Mild Hypoxemia Research Articles

High-flow nasal cannulas versus standard oxygen therapy for moderate bronchiolitis: a quasi-experimental analysis.

In the last decades none of the medical therapies investigated have shown clear efficacy in the treatment of bronchiolitis, and literature agrees on a general de-implementation of pharmacological therapies, recognizing an effective role only to nutritional support and oxygen therapy. High-flow nasal cannulas (HFNC) has become increasingly popular in the last decade, despite its lack of clear efficacy. Recent randomized controlled trials (RCT) comparing standard oxygen therapy (SOT) and HFNC did not demonstrate significant benefit of HFNC. To acquire more clinical data on HFNC efficacy we performed a retrospective, quasi-experimental analysis of patients admitted for bronchiolitis in the epidemic seasons 2021-2022 and 2022-2023. To assess the efficacy of SOT and HFNC we used a pragmatic approach, a fuzzy regression discontinuity design, which is a quasi-experimental test. Unlike RCTs, this process is not a true randomization, but may be interpreted as quasi-randomization in an observational setting. HFNC did not reduce length of oxygen therapy (LOO) nor length of hospitalization (LOS) (respectively, p: 0.383 and p: 0.454). Treatment failure was not significantly different in the treatment groups (p: 0.354). It is crucial to perform additional RCTs with uniform protocols to determine the efficacy of HFNC more accurately in the treatment of bronchiolitis. HFNC does not reduce LOO, suggesting that early use of HFNC does not change the course of disease in moderate bronchiolitis. In view of the greater complexity and higher cost, HFNC should not be routinely used as first-line treatment in children with moderate respiratory distress and mild hypoxemia.

Intranasal vs. intramuscular administration of azaperone, midazolam and ketamine in pigs.

To compare the efficacy of intranasal (IN) and intramuscular (IM) administrations of azaperone (3 mg kg-1), midazolam (0. 3 mg kg-1), and ketamine (7 mg kg-1) combination (AMK) in pigs. Study design: Randomized clinical trial. Animals: sixteen adult male pigs, immunocastrated, of mixed lineage. In phase I, these animals were randomly assigned to intranasal (GIN, n = 8) and intramuscular (GIM, n = 8) groups for arterial blood sample collection at 10, 20, 30, 45, 60, and 90 min after AMK administrations for gas and electrolyte analysis. In phase II, performed 1 week after phase I, the 16 pigs were allocated to both groups (GIM, n = 16/GIN, n = 16) and submitted to the same chemical restraint (CR) protocol, with a 96-h interval between administrations. Behavioral parameters (degree of CR, muscle relaxation, loss of postural reflex, and sound stimulus response) and vital parameters (pulse rate, respiratory rate, oxygen saturation, and rectal temperature) were evaluated after recumbency (Trec) and at 5, 15, 30, 45, 60, and 90 min after administrations. In addition, the latency period and duration of CR were determined. Latency to recumbency and duration of CR in GIN were shorter. CR scores did not vary between groups. Muscle relaxation was more intense in GIN at Trec. An initial tachycardia was observed, followed by a reduction in heart rate from T5 to T90 in both treatments (p < 0.05). The respiratory rate was higher at T45, T60, and T90 in GIN compared to baseline. Rectal temperature reduced in GIM from T45 onwards. elevated at T90 in the GIM (p < 0.05) and there was an incidence of mild hypoxemia in 47% of the animals in the GIM. IN administration was as effective as IM administration in promoting safe chemical restraint, with minimal changes in homeostasis, with a shorter duration and latency period.

Nasal High-Flow Oxygen Therapy in Chronic Respiratory Failure for Homecare Applications-A Feasibility Study.

Background: While high-flow nasal cannulas (HFNCs) represent the standard of care in the intensive care unit for patients with severe hypoxemia, its use in homecare settings is uncommon despite its potential. The potential benefits and challenges of the high-flow nasal cannula (HFNC) in homecare settings compared to standard long-term oxygen via nasal low-flow therapy are unclear. Methods: We conducted a prospective monocentric feasibility study at the Department of Respiratory Medicine, University Hospital, Goethe University Frankfurt, Germany. Patients with interstitial lung disease or severe bronchiectasis (including cystic fibrosis) were enrolled into the study. The HFNC was introduced during hospitalization. The patients' compliance with home use advice and arterial blood gas results were evaluated at a 4-6-week follow-up. Results: A total of 12 patients were analyzed. HFNC initiation did not result in a significant improvement of the pO2/fiO2 (p/f) ratio. Only 8 out of 12 (66.6%) patients used the HFNC at home after the initial in-hospital initiation. Only 7 of the total 12 patients were using the therapy at a follow-up 3-6 weeks after HFNC onset. Two patients died during the observation, resulting in a surveillance mortality rate of 16.7%. Conclusions: The feasibility data showed low adherence to the HFNC at home. The lack of any positive effect on the p/f ratio may be due to low airflow rates and overall mild hypoxemia compared to patients with severe respiratory failure in the ICU.

0856 Association of Naturally Occurring Mild Intermittent Hypoxemia and Health Outcomes in Sleep Apnea

0856 Association of Naturally Occurring Mild Intermittent Hypoxemia and Health Outcomes in Sleep Apnea

Clinical predictors of hypoxemia in patients of acute lower respiratory tract infections: A hospital-based study

Aim: The aim of this study was to study clinical predictors of hypoxemia in patients of acute lower respiratory infections in children. Materials and Methods: An observational prospective study was conducted for 8 months in the General Pediatric Ward and Pediatric Intensive Care Unit of Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, a tertiary care hospital in Rohilkhand region. This is a hospital-based study. All children admitted with acute lower respiratory tract infections between the age group of 1 month to 59 months of age and diagnosed with pneumonia and bronchiolitis were enrolled and oxygen saturation of patients was recorded and compared with arterial blood gas. Results: A total of 40 patients were enrolled in the study. More than 90% cases of pneumonia and bronchiolitis presented with difficulty in breathing followed by rapid breathing as the next most common symptom. The least common symptom was noisy breathing and pain in abdomen. The most common signs observed were tachypnea which was present in 100% cases of mild, moderate, and severe hypoxemia. Tachypnea (91%), pallor (89%) and nasal flaring (84%), crepitations (added sounds), and subcostal retractions had better sensitivity for detecting hypoxemia. Conclusion: It was observed that a combination of clinical signs and symptoms can be used to predict hypoxemia when facilities of pulse oximetry and arterial blood gas analysis are not available, especially in low-resource settings.

Increased Levels of IFN-γ, PAI-1, and NT-proBNP are Associated with the Occurrence of Hypoxemia in COVID-19

BACKGROUND: Acute respiratory distress syndrome (ARDS) is one of the severe complications of Coronavirus disease 2019 (COVID-19) that can lead to the occurrence of hypoxemia. Hypoxemia occurs due to the role of pro-inflammatory cytokines and coagulation factors. Several studies have shown that interferon (IFN)-γ, plasminogen activator inhibitor 1 (PAI-1) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are biological markers that can be used to evaluate the severity and prognosis of the disease in severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. This study was conducted to evaluate the association between IFN-γ, PAI-1, NT-proBNP and hypoxemia in COVID-19 patients.METHODS: This was a cross-sectional study of COVID-19 subjects with hypoxemia. Hypoxemia assessment was performed based on arterial blood gas analysis. IFN-γ and PAI-1 were measured with ELISA, while NT-proBNP levels were measured with Roche NT-proBNP.RESULTS: Fifty-five COVID-19 subjects with hypoxemia were observed. Thirty subjects experiencing moderate to severe hypoxemia and 25 with mild hypoxemia. Levels of IFN-γ, PAI-1, and NT-proBNP were higher in COVID-19 subjects with moderate to severe hypoxemia compared to those with mild hypoxemia (261.14 (121-348.60) pg/mL vs. 145.50 (59.90-348.60) pg/mL, p&lt;0.001; 5.47 (3.50-8.50) pg/mL vs. 3.40 (2.20-9.30) pg/mL, p&lt;0.001; 760 (112-34,066) pg/mL vs. 71 (48-364) pg/mL, p&lt;0.001).CONCLUSION: Elevated levels of IFN-γ, PAI-1, and NT-proBNP are associated with hypoxemia in COVID-19 patients, suggesting that these markers may be useful in assessing hypoxemia in COVID-19 patients.KEYWORDS: IFN-γ, PAI-1, NT-proBNP, hypoxemia, COVID-19

The Effect of Diaphragmatic Breathing Exercise Technique on Increasing Oxygen Saturation in Asthma Patients

This study aims to determine the effect of the Diaphragmatic Breathing Exercise technique on increasing oxygen saturation in asthma patients. This study uses a quantitative approach with the type of Pre-Experimental One Group Pre-Test and post-test research with the Paired Sample T-Test. The results showed that administering the Diaphragmatic Breathing Exercise technique can increase oxygen saturation in asthma patients before and after the intervention. The oxygen saturation value before being given the Diaphragmatic Breathing Exercise technique showed that the frequency of oxygen saturation of respondents was in the range of 90%-94%, amounting to 38 people (67.9%) with the category of mild hypoxemia and in the field of 75%-89% amounting to 18 people (32.1%) with the type of moderate hypoxemia with an average value of 89.61%. The oxygen saturation value after being given the Diaphragmatic Breathing Exercise technique showed that the frequency of oxygen saturation in the range of 95%-100% amounted to 49 people (87.5%) with the standard category and in the field of 90%-94% amounted to 7 people (12.5%) with the type of mild hypoxemia with an average value of 96.61%. It can be concluded that the Diaphragmatic Breathing Exercise technique affects increasing oxygen saturation in asthma patients.&#x0D; &#x0D; Keywords: Asthma, Diaphragmatic Breathing Exercise, Oxygen Saturation

Comparison of the different oxygen delivery and ventilatory support methods for treating patients with COVID-19 induced type 1 hypoxemic respiratory failure

Having claimed the lives of over five million people in the span of two years, SARS-COV-2 caused a global health crisis and a debate between clinicians on the best respiratory interventions to use in fighting this disease. This paper aims to evaluate the different methods of respiratory support at a clinician’s disposal when treating COVID-19 induced type 1 hypoxemic respiratory failure. Data was acquired by running a literature search on MEDLINE and Web of Science using terms such as “COVID-19”, “Mortality”, “CPAP”, “Outcomes”. From 355 papers found, 11 are included in this paper. Studies have shown both CPAP and HFNO are effective when treating mild hypoxemia in COVID-19 patients, however if they fail, then chances of patient survival are slim, even if a patient’s treatment is escalated. The literature has shown that mechanical ventilation has a slightly higher survival rate than both CPAP and HFNO when used as a primary treatment and patients who are escalated to mechanical ventilation have a slim chance of survival. Considering the findings, it is crucial that clinicians consider factors such as a patient’s initial PaO2/FiO2 as well as age when deciding on whether a patient should be ventilated or treated with CPAP or HFNO.

Exploring the Anti-Hypoxaemia Effect of Hydromethylthionine: A Prospective Study of Phase 3 Clinical Trial Participants.

Methylthioninium chloride (MTC) is a standard treatment for methaemoglobinaemia. A preparation of reduced MTC has been reported to increase blood oxygen saturation (SpO2) and lower respiratory rates in patients with severe COVID-19. We have developed a stable form of reduced methylthionine (hydromethylthionine-mesylate, HMTM) having a benign safety profile in two Phase 3 trials in Alzheimer's disease. The aim of this prospective study was to determine the effects of oral HMTM on SpO2 and methaemoglobin (metHb) levels in a cohort of patients with mild hypoxaemia not due to COVID-19. Eighteen participants randomised to a single dose of 4, 75, 100 or 125 mg doses of HMTM had SpO2 levels below 94% at baseline. Patients were routinely monitored by pulse oximetry after 4 h, and after 2 and 6 weeks of twice daily dosing. Significant ~3% increases in SpO2 occurred within 4 h and were sustained over 2 and 6 weeks with no dose differences. There were small dose-dependent increases (0.060-0.162%) in metHb levels over 2 to 6 weeks. Minimum-energy computational chemistry revealed that HMT can bind within 2.10 Å of heme iron by donating a pair of electrons from the central nitrogen of HMT to d orbitals of heme iron, but with lower affinity than oxygen. In conclusion, HMTM can increase SpO2 without reducing metHb by acting as a strong displaceable field ligand for heme iron. We hypothesise that this facilitates a transition from the low oxygen affinity T-state of heme to the higher affinity R-state. HMTM has potential as an adjunctive treatment for hypoxaemia.

Quality Review of Prone Patient Transport Protocol

ObjectiveThis is a retrospective quality review of LifeFlight Nova Scotia's prone patient transport protocol. MethodsElectronic patient care records were queried for acute respiratory distress syndrome, prone position, proning, supine to prone, and prone to prone between February 2017 and June 2022. Eligible electronic patient care records were reviewed for demographics (sex, age, and weight); method of transports (ambulance, rotor wing, or fixed wing); duration of transports; mechanical ventilation parameters; medication infusions; arterial blood gases; occurrences of mild hypoxemia (any oxygen saturation [SpO2] < 88% or decrease in SpO2 > 5%); hypotension (any episode of MAP < 65 mm Hg); severe hypoxemia (any SpO2 < 80% or decrease in SpO2 > 10%); refractory hypotension (mean arterial pressure < 65 mm Hg not responsive to vasopressor/inotropes); cardiac arrests; and displacement of central lines, arterial lines, and endotracheal tubes. ResultsSeventeen prone patients were transported by ambulance, rotor wing, and fixed wing with 4 occurrences of mild hypotension, 4 occurrences of mild hypoxemia, and 1 occurrence of refractory hypotension. ConclusionInterfacility transfer of prone patients by a dedicated critical care team is feasible with minimal adverse occurrences while ensuring patients have access to the specialized lifesaving care they require.

A study on clinical and arterial blood gas parameters before and after tube thoracostomy among cases of primary and secondary spontaneous pneumothorax

Pneumothorax is a common respiratoryemergency that requires active interventions in many cases specially Tube thoracostomy. Objective of the present study is to find out changes in clinical and arterial blood gas parameters in primary and secondary pneumothorax following tube thoracostomy at different time intervals.Total 30 cases, Primary spontaneous pneumothorax (PSP) 11 and secondary spontaneous pneumothorax (SSP) 19. Clinical parameters: pulse rate, blood pressure, respiratory rates, oxygen saturation (SpO2). ABG analysis: pH, partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), AaDO2. Time interval: pre tube thoracostomy, 1hour and 24hours after thoracostomy and after tube removal. PSP was found more in young patients (mean 34.18), SSP in older patient (mean 52.68), (P=0.001). Among clinical parameters statistically significant changes were seen in pulse rate, (P&amp;#60;0.001) respiratory rate (P&amp;#60;0.001) in both groups, in both cases tachycardia and tachypnea decreased. Diastolic blood pressure in SSP group (P&amp;#60;0.01), SO in SSP group (P&amp;#60;0.05). There is an increase in mean arterial pressure from pre thoracostomy compared to in 1hr, 24hr and at removal. Which statistically significant in SSP group.In PSP group hypoxaemia was present in 54.54% patients before giving chest tube, after 1 hour of tube thoracostomy only 18.18% cases had mild hypoxaemia. In SSP group 68.42% cases presented with hypoxaemia initially, after tube removal 26.31% cases had mild hypoxaemia.No significant changes in other blood gas parameters were seen in either groups. The impact of tube thoracostomy on primary and secondary pneumothorax are mainly reflected on clinical parameters rather than blood gas parameters.

Broadening the Berlin definition of ARDS to patients receiving high-flow nasal oxygen: an observational study in patients with acute hypoxemic respiratory failure due to COVID-19

BackgroundHigh-flow nasal oxygen (HFNO) is increasingly used in patients with acute hypoxemic respiratory failure. It is uncertain whether a broadened Berlin definition of acute respiratory distress syndrome (ARDS), in which ARDS can be diagnosed in patients who are not receiving ventilation, results in similar groups of patients receiving HFNO as in patients receiving ventilation.MethodsWe applied a broadened definition of ARDS in a multicenter, observational study in adult critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), wherein the requirement for a minimal level of 5 cm H2O PEEP with ventilation is replaced by a minimal level of airflow rate with HFNO, and compared baseline characteristics and outcomes between patients receiving HFNO and patients receiving ventilation. The primary endpoint was ICU mortality. We also compared outcomes in risk for death groups using the PaO2/FiO2 cutoffs as used successfully in the original definition of ARDS. Secondary endpoints were hospital mortality; mortality on days 28 and 90; need for ventilation within 7 days in patients that started with HFNO; the number of days free from HFNO or ventilation; and ICU and hospital length of stay.ResultsOf 728 included patients, 229 patients started with HFNO and 499 patients with ventilation. All patients fulfilled the broadened Berlin definition of ARDS. Patients receiving HFNO had lower disease severity scores and lower PaO2/FiO2 than patients receiving ventilation. ICU mortality was lower in receiving HFNO (22.7 vs 35.6%; p = 0.001). Using PaO2/FiO2 cutoffs for mild, moderate and severe arterial hypoxemia created groups with an ICU mortality of 16.7%, 22.0%, and 23.5% (p = 0.906) versus 19.1%, 37.9% and 41.4% (p = 0.002), in patients receiving HFNO versus patients receiving ventilation, respectively.ConclusionsUsing a broadened definition of ARDS may facilitate an earlier diagnosis of ARDS in patients receiving HFNO; however, ARDS patients receiving HFNO and ARDS patients receiving ventilation have distinct baseline characteristics and mortality rates.Trial registration: The study is registered at ClinicalTrials.gov (identifier NCT04719182).

Assessment of Fitness for Air travel in Patients with Pulmonary Diseases

During air travel, increasing hypoxia with altitude ascent is a potentially serious problem for patients with hypoxemic chronic airway obstruction (CAO). Travel by air is the most popular way of transport nowadays &amp; estimated that each year worldwide, more than 3 billion passengers travel by air &amp; 736 million in the United States alone. For most passengers, even those with respiratory disease, air travel is safe and comfortable. Some patients with COPD &amp;other Chronic Lung diseases may be at risk but, with screening, these patients can be identified and most of them can travel safely with supplemental oxygen. Some patients with chronic lung disease may have mild hypoxemia at sea level but during air travel in a hypobaric hypoxic environment, compensatory pulmonary mechanisms may be inadequate despite normal sea-level oxygen requirements. In addition, compensatory cardiovascular mechanisms may be less effective in some patients who are unable to increase cardiac output. Air travel also presents an increased risk of venous thromboembolism. It's estimated that, almost 1 medical emergency for every 600 flights. Respiratory symptoms accounted for 12% of all these in-air emergencies.&#x0D; Pulse Volume 12-14 2020-2022 p.16-21

EVALUATION OF A COMBINATION OF TILETAMINE-ZOLAZEPAM, MEDETOMIDINE, AND AZAPERONE WITH NASAL OXYGEN SUPPLEMENTATION FOR THE IMMOBILIZATION OF CAPTIVE CHACOAN PECCARIES (CATAGONUS WAGNERI) IN THE CHACO REGION OF PARAGUAY.

A combination of tiletamine-zolazepam, medetomidine, and azaperone was used to immobilize captive Chacoan peccaries (Catagonus wagneri) for health assessments and biological sample collection at the Centro Chaqueño para la Conservación e Investigación (CCCI) in the Paraguayan Chaco during July in 2017 and 2018. In total, 83 peccaries kept in 0.25-1.50 hectare enclosures were immobilized via dart-administered anesthetic. Mean animal weight was 33.89±3.74 kg (standard deviation; n=77). The mean intramuscular (IM) anesthetic drug and dosages were 0.03±0.00 mg/kg of medetomidine, 0.91±0.10 mg/kg of Zoletil 50 (tiletamine-zolazepam), and 0.30±0.03 mg/kg azaperone. The mean time to recumbency after darting was 6.07±2.65 min. The mean time to reach the anesthetic plane postdarting was 10.00±2.00 min. Muscle relaxation was adequate to allow minor veterinary procedures. A mean dosage of 0.15±0.02 mg/kg of atipamezole was given IM to reverse the medetomidine. Recoveries were smooth and animals were standing by 59.17±30.18 min postreversal. Full recovery and release back to enclosures occurred 90±30 min postreversal. A single dose of this drug combination provided adequate anesthesia for 88% of adult Chacoan peccaries; 12% needed a supplemental dose of tiletamine-zolazepam because of failure to receive the full dose from the anesthetic dart. Sex and age did not impact the dosage required to achieve immobilization. Confinement during recovery from anesthesia is required with this protocol. Aside from mild hypoxemia, no adverse effects from anesthesia were observed. However, oxygen supplementation as a part of this protocol is recommended to support circulatory and respiratory capacity.

1028 Congenital Central Hypoventilation in a patient with MCEP2 duplication syndrome

Abstract Introduction Congenital central hypoventilation (CCHS) is a rare disorder due to impairment of autonomic nervous system clinically defined by a significantly reduced or abolished ventilatory response to hypercapnia and hypoxemia in the absence of pulmonary, neuromuscular, or cardiac disease. There is limited knowledge on associated respiratory manifestations and sleep-disordered breathing in children with the MECP2 duplication syndrome. Although sleep-disordered breathing and nocturnal hypoventilation are currently not well recognized in these children, we present a case of a patient with MECP2 mutation and congenital hypoventilation syndrome. Report of case(s) 24-week-old male born full-term via c-section presented with recurrent respiratory problems, laryngeal cleft, dysphagia, snoring and apneic episodes. Previous genetic work up showed chromosome 15q11.2 microdeletion. Past medical history was significant for neonatal ICU stay for respiratory distress immediately following birth. Tonsils are 1+ on exam. PSG showed profound central sleep apnea (CAI 300/h) with average apneic episodes lasted for 7 seconds and very significant periodic breathing (88%) and mild obstructive apnea. Mild hypoxemia was also seen with SpO2 in low 90s without any significant hypercapnia. Bradypnea with resp rate 10-20/m was seen. PHOX2B gene testing was negative. Genetic testing with SNP array showed MECP2 duplication syndrome. His development is delayed, currently at the age of 20 months, including cognitive, speech and motor function for which he is on therapy. Tracheostomy was recommended, however family preferred to continue with non-invasive ventilation while awaiting diaphragmatic pacing. Conclusion Respiratory manifestations in MECP2 duplication syndrome patients are common, with important impact and even a possible fatal outcome. Although sleep-disordered breathing and nocturnal hypoventilation is currently not cited as an important symptom in these children, there have been several case reports of CCHS associated with this. PSG should be considered in patients with MCEP2 duplication syndrome for timely diagnosis. Different treatment modalities (ENT surgery, CPAP and NIV) can be applied successfully to treat respiratory conditions associated with MECP2 duplication syndrome. Support (if any)

Effect of remimazolam tosilate on the incidence of hypoxemia in elderly patients undergoing gastrointestinal endoscopy: A bi-center, prospective, randomized controlled study.

Background: Remimazolam tosilate is a new ultra-short-acting benzodiazepine sedative medicine. In this study, we evaluated the effect of remimazolam tosilate on the incidence of hypoxemia during sedation in elderly patients undergoing gastrointestinal endoscopy. Methods: Patients in the remimazolam group received an initial dose of 0.1mg/kg and a bolus dose of 2.5mg of remimazolam tosilate, whereas patients in the propofol group received an initial dose of 1.5mg/kg and a bolus dose of 0.5mg/kg of propofol. Patients received ASA standard monitoring (heart-rate, non-invasive blood pressure, and pulse oxygen saturation) during the entire examination process. The primary outcome was the incidence of moderate hypoxemia (defined as 85%≤ SpO2< 90%, >15s) during the gastrointestinal endoscopy. The secondary outcomes included the incidence of mild hypoxemia (defined as SpO2 90%-94%) and severe hypoxemia (defined as SpO2< 85%, >15s), the lowest pulse oxygen saturation, airway maneuvers used to correct hypoxemia, patient's hemodynamic as well as other adverse events. Results: 107 elderly patients (67.6 ± 5.7years old) in the remimazolam group and 109 elderly patients (67.5 ± 4.9years old) in the propofol group were analyzed. The incidence of moderate hypoxemia was 2.8% in the remimazolam group and 17.4% in the propofol group (relative risk [RR] = 0.161; 95% confidence interval [CI], 0.049 to 0.528; p < 0.001). The frequency of mild hypoxemia was less in the remimazolam group, but not statistically significant (9.3% vs. 14.7%; RR = 0.637; 95% CI, 0.303 to 1.339; p = 0.228). There was no significant difference in the incidence of severe hypoxemia between the two groups (4.7% vs. 5.5%; RR = 0.849; 95% CI, 0.267 to 2.698; p = 0.781). The median lowest SpO2 during the examination was 98% (IQR, 96.0%-99.0%) in patients in the remimazolam group, which was significantly higher than in patients in the propofol group (96%, IQR, 92.0%-99.0%, p < 0.001). Patients in the remimazolam group received more drug supplementation during endoscopy than patients in the propofol group (p = 0.014). There was a statistically significant difference in the incidence of hypotension between the two groups (2.8% vs. 12.8%; RR = 0.218; 95% CI, 0.065 to 0.738; p = 0.006). No significant differences were found in the incidence of adverse events such as nausea and vomiting, dizziness, and prolonged sedation. Conclusion: This study explored the safety of remimazolam compared with propofol during gastrointestinal endoscopy in elderly patients. Despite the increased supplemental doses during sedation, remimazolam improved risk of moderate hypoxemia (i.e., 85%≤ SpO2 < 90%) and hypotension in elderly patients.

The use of High-Flow Nasal Oxygen Therapy in 4 dogs undergoing bronchoscopy.

High-Flow Nasal Oxygen Therapy is a method to deliver warmed, humidified air-oxygen blended at high flow rates to patients through a nasal cannula using a specialized, commercially available machine. This is a well-tolerated, safe and effective method for oxygen delivery to healthy and hypoxemic dogs. Patients undergoing bronchoscopic procedures frequently develop hypoxemia. Human trials have shown a reduction in incidents of hypoxemic events and higher pulse oximeter oxygen saturation during bronchoscopies in patients on High-Flow Nasal Oxygen. This is a single-centre, prospective case series. All dogs weighing between 5 and 15 kg and undergoing bronchoscopy during the study period (03/07/2022-01/10/2022) were eligible. Twelve patients were eligible for inclusion of which four were enrolled. No clinically significant complications related to the use of High-Flow Nasal Oxygen Therapy were recorded. Two of the patients were re-intubated post bronchoscopy due to clinician preference for recovery. One of the patients had a self-limiting period of severe hypoxemia with a pulse oximeter oxygen saturation of 84% for < 1 min during bronchoalveolar lavage, and whilst undergoing High-Flow Nasal Oxygen administration. Another patient had a self-limiting episode of mild hypoxemia (SpO2 of 94% lasting < 1 min) 5 min after completion of bronchoalveolar lavage. No clinically relevant complications relating to High-Flow Nasal Oxygen Therapy were recorded in this case series, although further studies are required to confirm this conclusion. This initial data suggests that the use of High-Flow Nasal Oxygen therapy during bronchoscopy is feasible and potentially safe, although it may not prevent hypoxemia in these patients. The use of High-Flow Nasal Oxygen Therapy during bronchoscopy in small patients carries multiple potential benefits and further studies to compare its efficacy against other traditional oxygen delivery systems are warranted in this patient population.

Effects of opioid-free propofol or remimazolam balanced anesthesia on hypoxemia incidence in patients with obesity during gastrointestinal endoscopy: A prospective, randomized clinical trial.

There are presently no consensuses on the optimal sedation strategy for obese patients during gastrointestinal endoscopy. This study aim to explore the effects of opioid-free propofol or remimazolam balanced anesthesia on hypoxemia incidence in patients with obesity. A total of 264 patients were randomized to remimazolam + esketamine group (group R) or propofol + esketamine group (group P). Anesthesia in group P was administrated by propofol, esketamine and in group R by remimazolam, esketamine. The primary outcome was incidence of hypoxemia. Secondary outcomes were the time to loss of consciousness (LoC) and to recovery and the incidence of intraoperative and postoperative adverse reactions. We found the incidence of mild hypoxemia in group R was similar to that in group P (14.2% vs. 11.5%, p = 0.396). The incidence of severe hypoxemia in group R was significantly lower than Group P (4.2% vs. 9.2%, p = 0.019). The time to LoC in group R was longer than group P [Median (interquartile range, IQR): 53 s (45 to 61) vs. 50 s (42 to 54), p = 0.001]. The time to recovery from anesthesia in group R was less than group P [Median (IQR): 48 min (41 to 58) vs. 55.5 min (46 to 67), p<0.001]. There was no significant difference in the incidence of adverse events (p > 0.05 for all). We concluded that compared with propofol combined with esketamine, remimazolam combined with esketamine can reduce the incidence of severe hypoxemia during gastrointestinal endoscopy in obese patients. Clinical Trial Registration: www.chictr.org.cn, Identifier: ChiCTR2200065575.

Cardiovascular abnormalities in chest radiographs of children with pneumonia, Uganda.

To describe chest radiograph findings among children hospitalized with clinically diagnosed severe pneumonia and hypoxaemia at three tertiary facilities in Uganda. The study involved clinical and radiograph data on a random sample of 375 children aged 28days to 12years enrolled in the Children's Oxygen Administration Strategies Trial in 2017. Children were hospitalized with a history of respiratory illness and respiratory distress complicated by hypoxaemia, defined as a peripheral oxygen saturation (SpO2) < 92%. Radiologists blinded to clinical findings interpreted chest radiographs using standardized World Health Organization method for paediatric chest radiograph reporting. We report clinical and chest radiograph findings using descriptive statistics. Overall, 45.9% (172/375) of children had radiological pneumonia, 36.3% (136/375) had a normal chest radiograph and 32.8% (123/375) had other radiograph abnormalities, with or without pneumonia. In addition, 28.3% (106/375) had a cardiovascular abnormality, including 14.9% (56/375) with both pneumonia and another abnormality. There was no significant difference in the prevalence of radiological pneumonia or of cardiovascular abnormalities or in 28-day mortality between children with severe hypoxaemia (SpO2: < 80%) and those with mild hypoxaemia (SpO2:80 to < 92%). Cardiovascular abnormalities were relatively common among children hospitalized with severe pneumonia in Uganda. The standard clinical criteria used to identify pneumonia among children in resource-poor settings were sensitive but lacked specificity. Chest radiographs should be performed routinely for all children with clinical signs of severe pneumonia because it provides useful information on both cardiovascular and respiratory systems.

A 10-month-old infant with respiratory distress and hypoxemia

A 10-month-old infant with Prader-Willi Syndrome presented with a 7 month history of increased work of breathing, wheeze, inspiratory crepitations, and mild hypoxemia. Subsequent investigations including chest CT suggested the diagnosis to be neuroendocrine cell hyperplasia of infancy (NEHI). NEHI is a rare cause of children’s interstitial lung disease. Childhood interstitial lung disease should be considered in an infant with persistent tachypnea, crepitations, and hypoxemia.