Hypoxic Index Research Articles

Effect of Low Dose Insulin Therapy on Normoglycemic Critically Ill Patients in Intensive Care Units

Abstract Background Insulin has anti-inflammatory effect and vasodilatory effect via endothelial NO release in arteries, veins and capillaries. Insulin inhibits release of inflammatory mediators like IL-6, TNF-α and enhances the immune function of monocytes. Stress-induced hyperglycemia is very common in the ICU, being detected in 50–85% of critically ill patients. It is defined as a blood glucose level >140 mg/dL or glycated hemoglobin (HbA1c) > 6.5 without a past history of pre-existing diabetes. Aim of the Work to evaluate the effect of low dose insulin therapy on the clinical progression of organ dysfunction and on the level of C-reactive protein (CRP), procalcitonin and lipid profile in patients known to be normoglycemic complaining of systemic inflammatory response syndrome (SIRS) or sepsis in intensive care unit. Patients and Methods The study was conducted on 60 patients which were randomized into 2 groups: 30 patients received moderate insulin therapy (group 1) and 30 patients received iv infusion of placebo (normal saline 0.9% NaCl) during the course of the study (group 2). Results There was an improvement in blood pressure, heart rate and body temperature in group 1 compared to group 2 and throughout the study period in group 1. CRP and lactate levels were declined in group 1 with better creatinine values. Triglycerides were decreased in group 1 and hypoxic index was higher in group 1 compared to group 2. Conclusion Insulin therapy with target blood glucose (120-140 mg/dL) has been found in our study that it reduces the complications of SIRS and organ failure, which was expressed by the gradual improvement in heart rate, means arterial blood pressure, body temperature, serum lactate level and urine output. These results support the hypothesis that insulin has a positive inotropic effect. Recommendations Future studies are required to compare between moderate insulin therapy with target blood glucose (120 – 140 mg/dL) and intensive insulin therapy with target blood glucose (80-110 mg/dL) as regard patients' mortality and morbidity.

Role of early progressive mobilization protocol on outcomes of mechanically ventilated patients with pneumonia

Introduction Mobilization targets include upgrading respiratory function by improving ventilation/perfusion matching, increasing lung capacity, improving secretion clearance, reducing the hazards of immobility, improving levels of consciousness, improving functional independence, improving cardiovascular status, and improving psychological well-being. Objectives The aim of the study was to determine the effect of early mobilization of mechanically ventilated patients with pneumonia on morbidity (facilitating weaning, hospital stay, incidence of muscle weakness, and incidence of delirium) and mortality. Patients and methods This comparative randomized single-blinded study enrolled 70 adult mechanically ventilated patients of both sexes having pneumonia. They were categorized into two groups according to applying the mobilization protocol: mobilization group and control group. Before starting the protocol, the participants were subjected to history taking, complete physical examination, neurological examination (Glasgow Coma Scale and muscle power), full laboratory and radiological investigations. Initiation of stepwise progressive mobilization protocol after 24 h of intubation was done, and respiratory and hemodynamic stability were assessed. Results The first group (mobilization group) included 35 patients, in whom mobilization protocol was applied, and second group (control group) included 35 patients, in whom no protocol was applied. The mobilization group showed less ventilator days, ICU stay, and hospital stay. Moreover, they showed improvement in the static compliance, hypoxic index, and Sequential Organ Failure Assessment score (SOFA score) values in comparison between the first and last day of the study in each group. They showed less incidence of delirium and less mortality at days 7 and 28 in comparison with the control group. Conclusions The mobilization intervention is a feasible and safe intervention and offers improvement in multiple outcomes for patients with pneumonia such as reduction of the duration of mechanical ventilation, ICU stay, hospital stay, delirium, and mortality and improvement of muscle power and lung compliance.

Ante and Postnatal Ultrasound Contribution and Near-infrared Spectroscopy (NIRS) Monitoring in Preterm Newborns with Intrauterine Growth Restriction Under 32 Weeks of Gestation

IUGR remains an important health problem in developing countries around the world, being one of the major obstetrical syndromes associated with placental defects, but also one of the topical issues of neonatology, and in particular the association between IUGR and prematurity under 32 weeks of gestation. Neonatal morbidity and mortality remain significant and has an important economic impact. The need for more stringent diagnostic criteria remains a problem. The study proposes to follow the time of extraction of a premature pregnancy IUGR with gestation age �32 weeks, taking into account the centralization of bloodflow as well as IH (hypoxic index) during observation, following the immediate consequences on this new category - as well as their prognosis depending on the associated pathology using cerebral serial Doppler ultrasounds and near-infrared spectroscopy (NIRS).

Determination of end point of fluid resuscitation using simplified lung ultrasound protocol in patients with septic shock

Context Fluid administration requires dynamic measures that are preferred over static ones as they are easy to apply and noninvasive. Thoracic ultrasound could be used in assessing extravascular lung water by visualizing the so-called B-lines. Aim To assess the role of a new simple ultrasound protocol in identifying the end point of fluid resuscitation in patients with septic shock. Settings and design A single-blinded randomized controlled trial was carried out on 80 consecutive adult patients with septic shock. Patients and methods Patients were divided into two groups: the first received fluid resuscitation according to early goal-directed therapy with a target central venous pressure of 8–12 mmHg, whereas the second received fluids guided by simplified lung ultrasound protocol till reaching a score of 16. Statistical analysis used IBM SPSS software package, version 20.0 was used for statistical analyses. Results The ultrasound score showed a negative significant weak correlation with the hypoxic index (Spearman’s r=−0.39, P=0.012), whereas it showed a positive moderate significant correlation with the central venous pressure readings (Spearman’s r=0.50, P=0.001), and positive moderate significant correlation with the congestion by chest radiography (Spearman’s r=0.47, P=0.002). A score of more than or equal to 10 in patients with septic shock with a sensitivity of 84.21% and specificity of 90.48% was concluded, upon which resuscitation should be terminated (area under the curve was 0.818 with a significant correlation of P=0.001). Conclusion Simplified lung ultrasound protocol could be used as an end point of fluid resuscitation in patients with septic shock to avoid fluid overload effects.

ВЛИЯНИЕ СРЕДСТВ ГИПЕРКАПНИЧЕСКОЙ ГИПОКСИИ НА ФУНКЦИОНАЛЬНУЮ И СПЕЦИАЛЬНУЮ ФИЗИЧЕСКУЮ ПОДГОТОВЛЕННОСТЬ ЮНЫХ ДЗЮДОИСТОВ

Aim was to assess the efficiency of Karbonik respiratory trainer developed by professor Kulikov in 15-16-year-old judokas’ training. Materials and Methods. The study involved two groups of first- and second-category judokas. Each group included 10 athletes of approximately the same physical fitness level. Training of the experimental group used hypoxic hypercapnic gas mixture formed by the above mentioned respiratory trainer. Response of the functional systems to the training program was assessed based on the changes in hypoxic index, timed inspiratory and expiratory capacities, lung capacity, and heart rate; as well as tests reflecting the levels of special physical fitness and sport performance. Results. It was revealed that regular respiratory training via additional volume of dead air breath provided by Karbonik respiratory trainer system contributed to adaptation of a young judoka’s body to hypoxia and hypercapnia, which, in its turn, resulted in improvement of special physical fitness and sport performance. Conclusion. The respiratory trainer due to additional dead space volume creates the conditions of moderate hypoxia and hypercapnia which have a combined positive effect on the increase of special physical fitness and sport performance in young judokas.

Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report

IntroductionObstructive sleep apnea (OSA) and hyperaldosteronism are very common in subjects with resistant hypertension. We hypothesized that aldosterone mediated chronic fluid retention may influence OSA severity in patients with resistant hypertension. We tested this in an open label evaluation by assessing the changes in the severity of OSA in patients with resistant hypertension following treatment with spironolactone.MethodsSubjects with resistant hypertension [clinic blood pressure (BP) ≥140/90 mm Hg on ≥3 antihypertensive medications, including a thiazide diuretic and OSA [defined as an apneahypopnea index (AHI) ≥ 15] had full diagnostic, polysomnography before and 8 weeks after spironolactone (25–50 mg/day) was added to their ongoing antihypertensive therapy.ResultsTwelve patients (mean age 56 years and body mass index 36.8 kg/m2) were evaluated. Following treatment with spironolactone, the AHI (39.8±19.5 vs. 22.0±6.8 events/hr; p < 0.05) and hypoxic index (13.6±10.8 vs. 6.7±6.6 events/hr; p < 0.05), weight, clinic and ambulatory BP were significantly reduced. Plasma renin activity and serum creatinine were significantly higher.ConclusionThis study provides preliminary evidence that treatment with a mineralocorticoid receptor antagonist substantially reduces the severity of OSA. If confirmed in a randomized assessment it will support aldosterone-mediated chronic fluid retention as an important mediator of OSA severity in patients with resistant hypertension.

Fetal Doppler Hypoxic index for the prediction of abnormal fetal heart rate at delivery in chronic fetal distress

Objective: To design a Doppler Hypoxic index (HI), which takes into account both the duration and the intensity of fetal flow redistribution (i.e. hypoxia) for predicting the occurrence of abnormal fetal heart rate (FHR) at delivery. Method: Sixty-six pregnancies with hypertension and/or growth retardation (IUGR) were investigated (age: 23 ± 5 years; primigravidas: 30%, CS 59%; hospitalisation: 10 ± 8 days, IUGR (<10 c) 82%, intensive care 23%, fetal death 1). Umbilical (URI) and cerebral (CRI) Doppler resistance indices, and the C/U ratio (CRI/URI) were measured every 2 days from admission to delivery. HI was calculated by summing the daily %C/U reduction (in % from normal cut-off limit 1.1) over the period of observation (or mean C/U reduction in % from 1.1 × number of days of observation). Doppler C/U and HI were compared with fetal heart rate (FHR) traces, and perinatal data. Results: HI > 160% was associated with abnormal FHR in 80% of the cases (PPV = 87%, NPV = 88%). HI > 160% predicted the occurrence of abnormal FHR 8 ± 6 days before they happened. Conclusion: A combination of intensity and duration of the fetal flow redistribution (i.e. hypoxia) evaluated by Doppler is correlated with the occurrence of abnormal fetal heart rate.

Consequences of reduced umbilical and increased foetal cerebral flow during malaria crisis on foetal behaviour.

The objectives of this study were (a) to evaluate the sensitivity and specificity of foetal Doppler indices for the prediction of abnormal foetal heart rate (aFHR) at delivery after malaria crisis and (b) to test Doppler parameters against crisis duration for predicting aFHR. Every day during the malaria crisis, the umbilical and cerebral vascular resistance indices were measured by Doppler. These indices allowed evaluation of the amplitude of the foetal flow redistribution induced by malaria (C/U=cerebral resistance/umbilical resistance ratio), the duration of the flow redistribution period and the hypoxic index (mean %C/U change x crisis duration). It was found that the mean duration of the flow redistribution period was: 7 +/- 2 days, mean C/U change -7% +/- 4, hypoxic index -56 +/- 37, prematures 35%, and aFHR 17%. An hypoxic index > 150 predicted occurrence of aFHR with high sensitivity and specificity (100%/91%). The highest foetal flow disturbance (max %C/U) and the duration of the period with flow disturbance (> 7 days) predicted aFHR at delivery with a sensitivity of 10% and 40% and a specificity of 77% and 78%. It was concluded that the hypoxic index was more predictive of aFHR at delivery than the amplitude or the duration (i.e. crisis duration) of the foetal flow redistribution.

Acute reversible placental dysfunction and abnormal fetal heart rate at delivery

Acute placental dysfunction induced by malaria is characterized by umbilical artery resistance increase and cerebral artery resistance decrease during the crisis. The objective was to evaluate the sensitivity and specificity of fetal Doppler indices and crisis duration for predicting abnormal fetal heart rate (aFHR) at delivery several weeks after the crisis. Method: Every day during the crisis, the umbilical and cerebral resistance indices were measured by Doppler. These indices allowed evaluation of the amplitude of the fetal flow redistribution (C/U = cerebral resistance/umbilical resistance ratio), the duration of the flow redistribution period (i.e. crisis duration) and the Hypoxic index (HI) (mean %C/U change × crisis duration). Results: Population: 46 pregnancies. Mean duration of the flow redistribution period 8±3.2 days, mean C/U change −9%±6; Hypoxic index −86±75; prematures 48%; aFHR 30%). Hypoxic index >150 predicted occurrence of aFHR with high sensitivity and specificity (83%/88%). The presence of abnormal flow distribution (C/U<1.1) and the duration of the period with flow disturbance (>8 days) predicted aFHR at delivery with a sensitivity of 45 and 48% and a specificity of 82 and 84%. Conclusion: The Hypoxic index was more predictive of aFHR at delivery than the amplitude or the duration of the fetal flow redistribution triggered by placental insufficiency.

Fetal flow redistribution to the brain in response to malaria infection: does protection of the fetus against malaria develop over time?

Malaria during pregnancy induces deterioration of placental function, resulting in transient fetal hypoxia. Our objective was to evaluate the sensitivity and specificity of fetal Doppler indices for prediction of abnormal fetal heart rate at delivery and to compare the amplitude of the fetal vascular response to malaria in 2 groups of fetuses (1994 and 1996) separated by an interval of 2 years. Every day during the crisis, the umbilical and cerebral resistance indices, the cerebral-umbilical resistance ratio, and the hypoxic index (mean percent cerebral-umbilical resistance ratio change x crisis duration) were calculated. In group 2 (1996), the duration of the flow redistribution period was about 7 days (mean cerebral-umbilical resistance ratio change +/- SD, 7%+/-4%; hypoxic index, 49+/-26; premature, 35%; and abnormal fetal heart rate, 17.5%). A hypoxic index greater than 150 predicted abnormal fetal heart rate with high sensitivity and specificity (group 1, 80% and 85%; and group 2, 100% and 91 %). Moreover, in group 2 (1996), the amplitude of the fetal vascular response and the rate of long-duration crisis were significantly lower than in group 1 (1994; P < .01). Nevertheless, the hypoxic index was much more predictive of fetal heart rate at delivery than the amplitude or duration (i.e., crisis duration) of the flow redistribution. The hypoxic index value during the crisis allowed prediction of abnormal fetal heart rate at delivery. In group 2, the absence of a long-term flow redistribution period and the smaller hemodynamic changes (lower hypoxic index) associated with a lower occurrence of abnormal fetal heart rate could be related to improvement of pregnancy management, acquired protection during the interval between the 2 studies, or both.