ◽

Preterm Neonates ◽

Therapeutic Trial ◽

Hypoxic Respiratory Failure

AbstractObjective:To analyze data from a registry of Japanese neonates with hypoxic respiratory failure associated with pulmonary hypertension (PH) to compare the effectiveness of inhaled nitric oxide (iNO) in neonates born <34 weeks vs. ≥34 weeks gestational age (GA).Materials and methods:iNO was administered according to approved Japanese product labeling. Study data were collected before iNO administration and at predefined intervals until discontinuation.Results:A total of 1,114 neonates were included (n=431, <34 weeks GA; n=675, ≥34 weeks GA; n=8, missing age data). Mean decrease from baseline oxygenation index (OI) was similar in both age groups. OI reduction was more pronounced in the <34 weeks subgroups with baseline OI ≥25. Survival rates were similar in the <34 weeks GA and ≥34 weeks GA groups stratified by baseline OI (OI<15, 89% vs. 93%; 15≤OI<25, 85% vs. 91%; 25≤OI≤40, 73% vs. 79%; OI>40, 64% vs. 66%).Conclusion:iNO improved oxygenation in preterm neonates as effectively as in late preterm and term neonates, without negative impact on survival. If clinically significant PH is present, as measured by pulse oximetry or echocardiography, a therapeutic trial of iNO might be indicated for preterm neonates.

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Surfactant Therapy in Full-term Neonates With Severe Respiratory Failure

PEDIATRICS ◽

10.1542/peds.92.1.135 ◽

1993 ◽

Vol 92 (1) ◽

pp. 135-139

Author(s):

Hatem Khammash ◽

Max Perlman ◽

Julian Wojtulewicz ◽

Michael Dunn

Keyword(s):

Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Oxygenation Index ◽

Meconium Aspiration Syndrome ◽

Full Term ◽

Surfactant Therapy ◽

Term Infants ◽

Meconium Aspiration

Objective. In light of the paucity of published data on the use of surfactant in full-term infants with respiratory failure due to meconium aspiration syndrome and respiratory distress syndrome, we report our experience with this therapy. Our goal was to explore possible justification for randomized controlled trials of surfactant treatment in similar patients at an earlier, less severe stage of the disease. Methods. Retrospective consecutive case series of 20 infants with severe meconium aspiration syndrome and 29 infants with severe respiratory distress syndrome who received bovine surfactant between March 1990 and December 1992 in three neonatal intensive care units in a regionalized setting. Outcome of treatment was assessed by comparing changes in several respiratory indices including the oxygenation index, between 4 and 6 hours and 1 and 3 hours before and after the first dose of surfactant. Differences were analyzed using analysis of variance for repeated measures, with treatment and time as co-variates. Results. In the meconium aspiration group the mean oxygenation index decreased from 36 ± 12 at 1 to 3 hours presurfactant to 24 ± 14 at 1 to 3 hours postsurfactant (P < .001). In the patients with respiratory distress syndrome the mean oxygenation index fell from 30 ± 17 at 1 to 3 hours presurfactant to 12 ± 6 at 1 to 3 hours postsurfactant (P = .0001). Three of 20 patients with meconium aspiration syndrome and 3 of 29 patients with respiratory distress syndrome received extracorporeal membrane oxygenation. Conclusions. Surfactant therapy in full-term infants with respiratory failure due to the meconium aspiration and respiratory distress syndromes is often effective in improving gas exchange. A randomized controlled trial of surfactant therapy at an earlier stage in the course of the illness should be performed.

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Inhaled Epoprostenol for Pulmonary Hypertension Treatment in Neonates: A 12-Year Experience

American Journal of Perinatology ◽

10.1055/s-0038-1676483 ◽

2018 ◽

Vol 36 (11) ◽

pp. 1142-1149 ◽

Cited By ~ 2

Author(s):

Frédérique Berger-Caron ◽

Bruno Piedboeuf ◽

Geneviève Morissette ◽

David Simonyan ◽

Philippe Chétaille ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Side Effects ◽

Retrospective Cohort ◽

Rebound Effect ◽

Oxygenation Index ◽

Pediatric Intensive Care ◽

Primary Objective ◽

Hypertension Treatment ◽

Fraction Of Inspired Oxygen ◽

Inspired Oxygen

Background Persistent pulmonary hypertension of the newborn (PPHN) occurs in 10% of neonatal respiratory insufficiency. To selectively reduce pulmonary vascular resistance, several treatments have been tried. Inhaled epoprostenol (iPGI2) has been used for 12 years in our institution for the management of refractory PPHN despite the gaps in the literature to support this use. Objectives The primary objective was to evaluate the efficacy of iPGI2 for PPHN. The secondary objectives were to describe its use in neonates and assess side effects. Study Design This retrospective cohort study included infants < 28 days with PPHN treated with iPGI2 in the neonatal or pediatric intensive care units of our institution between 2004 and 2016. Results We reviewed 43 patient' care episodes (mean gestational age of 36 weeks). This was an extremely ill population with 54% mortality rate. Oxygenation index improved significantly after 12-hour treatment (p = 0.047), with a rebound effect when discontinuing nebulization. By the end of the therapy, the fraction of inspired oxygen had significantly dropped (p = 0.0018). Echocardiographic markers tended to normalize during treatment. No potential side effects were reported. Conclusion In these sick newborns, we observed an improvement in PPHN under iPGI2 without significant adverse effects. To our knowledge, this is the largest neonatal cohort reported to have received iPGI2 for PPHN.

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Acute Kidney Injury in Pediatric Acute Respiratory Distress Syndrome

Journal of Intensive Care Medicine ◽

10.1177/0885066620944042 ◽

2020 ◽

pp. 088506662094404

Author(s):

Shubhi Kaushik ◽

Sindy Villacres ◽

Ruth Eisenberg ◽

Shivanand S. Medar

Keyword(s):

Acute Kidney Injury ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Kidney Injury ◽

Oxygenation Index ◽

Significant Difference

Objectives: To describe the incidence of and risk factors for acute kidney injury (AKI) in children with acute respiratory distress syndrome (ARDS) and study the effect of AKI on patient outcomes. Design: A single-center retrospective study. Setting: A tertiary care children’s hospital. Patients: All patients less than 18 years of age who received invasive mechanical ventilation (MV) and developed ARDS between July 2010 and July 2013 were included. Acute kidney injury was defined using p-RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria. Interventions: None. Measurements and Main Results: One hundred fifteen children met the criteria and were included in the study. Seventy-four children (74/115, 64%) developed AKI. The severity of AKI was risk in 34 (46%) of 74, injury in 19 (26%) of 74, and failure in 21 (28%) of 74. The presence of AKI was associated with lower Pao 2 to Fio 2 (P/F) ratio ( P = .007), need for inotropes ( P = .003), need for diuretics ( P = .004), higher oxygenation index ( P = .03), higher positive end-expiratory pressure (PEEP; P = .01), higher mean airway pressure ( P = .008), and higher Fio 2 requirement ( P = .03). Only PEEP and P/F ratios were significantly associated with AKI in the unadjusted logistic regression model. Patients with AKI had a significantly longer duration of hospital stay, although there was no significant difference in the intensive care unit stay, duration of MV, and mortality. Recovery of AKI occurred in 68% of the patients. A multivariable model including PEEP, P/F ratio, weight, need for inotropes, and need for diuretics had a better receiver operating characteristic (ROC) curve with an AUC of 0.75 compared to the ROC curves for PEEP only and P/F ratio only for the prediction of AKI. Conclusions: Patients with ARDS have high rates of AKI, and its presence is associated with increased morbidity and mortality.

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