Oxygen Administration Research Articles

The Effect of Prehospital Clinical Trial-Related Procedures on Scene Interval, Cognitive Load, and Error: A Randomized Simulation Study

Introduction Globally, very few settings have undertaken prehospital randomized controlled trials. Given this lack of experience, there is a risk that such trials in these settings may result in protocol deviations, increased prehospital intervals, and increased cognitive load, leading to error. Ultimately, this may affect patient safety and mortality. The aim of this study was to assess the effect of trial-related procedures on simulated scene interval, self-reported cognitive load, medical errors, and time to action. Methods This was a prospective simulation study. Using a cross-over design, ten teams of prehospital clinicians were allocated to three separate simulation arms in a random order. Simulations were: (1) Eligibility assessment and administration of freeze-dried plasma (FDP) and a hemoglobin-based oxygen carrier (HBOC), (2) Eligibility assessment and administration of HBOC, (3) Eligibility assessment and standard care. All simulations also required clinical management of hemorrhagic shock. Simulated scene interval, error rates, cognitive load (measured by NASA Task Load Index), and competency in clinical care (assessed using the Simulation Assessment Tool Limiting Assessment Bias (SATLAB)) were measured. Mean differences between simulations with and without trial-related procedures were sought using one-way ANOVA or Kruskal-Wallis test. A p-value of <0.05 within the 95% confidence interval was considered significant. Results Thirty simulations were undertaken, representing our powered sample size. The mean scene intervals were 00:16:56 for Simulation 1 (FDP and HBOC), 00:17:22 for Simulation 2 (HBOC only), and 00:14:24 for Simulation 3 (standard care). Scene interval did not differ between the groups (p = 0.27). There were also no significant differences in error rates (p = 0.28) or cognitive load (p = 0.67) between the simulation groups. There was no correlation between cognitive load and error rates (r = 0.15, p = 0.42). Competency was achieved in all the assessment criteria for all simulation groups. Conclusion In a simulated environment, eligibility screening, performance of trial-related procedures, and clinical management of patients with hemorrhagic shock can be completed competently by prehospital advanced life support clinicians without delaying transport or emergency care. Future prehospital clinical trials may use a similar approach to help ensure graded and cautious implementation of clinical trial procedures into prehospital emergency care systems.

Bleomycin and perioperative care: a case report.

Bleomycin is associated with pulmonary toxicity ranging from pneumonitis, pulmonary fibrosis, to fatal acute respiratory distress syndrome. Oxygen administration can potentiate or precipitate bleomycin pulmonary toxicity, and the most common setting of oxygen exposure is during anesthesia. We report here the successful management and perioperative care of a patient with documented bleomycin pulmonary toxicity who had to undergo an eight hour long retroperitoneal surgery. With proper preoperative assessment, chest physiotherapy, inhaled steroids and bronchodilators, antibiotics, operative restriction of oxygen and fluids and good postoperative care no further pulmonary insult was inflicted.

Liver Involvement during SARS-CoV-2 Infection Is Associated with a Worse Respiratory Outcome in COVID-19 Patients.

Coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may be complicated by life-threatening interstitial pneumonia. SARS-CoV-2 infection may also damage several tissues and/or organs beyond the lungs, including the liver. However, controversy still exists as to whether SARS-CoV-2-induced liver alterations can have an impact on the outcome of COVID-19. The aim of this study was therefore to assess whether SARS-CoV-2-infected patients with liver abnormalities at the time of hospital referral had a worse outcome with respect to patients with no liver biochemistry alterations. To this end, the medical records of 123 patients admitted to our COVID center between the end of 2020 and spring 2021 were retrospectively reviewed. Patients were divided into two groups: those with normal liver biochemistries (group 1, 77 patients) and those with altered liver function tests (group 2, 46 patients). Serum levels of aminotransferases (AST and ALT) and bile duct cell injury markers (γ-GT and ALP) were used to dichotomize patients. A higher percentage of patients with liver enzyme alterations were found to develop COVID-19 pneumonia with respect to group 1 patients (74% vs. 65%); moreover, they needed more days of respiratory support and, more importantly, more intensive administration of supplemental oxygen. A statistically significant correlation was also found between aminotransferase levels and duration of respiratory support. The mortality rate was not superior in group 2 vs. group 1 patients. In conclusion, liver abnormalities on admission predisposed COVID-19 patients to development of more severe interstitial pneumonia, because of a longer requirement for supplemental oxygen and a more intensive respiratory support, indicative of a worse disease evolution in these patients.

Effectiveness of high-flow nasal cannula oxygen in apneic oxygenation during intubation in high-risk surgical patients: a systematic review protocol.

This review will investigate the effectiveness of high-flow nasal oxygen in apneic oxygenation through safe apnea time and other ventilation parameters in patients at high risk of oxygen desaturation during induction and tracheal intubation for anesthesia management. High-risk surgical patient groups include obese patients, those with suspected or known obstructive sleep apnea, and critically ill patients, who are at risk of rapid oxygen desaturation during intubation. Conventional oxygen administration in induction and intubation of patients undergoing general anesthesia include nasal cannulas, simple face masks, Venturi, buccal oxygenation, bag-valve mask ventilation, and non-invasive ventilation. High-flow nasal oxygen has emerged as a novel technique, and is advantageous because it increases positive end-expiratory pressure and oxygen delivered. Eligible studies will include high-risk surgical patients aged 18 or above requiring endotracheal intubation in both emergency and elective anesthetic settings. High-risk patients are defined as those with suspected or known obstructive sleep apnea, obesity (BMI > 35), or critically ill patients (scored the American Society of Anesthesiologists classification as 3 or above). The review will follow the JBI methodology for systematic reviews of effectiveness. Databases to be searched include MEDLINE, Embase, and Scopus. Reference lists of selected studies will then be hand-searched for additional eligible studies. The primary outcome will be safe apnea time, with secondary outcomes including oxygen and carbon dioxide parameters, and adverse events (eg, gastric distension). Studies will, where possible, be pooled in statistical meta-analyses with data heterogeneity assessed using the standard χ2 and I2 tests. PROSPERO CRD42022312145.

Early restricted oxygen therapy after resuscitation from cardiac arrest (ER-OXYTRAC): protocol for a stepped-wedge cluster randomised controlled trial

IntroductionCardiac arrest is a critical condition, and patients often experience postcardiac arrest syndrome (PCAS) even after the return of spontaneous circulation (ROSC). Administering a restricted amount of oxygen in the...

Evaluating oxygen monitoring and administration during overdose responses at a sanctioned overdose prevention site in San Francisco, California: A mixed-methods study

BackgroundOverdose prevention sites (OPSs) are spaces where individuals can use pre-obtained drugs and trained staff can immediately intervene in the event of an overdose. While some OPSs use a combination of naloxone and oxygen to reverse overdoses, little is known about oxygen as a complementary tool to naloxone in OPS settings. We conducted a mixed methods study to assess the role of oxygen provision at a locally sanctioned OPS in San Francisco, California. MethodsWe used descriptive statistics to quantify number and type of overdose interventions delivered in 46 weeks of OPS operation in 2022. We used qualitative data from OPS staff interviews to evaluate experiences using oxygen during overdose responses. Interviews were coded and thematically analyzed to identify themes related to oxygen impact on overdose response. ResultsOPS staff were successful in reversing 100% of overdoses (n = 333) during 46 weeks of operation. Oxygen became available 18 weeks after opening. After oxygen became available (n = 248 overdose incidents), nearly all involved oxygen (91.5%), with more than half involving both oxygen and naloxone (59.3%). Overdoses involving naloxone decreased from 98% to 66%, though average number of overdoses concomitantly increased from 5 to 9 per week. Interviews revealed that oxygen improved overdose response experiences for OPS participants and staff. OPS EMTs were leaders of delivering and refining the overdose response protocol and trained other staff. Challenges included strained relationships with city emergency response systems due to protocol requiring 911 calls after all naloxone administrations, inconsistent supplies, and lack of sufficient staffing causing people to work long shifts. ConclusionsAlthough the OPS operated temporarily, it offered important insights. Ensuring consistent oxygen supplies, staffing, and removing 911 call requirements after every naloxone administration could improve resource management. These recommendations may enable success for future OPS in San Francisco and elsewhere.

SLAB51 Multi-Strain Probiotic Formula Increases Oxygenation in Oxygen-Treated Preterm Infants.

Preterm infants are at risk of hypoxia and hyperoxia because of the immaturity of their respiratory and antioxidant systems, linked to increased morbidity and mortality. This study aimed to evaluate the efficacy of a single administration of the SLAB51 probiotic formula in improving oxygenation in respiratory distress syndrome (RDS)-affected premature babies, thus reducing their need for oxygen administration. Additionally, the capability of SLAB51 in activating the factor-erythroid 2-related factor (Nrf2) responsible for antioxidant responses was evaluated in vitro. In two groups of oxygen-treated preterm infants with similar SaO2 values, SLAB51 or a placebo was given. After two hours, the SLAB51-treated group showed a significant increase in SaO2 levels and the SaO2/FiO2 ratio, while the control group showed no changes. Significantly increased Nrf2 activation was observed in intestinal epithelial cells (IECs) exposed to SLAB51 lysates. In preterm infants, we confirmed the previously observed SLAB51's "oxygen-sparing effect", permitting an improvement in SaO2 levels. We also provided evidence of SLAB51's potential to enhance antioxidant responses, thus counteracting the detrimental effects of hyperoxia. Although further studies are needed to support our data, SLAB51 represents a promising approach to managing preterm infants requiring oxygen supplementation.

Maternal Oxygen Administration during Labor: A Controversial Practice.

Oxygen administration to the mother is commonly performed during labor, especially in the case of a non-reassuring fetal heart rate, aiming to increase oxygen diffusion through the placenta to fetal tissues. The benefits and potential risks are controversial, especially when the mother is not hypoxemic. Its impact on placental gas exchange and the fetal acid-base equilibrium is not fully understood and it probably affects the sensible placental oxygen equilibrium causing a time-dependent vasoconstriction of umbilical and placental vessels. Hyperoxia might also cause the generation of radical oxygen species, raising concerns for the developing fetal cells. Moreover, this practice affects the maternal cardiovascular system, causing alterations of the cardiac index, heart rate and vascular resistance, and unclear effects on uterine blood flow. In conclusion, there is no evidence that maternal oxygen administration can provide any benefit in the case of a non-reassuring fetal heart rate pattern, while possible collateral effects warn of its utilization. Oxygen administration during labor should be reserved for cases of maternal hypoxia.

Assessment of pediatric residents’ knowledge, attitude, and practice regarding oxygen therapy and its complications at Tikur Anbessa Specialized Hospital and St. Paul Hospital Millennium Medical College, Ethiopia

Background: Oxygen therapy is beneficial, but too much of it or any oxygen therapy errors could be dangerous. Proper knowledge, appropriate practice, and favorable attitudes are important aspects of treatment. Hence, this study aimed to assess the knowledge, attitude, and practice of pediatric residents about oxygen therapy, its complications, and associated factors.&#x0D; Methodology: A cross-sectional study was conducted among pediatric residents at Tikur Anbessa Specialized Hospital and St. Paul Hospital, Millennium Medical College in Addis Ababa, Ethiopia, from June to August 2021. using a self-administered questionnaire. Level of knowledge, attitude, and practice was grouped by Bloom’s original cut-off points. A multinomial logistic regression model was fitted to identify significant predictor variables at a 5% level of significance.&#x0D; Results: Of 141 pediatric residents who responded, this study found 17.7%, 40.4%, and 19.1% prevalence of good knowledge, attitude, and practice, respectively. On the chi-square test, the total duration of service as a general practitioner and the year of residency were significantly associated with knowledge and attitude (P values = 0.027 and 0.037, respectively). Residents' knowledge level and year of residency were found to be independently associated with oxygen administration practice. The odds of residents with good knowledge having good practice than poor practice is 8 times (adjusted odds ratio: 7.90, 95% CI 1.15-45.25, P-value =0.035) higher than residents with poor knowledge levels and year of residency was also a significant predictor of practice level (adjusted odds ratio: 0.24, 95% CI 0.06-0.94, P-value =0.042).&#x0D; Conclusions: - The majority of participants had a positive attitude and had moderate to inadequate knowledge of oxygen administration. Their practice, on the other hand, was generally poor. Regular education and training in oxygen administration can help them improve their knowledge.

Predicting adverse outcomes in pregnant patients positive for SARS-CoV-2: a machine learning approach- a retrospective cohort study

BackgroundPregnant people are particularly vulnerable to SARS-CoV-2 infection and to ensuing severe illness. Predicting adverse maternal and perinatal outcomes could aid clinicians in deciding on hospital admission and early initiation of treatment in affected individuals, streamlining the triaging processes.MethodsAn international repository of 1501 SARS-CoV-2-positive cases in pregnancy was created, consisting of demographic variables, patient comorbidities, laboratory markers, respiratory parameters, and COVID-19-related symptoms. Data were filtered, preprocessed, and feature selection methods were used to obtain the optimal feature subset for training a variety of machine learning models to predict maternal or fetal/neonatal death or critical illness.ResultsThe Random Forest model demonstrated the best performance among the trained models, correctly identifying 83.3% of the high-risk patients and 92.5% of the low-risk patients, with an overall accuracy of 89.0%, an AUC of 0.90 (95% Confidence Interval 0.83 to 0.95), and a recall, precision, and F1 score of 0.85, 0.94, and 0.89, respectively. This was achieved using a feature subset of 25 features containing patient characteristics, symptoms, clinical signs, and laboratory markers. These included maternal BMI, gravidity, parity, existence of pre-existing conditions, nicotine exposure, anti-hypertensive medication administration, fetal malformations, antenatal corticosteroid administration, presence of dyspnea, sore throat, fever, fatigue, duration of symptom phase, existence of COVID-19-related pneumonia, need for maternal oxygen administration, disease-related inpatient treatment, and lab markers including sFLT-1/PlGF ratio, platelet count, and LDH.ConclusionsWe present the first COVID-19 prognostication pipeline specifically for pregnant patients while utilizing a large SARS-CoV-2 in pregnancy data repository. Our model accurately identifies those at risk of severe illness or clinical deterioration, presenting a promising tool for advancing personalized medicine in pregnant patients with COVID-19.

Characterization of non-cardiac arrest PulsePoint activations in public and private settings

BackgroundGeospatial smartphone application alert systems are used in some communities to crowdsource community response for out-of-hospital cardiac arrest (OHCA). Although the clinical focus of this strategy is OHCA, dispatch identification of OHCA is imperfect so that activation may occur for the non-arrest patient. The frequency and clinical profile of such non-arrest patients has not been well-investigated.MethodsWe undertook a prospective 3-year cohort investigation of patients for whom a smartphone geospatial application was activated for suspected OHCA in four United States communities (total population ~1 million). The current investigation evaluates those patients with an activation for suspected OHCA who did not experience cardiac arrest. The volunteer response cohort included off-duty, volunteer public safety personnel (verified responders) notified regardless of location (public or private) and laypersons notified to public locations. The study linked the smartphone application information with the EMS records to report the frequency, condition type, and EMS treatment for these non-arrest patients.ResultsOf 1779 calls where volunteers were activated, 756 had suffered OHCA, resulting in 1023 non-arrest patients for study evaluation. The most common EMS assessments were syncope (15.9%, n=163), altered mental status (15.5%, n=159), seizure (14.3%, n=146), overdose (13.0%, n=133), and choking (10.5%, n=107). The assessment distribution was similar for private and public locations. Overall, the most common EMS interventions included placement of an intravenous line (43.1%, n=441), 12-Lead ECG(27.9%, n=285), naloxone treatment (9.8%, n=100), airway or ventilation assistance (8.7%, n=89), and oxygen administration (6.6%, n=68).ConclusionsMore than half of patients activated for suspected OHCA had conditions other than cardiac arrest. A subset of these conditions may benefit from earlier care that could be provided by both layperson and public safety volunteers if they were appropriately trained and equipped.

Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database.

Studies indicated potential harm from empirical broad-spectrum therapy. A recent study of hospitalizations for community-acquired pneumonia suggested that empirical anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy was associated with an increased risk of death and other complications. However, limited evidence supports empirical anti-MRSA therapy for older patients with aspiration pneumonia. In a nationwide Japanese database, patients aged ≥65 years on admission with aspiration pneumonia were analyzed. Patients were divided based on presence of respiratory failure and further sub-categorized based on their condition within 3 days of hospital admission, either receiving a combination of anti-MRSA agents and other antibiotics, or not using MRSA agents. An inverse probability weighting method with estimated propensity scores was used. Out of 81,306 eligible patients, 55,098 had respiratory failure, and 26,208 did not. In the group with and without respiratory failure, 0.93% and 0.42% of the patients, respectively, received anti-MRSA agents. In patients with respiratory failure, in-hospital mortality (31.38% vs. 19.03%, p < 0.001), 30-day mortality, and 90-day mortality were significantly higher, and oxygen administration length was significantly longer in the anti-MRSA agent combination group. Anti-MRSA agent combination use did not improve the outcomes in older patients with aspiration pneumonia and respiratory failure, and should be carefully and comprehensively considered.

Mediastinitis due to Odontogenic Infection

Mediastinitis due to the spreading of odontogenic infection is rare, but the mortality rate is high. This report presents the case of mediastinitis caused by the spreading of odontogenic infection in healthy males. The patient complained of dyspnoea and trismus. The diffuse and fluctuating swelling was observed in the submandibular and submental area, which spreads to the neck and chest. It was diagnosed mediastinitis as a submandibular and submental abscess complication due to the impacted teeth’ pericoronitis. Two drainage incisions were made following the administration of oxygen and antibiotics injection. The success of mediastinitis treatment due to the spread of odontogenic infection is determined by proper diagnosis and appropriate initial management. Antibiotic administration and pus drainage are the very decisive stage of treatment to reduce the risk of death. It is necessary to eliminate the causative of odontogenic infection.

Retinopathy of Prematurity: Incidence and Risk Factor Analysis in Small for Gestational Age Neonates Compared to Appropriate for Gestational Age.

To analyze the incidence of retinopathy of prematurity (ROP) among preterm neonates who were born small for gestational age (SGA) and appropriate for gestational age (AGA). A prospective cohort study among preterm neonates born <34 weeks of gestational age (GA) and <2000 grams birth weight (BW) was conducted. The neonates were divided into AGA and SGA group. Incidence of ROP and risk factors was compared among the groups. 290 neonates were screened [AGA: 240 (82.8%); SGA: 50 (17.2%)]. The mean birth-weight and gestational age were 1510.7 ± 390.64 grams and 31.4 ± 4.8 weeks, respectively. The incidence of ROP in AGA and SGA was 30.2% and 33%, respectively (P = 0.58), whereas the incidence of type 1 ROP in AGA and SGA was 14% and 19% (P = 0.41). Male sex, anemia, oxygen administration, surfactant administration, sepsis, and PIH were independent significant risk factors for ROP on multivariate analysis. This study showed that both AGA and SGA premature infants have similar incidence of ROP. SGA is not an independent risk factor for ROP.

Carbon Monoxide Poisoning

Carbon monoxide (CO) poisoning is a common indoor pollutant that is quite dangerous if inhaled. It is a “silent killer”, as it is extremely hazardous to people when emitted in an enclosed area as it gets absorbed into the bloodstream and displaces oxygen due to a much higher affinity, resulting in cellular hypoxia. Children are vulnerable as they are less likely to take preventive measures and have higher oxygen requirements due to higher metabolic demands. We reported this case series among five siblings aged between 4 – 16 years (two boys and three girls) in Lafia Nasarawa State. The parents are petty traders, with secondary level of education. The children live with their parents in a one-bedroom apartment and the family possesses a small petrol generator usually situated outside the house when in use and kept within the apartment after use to avert theft. The children bought fuel from a local vendor (a black marketer) to watch a movie on a day the parents are away. They kept the generator within the apartment in a space between the bathroom and their store while keeping all windows and other air outlets closed so as to circumvent the noise from getting to neighbours. The children got exposed to CO fumes which had engulfed the apartment and were met unconscious by the mother when she came back from night vigil. They were rushed to a nearby hospital, before eventual referral to our facility after the demise of one of them aged 12 years. We reported CO poisoning among siblings with death in one of the five. Oxygen administration plays a vital role in the successes recorded.

Assessment of Knowledge and Associated Factors with Supplemental Oxygen Administration for Critically Ill Patients among Nurses

Oxygen is a commonly used medication. Insufficient oxygen levels in the bloodstream can lead to cellular malfunctions, organ failure, and ultimately, death. Oxygen, much like any other pharmaceutical substance, can be beneficial in reducing mortality when administered correctly, but it can also have adverse effects when misused. The use of supplemental oxygen therapy (SOT) plays a crucial role in preserving the lives of numerous patients suffering from cardio-pulmonary issues, requiring the development of updated guidelines. Objective: To assess the knowledge level of nurses and to identify the associated factors regarding oxygen administration for critical ill patients. Methods: A descriptive cross sectional study carried out among nurses of Shalamar hospital, Lahore with a sample size of 82. A modified form of questionnaire was used to collect data. Statistical chi-square test was utilized to analyze the study findings. Results: This study found that there were 69.5% females and 30.5% were male. Most of them had age between 20 to 30 years. Regarding knowledge level almost 75.6% participants had good knowledge, 19.5% had moderate knowledge with a mean score of 11.37. Furthermore there was a signification association among knowledge level and experience, duration of administration and duration of prescription with p&lt;0.05 while gender, age, qualification and working area were not directly associated with the knowledge level of nurses with p&gt;0.05. Conclusions: Most of participants were female having age between 20 to 30 years. Most of the nurses had good and moderate knowledge regarding supplemental oxygen therapy (SOT). So it needs a continuing education to stay updated regarding new guidelines for oxygen administration.

Effect of Ambulatory Oxygen on the Respiratory Pattern during the 6 Min Walking Test in Patients with Interstitial Lung Diseases.

Patients with pulmonary fibrosis experience early oxyhemoglobin desaturation under effort, which limits their ability to exercise and their quality of life. Recent studies have shown that in resting normoxaemic patients who become hypoxemic under exertion, administration of outpatient oxygen significantly improves stress dyspnoea and quality of life. It is unclear how this happens, since oxygen administration does not act directly on dyspnoea, and does not appear to have much effect on the heart rate and pulmonary artery pressure. We tested the hypothesis that correcting the hypoxaemia could reduce the increase in respiratory effort during the 6 min walking test, recording the breathing pattern during administration of oxygen or placebo. We evaluated 20 patients with fibrotic interstitial lung diseases (17 males and 3 females; mean age 72 ± 2 years; M ± SE) with a resting SpO2 ≥92 that fell to ≤88% during the 6 min walk test (6MWT). After first establishing the oxygen flow necessary to prevent desaturation, the patients underwent two further 6MWT, 15-20 min apart, one with administration of medical air and one with oxygen at the same flow, in randomized double-blind order. During the test, SpO2, heart rate, respiratory rate, tidal volume and minute ventilation (VE) were recorded, using a Spiropalm spirometer (Cosmed, Rome, Italy). Oxygen saturation during the 6MWT decreased to a minimum value of 82.3% (95% CI 80.1-84.5%) during placebo and to 92% (90.3-93.7%) during oxygen with an average difference of 9.7% (7.8-11.6%, p < 0.0001). On the contrary, heart rate showed an increasing trend with walking time reaching a significantly higher maximum rate during placebo, with a difference of 5.4 bpm (2.9-8.7, p < 0.005) compared to oxygen. The distance walked was slightly but significantly greater after oxygen by 28 m (2-53, p < 0.05) and end of test dyspnoea after placebo by 0.6 points (0.1-1.1, p < 0.05). Respiratory rate increased over time, without differences between oxygen and placebo in the first minute of walking, then increasing significantly more during placebo (p < 0.0005). With placebo, tidal volume increased rapidly reaching a plateau at about 48% of FVC after 3 min, while with oxygen, the increase was slower, reaching a maximum of about 45% of FVC at the end of the test. Nevertheless, the difference was highly significant (p < 0.0005) at all the time points. Minute ventilation also increased significantly with walking time but remained at a highly significant lower level during oxygen than placebo at all the time points. Mean reduction in VE during the test with oxygen compared to placebo was 4.4 L/min (3.9-4.9, p < 0.0005). In our ILD patients, administration of outpatient oxygen during walking was related to a reduced increase in heart rate, respiratory rate, tidal volume and minute ventilation necessary to meet increased oxygen requirements, resulting in a lower workload on the cardiovascular system and on respiratory muscles and a consequent reduction in dyspnoea.

Effect of oxygen giving with frequency of Fetal Heart Rate (DJJ) on inpartu fetal distress patients at Panti Nugroho Hospital, Purbalingga

ABSTRACT&#x0D; Background: Fetal distress is one of the causes of fetal death in the world, according to the World Health Organization (WHO) in 2015, data for the last 5 years amounted to 637,000 deaths caused by fetal distress. The incidence in Indonesia is that 34.7% of 100,000 live births experience fetal distress. Fetal distress is an emergency case of pregnancy in the fetus. Fetal distresss causes fetal hypoxia so that the fetus requires immediate oxygen supply. Objective: to determine the characteristics of the respondents, fetal heart rate before and after administration of oxygen, the effect of giving oxygen to in-partum patients with fetal distress at Panti Nugroho Hospital, Purbalingga. Method: using a pre-experimental design type of one group pretest posttest. The research sample was pregnant women in childbirth with fetal distress by accidental sampling technique, namely 30 respondents. Observation sheet containing mother's identity, mother's pregnancy status, gestational age and FHR value before and after administration of oxygen. Data analysis used bivariate analysis, namely the Wilcoxon test. Results: 20% showed an improvement in fetal heart rate of 10-20 beats/minute, 46% had an improvement in fetal heart rate of 20-30 beats/minute, while 33.3% had an improvement in fetal heart rate of more than 30 beats/minute. There is an effect of giving 4 liters/minute of oxygen to inpartu patients with fetal distress with a p value of 0.00 (p&gt;0.05). Conclusion: Administration of nasal cannula oxygen 4 liters/minute can affect the fetal heart rate. &#x0D; Key words: labor, administration of oxygen, fetal distress&#x0D;

The influence of physical fatigue on telephone-based neuropsychological test performance in COVID-19 survivors.

Fatigue has been characterized as a post COVID-19 condition known to persist months after SARS-CoV-2 infection. COVID-19 has been reported to be associated with impaired cognitive function, including disorders in attention, memory, information processing, and executive functions. The objective of this study was to determine if post-COVID fatigue, manifested as tiredness while performing low-intensity physical activity, has a detrimental effect on neuropsychological performance, to achieve this, we randomly selected 20 participants with post-COVID fatigue and 20 SARS-CoV-2 negative age-matched controls from a database of 360 residents of Tijuana, Baja California in a cross-sectional study design. All 40 participants responded to a health survey, along with a neuropsychological assessment test via telephone call. Statistical analysis was performed using a multiple linear regression model including the following independent variables: study condition (post-COVID fatigue or negative control), sex, age,years of education, hypertension, asthma, administration of supplemental oxygen during COVID-19 recovery, and the hour at which the evaluation started. Significant regression analysis was obtained for all global parameters of the assessment, including BANFE-2 score (p = 0.021, R2 Adj. = 0.263), NEUROPSI score (p = 0.008, R2 Adj. = 0.319), and total errors (p = 0.021, R2 Adj. = 0.263), with significant regression coefficients for study condition on two global parameters, BANFE-2 score (p = 0.028, β = - 0.371) and NEUROPSI score (p = 0.010, β = -0.428). These findings suggest that the presence of post-COVID fatigue is a factor associated with a decrease in neuropsychological performance.

Automated Oxygen Titration During CPAP and Noninvasive Ventilation in Healthy Subjects With Induced Hypoxemia.

Automated oxygen titration to maintain a stable SpO2 has been developed for spontaneously breathing patients but has not been evaluated during CPAP and noninvasive ventilation (NIV). We performed a randomized controlled crossover, double-blind study on 10 healthy subjects with induced hypoxemia during 3 situations: spontaneous breathing with oxygen support, CPAP (5 cm H2O), and NIV (7/3 cm H2O). We conducted in random order 3 dynamic hypoxic challenges of 5 min (FIO2 0.08 ± 0.02, 0.11± 0.02, and 0.14 ± 0.02). For each condition, we compared automated oxygen titration and manual oxygen titration by experienced respiratory therapists (RTs), with the aim to maintain the SpO2 at 94 ± 2%. In addition, we included 2 subjects hospitalized for exacerbation of COPD under NIV and a subject managed after bariatric surgery with CPAP and automated oxygen titration. The percentage of time in the SpO2 target was higher with automated compared with manual oxygen titration for all conditions, on average 59.6 ± 22.8% compared to 44.3 ± 23.9% (P = .004). Hyperoxemia (SpO2 > 96%) was less frequent with automated titration for each mode of oxygen administration (24.0 ± 24.4% vs 39.1 ± 25.3%, P < .001). During the manual titration periods, the RT made several changes to oxygen flow (5.1 ± 3.3 interventions that lasted 122 ± 70 s/period) compared to none during the automated titration to maintain oxygenation in the targeted SpO2 . Time in the SpO2 target was higher with stable hospitalized subjects in comparison with healthy subjects under dynamic-induced hypoxemia. In this proof-of-concept study, automated oxygen titration was used during CPAP and NIV. The performances to maintain the SpO2 target were significantly better compared to manual oxygen titration in the setting of this study protocol. This technology may allow decreasing the number of manual interventions for oxygen titration during CPAP and NIV.