Mai-Anh Nay, Lucie Fromont, Axelle Eugene, Jean-Louis Marcueyz, Willy-Serge Mfam, Olivier Baert, Francis Remerand, Céline Ravry, Auvet Auvet, Thierry Boulain
BACKGROUND: We aimed to determine whether high-flow nasal oxygen could reduce the incidence of decreased peripheral oxygen saturation (SpO2 ) compared with standard oxygen in patients at risk of hypoxaemia undergoing gastrointestinal endoscopy under deep sedation. METHODS: This was a multicentre, randomised controlled trial with blinded assessment of the primary outcome evaluating high-flow nasal oxygen (gas flow 70 L min-1 , inspired oxygen fraction 0.50) or standard oxygen delivered via nasal cannula or face mask (6 L min-1 ) or nasopharyngeal tube (5 L min-1 ) in patients at risk of hypoxaemia (i...
April 28, 2021: British Journal of Anaesthesia
Jay M J R Carr, Hannah G Caldwell, Philip N Ainslie
NEW FINDINGS: What is the topic of this review? Cerebrovascular reactivity to CO2 is a principle factor in determining ventilatory responses to CO2 through the role reactivity plays in determining cerebral extra- and intra-cellular pH. What advances does it highlight? Recent animal evidence suggests central chemoreceptor vasculature may demonstrate regionally heterogenous cerebrovascular reactivity to CO2 , potentially as a protective mechanism against excessive CO2 washout from the central chemoreceptors, thereby allowing ventilation to reflect the systemic acid-base balance needs (respiratory changes in PaCO2 ) rather than solely the cerebral needs...
May 1, 2021: Experimental Physiology
Peter Santer, Karuna Wongtangman, Mandeep S Sawhney, Matthias Eikermann
No abstract text is available yet for this article.
April 27, 2021: British Journal of Anaesthesia
Yet Hong Khor, Yvonne Ng, Duncan Sweeney, Christopher J Ryerson
BACKGROUND: Patients with interstitial lung disease (ILD) are at risk of developing nocturnal hypoxaemia due to ventilatory restriction and impaired gas exchange that worsen with supine posture and reduced ventilatory drive during sleep. This systematic review synthesised literature on the diagnostic evaluation, epidemiology, associations, management and prognosis of nocturnal hypoxaemia in ILD. METHODS: Ovid MEDLINE, Embase and CENTRAL databases were searched for eligible studies...
April 29, 2021: Thorax
Michael A Matthay, B Taylor Thompson, Lorraine B Ware
The 2012 Berlin definition of acute respiratory distress syndrome (ARDS) provided validated support for three levels of initial arterial hypoxaemia that correlated with mortality in patients receiving ventilatory support. Since 2015, high-flow nasal oxygen (HFNO) has become widely used as an effective therapeutic support for acute respiratory failure, most recently in patients with severe COVID-19. We propose that the Berlin definition of ARDS be broadened to include patients treated with HFNO of at least 30 L/min who fulfil the other criteria for the Berlin definition of ARDS...
April 26, 2021: Lancet Respiratory Medicine
Michael Furian, Deborah Flueck, Philipp M Scheiwiller, Séverine Mueller-Mottet, Lorenz M Urner, Tsogyal D Latshang, Silvia Ulrich, Konrad E Bloch
Altitude exposure induces hypoxaemia in patients with chronic obstructive pulmonary disease (COPD), particularly during sleep. The present study tested the hypothesis in patients with COPD staying overnight at high altitude that nocturnal arterial hypoxaemia is associated with impaired cerebral tissue oxygenation (CTO). A total of 35 patients with moderate-to-severe COPD, living at <800 m (mean [SD] age 62.4 [12.3] years, forced expiratory volume in 1 s [FEV1 ] 61 [16]% predicted, awake pulse oximetry ≥92%) underwent continuous overnight monitoring of pulse oximetry (oxygen saturation [SpO2 ]) and near-infrared spectroscopy of prefrontal CTO, respectively, at 490 m and 2,590 m...
April 26, 2021: Journal of Sleep Research
Yasushi Kondo, Yuko Kaneko, Hiroshi Takei, Hiroya Tamai, Hiroki Kabata, Tomohiro Suhara, Ryo Yamamoto, Hiromasa Nagata, Makoto Ishii, Junichi Sasaki, Naoki Hasegawa, Koichi Fukunaga, Tsutomu Takeuchi
OBJECTIVES: To investigate the similarities and differences between Coronavirus disease 2019 (COVID-19) and autoimmune and autoinflammatory rheumatic diseases characterised by hyperferritinaemia, such as antimelanoma differentiation-associated protein 5 (MDA5) autoantibody-positive dermatomyositis and adult Still's disease. METHODS: We reviewed consecutive, newly diagnosed, untreated patients with COVID-19, anti-MDA5 dermatomyositis, or adult Still's disease. We compared their clinical, laboratory, and radiological characteristics, including the prevalence of macrophage activation syndrome and lung involvement in each disease...
April 8, 2021: Clinical and Experimental Rheumatology
Jojanneke Epke van Amesfoort, Dominique E Werter, Rebecca C Painter, Frederik J R Hermans
We present a case of a metabolic acidosis in a term-pregnant woman with SARS-CoV-2 infection.Our patient presented with dyspnoea, tachypnoea, thoracic pain and a 2-day history of vomiting, initially attributed to COVID-19 pneumonia. Differential diagnosis was expanded when arterial blood gas showed a high anion gap metabolic non-lactate acidosis without hypoxaemia. Most likely, the hypermetabolic state of pregnancy, in combination with maternal starvation and increased metabolic demand due to infection, had resulted in metabolic ketoacidosis...
April 19, 2021: BMJ Case Reports
Samir Gupta, Rosalind Tang, Abdul Al-Hesayen
The hepatopulmonary syndrome (HPS) is defined by liver dysfunction, intrapulmonary vasodilatation and abnormal oxygenation. Hypoxaemia is progressive and liver transplant is the only effective treatment. Severe hypoxaemia is a life-threatening HPS complication, particularly after transplant. We evaluated gas-exchange and haemodynamic effects of invasive therapies in a consecutive sample of 26 pre-transplant patients. Inhaled nitric oxide significantly improved partial pressure of oxygen (12.4 mm Hg; p=0.001) without deleterious effects on cardiac output...
April 15, 2021: Thorax
Wolfram Windisch, Stefan Kluge, Martin Bachmann, Carl-Peter Criée, Steffen Weber-Carstens, Michael Westhoff, Christian Karagiannidis, Tobias Welte
This correspondence argues that the conclusion given in the article "Conservative management of COVID-19-associated hypoxaemia" is not supported by the data
April 2021: ERJ Open Research
Thomas Voshaar, Patrick Stais, Dieter Köhler, Dominic Dellweg
This correspondence argues that happy hypoxaemic patients should not be intubated as long as they remain happy
April 2021: ERJ Open Research
G Peiffer, M Underner, J Perriot, G Fond
COPD is a chronic respiratory disease, often associated with extrapulmonary manifestations. Co-morbidities, including anxiety, depression and cognitive impairment, worsen its progression and quality of life. The prevalence of these disorders is high, yet they are often poorly understood and inadequately managed. In the development of psychological disorders, there is accumulated evidence highlighting the major role of systemic inflammation, as well as chronic disease, genetics, the consequences of smoking, hypoxaemia, oxidative stress, and the gut microbiome In addition to traditional treatments such as bronchodilatator medications, respiratory rehabilitation and smoking cessation, systemic inflammation is an interesting therapeutic target, with the use of anti-inflammatory drugs, anti-cytokines, and nutritional interventions...
April 2, 2021: Revue des Maladies Respiratoires
Nicola Disma, Francis Veyckemans, Katalin Virag, Tom G Hansen, Karin Becke, Pierre Harlet, Laszlo Vutskits, Suellen M Walker, Jurgen C de Graaff, Marzena Zielinska, Dusica Simic, Thomas Engelhardt, Walid Habre
BACKGROUND: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. METHODS: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention...
March 31, 2021: British Journal of Anaesthesia
Rohit Saha, Benjamin Assouline, Georgina Mason, Abdel Douiri, Charlotte Summers, Manu Shankar-Hari
BACKGROUND: Control-arm mortality varies between acute respiratory distress syndrome (ARDS) RCTs. METHODS: We systematically reviewed ARDS RCTs that commenced recruitment after publication of the American-European Consensus (AECC) definition (MEDLINE, Embase, and Cochrane central register of controlled trials; January 1994 to October 2020). We assessed concordance of RCT inclusion criteria to ARDS consensus definitions and whether exclusion criteria are strongly or poorly justified...
April 1, 2021: British Journal of Anaesthesia
Nicola Disma, Katalin Virag, Thomas Riva, Jost Kaufmann, Thomas Engelhardt, Walid Habre
BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation...
March 30, 2021: British Journal of Anaesthesia
Renée Schavemaker, Marcus J Schultz, Wim K Lagrand, Eline R van Slobbe-Bijlsma, Ary Serpa Neto, Frederique Paulus
We describe the practice of ventilation and mortality rates in invasively ventilated normal-weight (18.5 ≤ BMI ≤ 24.9 kg/m2 ), overweight (25.0 ≤ BMI ≤ 29.9 kg/m2 ), and obese (BMI > 30 kg/m2 ) COVID-19 ARDS patients in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. The primary outcome was a combination of ventilation variables and parameters over the first four calendar days of ventilation, including tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, and driving pressure in normal-weight, overweight, and obese patients...
March 11, 2021: Journal of Clinical Medicine
Andras Bikov, Martina Meszaros, Esther Irene Schwarz
Obstructive sleep apnoea (OSA) is a common disease which is characterised by repetitive collapse of the upper airways during sleep resulting in chronic intermittent hypoxaemia and frequent microarousals, consequently leading to sympathetic overflow, enhanced oxidative stress, systemic inflammation, and metabolic disturbances. OSA is associated with increased risk for cardiovascular morbidity and mortality, and accelerated coagulation, platelet activation, and impaired fibrinolysis serve the link between OSA and cardiovascular disease...
March 11, 2021: International Journal of Molecular Sciences
Ian Kintwa, Paulus Ripa, Jonah Kurubi, Magdalynn Kaupa, Trevor Duke
Background: The World Health Organization has a clinical and syndromic approach to the management of severe acute malnutrition which recognises that laboratory investigations are often not possible where children with severe malnutrition present. In low- and middle-income countries including Papua New Guinea, rates of death from severe malnutrition in many hospitals remain 10% or more. Aim: To evaluate the clinical predictors of death and the association between disturbances of electrolytes and haematological investigations in children with severe malnutrition and the risk of mortality...
April 2, 2021: Paediatrics and International Child Health
Belén Pérez-Mies, María Gómez-Rojo, Irene Carretero-Barrio, Tommaso Bardi, Amparo Benito, Mónica García-Cosío, Álvaro Caballero, Raul de Pablo, Juan Carlos Galán, David Pestaña, Jose Palacios
Diffuse alveolar damage and thrombi are the most common lung histopathological lesions reported in patients with severe COVID-19. Although some studies have suggested increased pulmonary angiogenesis, the presence of vascular proliferation in COVID-19 lungs has not been well characterised. Glomeruloid-like microscopic foci and/or coalescent vascular proliferations measuring up to 2 cm were present in the lung of 14 out of 16 autopsied patients. These lesions expressed CD31, CD34 and vascular endothelial cadherin...
March 23, 2021: Thorax
Paul C Cremer, Antonio Abbate, Kristin Hudock, Carla McWilliams, Jinesh Mehta, Steven Y Chang, Calvin C Sheng, Benjamin Van Tassell, Aldo Bonaventura, Alessandra Vecchié, Brenna Carey, Qiuqing Wang, Katherine E Wolski, Prabalini Rajendram, Abhijit Duggal, Tisha S Wang, John F Paolini, Bruce C Trapnell
Background: In patients with COVID-19, granulocyte-macrophage colony stimulating factor (GM-CSF) might be a mediator of the hyperactive inflammatory response associated with respiratory failure and death. We aimed to evaluate whether mavrilimumab, a monoclonal antibody to the GM-CSF receptor, would improve outcomes in patients with COVID-19 pneumonia and systemic hyperinflammation. Methods: This investigator-initiated, multicentre, double-blind, randomised trial was done at seven hospitals in the USA...
March 17, 2021: The Lancet Rheumatology
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