Mean SpO2 Research Articles

Perioperative adherence to continuous positive airway pressure and its effect on postoperative nocturnal hypoxemia in obstructive sleep apnea patients: a prospective cohort study

BackgroundAlthough continuous positive airway pressure (CPAP) is the first line treatment for obstructive sleep apnea (OSA) patients, the perioperative adherence rate is unclear. The objective of this study was to determine the perioperative adherence rate of patients with OSA with a CPAP prescription and the effect of adherence on nocturnal oxygen saturation.MethodsThis prospective cohort study included adult surgical patients with a diagnosis of OSA with CPAP prescription undergoing elective non-cardiac surgery. Patients were divided into CPAP adherent and non-adherent groups based on duration of usage (≥ 4 h/night). Overnight oximetry was performed preoperatively and on postoperative night 1 and 2 (N1, N2). The primary outcome was adherence rate and the secondary outcome was nocturnal oxygen saturation.ResultsOne hundred and thirty-two patients completed the study. CPAP adherence was 61% preoperatively, 58% on postoperative N1, and 59% on N2. Forty-nine percent were consistently CPAP adherent pre- and postoperatively. Using a linear fixed effects regression, oxygen desaturation index (ODI) was significantly improved by CPAP adherence (p = 0.0011). The interaction term CPAP x N1 was significant (p = 0.0015), suggesting that the effect of CPAP adherence varied on N1 vs preoperatively. There was no benefit of CPAP adherence on postoperative mean SpO2, minimum SpO2, and percentage of sleep duration with SpO2 < 90%. Use of supplemental oxygen therapy was much lower in the CPAP adherent group vs non-adherent group (9.8% vs 46.5%, p < 0.001).ConclusionsAmong patients with a preoperative CPAP prescription, approximately 50% were consistently adherent. CPAP adherence was associated with improved preoperative ODI and the benefit was maintained on N1. These modest effects may be underestimated by a higher severity of OSA in the CPAP adherent group and a higher rate of oxygen supplementation in the non-adherent group.Trial registrationClinicalTrials.Gov registry (NCT02796846).

Predictive Intelligent Control of Oxygenation (PRICO) in preterm infants on high flow nasal cannula support: a randomised cross-over study

ObjectiveTo investigate the efficacy of automated control of inspired oxygen (FiO2) by Predictive Intelligent Control of Oxygenation (PRICO) on the Fabian ventilator in maintaining oxygen saturation (SpO2) in preterm infants...

Endothelial dysfunction in obstructive sleep apnea patients

PurposeObstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular diseases. The aim of the study was to assess the influence of OSAS on endothelial dysfunction and thrombosis biomarkers and to evaluate the effect of treatment with continuous positive airway pressure (CPAP) on biomarker levels.MethodsNT-proBNP, sICAM-1, endothelin-1, von Willebrand factor, D-dimers, and thrombin-antithrombin complex (TAT) were measured in 50 patients diagnosed with moderate-to-severe OSAS. All patients underwent transthoracic echocardiography, and 38 months after the inclusion, 16 CPAP users and 22 non-CPAP users were reassessed.ResultsSleep-related indices of apnea-hypopnea index (AHI) and mean SpO2 were associated with higher sICAM-1 levels (AHI < 30: 7.3 ± 4.7 vs. AHI ≥ 30: 19.5 ± 19.4 mg/ml, p = 0.04; SpO2 ≥ 90%: 11.9 ± 9.3 vs. SpO2 < 90%: 23.6 ± 25.8, p = 0.04). sICAM-1 levels were significantly higher in obese patients, particularly with BMI ≥ 40. Plasma levels of TAT were significantly correlated with the increased right ventricular size (right ventricular diameter ≤ 37 mm: 0.86 ± 0.70 vs. > 37 mm: 1.96 ± 1.20 ng/ml, p = 0.04). Endothelin-1 levels were higher in patients with decreased right ventricular function (right ventricle TDI-derived S′ ≥ 12 cm/s: 11.5 ± 10.9 vs. < 12 cm/s: 26.0 ± 13.2 pg/ml, p = 0.04). An increase in NT-proBNP was related to impaired parameters of the right ventricular contractile function. There were no correlations between long-term CPAP therapy and the levels of biomarkers.ConclusionSevere OSAS influences endothelial damage as manifested by an increase in sICAM-1 levels. Changes in right ventricular structure and function, observed mainly in patients with higher TAT and endothelin-1 levels, are also manifested by an increase in NT-proBNP levels. Long-term CPAP treatment does not seem to influence biomarkers in patients with moderate-to-severe OSAS, which may help to explain the lack of influence of CPAP on cardiovascular risk reduction.

684 Use of Overnight Pulse Oximetry and STBUR Questionnaire for Paediatric OSA In A District General Setting

Abstract Introduction Overnight pulse oximetry (OPO) is often used to support the diagnosis of obstructive sleep apnoea (OSA) and stratify risk of peri-operative breathing difficulties in children undergoing adenotonsillectomy for OSA. Our objective was to audit our indications for OPO and the impact on subsequent ENT management. We sought to assess the correlation of STBUR (Snoring, Troubled-breathing, Unrefreshed Questionnaire) score with OPO values in these patients. Method Retrospective review of 32 OPO reports over a 7-month period. Data collected included age, weight, indication, mean spO2, number of dips &amp;gt;4%, outcome and STBUR score. Results The commonest indication (19) for OPO was to assess severity of OSA in children &amp;lt;3 or those with significant comorbidity to determine best setting for surgery; 50% were ultimately managed in a tertiary centre. 10 children underwent OPO due to diagnostic uncertainty but significant parental concern; all studies normal and parents reassured. STBUR score correlated poorly with number of dips &amp;gt;4% (R = 0.0109) and mean nadir &amp;gt;4% (R = 0.0031) Weight poorly recorded (19%). Conclusions Referrals were generally appropriate and influenced management in all cases. STBUR scores insufficiently sensitive to stratify severity of OSA. New protocol developed.

357 Daridorexant Does Not Impair Respiratory Function in Patients with Mild/Moderate Obstructive Sleep Apnea Irrespective of Severity

Abstract Introduction Daridorexant is a dual orexin receptor antagonist developed for the treatment of insomnia. The effect of the highest phase-3 dose of 50 mg daridorexant on nighttime respiratory function was evaluated in patients with mild/moderate obstructive sleep apnea (OSA). This study showed that repeated doses of daridorexant had no clinically meaningful effect on nighttime respiration (i.e., apnea-hypopnea index [AHI] and peripheral oxygen saturation [SpO2]). In the same study, other relevant respiratory endpoints were evaluated. Methods In this randomized, double-blind, placebo-controlled, two-period, crossover study, daridorexant or placebo was administered in each period once daily for 5 consecutive nights to 28 patients. Treatment differences (daridorexant – placebo) for total number and mean/longest duration of apneas and hypopneas as well as mean and lowest SpO2 during apnea/hypopnea events in Night 5 were explored using linear mixed-effects modeling. Treatment differences for the above-mentioned endpoints versus AHI during TST at baseline (i.e., OSA severity) was analyzed by linear regression using least square approach. Results Of 28 patients enrolled, 25 completed the study and were included in the analysis (n=15/10 with mild/moderate OSA; mean [standard deviation, SD] AHI: 16.3 events/h [8.2]). Compared to placebo, daridorexant increased mean duration of TST and accordingly to a not statistically significant extent the mean number of apneas + hypopneas by 16.4 events (n=103 versus 86.2; 90% confidence interval [CI]: -0.4–33.2]) without difference in mean [SD] AHI between daridorexant (15.1 events/h [7.9] and placebo (14.2 [7.7]). No treatment difference was detected for mean (0.0 sec [-2.6–2.7]) or longest (0.8 sec [-8.9–10.5]) duration of apneas nor for mean (0.2 sec [-2.2–2.5]) or longest (8.3 sec [6.4–23.1]) duration of hypopneas. No treatment difference was observed for mean (0.3% [-0.2–2.1]) and lowest (0.9% [0.3–2.1]) SpO2 during apnea/hypopnea events. Treatment differences for any of the evaluated endpoints did not significantly correlate with AHI at baseline as a marker of OSA severity (r2 ≤ 0.09). Conclusion Daridorexant can safely be administered to patients with mild/moderate OSA as treatment differences for respiratory-related endpoints were not of statistical significance and independent of disease severity in the studied population. Support (if any) Funded by Idorsia Pharmaceuticals Ltd.

Ventilation Adjustment in ECT During COVID-19: Voluntary Hyperventilation is an Effective Strategy.

PurposeAirway management is a key objective in adapted electroconvulsive therapy (ECT) protocols during the COVID-19 pandemic to prevent infection. The objective of this study was to describe the effectiveness of a modified ventilation procedure designed to reduce aerosol-generating bag-mask ventilation (BMV) and isolate possible droplets while maintaining adequate respiratory gas values in ECT sessions.Materials and MethodsThis prospective study analyzed the results of the modified protocol applied over a month. Adaptations entailed preoxygenation and extension of the voluntary hyperventilation (VHV) time for two minutes before anesthesia induction, asking patients to hyperventilate with oxygen therapy via nasal cannula and while wearing a face mask. Thereafter, vigorous hyperventilation was avoided, and patients were only assisted with tightly sealed BMV until emergence from anesthesia, isolating the ventilation by using a single-use plastic device. Oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (TcPCO2) were recorded throughout the session.ResultsThe study included 74 sessions of bilateral ECT with the modified ventilation protocol in 15 subjects. After VHV, the mean SpO2 increase was 2.12±2.14%, and the mean TcPCO2 decrease was 4.05±2.98 mmHg. TcPCO2 values at the moment of stimulus administration were 2.22±3.07 mmHg below pre-ECT values. The mean EEG seizure was 38.70±17.03 s, and postictal suppression was 68.31± 34.58% and 2.13±0.75 on a 0–3 scale. Brief desaturation (SpO2 <90) of 4–5 seconds duration was observed in 4 sessions.ConclusionThis modified ventilation protocol was effective during COVID-19, and it did not elicit significant side effects. In addition to avoiding vigorous BMV, it induced moderate hypocapnia, which has been tied to seizure optimization and less hypercapnia during the apnea period.

Comparative Study between Dexmedetomidine and Midazolam in Inducing Conscious Sedation in Patients Undergoing Cataract Surgery

Background: Cataract surgery are usually done in elderly patients. Dexmedetomidine is a potent non-opiod sedative and analgesic devoid of respiratory depression. Midazolam is the most commonly used sedative which is commonly associated with respiratory depression specially in elderly patients. Objectives: To compare the effects of intravenous dexmedetomidine and midazolam on the haemodynamic stability, sedation and intraocular pressure and to study the safety profile of the drug Methodology: After obtaining permission from institutional ethical committee and patient informed consent, study was conducted at BMCRI from November 2016 to May 2018 in ASA Grade 1 and 2 patients of 40 to 70 year age undergoing cataract surgery. Patients were randomly allocated to two Group D and M of 32 each. Group D received inj. dexmedetomidine 0.25mcg/kg, Group M received inj. midazolam 0.02mg/kg diluted to 10ml over 10 minutes as intravenous injection. Peribulbar block was given with 8-10ml of injection 2% lignocaine with adrenaline with hyaluronidase. Haemodynamic parameters like Heart Rate, Mean Arterial Pressure and SpO2, Intra Ocular Pressure in non-operating eye, Ramsay Sedation Score, Visual Analogue Score and Modified Aldrete Score were recorded. Results: We concluded that in our study demographic data were comparable. Patients of Dexmedetomidine group had reduction of IOP after drug injection (p=0.001) and at post bulbar block (p=0.002) which is statistically significant compared to Group M patients and also there was statistically significant difference in RSS Score between two groups. Conclusions: Dexmedetomidine provides same conscious sedation as Midazolam. Dexmedetomidine reduces intraocular pressure and maintains SpO2 when compared to Midazolam in cataract surgery.

English

BACKGROUND Real-time reverse transcription polymerase chain reaction (rRTPCR) test is the gold standard assay to diagnose Covid-19 in-spite of few concerns. The disease is suspected in patients presenting with clinical features suggestive of Covid-19 supported by laboratory markers and imaging studies. We describe a case series of ten patients suspected to have SARS CoV-2 infection but RTPCR negative. METHODS We carried out a retrospective observational study of patients who presented with clinical features suggestive of Covid-19 but were RTPCR negative. As dedicated Covid hospitals, RTPCR negative patients were not admitted because of overload. We admitted such patients in isolation ward in non Covid hospitals, evaluated them further with laboratory biomarkers, and imaging studies. All patients were categorised in disease severity and were managed according to guidelines of Ministry of Health and Family Welfare (MoHFW) India. RESULTS Our case series included ten patients with a mean age of 55.1 years and the male to female ratio was 1.5:1. All patients (100 %) were suspected to have SARS CoV2 infection. Commonest symptom was fever in all (100 %) and least common was diarrhoea in 30 % patients. Mean SpO2 was 92.5 % on pulse oximeter (range 91 to 94 %). The laboratory findings showed (median): white blood cell count 9400 / cumm, N / L ratio 3.78, C-reactive protein (CRP) 46.21 mg / L, D-dimer 465 ng / mL, lactate dehydrogenase 499.59 U / L, serum ferritin 160.55 ng / mL, interleukin 6 31.6 pg / mL. Chest radiograph showed patchy non homogenous opacities in lungs in 6 (60 %) out of 10 patients, high resolution computed tomography (HRCT) chest revealed peripheral ground glass opacities (GGOs) in 10 (100 %) patients, Coronavirus Disease 2019 Reporting and Data System (CORADS) score was 5 in 8 (80 %) patients and less than 5 in 2 (20 %) patients. CONCLUSIONS In current pandemic, patients presenting with clinical features suggestive of Covid19, but RT-PCR negative should be suspected to have SARS CoV-2 infection, further evaluation with laboratory markers and imaging study help in diagnosis. Managing and monitoring according to MoHFW guidelines show good clinical recovery. KEYWORDS Corona Virus Disease (Covid-19), Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR), High Resolution Computed Tomography (HRCT), Chest X-Ray (CXR)

Are there gender differences in blood oxygen saturation in prepubertal children?

Previous studies reported higher oxygen saturation (SpO2 ) in healthy young adult females as compared to males. The objective of the current study was to evaluate whether or not similar differences exist in prepubertal children. SpO2 levels, respiratory rate, and pulse were measured in 4- to 10-year-old males and females. Anthropometric variables, including ethnic origin, age, height, weight, BMI (Body Mass Index), BSA (Body Surface Area), barometric pressure, and altitude above sea level were collected as well. Ninety five males and 93 females participated in the study. Groups were similar, in terms of respiratory rate, pulse, and anthropometric variables. Mean SpO2 in males was 96.95±1.09%, similar to SpO2 in females measuring 96.85±0.98%, P=.52. In contrast to young adults, there is no gender-related difference in mean oxygen saturation in prepubertal healthy children. It is likely that this difference is due to variations in age-related sex hormones. Further studies are needed to explore the mechanism explaining why prepubertal children do not show gender-specific differences in oxygen saturation in contrast to adults.

Impact of Interface Type on Noninvasive Ventilation Efficacy in Patients With Neuromuscular Disease: A Randomized Cross-Over Trial

Background and objectiveAround 25% of patients with neuro-muscular diseases (NMD) are treated by home noninvasive ventilation (NIV) through an oronasal mask. However, there is growing evidence that nasal masks require lower NIV pressures and result in fewer residual obstructive events. We hypothesized that nasal masks would improve efficacy and reduce side effects compared to oronasal masks in this population. Methodsopen label, cross-over, randomized, study in 2 tertiary care hospitals. Patients with NMD treated by home NIV were randomized for one-week periods to nasal and oronasal interfaces respectively (cross-over). At the end of each period, nocturnal polygraphy (monitoring mouth opening) under NIV, synchronized with transcutaneous partial pressure in CO2 (tcCO2) was performed. Data were collected from the NIV built-in software and NIV side-effects were collected. Intention-to-treat and per protocol analyses were performed. The primary outcome was mean nocturnal SpO2. The secondary outcomes were: percentage of sleep with SpO2<90%, oxygen desaturation index (ODI), mean tcCO2, mean duration of mouth opening during sleep, level of non-intentional leaks and side-effects. ResultsThirty patients with NMD were included. There were no between-group differences for either the primary or secondary outcomes. Post hoc comparisons showed that changing between interfaces reduced NIV efficacy: mean nocturnal SpO2 (p=0.04), ODI (p=0.01), mean tcCO2 (p=0.048), side-effects (p=0.008). ConclusionNasal masks did not improve NIV efficacy or reduce side effects compared to oronasal masks in patients with NMD treated by home NIV. The efficacy of NIV is reduced during the transition to another interface, requiring close monitoring.Registration number: NCT03458507.

Comparison of mixture of sevoflurane in 50% N&lt;sub&gt;2&lt;/sub&gt;O/O&lt;sub&gt;2&lt;/sub&gt; with sevoflurane in 100% O&lt;sub&gt;2&lt;/sub&gt; in neonates undergoing TEF/EA repair

Background: The efficient recognition and prompt management of illness in the neonatal period may be lifesaving. Perioperative airway management in the neonate undergoing tracheoesophageal fistula (TEF) repair could be a challenge for anesthesiologist. We need to place the tip of the endotracheal tube (ETT) below the fistula but above the carina to ensure airway protection, adequate ventilation and avoid gastric dilatation during positive pressure ventilation (PPV). Materials and Methods: Thirty neonates undergoing TEF repair were taken for the study. Neonates were randomised into two groups of 15 each. In group-I induction was done with 8% sevoflurane in 50% N2O and 50% O2 and in group-II with 8% sevoflurane in 100% oxygen. Results: The mean induction time in group-I was 32.91 sec. which was significantly less than that in group-II 54.60. The mean intubation time in group-I was 112.35 sec. which was significantly less than that in group-II 134.53. In both cases P-value is highly significant. In group I mean SpO2 value was 96.18, which is slightly less than in group-II 98.22. Here the P-value is slightly significant. In both the groups there was no difference in heart rate. Conclusion:Thus, induction of anaesthesia with a mixture of 8% sevoflurane in 50% N2O and 50% O2 was faster, smoother with only slightly significant decrease in SpO2 which was acceptable during induction and with minimal side effects as compared to group-II.

Vital sign metrics of VLBW infants in three NICUs: implications for predictive algorithms.

Background:Continuous heart rate (HR) and oxygenation (SpO2) metrics can be useful for predicting adverse events in very low birth weight (VLBW) infants. To optimize the utility of these tools, inter-site variability must be taken into account.Methods:For VLBW infants at three NICUs, we analyzed the mean, standard deviation, skewness, kurtosis, and cross-correlation of electrocardiogram HR, pulse oximeter pulse rate, and SpO2. The number and durations of bradycardia and desaturation events were also measured. Twenty-two metrics were calculated hourly, and mean daily values were compared between sites.Results:We analyzed data from 1,168 VLBW infants from birth through day 42 (35,238 infant-days). HR and SpO2 metrics were similar at the three NICUs, with mean HR rising by ~10 beats/minute over the first two weeks and mean SpO2 remaining stable around 94% over time. The number of bradycardia events was higher at one site, and the duration of desaturations was longer at another site.Conclusion:Mean HR and SpO2 were generally similar among VLBW infants at three NICUs from birth through six weeks of age, but bradycardia and desaturation events differed in the first two weeks after birth. This highlights the importance of developing predictive analytics tools at multiple sites.

Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients.

Background: Tocilizumab (TCZ), a monoclonal antibody against the most prevalent cytokine interleukin-6 (IL-6), is an emerging therapeutic option for COVID-19 infections. The present study was undertaken to assess the therapeutic response of TCZ therapy in severely or critically ill COVID-19 patients and its role as an effective modality of management.Methods: The present retrospective observational study included 30 admitted severely or critically ill COVID-19 patients, treated with TCZ therapy on behalf of raised IL-6 levels. The patients’ data concerning medical history, clinical manifestation, arterial blood gas analysis, mode of oxygenation, radiological imaging, and outcome were extracted from their medical records and compared pre- and post-TCZ infusion.Results: All patients of the study group had symptomatic presentations with a mean PaO2/FiO2 (P/F) ratio of 205.41 before TCZ infusion. All patients had a raised IL-6 level (mean value 206.56 pg/mL) that was extremely elevated in 90% of patients. Infusion of TCZ dramatically reduced mean body temperature (100.78–99.32°F) and the requirement for supplemental oxygen (68–48%) and improved mean SpO2 (86–89%) and mean P/F ratio (208–240) within 24 hours. Three patients on noninvasive ventilation were weaned off after TCZ infusion. Serum levels of IL-6 were raised initially but declined within 3–5 days of post-TCZ infusion.Conclusion: TCZ appears to be an effective therapeutic option in severely or critically ill COVID-19 patients with raised IL-6 levels. TCZ immediately improves the clinical status of patients by a probable mechanism of inhibition of cytokine storm and reduces COVID-19-related mortalities.How to cite this article: Bhandari S, Rankawat G, Singh A. Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients. Indian J Crit Care Med 2021;25(3):260–266.

Respiratory Safety of Lemborexant in Healthy Subjects: A Single-Dose, Randomized, Double-Blind, Placebo-Controlled, Crossover Study

Lemborexant is a dual orexin receptor antagonist recently approved in the USA, Japan, and Canada for the treatment of adults with insomnia. Because some pharmacotherapy for insomnia causes respiratory depression, this study assessed the effects of lemborexant treatment on respiratory safety parameters. This single-dose, randomized, double-blind, placebo-controlled, three-period crossover study enrolled healthy adult and elderly subjects (n = 17). Subjects were randomized to one of three treatment sequences, each consisting of three treatment periods in which they received a single dose of placebo, lemborexant 10 mg, or lemborexant 25 mg. Each treatment period was separated by a washout period of at least 14 days. Assessments included pharmacodynamic respiratory parameters (peripheral capillary oxygen saturation (SpO2) and apnea-hypopnea index (AHI)) and safety. There were no significant differences for either dose of lemborexant versus placebo in mean peripheral capillary oxygen saturation (SpO2; least squares mean (LSM) difference (95% confidence interval (CI)): lemborexant 10 mg, -0.36 (-0.78 to 0.07); lemborexant 25 mg, - 0.29 (- 0.72 to 0.14)) or AHI (LSM difference (95% CI): lemborexant 10 mg, 0.52 (- 1.72 to 2.76); lemborexant 25 mg, - 1.16 (- 3.40 to 1.08)) during sleep. Additionally, significant differences were not observed for the percentage of total sleep during which SpO2 was < 85% (LSM difference (95% CI): lemborexant 10 mg, 0.004 (- 0.058 to 0.067); lemborexant 25 mg, 0.044 (- 0.018 to 0.107)) or < 80% (LSM difference (95% CI): lemborexant 10 mg, 0.001 (- 0.002 to 0.005); lemborexant 25 mg, 0.002 (-0.001 to 0.006)) for either lemborexant dose versus placebo. There was also no significant difference for lemborexant 10 mg versus placebo, for which SpO2 was < 90% during total sleep time (LSM difference (95% CI): 0.185 (- 0.034 to 0.405)). Overall, lemborexant at recommended doses did not have a negative effect on mean SpO2 or AHI and was well tolerated in this cohort of healthy subjects.

Comparison of high flow nasal oxygen and conventional nasal cannula during gastrointestinal endoscopic sedation in the prone position: a randomized trial.

Deep sedation for endoscopic retrograde cholangiopancreatography (ERCP) can be challenging in elderly patients in the prone position. This study investigated the effect of a high flow nasal oxygen (HFNO) delivery system on oxygenation in this procedure compared with that of conventional nasal cannula oxygen administration. A prospective randomized trial was conducted using HFNO and conventional nasal cannula in patients undergoing ERCP in the prone position. For each patient, the lowest oxygen saturation (SpO2), the incidence of hypoxemia defined as an SpO2 below 90%, and interruptions due to airway interventions were recorded during the procedure. The lowest mean (standard deviation) SpO2 recorded during the procedure was higher in the HFNO group than in the conventional control group [99.8 (0.6)% vs 95.1 (7.3)%; mean difference, 4.7%; 95% confidence interval, 2.3% to 7.1%; P Group x Time < 0.001]. While the lowest SpO2 during the procedure was lower than the baseline SpO2 in the control group, the lowest SpO2 during the procedure was higher than the baseline SpO2 in the HFNO group. Hypoxemia occurred only in the control group (n = 7; 19%; P = 0.01). Procedural interruptions, including discontinuation of sedation, patient stimulation, and jaw thrusting, occurred only in the control group (n = 9 [25%], n = 10 [28%], and n = 10 [28%] cases, respectively; P = 0.001 for each). In contrast to conventional nasal cannula, high flow nasal oxygen provided adequate oxygenation without causing procedural interruptions during ERCP, suggesting that HFNO may be used as a standard oxygen delivery method during these procedures. www.ClinicalTrials.gov (NCT03872674); registered 11 March 2019.

An Observational Study to Compare the Effect of Two Different Doses of Dexmedetomidine on Hemodynamic Response to Laryngoscopy and Endotracheal Intubation

Background: Laryngoscopy and intubation are associated with intensesympathoadrenal stimulationresulting in hypertension, tachycardia & arrhythmias consequent to the release of catecholamines. Variousdrug regimens and techniques have been used from time to time for attenuating the stress response tolaryngoscopy and intubation, including opioids, barbiturates, benzodiazepines, beta blockers, calciumchannel blockers, vasodilators etc. Dexmedetomidine is a highly selective alpha 2 receptor agonist havingeight times higher affinity and alpha 2 selectivity compared to clonidine and has a shorter duration of actionthan clonidine.Material and Method: 60 patients scheduled for elective surgical procedures under general anaesthesiabelonging to ASA Grade I and II, in the age group of 18 to 60 years were divided into two study groups,D1 and D0.5 received dexmedetomidine 1 µg/kg and 0.5 µg/kg intravenously (iv) over 10 minutes beforeinduction. Hemodynamic responses were compared in both groups by measuring Heart rate (HR),Systolicblood pressure (SBP),Diastolic blood pressure(DBP),Mean arterial pressure (MAP) and SpO2 beforegiving the test drug (base line values),just before induction,during intubation and at 1 minute, 3 minutes, 5minutes,10 minutes after intubation. Statistical data were analyzed by using student’s unpaired t test.Observation and Results: Group D1 had 4.70% rise in HR and Group D0.5 had 9.59% rise during intubationwhich was statistically significant(p<0.05). Maximum rise in SBP and DBP in Group D0.5 was 14.53% and12.84% respectively, whereas in Group D1 it was 5.55% and 8.90% respectively. In Group D0.5, rise in BPlasted longer after intubation compared to Group D1.Conclusion: The present study demonstrated that ivdexmedetomidine 1µg/kg was better thandexmedetomidine 0.5µg/kg in attenuation of the pressor response of laryngoscopy and intubation withoutany significant side effects.

Outcome of Instrumental Oxygen Therapy in COVID-19: Survivors Versus Non-survivors in Bangladeshi Cohort

<i>Background and objectives</i>: Mortality of critically ill COVID-19 patients in ICU are high around the globe. There are variable reports on the outcome of invasive and non-invasive ventilation, change of oxygen saturation, and clinical characteristics in different countries and hospital set-ups. This study aimed to observe the demographic and clinical characteristics of critical COVID-19 cases, the trend of SpO₂ in 10-days, and the mortality outcome of oxygen therapy in a tertiary level hospital in Bangladesh. <i>Methods</i>: In this retrospective study, data obtained from 99 patients admitted in ICU with COVID-19 was confirmed by RT-PCR of the nasopharyngeal swab. The 720-bed Holy Family Red Crescent Medical College Hospital (HFRCMCH), Dhaka, Bangladesh with a 9-bed ICU facility designated as "COVID-dedicated" from May17 to September 9, 2020. Ninety-nine patients were selected for the study, divided into two groups. 39 of them were non-survivors, whereas 60 included in the survivors group. Demographic data, correlation with age groups, clinical symptoms, instrumental oxygen therapy, and mortality were collected from hospital records. Appropriate statistical analysis was done using SPSS version 26.0. <i>Results</i>: Out of 99 patients admitted in ICU with COVID-19, 72 were male and 27 were female. The mean age of the patients was 61.08 years. Most of the ICU patients were in the 60-69 years of age group and the highest mortality rates (35.89%) were observed in this age range. The presenting symptoms of the patients were shortness of breath (85.85%) was the most common symptom followed by fever (66.66%), cough (32.32%), lethargy (12.12%), and others (7.77%). The mean SpO₂ of their 10-days ICU stay was also variable between the two groups. A gradual increase of mean SpO₂ was observed in the survivors' group. Whereas, the mean SpO₂ level of non-survivor had ups and downs from 92% to 83% on day-10, along with the lowest level of mean SpO₂ (77%) was on the 7^th day. <i>Conclusions</i>: With the constrain of the healthcare support system and limited ICU facilities in a low-middle income country like Bangladesh, the mortality outcome and instrumental oxygen therapy to fight the ARDS caused by COVID-19 is far challenging. The present study clearly showed the highest mortality in patients who required mechanical ventilation, whereas, almost 75% of patients survived with high flow nasal cannula (HFNC). Therefore, the experience advocates the necessity of HFNC at the earliest possible time to avoid invasive ventilation in COVID-19 patients admitted in ICU.

Comparative study of two supraglottic airway devices- LMA Supreme and I-Gel in adult patients undergoing general anaesthesia at a tertiary hospital

Background: The LMA Supreme is a supraglottic airway device made of medical grade PVC and is latex-free. The I-Gel is a new supraglottic airway device with a non-inflatable cuff, composed of soft gel like, transparent thermoplastic elastomer. The main aim of present study was to compare the LMA Supreme with the I-Gel LMA in terms of the success of insertion of the device, hemodynamic changes and postoperative device related complications. Material and Methods: Present study was a prospective, randomized, comparative, observational study conducted in patients admitted for various elective surgeries, were randomly divided (by envelope selection) as I-Gel LMA and Supreme LMA insertion for general anaesthesia. Results: The mean age in group I and S were 41.26 ± 10.22 and 44.86 ± 10.1 years respectively. The mean body weight in Group I was 55.51 ± 9.61 kgs and in Group S it was 53.12 ± 9.65 kgs. There was no significant difference in the age, gender, body weight, ASA Grades of the patients between Group 1 and Group 2 .Statistically there was no significant difference in the SAD Sizes, Surgical Procedures, ease of insertion in both the groups. The basal heart rate was, mean SBP, mean basal DBP, mean basal MAP and mean SpO2 were comparable in both groups. Blood Tinged SAD was noted in 6 patients in both group I (I-Gel) and group S (SLMA). None of the patients in group I (I-Gel) out of 43 patients had Lip or Dental Injury, whereas 2 patients in group S (SLMA) out of 43 patients had Lip or Dental Injury. Only 4 of the patients in group I (I-Gel) out of 43 patients had Sore Throat within 24 hours post removal of SAD, whereas 6 patients in group S (SLMA) out of 43 patients had Sore Throat within 24 hours post removal of SAD. Conclusion: Both LMA Supreme and I-Gel can be used effectively and comfortably in selected adult patients during general anaesthesia. Both LMA Supreme and I-Gel are easy to insert, both are almost inserted in first attempt, no significant difference in hemodynamic changes during usage is noted.

Oxygen saturation nomogram by pulse oximetry in the first 24 h of life

Aims: The aim of this study is to plot a nomogram of oxygen saturation (SpO2) in healthy newborns during the first 24 h of life and study the possible relationship to birth weight, mode of delivery, parity, and gender. Materials and Methods: This was a retrospective study done on a healthy newborn population. The primary purpose of the study was to see preductal saturation during the first 24 h of life and to plot a nomogram of the 5th and 95th percentile for the first 24 h of life. Results: From 5252 babies born in our hospital during 2016, 4139 (78.8%) were included in the study. Mean SpO2 was 98.82%, with a standard deviation of 1.21%. Saturation nomogram of 5th and 95th percentile of preductal saturation during the first 24 h of life was between 96% and 100%. There was no significant difference in gender and mode of delivery. Conclusion: Baseline arterial SpO2 was relatively stable during the first 24 h of life. Moreover, it was similar to the other studies reported earlier.

A comparative study of dexmedetomidine propofol and midazolam with respect to changes in mean arterial pressure and SpO2 after sedation at tertiary health care centre

Background: Sedation is an important component of compassionate care in ICU patients to promote rest and sleep. The sedatives used most often include propofol and midazolam. These medications provide adequate sedation but also can cause oversedation. The α2 agonist dexmedetomidine have unique sedative properties that it produces only mild cognitive impairment, allowing easy communication between health-care provider and patient in the ICU. We therefore compared the sedative and analgesic properties, cardiovascular responses, ventilation and extubation characteristics, and patient perceptions of dexmedetomidine with those of the commonly used i.v. sedative agent propofol in the ICU. Material and Methods: Present study was a randomized. open label trial conducted in the ICU ppatients &gt;18 years of age, who required immediate sedation as to permit the initiation and tolerance of mechanical ventilation. 30 patients each were randomly allocated to dexmedetomidine, propofol &amp; midazolam group. Results: Male predominance was noted, in all groups (dexmedetomidine, propofol &amp; midazolam), M:F ratio was 1.3 : 1. According to age distribution most common age group in dexmedetomidine, propofol &amp; midazolam group was 31-45 years (40 %). At all times the difference in systolic blood pressure, diastolic blood pressure, SpO2, mean arterial blood pressure among all the three groups calculated by ANOVA test was not statistically significant (P&gt;0.05). The mean time (hours) from cessation of sedation to extubation for dexmedetomidine is 7.4 hours, for propofol is 5.6 hours and for midazolam is 16.9 hours. P-value of dexmedetomidine, propofol and midazolam group is &lt;0.001, which is statistically significant. Conclusion: Dexmedetomidine provides hemodynamic stability and have no clinically important adverse effects on respiration in terms of mean SpO2. Tracheal extubation was earlier in patients receiving dexmedetomidine and propofol than from midazolam.