High Concentration Oxygen Inhalation Research Articles

The predictive and prognostic value of risk factors in patients receiving hybrid coronary revascularization with postoperative pulmonary complications.

The mortality rate of coronary artery disease ranks first in developed countries, and coronary revascularization therapy is an important cornerstone of its treatment. The postoperative pulmonary complications (PPCs) in patients receiving one-stop hybrid coronary revascularization (HCR) aggravate the dysfunction of multiple organs such as the heart and lungs, therefore increasing mortality. However, the risk factors are still unclear. The objective of this study was to explore the risk factors of PPCs after HCR surgery. In this study, the perioperative data of 311 patients undergoing HCR surgery were reviewed. All patients were divided into two groups according to whether the PPCs occurred. The baseline information and surgery-related indicators in preoperative laboratory examination, intraoperative fluid management, and anesthesia management were compared between the two groups. Advanced age [odds ratio (OR): 1.065, 95% confidence interval (CI): 1.030-1.101, P<0.001], high body mass index (BMI; OR: 1.113, 95% CI: 1.011-1.225, P=0.02), history of percutaneous coronary intervention (PCI) surgery (OR: 2.831, 95% CI: 1.388-5.775, P=0.004), one-lung volume ventilation (OR: 3.804, 95% CI: 1.923-7.526, P<0.001), inhalation of high concentration oxygen (OR: 3.666, 95% CI: 1.719-7.815, P=0.001), the application of positive end-expiratory pressure (PEEP; OR: 2.567, 95% CI: 1.338-4.926, P=0.005), and long one-lung ventilation time (OR: 1.015, 95% CI: 1.006-1.023, P=0.001) may be risk factors for postoperative PPCs in patients undergoing one-stop coronary revascularization surgery. Using the above seven factors to jointly predict the risk of PPCs in patients undergoing one-stop coronary revascularization surgery, the receiver operating characteristic (ROC) curve showed an area under the curve (AUC) =0.873, 95% CI: 0.835-0.911, sensitivity: 84.81%, and specificity: 75.82%; the predictive model was shown to be effective. Patients undergoing HCR surgery with advanced age, high BMI, a history of PCI surgery, one-lung volume ventilation, inhalation of high concentration oxygen, use of PEEP, and prolonged single lung ventilation are more prone to PPCs.

Type III procollagen peptide level can indicate liver dysfunction associated with volume overload in acute heart failure.

AimThe role of serum type III procollagen peptide (P3P) level in the acute phase of acute heart failure (AHF) requires clarification. We hypothesized that serum P3P level is temporarily higher during the acute phase, reflecting liver dysfunction due to congestion.Methods and resultsA total of 800 AHF patients were screened, and data from 643 patients were analysed. Heart failure was diagnosed by the treating physician according to the European Society of Cardiology (ESC) guidelines, and included patients being treated with high‐concentration oxygen inhalation (including mechanical support) for orthopnea, inotrope administration, or mechanical support for low blood pressure, and various types of diuretics for peripheral or pulmonary oedema. In all cases, diuretics or vasodilators were administered to treat AHF. The patients were divided into three groups according to their quartile (Q) serum P3P level: low‐P3P (Q1, P3P ≤ 0.6 U/mL), mid‐P3P (Q2/Q3, 0.6 < P3P <1.2 U/mL), and high‐P3P (Q4, P3P ≥ 1.2 U/mL). The plasma volume status (PVS) was calculated using the following formula: ([actual PV − ideal PV]/ideal PV) × 100 (%). The primary endpoint was 365 day mortality. A Kaplan–Meier curve analysis showed that prognoses, including all‐cause mortality and heart failure events within 365 days, were significantly (P < 0.001) worse in the high‐P3P group when compared with the mid‐P3P and low‐P3P groups. A multivariate logistic regression analysis showed that high PVS (Q4, odds ratio [OR]: 4.702, 95% CI: 2.012–20.989, P < 0.001), high fibrosis‐4 index (Q4, OR: 2.627, 95% CI: 1.311–5.261, P = 0.006), and low estimated glomerular filtration rate per 10 mL/min/1.73 m2 decrease (OR: 1.996, 95% CI: 1.718–2.326, P < 0.001) were associated with high P3P values. The Kaplan–Meier curve analysis demonstrated a significantly lower survival rate, as well as a higher rate of heart failure events, in the high‐P3P and high‐PVS groups when compared with the other groups. A multivariate Cox regression model identified high P3P level and high PVS as an independent predictor of 365 day all‐cause mortality (hazard ratio [HR]: 2.249; 95% CI: 1.081–3.356; P = 0.026) and heart failure events (HR: 1.586, 95% CI: 1.005–2.503, P = 0.048).ConclusionA high P3P level during the acute phase of AHF served as a comprehensive biomarker of liver dysfunction with volume overload (i.e. liver congestion) and renal dysfunction. A high P3P level at admission may be able to predict adverse outcomes in AHF patients.

Névralgies de la face

Facial nevralgias are rare but debilitating paroxystic or chronic pains. Consensual diagnostic criteria can help to establish the diagnosis, but misleading presentations exist. Trijeminal neuralgia has a pic incidence in women in theirs 1950s. Patients complains of lightning pain in the territory of a branch of the trijeminal nerve. The nerve lesion is most often secondary to a microvascular compression. The pain is triggered by a light sensation on a small area of the face. Pain are severe and sometimes confused with a dental affection. Pharmacotherapy is primarily based on carbamazepine/oxcarbazepine. Microvascular decompression is offered to patients not sufficiently controlled medically. Cluster headache is more common in young men. The pain last 30minutes to one hour is periorbital. Region and is accompanied by cranial autonomic symptoms. Cluster attacks have a circadian and circumannual rhythmicity. The pathyphysiology is nor fully understood. Intranasal/subcutaneous triptan or high concentration oxygen inhalation are the mainstay of acute treatment. Prevention of cluster recurrence is based on verapamil or lithium administration. Postherpetic neuralgia is defined of the persistence of pain 3 months after a herpes zoster rash. The prevalence of the disease increased with age. It presents as a chronic neuropathic pain that must be treated with appropriate medications. Other facial nevralgias have been described such as occipital or glossopharyngeal nevralgia. Due to their significant impact on quality of life, awareness of the entities is critical an early and to avoid misdiagnosis.

Normobaric hyperoxia plays a protective role against renal ischemia-reperfusion injury by activating the Nrf2/HO-1 signaling pathway

Following renal ischemia-reperfusion injury (RIRI), because of the decrease in oxygen supply to the kidney, a large amount of oxygen-free radicals is generated, and in severe cases, tissue cells will undergo apoptosis or even die. Normobaric hyperoxia (NBHO) is a very common clinical adjuvant treatment. It restores the oxygen supply after renal ischemia and combats oxidative stress in tissues, thus playing a protective role. In this study, our aim is to elucidate the protective mechanism of NBHO inhalation in a rat RIRI model. We performed a surgical excision of the left kidney of the rat and established a right kidney solitary kidney model. Later, the right renal pedicle of the rat was clamped using a non-invasive vascular clamp for 45 min. After the vascular clamp was released and reperfused for 24 h, the rat was placed in a closed oxygen chamber. It was subjected to inhalation of high-concentration oxygen (50%–55%), 2 h daily, for 7 days.RIRI induces postoperative weight loss, impaired renal function, increased oxygen free radicals, reduced antioxidant substances, increased histopathological damage, and increased levels of apoptosis. These effects were significantly improved after treatment with NBHO. At the same time, NBHO significantly increased the expression levels of Nrf2 and HO-1 in the tissues after RIRI. To verify whether HO-1 induced by Nrf2 is involved in the resistance to oxidative stress, after the rat RIRI and before inhaling NBHO, we intraperitoneally injected HO-1 specific inhibitor zinc protoporphyrin (ZnPP) (45 μmol/Kg). However, we found that ZnPP reversed the protective effect of NBHO on RIRI in rats. Combining all the results, we have demonstrated the protective effect of NBHO on RIRI, which can be at least partially attributed to the activation of the Nrf2/HO-1 antioxidative stress pathway.

Inhalation of 50% Oxygen Does Not Impair Respiratory Depression During Midazolam Sedation

To investigate how inhalation of 50% oxygen during intravenous midazolam sedation affects respiratory variables and thus the availability of oxygen. Study subjects were 21 healthy adult volunteers (American Society of Anesthesiologists physical status I). They were allocated to undergo midazolam sedation during high-concentration oxygen inhalation (group H) or during normal air inhalation (group N) in a single-blinded randomized crossover design, with an interval of at least 3days between the 2 sedation sessions. In each experiment, midazolam 0.05mg/kg was administered, after which the following variables were measured for 40minutes: oxygen saturation by pulse oximetry (SpO2), end-tidal carbon dioxide partial pressure (ETCO2), respiration rate (RR), tidal volume (VT), and minute volume (MV). Subsequently, flumazenil 0.5mg was administered, and the same variables were measured for 10minutes. SpO2 decreased after midazolam administration in the 2 groups. SpO2 in group H was higher than that in group N at all time points. RR increased and VT decreased after midazolam administration in the 2 groups; however, in contrast to SpO2, the levels of these parameters did not meaningfully differ between groups at any time point. MV remained unchanged in the 2 groups. ETCO2 decreased similarly after midazolam administration in the 2 groups. Inhalation of 50% oxygen during midazolam sedation did not enhance respiratory depression by midazolam. This suggests that high-concentration oxygen inhalation during midazolam sedation could prevent hypoxia.

Influence of prone position ventilation in conjunction with inhalation of NO on acute respiratory distress syndrome in patients

Objective To evaluate the effects of prone position ventilation (PPV) combined with inhalation of NO on oxygenation of acute respiratory distress syndrome (ARDS) patients.Methods A total of 21 patients with ARDS composed of 15 male and 6 female aged ranging from 2 to 74 years with mean age of 39 ± 17.4 years were hospitalized from September 2008 through January 2011.After application of mechanical ventilation with optimal PEEP,patients still needed the high concentration oxygen inhalation (FiO2 ≥ 60％).They were randomly (random number) divided into three groups for controlled study.Patients of group A were given NO in addition to oxygen inhalation for 4 hours,patients of group B were put in prone position ventilation with oxygen inhalation for 2 hours,then they were returned to the supine position ventilation,and patients of group C were put into prone position ventilation with inhalation of oxygen plus NO for 2 hours,and then they were returned to the supine position ventilation,but they were continued to inhaled NO.The oxygenation indexes of three groups of patients were measured before the intervention,2 hours and 4 hours after the procedure of experiment.Results The oxygenation indexes of three groups of patients were improved in terms of comparison between pre-intervention and 2 hours after intervention,but there was no statistically significant difference found in group A (P ＞ 0.05),the differences in group B and group C were statistically significant (P ＜ 0.05).Compared the oxygen index between pre-intervention and 4 hours after intervention,the differences in group A and group B were not statistically significant (P ＞0.05),but the difference in group C was statistically significant (P ＜ 0.05).Conclusions PPV could improve oxygenation in acute respiratory distress syndrome (ARDS) patients.PPV with NO inhalation could improve oxygenation in acute respiratory distress syndrome (ARDS) patients as well as effectively maintain the oxygenation after patients were returned to the supine position ventilation.Therefore prone position ventilation combined with inhalation of NO improved oxygenation and at the same time reduced the prone position time. Key words: Prone position ventilation; NO; ARDS; Oxygenation index

Subcutaneous Emphysema without Pneumothorax or Pneumomediastinum in Pulmonary Tuberculosis

We report a rare case of subcutaneous emphysema without pneumothorax or pneumomediastinum. A 20-year-old gentleman presented with swelling of face and neck, dysphagia and dyspnoea, with the background history of fever, dry cough and weight loss. On examination, there was feeling of crepitus all over the swollen areas, and crackles heard over both lung fields. He had high ESR, with positive Mantoux Test and sputum was positive for AFB. He was put on high concentration oxygen inhalation along with anti-tubercular chemotherapy. Following treatment he was clinically and radiologically improved, and was discharged with the advice to complete the anti-tubercular chemotherapy. DOI: http://dx.doi.org/10.3329/jom.v13i2.12773 J Medicine 2012; 13 : 250-251

Study on the effect of different oxygen therapies on rats with acute carbon dioxide poisoning

To study the effect of different oxygen therapies on the rats with carbon dioxide poisoning for screening out the best on-the-spot oxygen-therapy technology for treating acute carbon dioxide poisoning. The 60 healthy male Sprague Dawley rats were randomly divided into normal control group (A group), carbon dioxide poisoning group (B group), low-concentration oxygen inhalation treatment group (C group), high-concentration oxygen inhalation treatment group (D group) and hyperbaric oxygen-therapy group (E group). Various kinds of oxygen therapies were given after the contamination. The pH, partial pressure of oxygen (PO(2)) and partial pressure of carbon dioxide (PCO(2)) of arterial blood, serum troponin I (CTNI), creatine kinase (CK), glutamic-oxaloacetic transaminase (AST), γ-glutamyl transpeptidase (GGT), blood urea nitrogen (BUN), potassium (K), sodium (Na) and chlorine (Cl) for the rats of each group were inspected. The lung and the brain tissues were taken for observing the pathological changes. There is no significant difference in pH, PO(2) and PCO(2) among all oxygen-therapy groups (p > 0.05). The levels of CTNI, CK and AST in E group are obviously lower than that in B, C and D groups (p < 0.05). The level of serum K in E group is obviously lower than that in B, C and D groups (p < 0.05). The levels of serum Na and Cl in E group are obviously higher than that in B, C and D groups (p < 0.05). The pathological change of lungs in E group is significantly better than that in C and D groups. We recommend that the medical units with related conditions can give the hyperbaric oxygen therapy to patients as soon as possible.

Allopurinol reduced hepatic ischemia-reperfusion injury exacerbated by inhalation of high-concentration oxygen in rats.

Exposure to high-concentration oxygen (O2) increases lipid peroxidation of the cellular membrane, leading to tissue injury which may involve hepatic ischemia-reperfusion (I/R) injury. We examined the effects of inhaling high-concentration O2 on hepatic I/R injury with allopurinol, which is a xanthine oxidase inhibitor. Partial hepatic ischemia was performed in rats with or without allopurinol under 21 or 100% O2 inhalation. Levels of lipid peroxide, serum liver enzymes, and hepatocellular oxidative stress in the 100% O2 group were significantly higher than in the 21% O2. Administration of allopurinol significantly inhibited those changes in the 100% O2 group. Severe degeneration of mitochondria were noted in the 100% O2 group, but appeared to be reduced by allopurinol. Results suggest that inhalation of high-concentration O2 during liver surgery may increase lipid peroxidation and exacerbate hepatic I/R injury, but those changes may be prevented by allopurinol.