Continuous Oxygen Therapy Research Articles

The Immediate Effect of Chest Mobilization Technique on Chest Expansion in Patients of COPD

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by chronic airflow obstruction. Patients with COPD often experience reductions in lung volumes and vital capacity due to chronic respiratory muscle weakness. Additionally, they may exhibit decreased lung distensibility, leading to restrictions in lung volume. The passive recoil of the thoracic cage is influenced by gross muscle weakness, altering the neutral position at which lung and cage recoil pressures are balanced. Mobilizing rib cage joints is a specific therapeutic goal, as it aims to improve reduced rib cage mobility commonly observed in obstructive lung disease. Method: A study was conducted on COPD patients aged over 40 years, specifically including males with VC<80%. Participants with unstable vital parameters, active lung infections, or those requiring continuous oxygen therapy or mechanical ventilation were excluded. The participants were divided into two groups: Group 1 received chest mobilization and breathing exercises, while Group 2 received only breathing exercises. Chest expansion measurements were taken at the 2nd intercostal space, 4th intercostal space, and xiphoid process in both groups before and after the procedures. Result: Result obtained from SPSS20. Mean-age of Group1 was (61.9+6.0) & of Group2 was (62.05+6.1). Comparison between groups found using independent t-tests. There was significant difference of chest-expansion at 2nd IC, 4th IC and xiphoid process between both the groups. Chest-expansion at 2nd IC(M=2.0), 4th IC(M=2.85) and xiphoid process (M=3.43) was increased in group1 than group2 (M=1.58), (M=2.01) & (M=2.49) having significant difference of p<0.05. Conclusion: This study concludes that Chest Wall mobilization has significant effect on Chest-expansion in COPD patients. Hence Chest-Mobilization is definite tool for the improving condition of COPD patients, so it should be included as a part of management in COPD patients with other exercise treatment-programs. Keywords: Chest mobilization, COPD, Chest expansion, Cloth tape measurement

Congenital Central Hypoventilation Syndrome: neonatal diagnosis and management

To report a neonatal case successfully treated with non-invasive ventilatory support (NVS), avoiding tracheostomy. Full-term newborn, whose mother uses nocturnal NVS due to CCHS. During the transition period, she presented desaturations associated with hypercapnia and respiratory acidosis, without pulmonary involvement. She developed severe hypoventilation during sleep, with no respiratory effort, peripheral oxygen saturation (SpO2) < 80%, plus respiratory acidosis. While awake, she had good respiratory effort and normal SpO2 without assistance. Noninvasive continuous positive airway pressure and oxygen therapy worsened her condition while sleeping. Complete NVS with nasal interface and bi-level airway positive pressure, inspiratory/expiratory pressure 14-16/4 cm H2O, normalized SpO2 during sleep, and arterial blood gases while awake. Sequencing of the PHOX2B gene confirmed the presence of a heterozygous pathogenic variant with the 20/26 genotype. At 2 months of age, she was discharged maintaining NVS with nasal interface and 0 PEEP, achieving adequate neurodevelopment. We highlight the importance of genetic diagnosis of CCHS in neonates with clinical presentation of early alveolar hypoventilation, especially if there is a family history. We are not aware of other reports of neonatal onset in which NVS prevents IMV, in this potentially lethal pathology.

The role of continuous topical oxygen therapy as an adjunctive treatment in non-healing chronic wounds: a South African perspective

The role of continuous topical oxygen therapy as an adjunctive treatment in non-healing chronic wounds: a South African perspective

Occult retinal neovascularization following intravitreal bevacizumab and laser treatment for retinopathy of prematurity

BackgroundWe present a patient with retinopathy of prematurity (ROP) who developed worsening plus disease after complete regression of stage 3 ROP. The use of fundus fluorescein angiography (FFA) aided the visualization of occult neovascularization that caused the disease progression.Case presentationThe patient was at high risk for ROP due to low birth weight of 690 g and gestational age of 25 weeks. After the diagnosis of stage 3 ROP in zone I without plus disease, she was treated initially with bilateral intravitreal bevacizumab (IVB) and followed by laser photocoagulation 5 weeks later. Despite the resolution of ROP stage, the plus disease worsened. Neither systemic risk factors nor skip laser areas were observed. Hence, FFA was performed and subsequently identified occult neovascularization with active leakage. Additional IVB and laser treatment in the capillary dropout area inside vascularized retina were added. The plus disease improved but mild arteriolar tortuosity persisted.ConclusionsWorsening of plus disease after completion of laser ablation and IVB with complete regression of stage 3 ROP is rare. Systemic risk factors such as continuous oxygen therapy and cardiovascular disease should be ruled out. FFA aided in identifying occult neovascularization and prompted further treatment.

The chest X-ray score baseline in predicting continuous oxygen therapy failure in low-risk aged patients after thoracic surgery.

Radiographic severity assessment can be instrumental in diagnosing postoperative pulmonary complications (PPCs) and guiding oxygen therapy. The radiographic assessment of lung edema (RALE) and Brixia scores correlate with disease severity, but research on low-risk elderly patients is lacking. This study aimed to assess the efficacy of two chest X-ray scores in predicting continuous oxygen therapy (COT) treatment failure in patients over 70 years of age after thoracic surgery. From January 2019 to December 2021, we searched for patients aged 70 years and above who underwent thoracic surgery and received COT treatment, with a focus on those at low risk of respiratory complications. Bedside chest X-rays, RALE, Brixia scores, and patient data were collected. Univariate, multivariate analyses, and 1:2 matching identified risk factors. Receiver operating characteristic (ROC) curves determined score sensitivity, specificity, and predictive values. Among the 242 patients surviving to discharge, 19 (7.9%) patients experienced COT failure. COT failure correlated with esophageal cancer surgeries, thoracotomies (36.8% vs. 9%, P=0.003; 26.3% vs. 9.4%, P=0.004), and longer operation time (3.4 vs. 2.8 h, P=0.003). Surgical approach and RALE score were independent risk factors. The prediction model had an area under the curve (AUC) of 0.839 [95% confidence interval (CI), 0.740-0.938]. Brixia and RALE scores predicted COT failure with AUCs of 0.764 (95% CI, 0.650-0.878) with a cut-off value of 6.027 and 0.710 (95% CI, 0.588-0.832) with a cut-off value of 17.134, respectively, after 1:2 matching. The RALE score predict the risk of COT failure in elderly, low-risk thoracic patients better than the Brixia score. This simple, cheap, and noninvasive method helps evaluate postoperative lung damage, monitor treatment response, and provide early warning for oxygen therapy escalation. Further studies are required to confirm the validity and applicability of this model in different settings and populations.

Remote assessment and monitoring with advanced wound therapy to optimise clinical outcomes, access and resources.

Patients in rural communities may have limited access to wound care; however, this may be mitigated by using a shared care approach. This study assessed the impact of a remote assessment and monitoring tool in combination with adjunctive continuous topical oxygen therapy (cTOT) in patients with diabetes and hard-to-heal wounds. Patients with hard-to-heal wounds (defined as no visible improvement in the previous four weeks) were enrolled to this 12-week pilot study to validate a shared care approach using an Advanced Digital Wound Care Platform-telehealth (ADWCPt) system (eKare Inc., US) coupled with cTOT. Patient and wound assessments were reviewed by the clinician either remotely, via telehealth calls, or at the clinic, and the number of face-to-face clinic visits was recorded. Patient health status scores were captured before and after the study, along with feedback on usability of the remote platform and cTOT device. The wounds in all eight patients studied reduced in size over 12 weeks (mean percentage area reduction 92.0%), and two wounds were completely re-epithelialised. Another wound almost healed (99.2% wound area reduction). Clinical interactions consisted of self-assessments (n=80, 50.0%), video assessments with the clinician (n=27, 16.9%), and face-to-face interactions in clinic (n=53, 33.1%). Operational efficiencies encompassed a 54.0% increase in the number of clinical interactions, whereas clinical time was reduced by 25.8%. Health status scores improved across all eight patients and feedback on the shared approach and cTOT device was favourable. A shared care model with ADWCPt coupled with an innovative cTOT device saved time and resources, improving patient access and engagement, along with a marked improvement in the wound healing trajectory.

Monitoring the Effect of Continuous Topical Oxygen Therapy With Near-Infrared Spectroscopy: A Pilot Case Series in Wound Healing

Background. Sufficient oxygen is critical for multiple processes in wound healing. Nonhealing wounds have low tissue oxygen levels due to damaged microvasculature and comorbidities limiting tissue perfusion. Hypoxia may be reversed using continuous topical oxygen therapy (cTOT). Objective measures to identify and track hypoxic wounds and their response to adjunctive oxygen are key. Objective. To understand the effect of cTOT on recalcitrant wounds by tracking wound area and changes in tissue oxygenation using a near-infrared spectroscopy (NIRS) device. Materials and Methods. Five patients with nonhealing wounds received treatment with cTOT over 5 weeks. Routine wound measures and tissue oxygenation were recorded over that period. Results. Reductions in wound area and improvements in tissue oxygenation were seen in all 5 patients, with 3 patients healing within 5 weeks despite the previous long duration of their wounds. Trends in tissue oxygenation and relative wound surface area over the treatment period demonstrated a reduction in wound area as tissue oxygenation improved. Conclusion. This case series reinforces previous studies that cTOT is an effective, noninvasive treatment as a key adjunct to standard care in nonhealing wounds. Moreover, point-of-care tools such as the NIRS imaging device provided objective information concerning tissue oxygenation improvements, thus giving useful insights to the clinician.

Evaluation of feasibility phase of adaptive version of locally made bubble continuous positive airway pressure oxygen therapy for the treatment of COVID-19 positive and negative adults with severe pneumonia and hypoxaemia.

Bubble continuous positive airway pressure (bCPAP) oxygen therapy has been shown to be safe and effective in treating children with severe pneumonia and hypoxaemia in Bangladesh. Due to lack of adequate non-invasive ventilatory support during coronavirus disease 2019 (COVID-19) crisis, we aimed to evaluate whether bCPAP was safe and feasible when adapted for use in adults with similar indications. Adults (18-64 years) with severe pneumonia and moderate hypoxaemia (80 to <90% oxygen saturation (SpO2) in room air) were provided bCPAP via nasal cannula at a flow rate of 10 litres per minute (l/min) oxygen at 10 centimetres (cm) H2O pressure, in two tertiary hospitals in Dhaka, Bangladesh. Qualitative interviews and focus group discussions, using a descriptive phenomenological approach, were performed with patients and staff (n = 39) prior to and after the introduction (n = 12 and n = 27 respectively) to understand the operational challenges to the introduction of bCPAP. We enrolled 30 adults (median age 52, interquartile range (IQR) 40-60 years) with severe pneumonia and hypoxaemia and/or acute respiratory distress syndrome (ARDS) irrespective of coronavirus disease 2019 (COVID-19) test results to receive bCPAP. At baseline mean SpO2 on room air was 87% (±2) which increased to 98% (±2), after initiation of bCPAP. The mean duration of bCPAP oxygen therapy was 14.4 ± 24.8 hours. There were no adverse events of note, and no treatment failure or deaths. Operational challenges to the clinical introduction of bCPAP were lack of functioning pulse oximeters, difficult nasal interface fixation among those wearing nose pin, occasional auto bubbling or lack of bubbling in water-filled plastic bottle, lack of holder for water-filled plastic bottle, rapid turnover of trained clinicians at the hospitals, and limited routine care of patients by hospital clinicians particularly after official hours. If the tertiary hospitals in Bangladesh are supplied with well-functioning good quality pulse oximeters and enhanced training of the doctors and nurses on proper use of adapted version of bCPAP, in treating adults with severe pneumonia and hypoxaemia with or without ARDS, the bCPAP was found to be safe, well tolerated and not associated with treatment failure across all study participants. These observations increase the confidence level of the investigators to consider a future efficacy trial of adaptive bCPAP oxygen therapy compared to WHO standard low flow oxygen therapy in such patients. s Although bCPAP oxygen therapy was found to be safe and feasible in this pilot study, several challenges were identified that need to be taken into account when planning a definitive clinical trial.

Consenso de expertos sobre la eficacia clínica y directrices sobre la terapia de oxígeno transdérmico continuo para la cicatrización de las heridas complejas o difíciles de cicatrizar

Oxygen is pivotal for wound healing. Its lack or hypoxia can delay this process, especially in individuals with comorbidities, potentially resulting in complex or hard-to-heal wounds. The Colombian Association of Diabetes (ACD) and the Colombian Association of Internal Medicine (ACMI) collaborated with a diverse group of experts to provide recommendations on the efficacy and best practices of continuous transdermal oxygen therapy (TOTc) in the care of such wounds. A modified Delphi technique was employed to obtain controlled feedback and responses. Experts from various disciplines engaged in reviewing and discussing numerous relevant scientific studies, focusing on the role of TOTc in treating chronic ulcers. Continuous transdermal oxygen therapy has proven to be an effective and safe treatment for chronic and/or hard-to-heal ulcers. This therapy directly addresses the wound's oxygen deficiency, providing an environment conducive to healing. Significant benefits were observed, including the acceleration of the healing process, wound size reduction, and an enhancement in patient quality of life. Its efficacy was found across various ulcer etiologies, underscoring its therapeutic versatility. Continuous transdermal oxygen therapy is effective and safe for treating chronic and hard-to-heal ulcers. It's crucial to address each case individually and through a multidisciplinary approach to maximize this therapy's benefits. Both evidence and clinical experience back its utility across a variety of ulcer etiologies.

Feasibility and acceptability of bubble continuous positive airway pressure oxygen therapy for the treatment of childhood severe pneumonia and hypoxaemia in Bangladeshi children

Effective management of hypoxaemia is key to reducing pneumonia deaths in children. In an intensive care setting within a tertiary hospital in Bangladesh, bubble continuous positive airway pressure (bCPAP) oxygen therapy was beneficial in reducing deaths in this population. To inform a future trial, we investigated the feasibility of introducing bCPAP in this population in non-tertiary/district hospitals in Bangladesh. We conducted a qualitative assessment using a descriptive phenomenological approach to understand the structural and functional capacity of the non-tertiary hospitals (Institute of Child and Mother Health and Kushtia General Hospital) for the clinical use of bCPAP. We conducted interviews and focus group discussions (23 nurses, seven physicians, 14 parents). We retrospectively (12 months) and prospectively (three months) measured the prevalence of severe pneumonia and hypoxaemia in children attending the two study sites. For the feasibility phase, we enrolled 20 patients with severe pneumonia (age two to 24 months) to receive bCPAP, putting in place safeguards to identify risk. Retrospectively, while 747 of 3012 (24.8%) children had a diagnosis of severe pneumonia, no pulse oxygen saturation information was available. Of 3008 children prospectively assessed with pulse oximetry when attending the two sites, 81 (3.7%) had severe pneumonia and hypoxaemia. The main structural challenges to implementation were the inadequate number of pulse oximeters, lack of power generator backup, high patient load with an inadequate number of hospital staff, and inadequate and non-functioning oxygen flow meters. Functional challenges were the rapid turnover of trained clinicians in the hospitals, limited post-admission routine care for in-patients by hospital clinicians due to their extreme workload (particularly after official hours). The study implemented a minimum of four hourly clinical reviews and provided oxygen concentrators (with backup oxygen cylinders), and automatic power generator backup. Twenty children with a mean age of 6.7 (standard deviation (SD) = 5.0)) months with severe pneumonia and hypoxaemia (median (md) SpO2 = 87% in room air, interquartile range (IQR) = 85-88)) with cough (100%) and severe respiratory difficulties (100%) received bCPAP oxygen therapy for a median of 16 hours (IQR = 6-16). There were no treatment failures or deaths. Implementation of low-cost bCPAP oxygen therapy is feasible in non-tertiary/district hospitals when additional training and resources are allocated.

The Same Day on Repeat: A Unique Case of Persistent Déjà Vu Phenomenon as a Long COVID Symptom in an Older Adult

IntroductionDéjà vu is a condition characterized by the experience of recognizing a current situation as familiar with the awareness that the recognition is inappropriate (Pasic et al. Psychiatria Danubina; 30, 21–25). This phenomenon has been well described in temporal lobe epilepsy, and is thought to be caused by abnormal synchronization in the corticolimbic network. While the etiology of neuropsychiatric symptoms in long COVID is still not well demarcated, studies have found that the virus attacks the temporal lobe and limbic system; therefore, we suggest that the ongoing symptoms of déjà vu, in this case, may be a manifestation of long COVID.ObjectivesTo illustrate a unique case of persistent déjà vu after severe infection with COVID-19 virus.MethodsThe patient is a 79-year-old female with a pertinent past medical history of generalized anxiety disorder, major depressive disorder, and prior hospitalization for delirium who presented with a chief complaint of being tired of living the same day. The patient was hospitalized eight months prior for a severe COVID-19 infection that now requires continuous oxygen therapy. Since leaving the hospital, the patient began to develop episodic confusion, memory impairment, and tinnitus which gradually improved. However, the patient developed severe distress due to a constant feeling of déjà vu characterized by a sense of familiarity with events in her daily life. There was no history of loss of consciousness, abnormal involuntary movements, or other semiology related to seizures. Due to distress caused by the déjà vu symptoms, the patient also endorsed depression, anxiety, and insomnia, with deterioration of quality of life.ResultsMRI showed mild volume loss and multifocal regions, including bilateral temporal lobes, of subcortical and periventricular high T2/FLAIR signal abnormality consistent with chronic white matter microangiopathy. MOCA score was 24/30, and the dissociative experiences scale score was 15.36/100. The patient continues to be treated for her depression, insomnia and anxiety with escitalopram 10mg daily and mirtazapine 7.5mg at night as a neuropsychological assessment and electroencephalogram are done.ConclusionsThe incidence of neurological symptoms is more than 80% in severe cases of COVID-19 (Douaud et al. Nature; 604,697–707). This patient was likely predisposed to developing these symptoms due to her age and psychiatric history. Déjà vu occurs in temporal lobe epilepsy, schizophrenia, and depersonalization disorders, all of which affect the limbic-temporal lobe networks (Pasic et al. Psychiatria Danubina; 30, 21–25). Signal abnormalities in the medial temporal lobe are one of the findings seen on MRI in patients with neuropsychiatric symptoms after severe COVID-19 infection. We propose that the persistent déjà vu phenomenon along with cognitive impairments described in this case are manifestations of long COVID.Disclosure of InterestNone Declared

Management of Late Radiation Tissue Injury Ulcers With Continuous Topical Oxygen Therapy Supports Wound Healing in Patients of Advanced Age Following Mohs Surgery: A Case Series

Background. The long-term chronic effect of radiotherapy is commonly referred to as LRTI. Clinical complications such as skin atrophy, tissue fibrosis, endothelial damage, ulcer formation, and compromised wound healing are common sequela. Despite advances in medicine over the past decade, there remains a need for effective treatments for LRTI skin necrosis and ulcerations. Materials and Methods. This case series discusses cTOT in 3 patients of advanced age with LRTI wounds having undergone Mohs surgery. All wounds had been recalcitrant to multiple wound care treatments. All patients suffered with significant wound pain as well. Results. cTOT resulted in complete wound healing in all 3 patient cases. Additionally, all 3 patients reported a significant reduction in wound pain during the course of therapy. Conclusions. The positive outcomes exhibited in this case series suggest that cTOT is an effective treatment in the management of Mohs surgery patients with compromised wound healing due to radiation, advanced age, and comorbidities.

Evaluation of intratracheal salbutamol effects in addition to surfactant in the clinical course of premature neonates with respiratory distress syndrome.

In addition to surfactant deficiency, secretion of fluid from blood to the lungs and increase in the fluid content of the lung play significant roles in the pathogenesis of respiratory distress syndrome (RDS). Thus, we aimed to evaluate the effect of salbutamol (a beta-agonist) on fluid clearance from the lungs in neonates with RDS. This randomized controlled clinical trial included 82 neonates with RDS admitted to the neonatal intensive care units of Alzahra and Shahid Beheshti Hospitals of Isfahan University of Medical Science from 2017 to 2018. Patients were recruited through convenience sampling. They were randomized into two groups, using simple randomization: 42 were only treated with intra-tracheal surfactant (control group) and 40 with intra-tracheal surfactant plus salbutamol (intervention group). The two groups were compared regarding intubation surfactant administration and extubation (INSURE) failure, duration of nasal continuous positive airway pressure, intubation, oxygen therapy, morbidity, and mortality. INSURE failure leading to mechanical ventilation occurred in 3 neonates in the control group and 2 in the intervention group (P = 0.680). Mean hospital length of stay did not differ significantly between groups (P = 0.230). Comparison of controls with the intervention group regarding complications and the incidence of morbidities revealed no statistically significant difference (P > 0.05). Findings of this study were not in favor of the routine use of salbutamol in neonates with RDS as it did not improve the course of the disease among newborns.

372 PLATYPNEA-ORTHODEOXIA SYNDROME CAUSING POSITIONAL DYSPNEA AND ARTERIAL DESATURATION IN AN ELDERLY WOMAN: A CASE REPORT

Abstract A 72-years-old woman was admitted to the Emergency Department due to acute stroke in April 2022. Some days later the patient developed acute respiratory failure with oxygen arterial desaturation (SpO2 &amp;lt;80%). Interestingly, she experienced deep hypoxia when she was in the orthostatic position, with partial resolution in the supine position, thus necessitating continuous oxygen therapy. Her pertinent medical history included hypertension for which she was taking valsartan 80 mg daily and bisoprolol 2.5 mg daily, obstructive sleep apnea syndrome under treatment with nocturne continuous positive airway pressure, thyroidectomy for multinodular goiter in replacement therapy with levothyroxine 100 mcg daily, and anxious-depressive syndrome for which she was taking trazodone 75 mg daily and escitalopram 10 mg daily. Given her presentation, our top differential diagnosis included acute pulmonary embolism, pneumonia, Sars-CoV-2 infection, and platypnea-orthodeoxia syndrome. The patient was then admitted to the Pneumology Department, where she underwent computed tomography angiography, which was negative for acute pulmonary embolism and pneumonia, and two SARS-CoV-2 nasal swabs, which were both negative. The transcranial Doppler showed a high-grade shunt (curtain effect). The transesophageal echocardiography with bubble test showed a lipomatous and aneurismatic interatrial septum with a massive right-to-left shunt through a patent foramen ovale (PFO) during the Valsalva maneuver. In the absence of other obvious cause of the positional desaturation and hypoxia, a diagnosis of platypnea-orthodeoxia syndrome was made. Platypnea-orthodeoxia syndrome is a rare clinical condition difficult to diagnose. However, it represents a potentially reversible cause of positional dyspnea and arterial desaturation. The patient then underwent percutaneous PFO closure with the Gore Septal Occluder 30/30 mm (W.L. Gore and Associates, Inc.) through intracardiac echocardiography guidance without any residual shunt. Although unfavorable anatomical features were present (atrial septal aneurism and lipomatous septum), the procedure was straightforward and without complication. The oxygen saturation on pulse oximeter, which was 91% in supine position with oxygen therapy with FiO2 60% during the procedure, rapidly became 97% soon after the placement of the prosthesis. The patient then experienced relief of the dyspnea and the oxygen therapy was stopped. The clinical follow-up performed three weeks later showed an asymptomatic patient with no limitation of daily physical activity.

The danger of hyperoxia on the rat kidneys: is tadalafil a real shield?

Continuous oxygen therapy to compensate for decreased oxygen saturation in the blood is a life-saving treatment used in case lung involvement. Excess oxygen delivery was reported to be a common situation, in which about 50% of the patients showed hyperoxemia and 4% in severe hyperoxemia. In this work, we investigated the effects of hyperoxia on the rat kidneys and whether tadalafil has an effect to reduce this damage. Three groups of 8 male rats each weighing 300-350g were formed. The groups were divided into the control group, hyperoxia group, and hyperoxia and tadalafil administered group for 10 days. At the end of the 10th day, blood and kidney samples were taken for biochemical analysis (SOD and NO levels) and histopathological examination. While our findings showed that SOD levels were significantly different among the control and experimental groups and within the experimental groups, no statistical difference was found in terms of NO levels among the groups (Table 1). While the glomerular and tubular injury was higher in the Hyperoxia group and the Hyperoxia + Tadalafil group than in the control group (p < 0.001), as a result of the rate of severe glomerular and tubular injury in the hyperoxia group, was 62.5% and 43.8% and in the group given tadalafil was 43.8% and 31.3%, respectively (Table 2). Exposure to hyperoxia condition causes renal glomerular and tubular damage, and tadalafil does not show a protective effect on this damage according to this study's dose and exposure time.

Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone.

The hyperinflammatory phase represents the main cause for the clinical worsening of acute respiratory distress syndrome (ARDS) in Coronavirus disease 2019 (COVID-19), leading to the hypothesis that steroid therapy could be a mainstream treatment in COVID-19 patients. This is an observational study including all consecutive patients admitted to two Italian University Hospitals for COVID-19 from March 2020 to December 2021. The aim of this study was to describe clinical characteristics and outcome parameters of hospitalized COVID-19 patients treated with dexamethasone 6 mg once daily (standard-dose group) or methylprednisolone 40 mg twice daily (high-dose group). The primary outcome was the impact of these different steroid treatments on 30-day mortality. During the study period, 990 patients were evaluated: 695 (70.2%) receiving standard dosage of dexamethasone and 295 (29.8%) receiving a high dose of methylprednisolone. Cox regression analysis showed that chronic obstructive pulmonary disease (HR 1.98, CI95% 1.34–9.81, p = 0.002), chronic kidney disease (HR 5.21, CI95% 1.48–22.23, p = 0.001), oncologic disease (HR 2.81, CI95% 1.45–19.8, p = 0.005) and high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation oxygen therapy (HR 61.1, CI95% 5.12–511.1, p < 0.001) were independently associated with 30-day mortality; conversely, high-dose steroid therapy was associated with survival (HR 0.42, CI95% 0.38–0.86, p = 0.002) at 30 days. Kaplan–Meier curves for 30-day survival displayed a statistically significant better survival rate in patients treated with high-dose steroid therapy (p = 0.018). The results of this study highlighted that the use of high-dose methylprednisolone, compared to dexamethasone 6 mg once daily, in hospitalized patients with COVID-19 may be associated with a significant reduction in mortality.

Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): a pilot randomised control trial

ObjectivesPostoperative pulmonary complications (PPCs) are a common serious complication following upper abdominal surgery. Postoperatively, physiotherapy-led non-invasive ventilation (NIV) may be a promising method to reduce PPC incidence. The objectives of this pilot trial were to examine preliminary effectiveness, feasibility and safety of additional intermittent physiotherapy-led NIV compared to continuous high-flow nasal cannula oxygen therapy (HFNC) alone. DesignSingle-centre, assessor-blinded, parallel-group, pilot randomised control trial. SettingPrimary-referral hospital in Australia. Participants130 high-risk patients undergoing upper abdominal surgery. InterventionsContinuous HFNC for 48-hours following surgical extubation, or HFNC plus five 30-minute physiotherapy-led NIV sessions. OutcomesPPC incidence, trial feasibility and safety. ResultsPPC incidence was similar between groups (HFNC alone 12/65 (18%) vs HFNC plus NIV 10/64 (16%) adjusted HR 0.95; 95% CI 0.40–2.29). Delivery of HFNC as per-protocol was achieved in 81% (n = 105) of all participants. Physiotherapy-led NIV initiated within four-hours of surgical extubation was achieved in 81% (n = 52) of intervention group participants, with a mean 4.2 (SD 1.3) total number of NIV sessions delivered in the first two postoperative days. NIV was delivered as per-protocol in 52% of this cohort. Two episodes of severe hypotension during NIV requiring medical intervention were reported. ConclusionDelivery of continuous HFNC was feasible. Delivery of NIV within four-hours of extubation was achieved and delivered safely with< 1% adverse events. The planned NIV intervention of five sessions within two postoperative days was not feasible. The results of this pilot study have informed the decision not to proceed to a fully powered trial. Clinical Trial RegistrationAustralian New Zealand Clinical Trials Registry, www.anzctr.org.au ACTRN12617000269336. Contribution of the Paper•A protocol of continuous postoperative HFNC is feasible, well-tolerated and acceptable to high-risk adults following elective upper abdominal surgery.•Prophylactic physiotherapy-led NIV within the early postoperative period is feasible in some cases. Physiotherapy-led NIV can be delivered safely to high-risk adults following elective upper abdominal surgery in the post-anaesthetic care unit, ICU and surgical ward setting.•Delivery of a physiotherapy-led NIV protocol of five sessions over two postoperative days is not feasible to warrant progression to a future definitive trial.

The neuroprotective effects of oxygen therapy in Alzheimer’s disease: a narrative review

Alzheimer’s disease (AD) is a degenerative neurological disease that primarily affects the elderly. Drug therapy is the main strategy for AD treatment, but current treatments suffer from poor efficacy and a number of side effects. Non-drug therapy is attracting more attention and may be a better strategy for treatment of AD. Hypoxia is one of the important factors that contribute to the pathogenesis of AD. Multiple cellular processes synergistically promote hypoxia, including aging, hypertension, diabetes, hypoxia/obstructive sleep apnea, obesity, and traumatic brain injury. Increasing evidence has shown that hypoxia may affect multiple pathological aspects of AD, such as amyloid-beta metabolism, tau phosphorylation, autophagy, neuroinflammation, oxidative stress, endoplasmic reticulum stress, and mitochondrial and synaptic dysfunction. Treatments targeting hypoxia may delay or mitigate the progression of AD. Numerous studies have shown that oxygen therapy could improve the risk factors and clinical symptoms of AD. Increasing evidence also suggests that oxygen therapy may improve many pathological aspects of AD including amyloid-beta metabolism, tau phosphorylation, neuroinflammation, neuronal apoptosis, oxidative stress, neurotrophic factors, mitochondrial function, cerebral blood volume, and protein synthesis. In this review, we summarized the effects of oxygen therapy on AD pathogenesis and the mechanisms underlying these alterations. We expect that this review can benefit future clinical applications and therapy strategies on oxygen therapy for AD.

Feasibility of Single Lung Transplant for Post-COVID Fibrosis: A Case Report

IntroductionPreviously we reported bilateral lung transplantation is the last treatment option for irrecoverable COVID ARDS and post-COVID fibrosis. Now we report our first single lung transplant (SLTx) for post-COVID fibrosis.Case ReportA 59-year-old, never-smoker, female, with history of obstructive sleep apnea, hypertension and hyperlipidemia, presented to an outside hospital with COVID-19, shortness of breath, and bilateral pulmonary infiltrates on chest X-ray (CXR) (Figure 1a). She was admitted to the intensive care unit, never requiring intubation, for an overall 40-day hospitalization. At discharge, she had shortness of breath with minimal activity and required continuous oxygen (O2) therapy.One year later she presented to our institution for an outpatient lung transplant evaluation for her post-COVID fibrosis. Her cardiac work up was unremarkable, with the absence of pulmonary hypertension on echocardiogram and right heart catheterization. Computed Tomography of her chest showed only significant fibrosis in the upper lobes with traction bronchiectasis and volume loss (Figure 1c). Her lung ventilation perfusion scan showed grossly normal perfusion to both lungs. Thus, she was listed for left, right, and bilateral lungs with a Lung Allocation Score of 42.After 39 days of listing, she underwent left SLTx. Final pathology of her explanted lung (Figure 1d) showed both uninvolved lung parenchyma and interstitial fibrosis and capillary congestion (Figure 1e). Post-operatively, her course was unremarkable and she was discharged home on POD 19. She was seen in clinic on POD 22 and doing well with no need for supplemental O2 and improving CXR (Figure 1b).SummarySLTx can be used to treat debilitating post-COVID lung fibrosis when there is the absence of severe lung damage and pulmonary hypertension. Considering SLTx in these patients is necessary to expand the donor pool of lungs for a population of patients that will continue to grow with the continued COVID-19 pandemic.

Topical oxygen treatment relieves pain from hard-to-heal leg ulcers and improves healing: a case series.

Managing painful hard-to-heal leg ulcers is challenging with current therapeutic options. Wounds are prone to being hypoxic, and the subsequent pain is often related to hypoxia. Hyperbaric oxygen therapy (HBOT) is used to treat hard-to-heal leg wounds by delivering 100% oxygen at a pressure 2-3 times higher than atmospheric pressure. Unfortunately, most patients cannot be offered HBOT because it is costly and needs to be applied at specialised centres. Therefore, topical continuous oxygen therapy (TCOT) is a novel alternative for continuous local oxygen delivery to wounds and is associated with improved wound healing; however, its effect on painful wounds is unknown. This retrospective study was conducted on 20 patients, of whom 17 had painful hard-to-heal leg ulcers. In 13 patients (76%) with painful ulcers, TCOT was associated with rapid and substantial pain alleviation. Also, eight (40%) of the patients' wounds healed entirely with TCOT. This study suggests that TCOT may represent a novel pain management device for hard-to-heal wounds.