Oxygen Administration Research Articles

Spontaneous hemodynamic improvement after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension is observed within a short term after balloon pulmonary angioplasty.

Natural hemodynamic changesafter balloon pulmonary artery angioplasty (BPA) in a unified state without oxygen administration in patients with chronic thromboembolic pulmonary hypertension (CTEPH) remains undetermined. This study aimed to clarify the delayed changes in the hemodynamics after BPA in patients with CTEPH. We analyzed 73 consecutive patients with CTEPH who underwent BPA between July 2014 and December 2022. We extracted and evaluated hemodynamic data of the right heart catheter without oxygen administration immediately before and after the first BPA; and immediately before the second BPA, as the "post-delayed changes" after BPA. BPA significantly improved the mean pulmonary artery pressure (mPAP, mmHg) and pulmonary vascular resistance (PVR, dyn-s/cm5) from 36 (32-43) mmHg and 449 (312-627) dyn-s/cm5 before the first BPA to 28 (23-32) mmHg and 275 (217-366) dyn-s/cm5 immediately after BPA, and further significantly improved the values to 23 (20-28) mmHg and 225 (175-301) dyn-s/cm5 post-delayed changes after BPA, respectively. Improvement observed on account of delayed changes was observed both with and without pulmonary hypertension drugs. The delayed changes were observed during a period of 5-180days, which did not correlate with the changes in mPAP and PVR. Hemodynamic improvement owing to BPA was observed immediately after BPA; however, further improvement was observed as a result of delayed changes. mPAP improved by 3.4 ± 5.2mmHg and PVR by 53 (10-99) dyn-s/cm5 as delayed improvement. mPAP and PVR showed delayed improved by approximately 10% of their values before BPA.

Comfort Terminal Care in the intensive care unit: recommendations for practice

The Working Group on Ethics in Anesthesia and Intensive Care Medicine of the Austrian Society for Anesthesiology Resuscitation and Intensive Care Medicine (ÖGARI) already developed documentation tools for the adaption of therapeutic goals 10years ago. Since then the practical implementation of Comfort Terminal Care in the daily routine in particular has raised numerous questions, which are discussed in this follow-up paper and answered in an evidence-based manner whenever possible. The practical implementation of pain therapy and reduction of anxiety, stress and respiratory distress that are indicated in the context of Comfort Terminal Care are described in more detail. The measures that are not (or no longer) indicated, such as oxygen administration and ventilation as well as the administration of fluids and nutrition, are also commented on. Furthermore, recommendations are given regarding monitoring, (laboratory) findings and drug treatment and the importance of nursing actions in the context of Comfort Terminal Care is mentioned. Finally, the support for the next of kin and the procedure in the time after death are presented. Achange in treatment goals with atimely switch to Comfort Terminal Care enables good and humane care for seriously ill patients and their relatives at the end of life and the appreciation of their previous life with the possibility of positive experiences until the end.

Age-specific predictors of disease severity in children with respiratory syncytial virus infection beyond infancy and through the first 5 years of age.

Respiratory syncytial virus (RSV) infection is associated with significant morbidity in infants. Risk factors for severe disease beyond the first 2 years of life have not been fully defined. Children <5 years hospitalized with virologically confirmed RSV infection were identified over six respiratory seasons (10/2012-4/2018) and their medical records manually reviewed. Multivariable analyses were performed to define the age-specific (<6, 6-24, and >24-59 months) risk factors associated with oxygen administration, PICU admission, mechanical ventilation, and duration of hospitalization. We identified 5143 children hospitalized with RSV infection: 53.5% (n = 2749) <6 months; 31.7% (n = 1631) 6-24 months; and 14.8% (n = 763) >24-59 months. Rates of ICU admission were high (35%-36%) and comparable across age groups, while children >24-59 and 6-24 versus those <6 months required supplemental oxygen more frequently (73%; 71%; 68%, respectively; p = .003). The presence of comorbidities increased with age (25%, <6 months; 46%, 6-24 months; 70%, >24-59 months; p < .001). Specifically, neuromuscular disorders, chronic lung disease, and reactive airway disease/asthma were predictive of worse clinical outcomes in children aged 6-24 and >24-59 months, while RSV-viral codetections increased the risk of severe outcomes in children aged <6 and 6-24 months of age. Almost half of children hospitalized with RSV infection were >6 months. Underlying comorbidities increased with age and remained associated with severe disease in older children, while RSV-viral codetections were predictive of worse clinical outcomes in the youngest age groups. These data suggest the importance of defining the clinical phenotype associated with severe RSV according to age, and the persistent burden associated with RSV beyond infancy.

Snoring Survivors: the impact of obstructive sleep apnoea and continuous positive airway pressure use on in-hospital mortality, length of stay and costs among patients hospitalised with acute cardiovascular disease – A retrospective analysis of 2016–2019 National Inpatient Sample Data

BackgroundThe routine administration of supplemental oxygen to non-hypoxic patients with acute myocardial infarction (AMI) has been abandoned for lack of mortality benefit. However, the benefits of continuous positive airway pressure...

A revision of maximal oxygen consumption and exercise capacity at altitude 70 years after the first climb of Mount Everest.

On the 70th anniversary of the first climb of Mount Everest by Edmund Hillary and Tensing Norgay, we discuss the physiological bases of climbing Everest with or without supplementary oxygen. After summarizing the data of the 1953 expedition and the effects of oxygen administration, we analyse the reasons why Reinhold Messner and Peter Habeler succeeded without supplementary oxygen in 1978. The consequences of this climb for physiology are briefly discussed. An overall analysis of maximal oxygen consumption ( ) at altitude follows. In this section, we discuss the reasons for the non-linear fall of at altitude, we support the statement that it is a mirror image of the oxygen equilibrium curve, and we propose an analogue of Hill's model of the oxygen equilibrium curve to analyse the fall. In the following section, we discuss the role of the ventilatory and pulmonary resistances to oxygen flow in limiting , which becomes progressively greater while moving toward higher altitudes. On top of Everest, these resistances provide most of the limitation, and the oxygen equilibrium curve and the respiratory system provide linear responses. This phenomenon is more accentuated in athletes with elevated , due to exercise-induced arterial hypoxaemia. The large differences in that we observe at sea level disappear at altitude. There is no need for a very high at sea level to climb the highest peaks on Earth.

Drug effectiveness for COVID-19 inpatients inferred from Japanese medical claim data using propensity score matching

Background Earlier studies and clinical trials of Coronavirus 2019 (COVID-19) showed that drugs such as antiviral drugs, antibody cocktails, and steroids and anti-inflammatory drugs can prevent severe outcomes and death. Methods Observational data in Japan assess drug effectiveness against COVID-19. We applied the average treatment effect model, particularly propensity scoring, which can treat the choice of administered drug as if administration were randomly assigned to inpatients. Data of the Medical Information Analysis Databank, operated by National Hospital Organization in Japan, were used. The outcome was defined as mortality. Subjects were all inpatients, inpatients with oxygen administration, and inpatients using respiratory ventilation, classified by three age classes: all ages, 65 years old or older, and younger than 65 years old. Information about demographic characteristics, underlying disease, administered drug, the proportions of Alpha, Beta and Omicron variant strains, and vaccine coverage were used as explanatory variables for logistic regression. Results Estimated results indicated that only one antibody cocktail (sotrovimab, casirivimab and imdevimab) was associated with raising the probability of survival consistently and significantly. By contrast, other drugs, an antiviral drug (remdesivir), a steroid (dexamethasone), and an anti-inflammatory drug (baricitinib and tocilizumab) were related to reduce the probability of survival. However, propensity score matching method might engender biased results because of a lack of data such as detailed information related to intervention and potential confounders. Therefore, the effectiveness of some drugs might not be evaluated properly in this study. Conclusions Results indicate high likelihood that antibody cocktails were consistently associated with high probability of survival, although low likelihood was found for other drugs for older patients with mild to severe severity and all age patients with moderate severity. Further study is necessary in light of the lack of available data.

Knowledge, Attitude and Practice and Associated Factors on Oxygen Therapy Among Nurses and Midwives in Y12 HMC-2022 Gc

Background: Oxygen is an essential medical therapy which saves a lot of lives. It is administered as a corrective treatment for conditions resulting in hypoxia (low level of oxygen in the blood). So, the nurse should have more skills and experience to performing this procedure in the aim to maintain the patient's life safe and avoid complications associated with incorrect oxygen administration technique. Objective: The study was conducted to assess the level of knowledge, attitude and practice towards oxygen therapy administration and associated factors among nurses and midwives at Yekatit 12 Hospital Medical college in 2022. Method: To achieve the research objectives a hospital based cross-sectional study was applied. The sample size drawn was 198. Pertinent data for the study were gathered through structured questionnaires. Descriptive and multiple logistic regression were used in the analysis of independent and outcome variables. Result: Data is collected from 211 participants and my response rate is (198)93.8%. Among 198 nurse and midwives 50.5% were males, 49.5% with the range of 30-39yrs and most of them (48.5%) have work experience of 6-9yrs.The mean score of knowledge, attitude and practice were 5.7(SD=1.608),4.01(SD=1.837) and 14.5(3.49) respectively. It is found that the level of knowledge was adequate in 117(59.1%) and poor 81 (40.9%) of participants. Practical skill is found to poor in 63.1% of participants and factors associated with this were absences of oxygen therapy guide line, not participating in any training about oxygen therapy and supply of oxygen delivery system with P-value of 0.01, 0.02 and 0.002 respectively. work experience also contributes for poor practice. Conclusion: There is a clear practical gap among nurses and midwives working in Y12HMC and this study also shows as there is poor attitude in almost have of the participants which high compared to another research. The possible associated factors for poor practice were identified as work experience less than 1yr and absence of training and oxygen guideline. So, to enhance safe use of oxygen therapy the referral hospital needs to push its effort for improving the practice and attitude of nurses and midwives towards oxygen therapy by facilitating trainings, increases the availability of guideline and supply of oxygen.

A randomized double-blind placebo-controlled trial of an inhibitor of plasminogen activator inhibitor-1 (TM5614) in mild to moderate COVID-19

An inhibitor of plasminogen activator inhibitor (PAI)-1, TM5614, inhibited thrombosis, inflammation, and fibrosis in several experimental mouse models. To evaluate the efficacy and safety of TM5614 in human COVID-19 pneumonia, phase IIa and IIb trials were conducted. In an open-label, single-arm trial, 26 Japanese COVID-19 patients with mild to moderate pneumonia were treated with 120–180 mg of TM5614 daily, and all were discharged without any notable side effects. Then, a randomized, double-blind, placebo-controlled trial was conducted in Japanese COVID-19 patients with mild to moderate pneumonia. The number of study participants was set to be 50 in each arm. Even after extension of the enrollment period, the number of study participants did not reach the initially intended sample size, and 75 patients were enrolled in the study. The total oxygenation scale from Day 1 to Day 14 as the primary endpoint was 1.5 in the TM5614 group vs 4.0 in the placebo group (p = 0.22), and the number of days of oxygen administration required as the secondary endpoint was 2.0 days in the TM5614 group vs 3.5 days in the placebo group (p = 0.34). Further studies will be necessary to verify the efficacy of PAI-1 inhibition for the treatment of COVID-19 pneumonia.Clinical trial registration: Two studies were conducted: a prospective, multicenter, open-label phase II study at https://jrct.niph.go.jp (jRCT2021200018) (First registration date 18/08/2020) and a prospective, multicenter, randomized, double-blind, placebo-controlled, phase II study at https://jrct.niph.go.jp (jRCT2021210006) (First registration date 28/05/2021).

Use of a Nasal Cannula as a Preoxygenation Adjunct: A Randomized Crossover Study.

Preoxygenation prior to induction of general anesthesia is intended to increase the oxygen reserve in the lungs. This technique delays the onset of hypoxemia during the placement of the tracheal tube. To observe the benefits of oxygen through nasal cannula when used as an adjunct during preoxygenation. We enrolled 30 healthy volunteers and conducted a sequence of six preoxygenation tests. These included 3-minute tidal volume breathing and 8 vital capacity breaths, with and without oxygen flowing through the nasal cannula as an adjunct. Subjects were kept at a supine position with a face mask on their faces. Their baseline vitals were measured and end-tidal O2 (ETO2) was recorded at the end of each test. The comfort of each technique was also assessed. When comparing the efficacy of the two preoxygenation methods, we found that the addition of oxygen through the nasal cannula improved the efficacy of preoxygenation with both the 3-minute tidal volume breathing method and the 8 vital capacity method (p < 0.001). The three-minute tidal volume breathing technique had higher end-tidal oxygen when compared to the eight vital capacity breaths. The administration of oxygen through a nasal cannula during preoxygenation improves the efficacy of preoxygenation in healthy volunteers. Tidal volume breathing for three minutes achieves a higher end-tidal oxygen concentration compared to eight vital capacity breaths over one minute.

Effectiveness of competency-based training on Nurses’ performance regarding oxygen administration safety for children with respiratory disorders

BackgroundSupplemental oxygen therapy is one of the main therapies used to manage respiratory distress; it must be given in a way that is both safe and efficient. To provide standardized care, competency-based training should be designed to prioritize the practical skills and talents of the nurses over the provision of theoretical knowledge. The study aimed to evaluate the effectiveness of competency-based training on nurses’ performance regarding oxygen administration safety for infants with respiratory disorders. The settingThe study was conducted at the pediatric critical care units at Mansoura University Hospital. Design: The quasi-experimental study was used. The sample: A convenient sampling technique was used for recruiting pediatric critical care nurses and the infants who were admitted in the previous setting. Data collection: three tools were utilized in this study: the first was a structured interview questionnaire encompassing the socio-demographic characteristics of the studied nurses and infants. The second tool is nurses’ knowledge and an observation checklist to assess nurse practices regarding oxygen administration safety. The third tool, the nurse competence scale (NCS). Resultspediatric critical care nurses’ standardization (knowledge, practice, and knowledge application) through pre- and post-intervention. It showed a marked improvement in mean score and standard deviation in the post compared to pre, and the total mean was in the post (15.9 ± 3.8) compared to pre (33.5 ± 7.2) with a p-value < 0.001. ConclusionAfter the implementation of the competency based training program regarding oxygen administration safety.Recommendations.To increase standardization in nursing care practices and produce the best patient outcomes, competency-based training should be applied to all aspects of health care delivery.

Pathological Factors Affecting the R2* Values of the Kidney in Blood Oxygenation Level-dependent MR Imaging: A Retrospective Study.

Despite the usefulness of blood oxygenation level-dependent (BOLD) MRI in assessing glomerulonephritis activity, its relationship with histological findings remains unclear. Because glomerulonephritis presents multiple complex injury patterns, analysis of each pattern is essential. We aimed to elucidate the relationship between the histological findings of the kidney and BOLD MRI findings in mesangial proliferative glomerulonephritis. Children under 16 years of age diagnosed with mesangial proliferative glomerulonephritis by kidney biopsy at our university hospital between January 2013 and September 2022 were included in this study. Cortical and medullary spin relaxation rate (R2*) values were measured using BOLD MRI at 3T within two weeks before and after the kidney biopsy. The R2* values, including the fluctuations with low-dose oxygen administration, were retrospectively examined in relation to the cortical (mesangial proliferation, endothelial cell proliferation, crescent, sclerosis, and fibrosis) and medullary findings (fibrosis). Sixteen times kidney biopsies were performed for glomerulonephritis during the study period, and one patient was excluded because of comorbidities; the remaining 14 patients included six boys with a mean age of 11.9 ± 3.5 years at the BOLD examination. None of the patients had medullary fibrosis. Among the kidney tissue parameters, only sclerosis showed a significant correlation with R2* values: medulla with R2* values under atmospheric pressure (r = 0.53, P < 0.05) and cortex with the rate of change in R2* values with low-dose oxygen administration (r = -0.57, P < 0.03). In the multiple regression analysis, only sclerosis was an independent contributor to the change in R2* values with oxygen administration in the cortex (regression coefficient -0.109, P < 0.05). Since the R2* values reflect histological changes in the kidney, BOLD MRI may facilitate the evaluation of mesangial proliferative glomerulonephritis, potentially reducing the patient burden.

Magnitude of Neonatal Sepsis and Factors Associated with It among Neonates Admitted to the Intensive Care Units of Neonate in the Primary Hospital of Hawzen, Tigray, Ethiopia, 2020.

Neonatal sepsis contributes substantially to neonatal mortality and morbidity and is an ongoing major global public health problem particularly in developing countries. A significant proportion of mothers give birth in primary health care, but studies regarding neonatal sepsis and its associated factors among admitted neonates are limited to the hospital which may not be generalized to the primary health care unit. Therefore, this study aimed to assess the proportion of neonatal sepsis and associated factors in the study areas. To assess the magnitude of neonatal sepsis and its associated factors among neonates admitted to Neonatal Intensive Care Units (NICUs) of Hawzen Primary Hospital, Eastern Zone, Tigray, North Ethiopia, 2020. An institution-based cross-sectional study design was carried out among 290 study participants in Hawzen Primary Hospital in January-March/2020. A systematic random sampling method was applied to select the study participants, and pretested and structured questionnaires were used to collect data. The collected data were coded, entered, cleaned, and analyzed using SPSS version 20.0 software. Binary logistic regression analyses with a confidence interval of 95% were used to select determinant factors. Statistically significant factors were identified using the adjusted odds ratio (AOR). Statistical significance was determined at p value <0.05. Binary and multivariable logistic regression analyses were applied to see the association of the variables at a p < 0.05. In this study, the overall proportion of neonatal sepsis was (60.2%) 95% CI (56, 68)]. Birth asphyxia [AOR = 2.04; 95%CI (1.07, 3.93)], maternal age of 15-19 [AOR = 2.00; 95% CI (1.81, 11.93)], duration of labor greater or equal to 24 hours [AOR = 3.00; 95% CI (2.67, 14.21)], history of oxygen administration [AOR = 2.37; 95% CI (1.18, 4.75)], neonatal age of greater or equal to seven days [AOR = 4.0595% CI (1.07, 3.93), and home delivery [AOR = 5.00; 95% CI (2.34, 18.92)] were the predictor variables for neonatal sepsis. In this study, neonatal sepsis was high. Birth asphyxia, intranasal oxygen administration, age of the mother, home delivery, and duration of labor were associated with neonatal sepsis.

Management of Delayed Hemolytic Transfusion Reaction in a Patient with Sickle Cell Disease: A Case Report

Background: Sickle cell disease (SCD) is a group of inherited blood disorders characterized by abnormalities in hemoglobin (Hb), leading to distortion in shape of red blood cells (RBCs) and their breakdown, potentially blocking blood flow and resulting in pain and anemia. This can significantly impact the patient’s quality of life. Patients often require multiple blood transfusions to prevent complications associated with SCD by reducing the concentration of damaged hemoglobin. However, one of the significant complications of blood transfusions is Delayed Hemolytic Transfusion Reaction (DHTR), which occurs due to RBC alloimmunization (i.e., formation of antibodies against donor RBC antigens). DHTR can manifest as a sudden decrease in hemoglobin levels, which may progress to rapid multiorgan failure and death. Thus, prompt diagnosis is crucial for timely management. This case report highlights the diagnosis and management of a 56-year-old African American female with SCD who presented with bilateral severe knee pain and low Hb levels. Case Presentation: The patient’s symptoms, past medical history, and investigation findings led to a diagnosis of DHTR. Management was conducted within the framework of Bloodless Medicine, incorporating strategies to minimize blood loss and optimize erythropoiesis. Treatment included the use of erythropoietin (EPO) to manage hemoglobin levels and the administration of opioids and supplemental oxygen for symptom relief. Conclusion: Our case report highlights the challenges and various management strategies employed in treating DHTR in SCD patients. It emphasizes the importance of early recognition of the complication and compares the risks and benefits of additional blood transfusions in such patients. By presenting this case, we aim to contribute to the growing literature on DHTR in SCD patients and highlight the need for further research and optimized management strategies in this population.

261 Maternal administration of oxygen to predict respiratory morbidities among growth restricted infants

261 Maternal administration of oxygen to predict respiratory morbidities among growth restricted infants

Prophylactic Anticoagulation and Thrombosis in Hospitalized Patients with Clinically Stable COVID-19 at Admission: From the Practice-Based Observational Study.

Objectives: The potential benefit of routine prophylactic anticoagulation for all hospitalized patients with clinically stable coronavirus disease 2019 (COVID-19) is still controversial. Method: The CLOT-COVID Study was a multicenter observational study enrolling 2894 consecutive hospitalized patients with COVID-19. The current study population consisted of 1738 hospitalized patients with mild COVID-19 at admission not requiring oxygen administration, who were divided into 2 groups: patients with prophylactic anticoagulation (n = 326) and those without (n = 1412). Results: Patients with prophylactic anticoagulation had more severe status of the worst severity of COVID-19 during hospitalization compared with those without (mild: 38% versus 82%, moderate: 55% versus 17%, and severe or death at discharge: 6.4% versus 0.7%, P <0.001). During hospitalization, 8 patients (0.5%) developed thrombosis, and the incidences of thrombosis were numerically higher in patients with more severe status of worst severity of COVID-19 during hospitalization (mild: 0.2%, moderate: 1.2%, and severe or death at discharge: 3.2%). Conclusions: Among hospitalized patients with clinically stable COVID-19 at admission, patients who did not worsen in COVID-19 severity after admission rarely developed thrombosis, although patients with worsening of COVID-19 severity after admission more often received prophylactic anticoagulation and might have a higher risk of thrombosis.

Usefulness of deep sedation with intravenous dexmedetomidine and midazolam in cardiac catheterization procedures for pediatric patients.

Dexmedetomidine (DEX) is a highly selective alpha 2 receptor agonist that has the advantage of causing less respiratory depression than other sedative agents. We evaluated the add-on effects of DEX on sedation among pediatric patients who received midazolam and pentazocine during cardiac catheterization. 120 cardiac catheterization procedures in 110 patients under deep sedation at Department of Pediatrics, Kanazawa University Hospital from January 2013 to August 2018: 63 procedures without DEX (i.e., non-DEX group) and 57 procedures with DEX (i.e., DEX group). Intravenous midazolam and pentazocine were used in both groups, and DEX without an initial loading dose (0.6 μg/kg/h) was used in the DEX group. We retrospectively investigated complications during catheterization, doses of sedative agents, and changes in vital signs. Hypoxemia requiring oxygen administration during catheterization tended to be higher in the non-DEX group than in the DEX group (4.8% vs. 0%). Additional dose of midazolam was significantly lower in the DEX group (median [IQR]: 0.05 mg/kg [0-0.11]) than in the non-DEX group [0.09 mg/kg (0-0.23), p = 0.0288]. The additional dose of midazolam in the non-DEX group with hypoxemia was significantly higher than the dose used in the non-DEX group without hypoxemia. No case of bradycardia below the criteria for bradycardia occurred and no serious complications occurred in the DEX group. The use of intravenous DEX in combination with midazolam and pentazocine in pediatric cardiac catheterization may reduce the need for an additional dose of midazolam and may contribute to the prevention of airway complications associated with respiratory depression caused by sedative agents.

Quality of Nursing Performance regarding Oxygen Administration for High Risk Infant

Quality of Nursing Performance regarding Oxygen Administration for High Risk Infant

Nursing Care Practice in Neonatal Care Units of Tertiary Hospitals of Nepal: An Exploratory Qualitative Study

Preterm infants (PTIs) require special care in neonatal care units (NCUs) for their survival, growth, and development. Nurses are in a pivotal position to provide quality care to those infants in NCUs. Available literature indicates that care practice needs to be improved in developing countries. This study aimed to explore the nursing care practice for PTIs in NCUs. An exploratory qualitative study was conducted in NCUs of three public tertiary care hospitals in Kathmandu, Nepal, from November 2019 to February 2020. Data were collected through six focus group discussions among 40 nurses working in NCUs. The thematic analysis of qualitative data revealed standardized and inadequate care practices for PTIs in NCUs. Standard practices regarding thermal care, oxygen administration, nutritional care, and infection prevention were found. Inadequate care was identified regarding sleep protection, proper positioning, supportive sensory environment, and pain management. The study reported the standard care practice areas and areas for improvement to enhance nursing care in NCUs, such as pain management, sleep promotion, breastfeeding support, kangaroo mother care, and a supportive sensory environment. The findings have important implications for enhancing care practices for PTIs in NCUs, which is important for promoting the short- and long-term outcomes among PTIs.

Aerobic Brain Metabolism, Body Temperature, Oxygen, Fetal Oxygen Supply and Fetal Movement Dynamics as Factors in Stillbirth and Neonatal Encephalopathy: Invention Review

Introduction: To date, there is no systematic review dedicated to the study of inventions that have not yet been introduced into clinical practice, but are devoted to the diagnosis, prevention, modeling and treatment of fetal intrauterine hypoxia. Hypoxic damage to fetal brain cells still remains an unsolved problem of obstetrics and gynecology. Methods: 27 inventions were found from the beginning of the 21st century to 26.08.2023 in databases such as EAPATIS, BYPATENTS, DWPI, DEPATISnet, PATENTSCOPE, Espacenet, RUPTO, USPTO, CIPO, CNIPA, KIPRIS, PatSearch, J-PlatPat, Google Patents and TPO. Due to the small number of inventions, methodological heterogeneity, and differences in the content of their claims, a quantitative meta-analysis could not be performed. Results: Prospects for innovative obstetric care proposals aimed at improving fetal viability in hypoxia during pregnancy and delivery were analyzed. Results of the included studies were presented only qualitatively (descriptively). Conclusion: Fetal resistance to impending labor hypoxia has not been previously investigated, so values of low fetal resistance to intrauterine hypoxia are still not among the indications for the use of excess oxygen and the choice of Cesarean section to exclude stillbirth and neonatal encephalopathy. The first systematic review of published inventions shows innovative ways of assessing fetal adaptive reserves to hypoxia, oxygen and apnea administration, and selecting the optimal timing and type of delivery to prevent stillbirth and neonatal encephalopathy.

An integrated, holistic, evidence-based, interdisciplinary approach to digital monitoring and remote care in patients with highly infectious diseases: TeleCovid.

During the first waves of the SARS-CoV-2 pandemic, hospitals were overrun with patients. To cope with this high influx of infectious patients, hospitals needed to postpone elective care. Additional ICU beds had to be opened, and the number of isolation units had to be increased. All of this placed considerable strain on the nursing and medical staff. At that time, the idea was launched to keep as many patients as possible at home and prevent their hospital admission through the use of a remote care program. Based on our previous experience with transmural care programs, we quickly developed a digital monitoring program to track the health status of Covid-19 infected patients at home.&#x0D; Patients could be registered for follow-up by their primary care physician or specialist. After registration, patients received access to a secured digital platform. They first had to complete an extensive survey in order to identify their medical and surgical history, as well as the symptoms present at that time. The severity of symptoms was also evaluated at the moment of the initiation of the digital monitoring. On the basis of the responses to the introductory questionnaire, a global personalized risk score was compiled. After this initial step was concluded, the patient was contacted by the medical monitoring team to arrange for the delivery of telemetric devices (such as peripheral oxygen saturation). Patients were monitored through a 4-layer system, consisting of diaries, validated surveys, telemonitoring of vital signs, and a digital communication system included in the digital platform. This resulted in close cooperation with GPs, home nurses, physiotherapists, and other caregivers. The remote care team monitored the condition of the patients on a 24/7 basis. If needed, they contacted the home caregivers with specific demands or instructions (e.g. administration of oxygen at home, blood sampling, administration of medication). &#x0D; In the spring of 2022, Paxlovid became available in Belgium for ambulatory treatment of Covid-19 symptoms in high-risk patients. It was quickly decided that we would also include the follow-up of Paxlovid treatment regimens within our care pathway. This created an entirely new approach to our remote monitoring since we had to tackle specific problems like drug-drug interactions but also therapeutic monitoring of certain specific drugs.&#x0D; &#x0D; TeleCovid was perceived as an integrated, comprehensive remote care program for Covid-19 patients. At first, this digital care program was perceived in such a way that we could prevent the hospitalization of Covid-19 patients. But very soon after its activation, GPs started to include patients so that they focus their attention and time on other patients. They could rely on the remote care program to be notified when the medical conditions of their patients deteriorated. The care program provided support and guidance to the patients AND their families so they felt safe while staying at home. We provided all possible care right at the home of the patients. This was only possible through intensive and continuing cooperation between many different healthcare providers, such as nurses, physiotherapists, social workers, GPs, and hospital specialists.