Changes In Respiratory Rate Research Articles

Propofol-diazepam or propofol-midazolam co-induction in healthy dogs: effects on propofol dosages, cardiovascular and respiratory events

PICO question
 In healthy dogs, does the use of diazepam or midazolam administered in co-induction with propofol result in a reduction in the dose of propofol required to induce anaesthesia and a decrease in adverse cardiovascular and respiratory events?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Eight papers were critically reviewed. A total of six manuscripts were prospective, randomised, blinded, clinical studies. One trial was prospective, randomised, blinded, clinical with a Latin square, incomplete design. One study was retrospective, randomised, blinded, crossover, experimental
 Strength of evidence
 Moderate
 Outcomes reported
 Variables assessed in this Knowledge Summary included: propofol dose required to induce anaesthesia (considering successful orotracheal intubation as an end point), changes in cardiovascular variables (heart rate, systolic, mean and diastolic blood pressure) and changes in respiratory variables (development of apnoea, changes in respiratory rates)
 Conclusion
 In healthy dogs, using propofol-diazepam or propofol-midazolam co-induction resulted in a reduction in propofol dose required to induce anaesthesia in some trials only. Midazolam appeared more effective than diazepam in this context. The dosages, timing and sequence of drug administration seemed relevant. No evidence suggested that using propofol-diazepam or propofol-midazolam co-induction resulted in a reduction of adverse cardiovascular or respiratory events. In addition, although this was out of the scope of the PICO question addressed here, adverse events (e.g. excitement, poorer quality of induction) were reported in several studies when diazepam or midazolam were used in co-induction
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

Slower Respiration Rate Predicts Lower Pain Sensitivity and Greater Supramarginal Gyrus Activation

The subjective experience of pain is driven by multiple physiological and psychological mechanisms supported by a dynamic interplay between low-level afferent input and higher-order cerebral mechanisms. Volitional changes in respiration rate predict changes in pain. However, it is unknown if naturally slower breathing rate is associated with lower pain sensitivity. Further, the brain mechanisms supporting breathing rate during noxious and innocuous stimulation have not been identified. Seventy-four healthy volunteers were administered innocuous (35°C) and noxious heat (Medoc; ten, 12s plateaus of 49°C) to the back of the right calf during pseudocontinuos arterial spin labeling fMRI acquisition (TI = 3 s, TE = 12 ms, TR = 4 s, reps = 66). A visual analogue scale (0 = no pain – 10 = worst pain imaginable) was used to collect pain intensity ratings after each fMRI series. Respiration rate was continuously acquired using a respiratory transducer (Biopac Systems). Linear regression analyses tested the hypothesized relationship between respiration rate and pain sensitivity (SPSS). Standard preprocessing of the functional images included 9 mm spatial smoothing, registration to MNI template and white matter signal regression. A whole-brain analysis examined the between-subjects neural correlates of respiration rate during noxious heat scans (FSL, z>3.1, cluster corrected p<0.05). Slower respiration rate during noxious and innocuous heat predicted lower pain intensity ratings (r = .26, p = 0.03; r = .28, p = .02 respectively). Slower breathing rate was associated with higher cerebral blood flow in the right supramarginal gyrus (SMG) during noxious heat. Individuals that naturally breathed slower during noxious and innocuous stimulation reported lower pain sensitivity. This is supported by stronger activity in the ipsilateral SMG, a region associated with higher somatic-awareness and attention-reorienting towards endogenously-driven stimuli. We propose that individuals that naturally breath slower might engage pain modulatory mechanisms through higher self-awareness.

Neurocognitive Capabilities and Physiological Responses to Cognitive Stress as well as General Health and Fitness Measurements in Competitive Gamers versus Non‐Gamers

Competitive video gaming, also known as eSports, is a growing industry in the US and worldwide. As interest in eSports has grown, so has the interest in those who participate, particularly competitive eSports athletes. The physiological and cognitive impact of various training regimes, high frequency and duration of play, and live or virtual competitions has gained recent attention. The aim of this study was to characterize potential cognitive and physiological differences among competitive gamers and non‐gamers while accounting for fitness levels. Specifically, the physiological parameters compared were differences in stress response [as measured by changes in heart rate (HR), blood pressure (MAP), and respiration rate (RR)] due to cognitive load (via various cognitive assessments) and fitness measurements such as body composition and health and skill related fitness components. Twenty‐two total participants were studied [n=11 in gamers (9M, 2F, play &gt;5 hrs/wk) and non‐gamers (8M, 3F)]. The six different cognitive tests used were to measure various neurocognitive components that have previously been shown to be enhanced in gamers: the Stroop Test (cognitive set shifting, inhibitory control, and set twitching), Modified Card Sorting Test (problem solving and abstract thinking), Finger Tapping Test (psychomotor speed), Trail Making Test (speeded visual search and tracking), Spatial Processing Task (spatial recognition), and Iowa Gambling Test (risky decision making) were administered via a computer (Millisecond). After completing cognitive testing, each subject’s health‐related fitness components (muscular strength and endurance, flexibility, and estimated aerobic capacity) were assessed with a handgrip dynamometer, Situp Bleep test, V Sit and Reach Test, and Modified Bruce Treadmill, respectively. Skill‐related fitness components (power, balance, hand‐eye coordination) were assessed with vertical jump, the Balance Error Scoring System, and the Alternate Hand Wall Ball Test, respectively. Body anthropometrics was measured through height, weight, BMI, body fat percentage (via bioelectrical impedance analysis), and hip‐to‐waist measurements. Of the cognitive components assessed, the only difference was that the video gamers had average scores for the Finger Tapping Test (70.1±10.6) that were trending towards significance versus the non‐gamers (62.3±6.7; p=0.052). The systemic physiological responses to the cognitive testing were minimal (non‐gamers: ∆MAP ‐1.7 to 0.3 mmHg, ∆RR 0.1 to 3.4 BPM, ∆HR ‐3.5 to 7.8 BPM; gamers: ∆MAP ‐0.01 to 1.5 mmHg, ∆RR 2.4 to 4.3 BPM, ∆HR ‐2.7 to 4.0 BPM) and did not differ between the two groups. As intended, given the potential impact of fitness on cognitive performance and sympathoexcitation, the fitness levels of the participants were not different. Thus, when physical activity is accounted for, competitive gamers and non‐gamers perform similarly in most cognitive tasks and have similar physiological responses to this stress.

Postoperative pain assessment with concurrent administration of intraperitoneal tramadol and incisional lidocaine following ovariohysterectomy in dogs

This study aimed to assess postoperative pain with concurrent administration of intraperitoneal tramadol and incisional lidocaine following ovariohysterectomy in dogs. A group of twenty mixed breed female dogs, aged 1–2 years, weighing 19.5 ± 0.8 kg were used. Initially, dogs were sedated with intramuscular administration of acepromazine 1%. Anaesthesia was induced with diazepam (0.5 mg/kg) and ketamine (10 mg/kg) and maintained with 1.5% Isoflurane. Ketoprofen (2 mg/kg) was administered intravenously immediately before surgery. Five minutes before midline incision, saline (0.2 ml/kg) was administered to the muscles and subcutaneous space around the incision in the tramadol-saline (TS) group. Also, in the tramadol-lidocaine (TL) group, lidocaine 2% with epinephrine (1.5 mg/Kg) was administered. Ovariohysterectomy was performed and before closing the linea alba, tramadol (4 mg/kg) was splashed on the abdominal viscera in both groups. Cortisol, vital signs and pain scoring systems were evaluated at different time points. Heart rate, respiratory rate and rectal temperature changes were not significant between groups. Cortisol level showed a significant difference between groups at 1, 3 and 6 hours after surgery (p≤0.05). Both UMPS and CMPS-SF pain scores in the TL group were significantly lower than the TS group at 30 minutes, 1, 3 and 6 hours after surgery (p≤0.05) and also at 12 hours after surgery (p≤0.05). It seems that intraperitoneal administration of tramadol (4 mg/kg) along with administration of incisional lidocaine with epinephrine (1.5 mg/kg) is recommended following ovariohysterectomy in dogs.

Evaluation of lung ventilation distribution using electrical impedance tomography in standing sedated horses with capnoperitoneum

ObjectiveTo determine changes in distribution of lung ventilation with increasing intra-abdominal pressure (IAP) from carbon dioxide (CO2) insufflation in standing sedated horses. Study designProspective experimental study. AnimalsA group of six healthy adult horses. MethodsEach horse was sedated with acepromazine, detomidine and butorphanol and sedation maintained with a detomidine infusion. The horse was restrained in a stocks system and a 32 electrode electrical impedance tomography (EIT) belt was wrapped around the thorax at the fifth–sixth intercostal space. EIT images and arterial blood samples for PaO2 and PaCO2, pH and lactate concentration were obtained during capnoperitoneum at 0 (baseline A), 5, 8 and 12 mmHg as IAP increased and at 8, 5, 0 (baseline B) mmHg as IAP decreased. At each IAP, after a 2 minute stabilization period, EIT images were recorded for ≥ 2 minutes to obtain five consecutive breaths. Statistical analysis was performed using anova for repeated measures with Geisser-Greenhouse correction and a Tukey’s multiple comparison test for parametric data. The relationship between PaO2 and the center of ventilation in the ventral-dorsal (CoV-VD) and right-left (CoV-RL) directions or total impedance change as a surrogate for tidal volume (ΔZVT) were tested using linear regression analysis. Significance was assumed when p ≤ 0.05. ResultsThere were no significant changes in CoV-VD, CoV-RL, PaO2, PaCO2, lactate concentration, pH, heart rate and respiratory rate with targeted IAP. There was a significant decrease in ΔZVT compared with baseline A at 5 mmHg IAP as IAP was increased. Conclusions and clinical relevanceCapnoperitoneum causes a significant decrease in ΔZVT in standing sedated horses with increasing IAP.

Feasibility and accuracy of the 40-steps desaturation test to determine outcomes in a cohort of patients presenting to hospital with and without COVID-19

Desaturation on exercise has been suggested as a predictive feature for deterioration in COVID-19. The objective of this paper was to determine the feasibility and validity for the 40-steps desaturation test.A prospective observational cohort study was undertaken in patients assessed in hospital prior to discharge. One-hundred and fifty-two participants were screened between November 2020 and February 2021, and 64 were recruited to perform a 40-steps desaturation test. Patients who were able to perform the test were younger and less frail. Four patients were readmitted to hospital and one patient deteriorated within 30 days but no patient died.The majority of patients showed little change in saturations during the test, even with pre-existing respiratory pathology. Change in saturations, respiratory rate, heart rate and breathlessness were not predictive of death or readmission to hospital within 30 days. Of 13 patients who had a desaturation of 3% or more during exercise, none was readmitted to hospital within 30 days.Not enough patients with COVID-19 could be recruited to the study to provide evidence for the safety of the test in this patient group.The 40-steps desaturation test requires further evaluation to assess clinical utility.

Physiological changes of pitayo fruit (Stenocereus thurberi) before and after harvest in Sonoran Desert

Open pitaya (Stenocereus thurberi) flowers were marked at 10, 20, 30 and 40 days after floration (DAF). When fruit were formed, they were collected from each of the dates with the objective of evaluating physical, physiological and quality changes before and after harvest. In fruits with different DAF, the analyses of fruit size (diameter and length), weight, density, firmness, color in pulp and peel (L*, a* and b*), respiration rate (CO2) and ethylene production were carried out. In the case of ripe and overripe fruit, in addition to the variables mentioned above, pH, percentage of total soluble solids TSS and total acidity (% citric acid equivalents) were evaluated. Fruit with 40 DAF were stored for up to 14 days at 25 ℃ and 80% RH to evaluate daily changes in respiration rate and ethylene production. It was found that during development the fruit tended to grow more in length than in diameter. In color, the best indicators of changes during fruit development were the parameters L* and b* for peel and for flesh L* and a*. For firmness in pitaya fruits, no significant differences were found with the methodology used. Changes in ethylene production and respiration rate during storage and development showed the usual behavior of climacteric fruits. Pitaya fruits with 40 FDD presented quality characteristics similar to those accepted by the consumer for this type of fruit. It is concluded that it is possible to evaluate the different stages of development in DDF of pitaya fruit based on the changes of the color space variables L*, a* and b*, in addition to the fact that the fruit follows the classical climacteric behavior.

The Effects of Aerated Irrigation on Soil Respiration and the Yield of the Maize Root Zone

To investigate the effect of aerated irrigation on the soil environment and yield in the root zone of maize, and to provide a basis for the extension of aerated irrigation, a 2-year experiment (2020–2021) was conducted at the Zhanjiang National Soil Quality Observation Experiment Station, with two experimental observations per year (spring-summer and fall-winter) to investigate the effects of aerated irrigation (AI) and non-aerated irrigation (CK) on soil respiration rate, soil temperature, water content, oxygen content, soil bacterial biomass and root biomass. We used partial least square regression analysis (PLSR) to establish the regression equations of soil respiration rate, soil temperature, water content, oxygen content, soil bacterial biomass and root biomass under the two treatments, and the screening of the main soil environmental factors affecting changes in soil respiration rate under aerated irrigation technology. The results showed that, compared with CK, the AI treatment significantly increased the soil respiration rate and soil oxygen content (15.38~17.87% and 18.94~25.17%, respectively), as well as the root biomass and soil bacterial biomass (14.99~19.09% and 35.10~45.59%, respectively), and reduced the soil water content by 5.33~12.71% (p &lt; 0.05). The effects of different treatments on soil temperature were not significant. The mean fruit yield with AI treatment was also 7.16~20.51% higher (p &lt; 0.05) than that with CK, and the stem thickness and leaf area of maize plants were significantly increased (9.31~17.06% and 8.68~15.20%, respectively (p &lt; 0.05)). The regression fitting results showed that the soil respiration rate is quadratic polynomial negatively correlated with soil temperature, water content and soil oxygen, and the power function is positively correlated with root biomass and bacterial biomass under the two treatments. The variable importance for projection (VIP) values of the PLSR model showed a soil temperature VIP = 1.51, soil oxygen content VIP = 1.42 and root biomass VIP = 1.40, demonstrating that aerated irrigation technology can drive soil respiration rate by changing soil oxygen content and root biomass. Furthermore, the improvements in soil aeration conditions and respiration with AI appeared to facilitate the improvement in fruit yields, which also suggests the economic benefits of AI.

Predicting Falls in Long-term Care Facilities: Machine Learning Study.

BackgroundShort-term fall prediction models that use electronic health records (EHRs) may enable the implementation of dynamic care practices that specifically address changes in individualized fall risk within senior care facilities.ObjectiveThe aim of this study is to implement machine learning (ML) algorithms that use EHR data to predict a 3-month fall risk in residents from a variety of senior care facilities providing different levels of care.MethodsThis retrospective study obtained EHR data (2007-2021) from Juniper Communities’ proprietary database of 2785 individuals primarily residing in skilled nursing facilities, independent living facilities, and assisted living facilities across the United States. We assessed the performance of 3 ML-based fall prediction models and the Juniper Communities’ fall risk assessment. Additional analyses were conducted to examine how changes in the input features, training data sets, and prediction windows affected the performance of these models.ResultsThe Extreme Gradient Boosting model exhibited the highest performance, with an area under the receiver operating characteristic curve of 0.846 (95% CI 0.794-0.894), specificity of 0.848, diagnostic odds ratio of 13.40, and sensitivity of 0.706, while achieving the best trade-off in balancing true positive and negative rates. The number of active medications was the most significant feature associated with fall risk, followed by a resident’s number of active diseases and several variables associated with vital signs, including diastolic blood pressure and changes in weight and respiratory rates. The combination of vital signs with traditional risk factors as input features achieved higher prediction accuracy than using either group of features alone.ConclusionsThis study shows that the Extreme Gradient Boosting technique can use a large number of features from EHR data to make short-term fall predictions with a better performance than that of conventional fall risk assessments and other ML models. The integration of routinely collected EHR data, particularly vital signs, into fall prediction models may generate more accurate fall risk surveillance than models without vital signs. Our data support the use of ML models for dynamic, cost-effective, and automated fall predictions in different types of senior care facilities.

Nasal pressure swings as the measure of inspiratory effort in spontaneously breathing patients with de novo acute respiratory failure

BackgroundExcessive inspiratory effort could translate into self-inflicted lung injury, thus worsening clinical outcomes of spontaneously breathing patients with acute respiratory failure (ARF). Although esophageal manometry is a reliable method to estimate the magnitude of inspiratory effort, procedural issues significantly limit its use in daily clinical practice. The aim of this study is to describe the correlation between esophageal pressure swings (ΔPes) and nasal (ΔPnos) as a potential measure of inspiratory effort in spontaneously breathing patients with de novo ARF.MethodsFrom January 1, 2021, to September 1, 2021, 61 consecutive patients with ARF (83.6% related to COVID-19) admitted to the Respiratory Intensive Care Unit (RICU) of the University Hospital of Modena (Italy) and candidate to escalation of non-invasive respiratory support (NRS) were enrolled. Clinical features and tidal changes in esophageal and nasal pressure were recorded on admission and 24 h after starting NRS. Correlation between ΔPes and ΔPnos served as primary outcome. The effect of ΔPnos measurements on respiratory rate and ΔPes was also assessed.ResultsΔPes and ΔPnos were strongly correlated at admission (R2 = 0.88, p < 0.001) and 24 h apart (R2 = 0.94, p < 0.001). The nasal plug insertion and the mouth closure required for ΔPnos measurement did not result in significant change of respiratory rate and ΔPes. The correlation between measures at 24 h remained significant even after splitting the study population according to the type of NRS (high-flow nasal cannulas [R2 = 0.79, p < 0.001] or non-invasive ventilation [R2 = 0.95, p < 0.001]).ConclusionsIn a cohort of patients with ARF, nasal pressure swings did not alter respiratory mechanics in the short term and were highly correlated with esophageal pressure swings during spontaneous tidal breathing. ΔPnos might warrant further investigation as a measure of inspiratory effort in patients with ARF.Trial registration: NCT03826797. Registered October 2016.

Effects of Warming and Increased Precipitation on Soil Respiration of Abandoned Grassland in the Loess-Hilly Regions

Clarifying the changing trends and driving factors of soil respiration in fragile habitats under the background of climate change is of great significance for understanding the regional carbon cycle and the conversion of ecosystem carbon source and sink functions. This research focused on grasslands that had been naturally abandoned and restored for 12 years in the loess hilly region of northern Shaanxi, using an open top chamber (OTC) and artificially increased natural rainfall to simulate climate warming and precipitation increase and their interaction. Furthermore, we used a combination of field monitoring and indoor analysis to explore soil water content, temperature, and nutrient characteristics and the response characteristics of soil respiration rate to warming and increased precipitation and further analyzed the key factors driving changes in soil respiration. The results showed that:① warming (W) significantly increased the 5 cm soil temperature, with an average increase of 1.34℃ throughout the sampling year, whereas the increased precipitation (P50%) treatment significantly reduced the 5 cm soil temperature, reducing the average 5 cm soil temperature during the entire sampling year by 0.88℃ and increasing the soil water content (SWC) at the same time. The SWC was 13.12% and 16.45% higher than that in the control (CK), respectively. In addition, compared with that in the CK, the treatment of warming and increased precipitation (WP50%) not only increased soil temperature but also increased SWC; in general, the increase in temperature and precipitation played an antagonistic effect on the influence of soil temperature and humidity. ② P50% significantly increased the content of soil organic carbon, dissolved organic carbon, and labile organic carbon, causing changes in the soil stoichiometric ratio and the distribution characteristics of labile-recalcitrant carbon components, whereas W did not have a significant impact on organic carbon. In addition, soil total nitrogen and phosphorus and available nitrogen and phosphorus nutrients were not significantly different between treatments. ③ P50% significantly increased the Rs rate, and the effect of W on the soil respiration rate mainly depended on the seasonal precipitation and temperature. It was demonstrated that warming in winter and seasons with abundant rainfall had a significant promotion effect on the soil respiration rate. The exponential fitting of soil respiration rate and 5 cm soil temperature found that the soil respiration temperature sensitivity (Q10) was the highest under the precipitation treatment, reaching 1.68, whereas the Q10 was the lowest under the warming treatment (1.50). ④ Linear regression analysis showed that soil organic carbon, dissolved organic carbon, and labile organic carbon were all significantly positively correlated with soil respiration rate. Variation partitioning analysis showed that soil temperature, SWC, and nutrient characteristics explained 64.43% of the variation in soil respiration rate. The soil temperature and SWC were the main controlling factors of the change in soil respiration rate, with an explanation degree of 31.16%. Correlation analysis also showed that there was a significant correlation between SWC, soil temperature and respiration rate, soil organic carbon, dissolved organic carbon, labile organic carbon, C:N, and C:P. In summary, the climate prediction of abandoned grassland tending toward warm temperatures and high humidity in the loess hilly region will significantly affect the regional hydrothermal environment and nutrient characteristics, change the distribution ratio of soil labile and recalcitrant carbon, and promote regional soil carbon emissions. The analysis results showed that the key factor driving the change in soil respiration rate of abandoned grassland in the loess hilly region was soil temperature and SWC characteristics.

Sensorial saturation improves infants’ procedure-related pain behaviour in the cardiac intensive care unit: A quasi-experimental study

BackgroundPainful procedures are unavoidable when providing critical care to infants in intensive care units. These adverse experiences during infancy can lead to later hyperalgesia and poor neurodevelopmental outcomes. Thus, appropriate interventions are required to relieve infant pain during these procedures. ObjectivesThis study evaluated the effectiveness of sensorial saturation in reducing pain for infants during jugular central venous catheter removal procedures in intensive care units. MethodsThis study involved a quasi-experimental, repeated-measures design. Data were collected from participants sequentially recruited from April to June 2019 (control period) and July to September 2019 (experimental period). Participants included 78 infants younger than 1 year with congenital heart disease. The control group (n = 38) received a general nursing intervention using swaddling, a common child-care practice that consists of wrapping infants to restrict movements, whereas the experimental group (n = 40) received sensorial saturation using oral sugar, body massage, and verbal interaction. Infants' physiological reactions to procedural pain were measured by changes in heart rate, oxygen saturation, and respiratory rate. Infants’ procedural pain and behavioural indicators were measured using the Modified Behavioural Pain Scale. Data were analysed using descriptive statistics, independent t-tests, χ2 tests, and repeated-measures analysis of variance. ResultsCompared with the control group, the experimental group had lower heart rates (F = 53.15, p < .001), respiratory rates (F = 15.19, p < .001), and behavioural pain scores (F = 45.21, p < .001), both during and after the procedure. ConclusionsSensorial saturation can be used as a nursing intervention in infants. Given the many invasive procedures that are part of infant clinical care, sensorial saturation may be a safe analgesic alternative. The findings of this study could lead to the development of evidence-based clinical practice guidelines for the nonpharmacological management of acute pain in infants.

Whole blood versus red cell concentrates for children with severe anaemia: a secondary analysis of the Transfusion and Treatment of African Children (TRACT) trial

SummaryBackgroundThe TRACT trial established the timing of transfusion in children with uncomplicated anaemia (haemoglobin 4–6 g/dL) and the optimal volume (20 vs 30 mL/kg whole blood or 10 vs 15 mL/kg red cell concentrates) for transfusion in children admitted to hospital with severe anaemia (haemoglobin <6 g/dL) on day 28 mortality (primary endpoint). Because data on the safety of blood components are scarce, we conducted a secondary analysis to examine the safety and efficacy of different pack types (whole blood vs red cell concentrates) on clinical outcomes.MethodsThis study is a secondary analysis of the TRACT trial data restricted to those who received an immediate transfusion (using whole blood or red cell concentrates). TRACT was an open-label, multicentre, factorial, randomised trial conducted in three hospitals in Uganda (Soroti, Mbale, and Mulago) and one hospital in Malawi (Blantyre). The trial enrolled children aged between 2 months and 12 years admitted to hospital with severe anaemia (haemoglobin <6 g/dL). The pack type used (supplied by blood banks) was based only on availability at the time. The outcomes were haemoglobin recovery at 8 h and 180 days, requirement for retransfusion, length of hospital stay, changes in heart and respiratory rates until day 180, and the main clinical endpoints (mortality until day 28 and day 180, and readmission until day 180), measured using multivariate regression models.FindingsBetween Sept 17, 2014, and May 15, 2017, 3199 children with severe anaemia were enrolled into the TRACT trial. 3188 children were considered in our secondary analysis. The median age was 37 months (IQR 18–64). Whole blood was the first pack provided for 1632 (41%) of 3992 transfusions. Haemoglobin recovery at 8 h was significantly lower in those who received packed cells or settled cells than those who received whole blood, with a mean of 1·4 g/dL (95% CI –1·6 to –1·1) in children who received 30 mL/kg and –1·3 g/dL (–1·5 to –1·0) in those who received 20 mL/kg packed cells versus whole blood, and –1·5 g/dL (–1·7 to –1·3) in those who received 30 mL/kg and –1·0 g/dL (–1·2 to –0·9) in those who received 20 mL/kg settled cells versus whole blood (overall p<0·0001). Compared to whole blood, children who received blood as packed or settled cells in their first transfusion had higher odds of receiving a second transfusion (odds ratio 2·32 [95% CI 1·30 to 4·12] for packed cells and 2·97 [2·18 to 4·05] for settled cells; p<0·001) and longer hospital stays (hazard ratio 0·94 [95% CI 0·81 to 1·10] for packed cells and 0·86 [0·79 to 0·94] for settled cells; p=0·0024). There was no association between the type of blood supplied for the first transfusion and mortality at 28 days or 180 days, or readmission to hospital for any cause. 823 (26%) of 3188 children presented with severe tachycardia and 2077 (65%) with tachypnoea, but these complications resolved over time. No child developed features of confirmed cardiopulmonary overload.InterpretationOur study suggests that the use of packed or settled cells rather than whole blood leads to additional transfusions, increasing the use of a scarce resource in most of sub-Saharan Africa. These findings have substantial cost implications for blood transfusion and health services. Nevertheless, a clinical trial comparing whole blood transfusion with red cell concentrates might be needed to inform policy makers.FundingUK Medical Research Council (MRC) and the Department for International Development.TranslationFor the French translation of the abstract see Supplementary Materials section.

Data Augmentation and Transfer Learning for Data Quality Assessment in Respiratory Monitoring.

Changes in respiratory rate have been found to be one of the early signs of health deterioration in patients. In remote environments where diagnostic tools and medical attention are scarce, such as deep space exploration, the monitoring of the respiratory signal becomes crucial to timely detect life-threatening conditions. Nowadays, this signal can be measured using wearable technology; however, the use of such technology is often hampered by the low quality of the recordings, which leads more often to wrong diagnosis and conclusions. Therefore, to apply these data in diagnosis analysis, it is important to determine which parts of the signal are of sufficient quality. In this context, this study aims to evaluate the performance of a signal quality assessment framework, where two machine learning algorithms (support vector machine–SVM, and convolutional neural network–CNN) were used. The models were pre-trained using data of patients suffering from chronic obstructive pulmonary disease. The generalization capability of the models was evaluated by testing them on data from a different patient population, presenting normal and pathological breathing. The new patients underwent bariatric surgery and performed a controlled breathing protocol, displaying six different breathing patterns. Data augmentation (DA) and transfer learning (TL) were used to increase the size of the training set and to optimize the models for the new dataset. The effect of the different breathing patterns on the performance of the classifiers was also studied. The SVM did not improve when using DA, however, when using TL, the performance improved significantly (p < 0.05) compared to DA. The opposite effect was observed for CNN, where the biggest improvement was obtained using DA, while TL did not show a significant change. The models presented a low performance for shallow, slow and fast breathing patterns. These results suggest that it is possible to classify respiratory signals obtained with wearable technologies using pre-trained machine learning models. This will allow focusing on the relevant data and avoid misleading conclusions because of the noise, when designing bio-monitoring systems.

Experimental investigation of animals survival adequacy and efficacy in case of their soft tissues gunshot wounds using the thermometry technique

The problem of gunshot wounds treatment is one of the urgent and incompletely resolved issues of modern surgery. Diagnosis of gunshot wounds is currently not efficient enough. There was a need to improve the content and scope of medical care with the possibility of strengthening its diagnostic chain. The aim of the work is to substantiate experimentally the feasibility and effectiveness of using diagnostic infrared thermometry in gunshot wounds of the soft tissues of the extremities. Experimental studies were performed under the chronic experimental conditions on Shinshilla breed rabbits which were subjected to gunshot wounds followed by laboratory, morphological and functional examination for 5 days. The animals were divided into 3 groups depending on the type of gunshot wound that was inflicted. The animals were removed from the experiment by the introduction of chloroethyl anesthesia on the 1st, 3rd and 5th days, after which the soft tissues with the capsule surrounding the fragment were subjected to histological and electron microscopic examination. On the 1st day of the study, a significant decrease in the diameter of the blood vessels of the affected area was determined in the group of animals that were subject to injury with firearms and metal fragments from the explosion of a grenade and an improvised explosive device. It was in these groups that the highest mortality rate was registered. Under the specified conditions of injury to the limbs of animals, as well as when injured by a pneumatic weapon with a temperature of fragments of 100 oC, pronounced changes in pulse and respiratory rate were noted. In further studies on rabbits on the 3rd and 5th days of the experiment, the actual results did not differ from those obtained 24 hrs after injury. Those rabbits that survived after the reproduction of various gunshot wounds had the greatest value. The results of their thermometric measurements were evaluated in the dynamics of experimental gunshot wounds and revealed the dependence of animal survival after gunshot wounds on the temperature of the limb in the area of the wound.&#x0D; There are the following leading criteria in favor of animals further survival after gunshot wounds - the presence of a perforating vessel in the area surrounding the affected space; the size of the diameter of the vessels in the adjacent area; no hemorrhage in the muscle tissue located near the affected area; comparable with normal data of the functional parameters of the animal's body – heart rate, blood oxygen pressure and respiration; thermometry results. The limb thermometry has the important prognostic value after their gunshot wound in terms of experimental animals survival. The correspondence of high thermometry indexes after a gunshot wound vs the higher risk of an animal death is statistically reliable and, accordingly, insignificant thermometric dynamics throughout the experiment is in favor of a positive outcome after injury. It is extremely important to evaluate thermometry data during the first 24 hours after receiving gunshot wounds, since we found out the maximum validity of this method in the early time intervals. All this, with adequate clinical testing and verification, has the most important medical prospects, aimed primarily at saving time for diagnostic measures and procedures. Thermometry allows to judge the activity and severity of connective tissue inflammation or sclerosis in the lesions of each wound and provides the possibility of clinical application of remote thermography as a non-invasive method of diagnosis and prediction of complications in wounded with gunshot and explosives in various wounds.

Music Therapy Supports Children with Neurological Diseases during Physical Therapy Interventions.

Recent research found evidence supporting music therapy for children with neurological diseases during their hospitalized neurological early rehabilitation to promote their development during physical therapy. We hypothesized that live music therapy might improve vital signs during a physical therapy session. Seventeen children received live music therapy during the physical therapy session twice a week. Two more physical therapy sessions per week were held without music therapy. Heart rate, respiratory rate and oxygen saturation were recorded from 15 min before to 15 min after the therapy sessions. Physical therapy interventions showed changes in heart rate, respiratory rate and oxygen saturation between, before and after the sessions with or without music therapy. Live music therapy was effective for the vital signs during the intervention. We observed significantly lower heart and respiratory rates and higher oxygen saturation during physical therapy intervention with live music therapy in general (mean differences −8.0 beats per min; −0.8 breaths per min and +0.6%). When physical therapy was applied without music therapy children’s heart rates increased by 8.5 beats per min and respiratory rates increased by 1.0 breaths per min. Live music therapy leads to a decrease in heart and respiratory rates and an increase in oxygen saturation in children with neurological diseases during physical therapy with live music therapy. Music therapy supports the children in physical therapy interventions during their hospitalization.

Fast Changes in the Bioenergetic Balance of Krill in Response to Environmental Stress

A Dynamic Energy Budget (DEB) model is applied to predict rapid metabolic shifts in an ecologically important krill, Nyctiphanes australis, in response to temperature and ultraviolet radiation (UVR). Specifically, we predict changes in fatty acids, amino acids and respiration rate in response to several light and temperature treatments. Environmental variability can alter the metabolic equilibrium and the mechanisms marine ectotherms used to obtain energy, which is a topical point given the current level of environmental change. Environmental variability also includes multiple stressors, which can have additive, antagonistic or synergistic effects on metabolism. In consequence, disentangling and quantifying the effects of multiple stressors on metabolism and the energy balance of ecthothermal species, such as krill, can be challenging. Here we apply a DEB model to direct measurements of fatty acids, amino acids and respiration rate of krill experimentally exposed simultaneously to several doses of UVR and temperatures. We found that on average light escalates metabolic rates by a factor of two, and temperature has an effect 1.35 times greater than the effect of light over respiration rates at temperatures from 9 to 19°C. The DEB model predicted shifts in metabolic function and indicated that the combined effect of light and elevated temperatures decrease the total of fatty acid concentrations at a higher rate than amino acids when krill are exposed to environmentally relevant temperatures and light treatments. Our results demonstrate that, when krill experience warmer conditions and higher levels of solar radiation, the mobilization of energy-relevant metabolites from the reserves increases by up to 36% and increase the total energetic cost by up to 45%. These findings suggest that ectothermal species with a fast metabolism, such as krill, quickly deplete energy reserves to compensate for changes in the environment. This renders krill susceptible to the effects of climate variability if the current climatic trend for the region continues to show temperature increases, even if solar radiation levels remain unchanged.

Lack of age-related respiratory changes in Daphnia.

Aging is a multifaceted process of accumulation of damage and waste in cells and tissues; age-related changes in mitochondria and in respiratory metabolism have the focus of aging research for decades. Studies of aging in nematodes, flies and mammals all revealed age-related decline in respiratory functions, with somewhat controversial causative role. Here we investigated age-related changes in respiration rates, lactate/pyruvate ratio, a commonly used proxy for NADH/NAD+ balance, and mitochondrial membrane potential in 4 genotypes of an emerging model organism for aging research, a cyclic parthenogen Daphnia magna. We show that total body weight-adjusted respiration rate decreased with age, although this decrease was small in magnitude and could be fully accounted for by the decrease in locomotion and feeding activity. Neither total respiration normalized by protein content, nor basal respiration rate measured in anaesthetized animals decreased with age. Lactate/pyruvate ratio and mitochondrial membrane potential (∆Ψmt) showed no age-related changes, with possible exceptions of ∆Ψmt in epipodites (excretory and gas exchange organs) in which ∆Ψmt decreased with age and in the optical lobe of the brain, in which ∆Ψmt showed a maximum at middle age. We conclude that actuarial senescence in Daphnia is not caused by a decline in respiratory metabolism and discuss possible mechanisms of maintaining mitochondrial healthspan throughout the lifespan.

Comparison of the effects of target-controlled infusion-remifentanil/midazolam and manual fentanyl/midazolam administration on patient parameters in dental procedures.

BackgroundModerate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times.MethodsIn this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed. Patient indicators (pre-, intra-, and post-procedure noninvasive systolic and diastolic blood pressure, respiration, and heart rate) were compared using independent t-test analysis. Patient recovery time, procedure length, and midazolam dosage required were also compared between the two groups.ResultsEighty-five patient charts were included in the final analysis: 47 received TCI-remifentanil/midazolam sedation, and 38 received manual fentanyl/midazolam sedation. Among the physiological parameters, diastolic blood pressure showed slightly higher changes in the fentanyl group (P = 0.049), respiratory rate changes showed higher changes in the fentanyl group (P = 0.032), and the average EtCO2 was slightly higher in the remifentanil group (P = 0.041). There was no significant difference in the minimum SpO2 levels and average procedure length between the fentanyl and remifentanil TCI pump groups (P > 0.05). However, a significant difference was observed in the time required for discharge from the chair (P = 0.048), indicating that patients who received remifentanil required less time for discharge from the chair than those who received fentanyl. The dosage of midazolam used in the fentanyl group was 0.487 mg more than that in the remifentanil group; however, the difference was not significant (P > 0.05).ConclusionThe combination of TCI administered remifentanil combined with manual administered midazolam has the potential to shorten the recovery time and reduce respiration rate changes when compared to manual administration of fentanyl/midazolam. This is possibly due to either the lower midazolam dosage required with TCI remifentanil administration or achieving a stable, steady-state low dose remifentanil concentration for the duration of the procedure.

RESPIRATORY PARAMETERS OF COVID-19 PATIENTS AFTER THE PRONE POSITION

&lt;p&gt;Hypoxemia is a condition when there is a lack of oxygen levels in the blood, especially from the arteries. In the early stages of COVID-19, several mechanisms such as intrapulmonary shunting, loss of pulmonary perfusion regulation, intravascular micro thrombus, and impaired diffusion capacity can contribute to the development of arterial hypoxemia, although there is no increase in respiratory work. The prone position is one of the most widely used therapies for patients with hypoxemia because the dorsal area has a large number of alveolar units that are not compressed by the weight of the abdominal cavity and mediastinum, thus creating a more efficient area for gas exchange. This study aimed to determine the effect of the prone position on changes in respiratory parameters of COVID-19 patients. This study used the descriptive correlation method on 27 respondents with purposive sampling. Each respondent was given a prone position for three hours and being observed before, during the three-hour, and after one hour of the prone position administration”. The results of the descriptive analysis of this study showed that the majority of respondents were middle adulthood (63%) with 70% of the respondents being male, 59% having a history of hypertension, and 85% experiencing coagulation disorders. The change in the mean respiratory rate during one hour of supination after three hours of prone position in males was greater than that in females although the mean decrease in oxygen saturation was the same. This shows that the prone position for three hours accompanied by oxygen therapy made an improvement in respiratory status in COVID-19 patients, although it needs further investigation with more respondents and different research methods.&lt;/p&gt;