Improvement In Oxygen Saturation Research Articles

Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure

Background:Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in...

Oxygen Saturation Improvement after Adenotonsillectomy in Children

The goal of this study was to establish whether adenotonsillectomy is effective on the severity of oxygen desaturation or improve oxygen saturation in children with sleep breathing disorders. Thirty-two children, aged 4-7 years, with clinical indication for adenotonsillectomy were enrolled in a non-controlled clinical trial. Pre- and postoperative nocturnal oxygen saturation monitoring was done and oxygen desaturation index as well as desaturation events were analyzed using Wilcoxon and paired Student's t-tests. Snoring was the most prevalent (87.5%) complaint before operation. The study revealed a significant improvement in the postoperative oxygen desaturation index (1.60 +/- 3.22) compared with the preoperative oxygen desaturation index (3.98 +/- 4.93) (p < 0.01). Oxygen desaturation events at the level of oxygen saturation 85-89% was significantly improved after operation (p < 0.01). No significant differences were seen in the desaturation events at the levels of oxygen saturation lower than 85%. Nocturnal oxygen saturation improves mildly after adenotonsillectomy in children with sleep breathing disorders.

Failure of LMA in a child with normal airway because of large tonsil – An unrecognized cause: case report

The Laryngeal Mask Airway (LMA) is a supraglottic airway device that was invented by Dr. Archie Brain, a British anesthetist. The Classic LMA is the original LMA and is considered a general purpose device. It has been used extensively for different general surgical, urologic, orthopedic and ophthalmic procedures. It has also proved useful in place of endotracheal intubation in difficult airway situations in children. It has also gained wide usage for airway resuscitation and rescue . LMA has many advantages over endotracheal tube like: increased speed and ease of placement by inexperienced personnel, increased speed of placement by anaesthetists, improved haemodynamic stability at induction and during emergence, minimal increase in intraocular pressure following insertion, reduced anaesthetic requirements for airway tolerance, lower frequency of coughing during emergence, improved oxygen saturation during emergence, and lower incidence of sore throat in adults. But in some cases it is more difficult to insert LMA than intubation even in MPG 1 cases. Here we are presenting a case report of such unrecognized obstruction as, an enlarge palatine tonsil, which made impossible to insert LMA even though the child was of mallampati class I.

Interventions Complementing Surgery as Part of Multistage Treatment for Hypoplastic Left Heart Syndrome: One Center’s Experience

Interventional procedures often are used as part of multistage treatment for hypoplastic left heart syndrome (HLHS). This study aimed to evaluate the efficacy of interventions in multistage treatment of HLHS. Between 1999 and 2007, 78 interventions were performed for 58 children with HLHS at different stages of surgical treatment. Group 1, involving 30 interventions for 22 patients with postoperative pulmonary arterial stenosis, showed reduced pulmonary artery pressure and increased vessel diameter. Group 2, involving 15 interventions after the Norwood operation for 12 patients with aortic arch obstruction, showed success for 11 patients. Group 3, involving eight balloon angioplasties of narrowed Glenn anastomosis for seven patients, showed abolition of the pressure gradient between the superior vena cava and the right pulmonary artery. Group 4, involving eight interventional closures of a fenestration for eight patients after a Fontan operation, showed increased oxygen saturation for all eight patients. Group 5, involving seven interventions for six patients in whom venovenous collaterals were closed percutaneously, showed improved oxygen saturation. For Group 6, uncommon miscellaneous interventions were used to stabilize the patients' condition before the next surgical treatment. Interventional procedures play an important role during multistage treatment of HLHS. They allow for a reduction in the number of operations or stabilization of the patients' condition before the next surgical treatment.

Effects of different glycerol feeding strategies on S-adenosyl- l-methionine biosynthesis by P GAP-driven Pichia pastoris overexpressing methionine adenosyltransferase

Methionine adenosyltransferase (MAT) was overexpressed within Pichia pastoris employing the promoter of glyceraldehyde-3-phosphate dehydrogenase gene (P GAP), to biosynthesize S-adenosyl- l-methionine (SAM). Effects of five glycerol feeding tactics on MAT activity were first investigated. Strategies A–C were based on limited feeding correlated with dissolved oxygen (DO) at 50.0%, 25.0% and 0.0%, respectively. For strategies D and E, unlimited supplementation was executed by pulsed feeding mode. Gradual decline (2–0%) (w:v) of the residual glycerol level was shown between any two pulses in strategy D, while a nearly stable content (2%) throughout fed-batch cultivation with strategy E. With shifting strategies A–E in alphabetical order, gradual improvements of MAT activities were achieved, with the maximum of 9.05 U g −1 dried biomass for strategy E, since the specific glycerol consumption rate ( F G) ascended due to the elevated specific oxygen uptake rate ( q O 2 ). The success was ascribed to the enhancement of oxygen transfer rate (OTR), because 2% glycerol improved oxygen saturation content in broth ( C*) and volumetric oxygen transfer coefficient ( k L a). Strategy E also led to the highest values of ATP and biomass besides MAT. Consequently, the highest SAM yield and volumetric level were obtained at 0.058 g g −1 and 9.26 g l −1, respectively.

Single-Stage versus Two-Stage Modified Fontan Procedure

We compared surgical outcomes of the single-stage and two-stage modified Fontan procedures to clarify clinical superiority. Of 28 children undergoing a modified Fontan procedure from October 1995 to October 2005, 15 had a 1-stage and 13 had a 2-stage operation. In the 2-stage group, pulmonary artery growth was evaluated before and after the first stage. Operative mortality was 26.6% in the 1-stage group and 0% in the 2-stage group. The benefits of a previous bidirectional Glenn shunt were decreased cyanosis and volume overload, but there was no significant difference in pulmonary artery growth reflected in pulmonary artery indices before and after the bidirectional Glenn procedure. Older children underwent a 2-stage modified Fontan procedure and had better outcomes in terms of lower mortality, improved oxygen saturation, decreased volume load, and less deterioration of atrioventricular valve regurgitation.

Improved Exercise Capacity during Single Ventricle Cycle Ergometry in Fontan Patients Post TVanscatheter Fenestration Closure

PURPOSE: To evaluate the exercise capacity of patients that have undergone a transcatheter Fontan fenestration closure. METHODS: We evaluated 11 patients (6 males, mean age 15 yrs) pre and post closure with a standardized cycle ergometer protocol developed for patients with single ventricle physiology. The average time between the two tests was 132 days. Successful fenestration closure was accomplished in all using an Amplatzer device 8.9 ± 2.9 years post Fontan. All had suitable anatomy and hemodynamics. RESULTS: Immediately following closure during cardiac catheterization, arterial saturation increased from 91 to 95% and cardiac index decreased from 2.4 to 1.8 (L/min/m2) (p<0.05). Similar peak heart rates were achieved during both exercise tests. Rest, submaximal and peak exercise O2 saturation increased from 88, 84 and 81% to 95, 94 and 92% respectively. Peak VO2, total working capacity and exercise duration increased by 7%, 17% and 11% respectively (p<0.005, p<0.05).TableCONCLUSION: O2 saturation improves throughout exercise after transcatheter fenestration closure in Fontan patients resulting in an increased aerobic and exercise capacity. These results indicate that during dynamic exercise, improved oxygen saturation increases oxygen uptake and more than compensates for the restricted resting cardiac output obtained immediately after fenestration closure with the Amplatzer device.

Oral Sildenafil Ameliorates Impaired Pulmonary Circulation Early After Bidirectional Cavopulmonary Shunt

We report a case of successful administration of oral sildenafil (ie, a phosphodiesterase-5 inhibitor) in an infant for impaired pulmonary circulation that caused early clinical deterioration after a bicavopulmonary shunt. The transpulmonary pressure gradient (ie, a clinical indicator of pulmonary circulation) was initially normalized by inhaled nitric oxide; however, an increase in transpulmonary pressure gradient and oxygen desaturation occurred after extubation and discontinuation of inhaled nitric oxide on postoperative day 1. Subsequent administration of oral sildenafil in stepwise doses resulted in normalization of transpulmonary pressure gradient and improved oxygen saturation with successful discontinuation of intravenous vasodilators. Our results suggest that oral sildenafil may be a potent adjunctive therapy for impaired postoperative pulmonary circulation after right heart bypass surgery.

O efeito da adenotonsilectomia na saturação de oxigênio em crianças com distúrbios respiratórios do sono

To evaluate the effect of adenotonsillectomy on oxygen saturation measured through nocturnal pulse oximetry in children with sleep disordered breathing. A pre- and post-intervention study was carried out using nocturnal pulse oximetry. The study involved 31 children who were suspected of having sleep disordered breathing and had been referred for adenotonsillectomy. A total of 27 children completed the study. The mean age was 5.2 +/- 1.8 years, and 18 (66.7%) of them were male. Upon physical examination, 23 (85.2%) of the children presented class III or class IV hyperplasia of the palatine tonsils. There was significant improvement in the post-operative period over the pre-operative period in terms of the oxygen desaturation rate (OR = 0.65; 95% CI: 0.5-1.3 vs. OR = 1.63; 95% CI: 1.1-2.4; p < 0.001). Adenotonsillectomy significantly improved oxygen saturation, as measured through nocturnal pulse oximetry, in children with sleep disordered breathing.

Bilevel positive airway pressure in the treatment of status asthmaticus in pediatrics

Objectives The aim of this study was to examine the safety, patient tolerance, and possible benefit of bilevel positive airway pressure (BiPAP) in conjunction with β-2 agonist therapy in the treatment of pediatric patients with status asthmaticus who were refractory to conventional medical therapy. Methods This descriptive retrospective chart review examined all patients with the diagnosis of acute asthma treated with BiPAP in an urban academic pediatric emergency department (ED) from April 1, 2003, to August 31, 2004. Results Eighty-three patients with status asthmaticus refractory to conventional pharmacological treatment were placed on BiPAP with β-2 agonist nebulization in the ED. The number of subjects tolerating BiPAP was 73 (88%) of 83 patients. All patients placed on BiPAP in the ED were initially designated for admission to the pediatric intensive care unit (PICU). However, only 78% (57/73) were actually admitted to the PICU. Sixteen patients on BiPAP were admitted to a ward service; of these patients, none were subsequently transferred to the PICU. In addition, there was an immediate improvement in subjects' clinical status upon initiation of BiPAP, with 77% showing a decrease in respiratory rate, averaging 23.6% (range, 4%-50%), and 88% showing an improved oxygen saturation, averaging 6.6 percentage points (1-28 percentage points). There were no adverse events due to the use of BiPAP. Conclusions These results suggest that the addition of BiPAP in treating pediatric status asthmaticus is safe and well tolerated. This intervention shows promise as a beneficial adjunct to conventional medical treatments. However, further prospective investigation is warranted to confirm these findings.

A Randomized, Double-Blind, Crossover Trial of the Effect of Oxygen on Dyspnea in Patients with Advanced Cancer

Dyspnea is a common symptom in palliative care. Despite this, there is uncertainty regarding the role of oxygen to treat the symptom in patients with advanced illness. This randomized, double-blind, crossover trial examined the effect of oxygen versus air on the relief of dyspnea in patients with advanced cancer. Following the blinded administration of air and oxygen via nasal prongs, 51 patients rated dyspnea and indicated preferences for the blinded treatments. On average, patients improved symptomatically with both air and oxygen, and there were no significant differences between the treatments. The subgroup of 17 hypoxic patients overall did not demonstrate a significant difference between air and oxygen, despite having improved oxygen saturations when administered oxygen. Hypoxia was corrected in 13 of 17 patients using the treatment dose of 4 L/min of oxygen. The experience of dyspnea is a complex, multifactorial phenomenon, with oxygen tension not correlating with the subjective experience. The administration of either air or oxygen via nasal prongs on average confers improvement of the symptom.

Endovascular stents for relief of cyanosis in single‐ventricle patients with shunt or conduit‐dependent pulmonary blood flow

Hypoxemia is a significant cause of early and interstage death in patients with single ventricle (SV). Obstruction of Blalock-Taussig shunts (BTS) in patients with SV has traditionally been managed with surgical revision. We report on the experience at our institution of deploying endovascular stents within BTS as well as obstructed right-ventricle (RV) to pulmonary artery (PA) conduits in patients with modified Norwood (ie Sano modification). Medical records were reviewed for the time period between January 1, 2002 and November 30, 2005. All patients with SV who presented for intervention for BTS or RV-PA conduit stenosis were reviewed. Specific endpoints reviewed included pre- and post-intervention arterial oxygen saturation, type of intervention (stent vs. ballon dilation), need for subsequent surgical shunt/conduit revision, and interval to second stage palliation. Fifteen patients with SV underwent intervention for acute cyanosis. Eight patients had BTS, and the other seven patients had RV-PA conduit stenosis. Coronary stents were deployed in 14 of the 15 patients. Four patients also underwent balloon angioplasty of branch PAs. Oxygen saturations improved in all patients, with a mean increase of 13.9% (p = 0.0001). Four patients died before second stage palliation--one due to complications of the catheterization. Of the eleven remaining patients, nine have undergone second stage palliation; interval from intervention to Glenn ranged from 28-205 days (mean 163d). Two patients are awaiting cavo-pulmonary anastamosis. Endovascular stenting in this high-risk population is effective at improving oxygen saturation as well as obviating need to surgical shunt/conduit revision.

Hemodynamic Effects of Monomeric Nonionic Contrast Media in Pulmonary Angiography in Chronic Thromboembolic Pulmonary Hypertension

The purpose of this study was to investigate the hemodynamic safety of the monomeric nonionic contrast agent iomeprol for selective pulmonary angiography in chronic thromboembolic pulmonary hypertension (CTPH), and to investigate the effect of periinterventional oxygen administration. Selective pulmonary digital subtraction angiography was performed in 94 patients with CTPH using six bolus injections of iomeprol (posteroanterior, oblique, and lateral projections; both pulmonary arteries; iomeprol, 25 mL at 13 mL/s). Hemodynamics were obtained with Swan-Ganz catheters, and systolic pulmonary artery pressure (PAsyst) was classified into one of three groups: 30 mm Hg or less (control group), greater than 30 but less than or equal to 60 mm Hg (group 1, moderate pulmonary hypertension), and greater than 60 mm Hg (group 2, severe pulmonary hypertension). At baseline, values for PAsyst were 21.4 +/- 2.3 (control group, n = 8), 49.8+/- 8.5 (group 1, n = 18), and 86.5 +/- 18.9 (group 2, n = 68) mm Hg (p < 0.001). Pulmonary vascular resistance indexes (PVRI) were 222 +/- 105 (control), 703 +/- 364 (group 1), and 1,582 +/- 562 (group 2) dyne x s x cm(-5) x m2 (p < 0.001). The mean cardiac indexes were 3.1 (control), 2.8 (group 1), and 2.3 (group 2) L/min/m2 (p < 0.05). Pulmonary capillary wedge pressure (PCw) indicated healthy left heart function. Periinterventional oxygen inhalation improved oxygen saturation in all groups and slightly reduced pulmonary artery pressure and heart rate. Online measurement of pulmonary artery pressure during contrast bolus injection for angiography showed only a minor increase, predominantly in severe pulmonary hypertension (triangle up [difference] PAsyst: 1.3 +/- 1.9 [control], 2.9 +/- 3.4 [group 1], and 3.8 +/- 4.5 [group 2] mm Hg [p < 0.001]). After completion of angiography, right atrial pressure (RAP) and PAsyst were moderately increased: triangle up RAP: 1.4 (control), 2.6 (group 1, p < 0.001), and 3.0 (group 2, p < 0.001) mm Hg; triangle up PAsyst: 3.2 (control), 7.7 (group 1, p < 0.01), and 8.5 (group 2) mm Hg (p < 0.001). PVRI was significantly higher in group 2 (triangle up PVRI: 188 dyne x s x cm(-5) x m2, p < 0.001). Selective pulmonary angiography using iomeprol is safe without critical pressure peaks during selective contrast bolus injection or significant hemodynamic derangement in severe CTPH. Periinterventional oxygen inhalation improved pulmonary circulation.

Effect and Duration of Lung Volume Reduction Surgery: Mid-Term Results of the Brompton Trial

Although many studies have reported improvement in lung function following LVRS, the magnitude of improvement and subsequent decline has not been evaluated against medical therapy after the second year. Existing pulmonary function records were collapsed for ech participant since randomisation from Brompton LVRS trial cohort. Longitudinal data analysis was used to profile th history of medically treated patients and the effect of LVRS. Pulmonary function results were collated from survivors over a median of 25 (17 to 39) months. The estimated immediate increase in mean FEV1, following surgery was +0.2591 (0.179, 0.339), with a rate of change of -0.0051 (-0.009, -0.001) per month compared to medical therapy (p < 0.001). The changes in the secondary outcome measures (LVRS compared to medical therapy) were an increase in FVC (p = 0.004), decrease in RV (p < 0.001) and TLC (p < 0.001), with differences that were maintained over time. The initial reduction in RV/TLC ration was sustained (p < 0.001), but the estimated initial increase in peak flow was accompanied by a gradual decline that was not statistically significant (p = 0.062). KCOc showed no immediate change, but there was a gradual sustained increase with time (p = 0.009). Mean oxygen saturations improved and continued to do so compared to patients on medical therapy (p = 0.001). The immediate increase in FEV1 is not sustained, although the mechanical improvements of LVRS on increasing FVC, reducing both the RV and RV/TLC ratio, appear to be maintained. The important benefits of LVRS may be the gradual and sustained increase in transfer factor accompanied by improved oxygen saturations.

Comparison of four demand oxygen delivery systems at rest and during exercise for chronic obstructive pulmonary disease

Objectives: The aim of this study was to assess the performance of four demand oxygen delivery systems (DODS) in improving oxygenation and effort tolerance, at rest and during exercise, in chronic obstructive pulmonary disease (COPD) patients.Materials and methods: Thirteen COPD patients were prospectively included. Four DODS (Oxiclip, Versatile, Venture and Impulse) were compared with continuous-flow oxygen (CFO).Nine of these patients performed 6-min walking tests on room air and on 3l/min oxygen by DODS and CFO; Oxygen saturation, walking distance and the Borg dyspnea score were recorded.Results: With all four DODS devices arterial oxygenation was improved with lower oxygen flow rates than with CFO. Oxygen economy was best with Impulse, but at a cost of less satisfactory oxygenation. Exercise desaturation was similar with CFO, Oxiclip, Venture, and Impulse but significantly higher with Versatile (P<0.05). Borg dyspnea scores were similar with CFO, Oxiclip, Venture, and Versatile but worse with Impulse (P<0.05). There was no significant difference in walking distances.Conclusions: All four DODS improved oxygen saturation and saved oxygen. However, performance was better with the two devices (Oxiclip and Venture) that deliver a bolus of oxygen at inspiration onset.

Orthodontics and the upper airway

One of the general aims of orthodontic treatment and of the combination of orthodontics and orthognathic surgery is to achieve good occlusion and aesthetic improvement, especially in cases of severe dentoskeletal deformities. However, on many occasions, the parameters of the upper airways are not taken into account when the aims of conventional treatment are fulfilled. Patients with obstructive alterations during sleep represent for the orthodontist a type of patient who differs from the normal; for them, treatment should include the objective of improving oxygen saturation. Here, functional considerations should outweigh purely aesthetic ones. It is important, when making an orthodontic, surgical or combined diagnosis for a patient, to bear in mind the impact that treatment may have on the upper airways. Good aesthetics should never be achieved for some of our patients at the expense of diminishing the capacity of their upper airways.

Nebuliser hood compared to mask in wheezy infants: aerosol therapy without tears!

Background: Small volume nebulisers (SVNs) with masks commonly provide aerosol therapy for infants with lung diseases. However, infants and toddlers are often disturbed by and thus reject masks. Aims: To...

The role of L-carnitine in treatment of a murine model of asthma.

Leukotrienes, one of the mediators of inflammation in asthma, have a strong bronchoconstrictive effect. L-carnitine has been reported to influence respiratory functions. It has also been reported that L-carnitine inhibits leukotriene synthesis. To evaluate the effects of L-carnitine on oxygen saturation, urine leukotriene E4 levels and lung histopathology in a murine model of asthma, high IgE responder BALB/c mice (n = 24) were systemically sensitized to ovalbumin and chronically challenged with low particle mass concentrations of aerosolized ovalbumin, and then they were divided into 3 groups (study groups A, B, and C) each including eight mice. After methacholine-induced bronchoconstriction, the mice in groups A and B were given intraperitoneal L-carnitine (250 and 125 mg/kg, respectively), while the mice in group C were given placebo. Oxygen saturation of the mice was measured by pulse oxymeter before and after methacholine and after L-carnitine/ placebo application. In addition, urine leukotriene E4 levels were measured before asthma development, and 24-h after L-carnitine injection in asthmatic mice. Inflammation in the lung tissues of the sacrificed animals was scored histopathologically to determine the effect of L-carnitine on tissue level. A control group of non-sensitized mice (n = 8) treated with placebo only was used for comparison of urine leukotriene E4 levels and of histopathological parameters. Oxygen saturation of the mice in the study groups tended to decrease after methacholine and to improve after L-carnitine injection, although these changes were not significant at all time points. Urine leukotriene E4 levels of all 3 study groups increased significantly after asthma development. The rate of increment was smallest in the group given the highest L-carnitine dose (group A). Inflammation at the tissue level was also mildest in group A, and severest in the group that was not given carnitine (group C). All of the study groups and the control group differed significantly with respect to inflammation scores. In conclusion, L-carnitine improved oxygen saturation, and decreased urine leukotriene E4 levels and inflammation in lung tissues in the present murine model of asthma.

Effects of a selective endothelin A receptor antagonist, ABT-627, in healthy normotensive anaesthetized rats developing acute pulmonary air embolism.

Acute pulmonary air embolism (APAE) injures the vascular endothelium in the lung and results in pulmonary hypertension (PH). Endothelins (ETs), a family of potent vasoactive peptides, are known to be associated with PH of various aetiologies. We evaluated the effects of ABT-627, a selective ET(A) receptor (ET(A)-R) antagonist in a rat model of APAE over 3 h. APAE rats developed a higher right ventricular systolic pressure (RVSP), lower mean arterial blood pressure (MABP), and had lower PaO(2). At 3 h, arterial plasma levels of ET-1 were increased. ABT-627-treated controls showed no effects. However, ABT-627 significantly lowered RVSP during APAE, abolished the short recovery phase (within 10-25 min) of MABP without affecting the subsequent lowering of MABP, and improved oxygen saturation in APAE rats. These results show that ET(A)-R subtype is involved in the pathogenesis of APAE since a blockade of this receptor subtype attenuated the cardiopulmonary deterioration and improved blood gas exchanges in rats with this disease.

Tienda invertida de administración de oxígeno para uso domiciliario: Descripción de un caso clínico

Home oxygen programmes have been developed to facilitate the discharge of children with oxygen dependent chronic lung disease. There are a variety of delivery systems depending on the clinical condition, oxygen requirements and other associated factors. We describe a 3 year old patient with Down’s syndrome who had bronchopulmonary dysplasia and obstructive sleep apnoea who suffered from severe nocturnal hypoxemia due to intolerance of nasal canula and other devices. He was suited to an inverted tent for nocturnal oxygen supply. The tent is made of plastic into which oxygen is flowed via a venturi like system and fed by an oxygen concentrator, improve oxygen saturation from 87 ± 3 to 95 ± 3% was obtained. The system is simple, safe, convenient and economically fabricated from clear plastic sheeting available from a local hardware store. We suggest that the tent may play a role in oxygen dependent patients with craneo-facial malformations and intolerance to conventional devices.