Duration Of Oxygen Administration Research Articles

Effect of azithromycin administration in cases of acute bronchiolitis – A systematic review and meta-analysis

Acute Bronchiolitis is the most common viral lower respiratory tract infection in infants requiring hospitalization. Management is usually symptomatic and supportive with no specific treatment options. Although viral, Azithromycin by its anti-inflammatory properties might play a role in improving the clinical outcome. The objective was to assess the effect of azithromycin on length of hospital stay and duration of oxygen requirement in cases of acute bronchiolitis. Data sources such as PubMed and Google Scholar were systematically searched till June 2023. The meta-analysis included all published, randomized controlled trials that investigated the efficacy of Azithromycin over placebo in infants <24 months with acute bronchiolitis. Data extraction was guided by a predetermined checklist. Using RevMan 5 software, the mean length of hospital stay and duration of oxygen administration were pooled from the selected studies. The fixed-effect model was used to compare the length of hospital stay and the duration of oxygen administration in the Azithromycin and placebo group. Data analyses were performed in July 2023. The primary outcome was a comparison of the length of hospital stay in infants with Bronchiolitis receiving either azithromycin (intervention) or placebo (control). The secondary outcome was the assessment of the duration of oxygen requirement in both intervention and control groups.The initial search yielded 601 records of which 68 articles underwent full-text evaluation, which identified four articles and a total of 571 patients that were included. The findings did not favor the usage of azithromycin antibiotic in treatment of acute bronchiolitis (Mean deviation = 1.21, 95% CI 0.53–2.78, P = 0.80). An insignificant Q statistic (P = 0.001) indicated the absence of heterogeneity (I2 = 0%). Length of hospital stay showed an overall insignificant effect as the length of stay is almost similar in both drugs (OR = 1.04 95% CI 0.49–2.23, P = 1.00). An insignificant Q statistic (P = 1.00) indicated the absence of heterogeneity (I2 = 0%).

Assessment of knowledge and practice of oxygen therapy among doctors and nurses: A survey from Ondo State, Southwest Nigeria

Objectives: Oxygen is among the commonly used drugs in acute emergencies. Prescription and administration of oxygen in emergencies by healthcare providers are reported to be inappropriate in most settings. There is a huge gap in the knowledge of health-care providers on various aspects of oxygen therapy. The purpose of this study was to assess the knowledge and practice of oxygen therapy among doctors and nurses working in Ondo State, South-West Nigeria and see how it compares with standard practice with a view to improving the quality care in this regard. Materials and Methods: A descriptive cross-sectional study was employed. The data were collected electronically using the Monkey survey application from consenting doctors and nurses through a self-administered validated and structured questionnaire. The questionnaire included the professional characteristics, educational background, awareness and use of oxygen therapy guidelines, knowledge of oxygen, indication for acute oxygen, and oxygen delivery practices. Data were analyzed using descriptive statistics and association between variables explored with Chi-square test at P < 0.05. Results: One hundred and seventy-six health workers participated in the study with mean age of 37.30 ± 8.88 years. One hundred and twelve (63.60%) of the respondents were doctors while 64 (36.40%) of the respondents were nurses. Sixty-eight (60.70%) of the doctors and 19 (29.70%) of nurses had a high level of knowledge of oxygen therapy (p<0.001). About half of both doctors and nurses had a poor practice level of oxygen therapy. The duration of oxygen administration (how long ago the respondent was involved in oxygen use and previous to formal training on oxygen therapy) were significantly associated with level of knowledge of oxygen therapy (p<0.001, 0.017). Conclusion: Results from this study suggest that the level of knowledge was high in about half of the respondents and about the same percentage had poor oxygen therapy practice in hospitals in Ondo State, South West Nigeria. Therefore, regular training of healthcare workers should be encouraged to update their knowledge and practice of oxygen therapy.

Early elevated NT-proBNP but not troponin I is associated with severe bronchiolitis in infants

BackgroundWe aimed to explore and to compare the association between the NT-proBNP and high-sensitivity troponin I (hs-cTnI) at early stages of acute bronchiolitis with echocardiographic alterations, clinical severity and outcomes. MethodsA single centre, prospective observational study including previously healthy infants aged 1–12 months with bronchiolitis admitted to a tertiary hospital from April 2019 to March 2020. All patients underwent clinical, laboratory and echocardiographic evaluation at the same time point within 12 h of hospital admission. NT-proBNP > 1121 pg/ml and hs-cTnI > 26 ng/L were considered elevated. The primary outcome measure was the association of raised cardiac biomarkers with the need for PICU admission. ResultsWe enrolled 40 infants with median levels of NT-proBNP of 1176 (520–3030) pg/ml and hs-cTnI of 11.5 (5–21) ng/L at the time of hospital admission. Raised levels of NT-proBNP and hs-cTnI in 50% and 20% of cases, respectively. Of them, 15 (37%) required PICU admission during the hospitalization. Increased NT-proBNP was associated with PICU admission (adjusted OR 9.5 (CI95% 1.4–64); p = 0.020), prolonged hospitalization (β = 2.7; p = 0.012) and duration of oxygen administration (β = 2.7; p = 0.004) in the multivariate analysis. There were no differences in hs-cTnI levels regarding PICU admission (p = 0.866). Increased hs-cTnI levels were only associated with oxygen administration duration (Spearman rho = 0.38; p = 0.017), but this association disappeared in the multivariate analysis. Only NT-proBNP was associated with echocardiographic parameters of myocardial dysfunction (p < 0.001), and pulmonary hypertension (p < 0.001) ConclusionEarly elevated NT-proBNP but not hs-cTnI could be used as a biomarker for myocardial strain and disease severity in bronchiolitis.

Automated oxygen administration versus conventional oxygen therapy after major abdominal or thoracic surgery: study protocol for an international multicentre randomised controlled study

IntroductionHypoxemia and hyperoxia may occur after surgery with potential related complications. The FreeO2 PostOp trial is a prospective, multicentre, randomised controlled trial that evaluates the clinical impact of automated O2...

Fluid restriction in the management of transient tachypnea of the newborn

Background Transient tachypnea of the newborn (TTN) is caused by delayed clearance of lung fluid at birth. TTN typically appears within the first two hours of life in term and late preterm neonates and is characterized by tachypnea and signs of respiratory distress. Although it is usually a self-limited condition, admission to a neonatal unit is frequently required for monitoring and providing respiratory support. Restricting intake of fluids administered to these infants in the first days of life might improve clearance of lung liquid, thus reducing the effort required to breathe, improving respiratory distress, and potentially reducing the duration of tachypnea. Objectives To evaluate the efficacy and safety of restricted fluid therapy as compared to standard fluid therapy in decreasing the duration of oxygen administration and the need for noninvasive or invasive ventilation among neonates with TTN. Search methods We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 12), in the Cochrane Library; Ovid MEDLINE and electronic ahead of print publications, in-process & other non-indexed citations, Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), on December 6, 2019. We also searched clinical trial databases and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. Selection criteria We included randomized controlled trials (RCTs), quasi-RCTs, and cluster trials on fluid restriction in term and preterm neonates with the diagnosis of TTN or delayed adaptation during the first week after birth. Data collection and analysis For each of the included trials, two review authors independently extracted data (e.g. number of participants, birth weight, gestational age, duration of oxygen therapy, need for continuous positive airway pressure [CPAP], need for mechanical ventilation, duration of mechanical ventilation) and assessed the risk of bias (e.g. adequacy of randomization, blinding, completeness of follow-up). The primary outcome considered in this review was the duration of supplemental oxygen therapy in hours or days. We used the GRADE approach to assess the certainty of evidence. Main results Four trials enrolling 317 infants met the inclusion criteria. Three trials enrolled late preterm and term infants with TTN, and the fourth trial enrolled only term infants with TTN. Infants were on various methods of respiratory support at the time of enrollment including room air, oxygen, or nasal CPAP. Infants in the fluid-restricted group received 15 to 20 mL/kg/d less fluid than those in the control group for varying durations after enrollment. Two studies had high risk of selection bias, and three out of four had high risk of performance bias. Only one study had low risk of detection bias, with two at high risk and one at unclear risk. The certainty of evidence for all outcomes was very low due to imprecision of estimates and unclear risk of bias. Two trials reported the primary duration of supplemental oxygen therapy. We are uncertain whether fluid restriction decreases or increases the duration of supplemental oxygen therapy (mean difference [MD] -12.95 hours, 95% confidence interval [CI] -32.82 to 6.92; I² = 98%; 172 infants). Similarly, there is uncertainty for various secondary outcomes including incidence of hypernatremia (serum sodium > 145 mEq/L, risk ratio [RR] 4.0, 95% CI 0.46 to 34.54; test of heterogeneity not applicable; 1 trial, 100 infants), hypoglycemia (blood glucose Authors' conclusions We found limited evidence to establish the benefits and harms of fluid restriction in the management of TTN. Given the very low certainty of available evidence, it is impossible to determine whether fluid restriction is safe or effective for management of TTN. However, given the simplicity of the intervention, a well-designed trial is justified.

Clinical implications of initial peripheral eosinophilia in acute eosinophilic pneumonia.

The initial peripheral eosinophil count (PEC) is rarely elevated but tends to increase during the clinical course of acute eosinophilic pneumonia (AEP). We evaluated whether initial peripheral eosinophilia is an indicator of mild disease in patients with AEP. We retrospectively examined associations between initial peripheral absolute eosinophil count, inflammatory markers and clinical characteristics in 85 patients with AEP. Of 85 patients, 24 (28%) had initial peripheral eosinophilia (>500/μL). Initial peripheral absolute eosinophil count was inversely correlated to white blood cell (WBC) count (ρ = -0.386, P < 0.001), neutrophil percentage (ρ = -0.645, P < 0.001) and C-reactive protein (CRP; ρ = -0.495, P < 0.001). During treatment, peripheral absolute eosinophil counts increased, while inflammatory markers (WBC, neutrophil percentage, and CRP) decreased. Patients with initial peripheral eosinophilia had a longer duration from onset of symptoms to admission (P = 0.006), had lower WBC counts, neutrophil percentages and CRP values (all P < 0.001), and higher oxygen saturation (P = 0.004) than patients with normal peripheral eosinophil counts. Oxygen requirements (P = 0.013), duration of oxygen administration (P = 0.028) and intensive care unit admission rates (P = 0.003) were lower in patients with initial peripheral eosinophilia. All patients survived and recovered fully after corticosteroid or conservative treatment. Initial PEC may be related to a milder disease status on admission, compared with normal PEC in patients with AEP. This may help to stratify disease severity in AEP.

Incidence of retinopathy of prematurity and risk factors in the South-Western Region of Iran

Aims:The aim of this study was to report the incidence of retinopathy of prematurity (ROP) and the contribution of various risk factors to ROP in the south-western region of Iran.Material and Methods:This cross-sectional case-control series reviewed all low birth weight (LBW, ≤2000 g) neonates and/or neonates less than 32 weeks gestational age who had been hospitalized in the Neonatal Intensive Care Unit from 2006 to 2010. The cohort was divided into infants without ROP (nonROP group) and infants with ROP (ROP group). Infants were first examined by a group of pediatric ophthalmologists 6 weeks after delivery, and then were followed every 1-2 weeks until death, discharge or complete retinal avascularization. If an infant developed ROP, further examinations were performed based on the Early Treatment for Retinopathy of Prematurity Study protocol. Demographic data, medical treatment, and ophthalmic disorders were all statistically analyzed.Results:A total of 576 infants met the criteria for evaluation. Of 576 total patients, 183 infants (32%) (88 males, 95 females) had ROP. There were significant differences between groups in gestational age, body weight, and duration of oxygen administration, and sepsis (P<0.05). Male/female ratio, single and multiple births, and jaundice, phototherapy, and blood transfusion were not significant. The majority of ROP was stage I or II (137, 74.8%). Stage III or greater developed in 46 infants (25.1%) [Note: The ocular history and ocular outcomes are not risk factors.]Conclusions:The incidence of ROP in this study is higher than that in other parts of the world. Awareness and knowledge of ROP and its relative risks need to be reinforced in ophthalmologists and other health practitioners.

VEGF 936C&amp;gt;T is predictive of threshold retinopathy of prematurity in Japanese infants with a 30-week gestational age or less

Vascular endothelial growth factor (VEGF) contributes to the development of retinopathy of prematurity (ROP). We investigated the association of ROP with VEGF genetic polymorphisms and its clinical parameters in Japanese people. Sixty-seven infants with a gestational age of 30 weeks or less were enrolled and classified into the threshold ROP group (infants with Stage 3 ROP in zone I or II, five continuous or eight total clock hours of the retina and the presence of plus disease, n = 30) and the nonthreshold ROP group (n = 37). The VEGF genotypes of −1498T.C, −1154G.A, −634C.G, −7C.T, 936C.T, and 1612G.A were determined. VEGF 936C.T polymorphism and 11 clinical parameters were significantly dif- ferent between the two ROP groups by univariate analysis. A logistic regression analysis with adjustments for gestational age and birth weight showed that the heterozygous or homozygous carrier state of the T alleles of VEGF 936C.T polymorphism (odds ratio 5.12; 95% confidence interval: 1.25-20.92; P = 0.023) and duration of oxygen administration (odds ratio 1.05; 95% confidence interval: 1.00-1.10; P = 0.042) were independent risk factors of threshold ROP. VEGF 936C.T polymorphism may predict threshold ROP in Japanese infants with a gestational age of 30 weeks or less.

Amniotic Fluid Transforming Growth Factor-β1 and the Risk for the Development of Neonatal Bronchopulmonary Dysplasia

Chorioamnionitis (CAM) can initiate fetal lung injury resulting in neonatal bronchopulmonary dysplasia (BPD). While neonates with BPD have higher amniotic fluid concentrations of proinflammatory cytokines, overexpression of transforming growth factor (TGF)-β₁ also appears important in the pathogenesis of BPD. The aim of this study was to investigate the relationship between TGF-β₁ and CAM-induced fetal lung injury. Forty-four amniotic fluid samples were obtained at delivery of preterm infants (median gestation, 28 weeks; birth weight, 908 g). TGF-β₁ and interleukin (IL)-6 concentrations in the amniotic fluid were measured with ELISA. Both TGF-β₁ and IL-6 concentrations in the amniotic fluid increased with increasing histological severity of CAM (each p < 0.0001). The presence of both BPD and histological CAM was associated with significantly higher amniotic fluid TGF-β₁ and IL-6 concentrations than the presence of BPD without histological CAM, or the absence of both (each p < 0.0001). Both concentrations also correlated with the duration of oxygen administration in the neonates (each p < 0.0001). Amniotic fluid TGF-β₁ seems to be important in CAM-induced fetal lung injury progressing to neonatal BPD.

Pulse Oximetry for Tapering Supplemental Oxygen in Hospitalized Patients: Evaluation of a Protocol

In a randomized study, we determined the clinical and financial effects of replacing arterial blood gas measurements with finger pulse oximeter readings during the process of tapering supplemental oxygen in hospitalized patients. The 16 patients in the control group, whose management followed conventional practice in our hospital, received a total of 57 arterial blood gas measurements during the 6.6 (mean) days it took for them to taper to their discharge supplemental oxygen level (usually room air). The 13 patients randomized to the oximeter study group had their arterial oxygen saturation monitored by pulse oximetry. The physicians of patients in the oximeter group were at liberty to obtain arterial blood gas determinations during the study if they desired. The oximeter study group had fewer (p less than 0.005) arterial punctures for blood gas measurements (total of 16 for the group) and fewer (p less than 0.001) days on supplemental oxygen (mean of 2.7 days per patient). We conclude that substituting noninvasive pulse oximetry for arterial blood gas measurements during reductions of supplemental oxygen shortened the days of oxygen use and decreased the number of arterial blood gas determinations in our patients. In addition to reducing the discomfort to patients, the use of oximetry was of financial benefit in that it reduced medical personnel time, blood gas analyzer use, and duration of oxygen administration.

Retrolental Fibroplasia: Further Clinical Evidence and Ultrastructural Support for Efficacy of Vitamin E in the Preterm Infant

To further evaluate the efficacy of oral vitamin E in preventing the development of severe retrolental fibroplasia (RLF) in very low-birth-weight infants, 100 infants treated with 100 mg/kg/d of vitamin E (dl-alpha-tocopheryl acetate) were compared with 75 infants treated with 5 mg/kg/d of vitamin E (dl-alpha-tocopherol) in the same nursery during the previous year. All 175 infants weighed less than or equal to 1,500 g at birth and required supplemental oxygen. A total of 120 infants (69 treatment; 51 control) survived greater than or equal to 10 weeks. Multivariate analysis of the control population identified five risk factors (P less than or equal to .10): gestational age, level and duration of oxygen administration, intraventricular hemorrhage, sepsis, and birth weight. When multivariate analysis was applied to both control and treatment groups, the severity of RLF was found to be significantly reduced in infants given the treatment dose of vitamin E (P = .003). Ultrastructural analyses of 58 pairs of whole-eye donations from high-risk infants surviving less than 10 weeks suggest that the initial morphologic event is gap junction increases between the plasma membranes of adjacent spindle cells of the van-guard retina. Such extensively gap junction-linked spindle cells are apparently removed from the vasoformative process as early as 4 days of life, forming a barrier to further normal vascular development and triggering retinal and vitreal neovascularizations approximately 8 weeks later. These events are maximally suppressed by elevated plasma vitamin E levels in infants greater than or equal to 27 weeks gestational age.

Diffuse and focal oxygen pneumonitis. A preliminary report on the threshold of pulmonary oxygen toxicity in man.

Utilizing hyaline membranes and proliferative pneumonitis as evidence of pulmonary oxygen toxicity, the lung changes in 21 patients (19 injured, two inhaled smoke) who died after oxygen therapy are correlated with the intensity and duration of oxygen administration. Diffuse pneumonitis inducing hypoxaemia was found in 10 (or 11) subjects, and in nine of them it was associated with the breathing of high concentrations of oxygen (60 to 100%) for at least two days. In at least eight subjects the pneumonitis contributed to death, and two others who survived for weeks had extensively fibrosed lungs. The breathing of 40% oxygen for a sufficient time seems to be a threshold for dangerous lung effects, since one patient developed a diffuse pneumonitis and another a partly-diffuse partly-focal pneumonitis while exposed to this concentration. Those respiring oxygen concentrations between 25 and 40% for days developed either subclinical focal lung lesions or had no relevant lung changes.