Prevention Of Hypoxia Research Articles

Mechanism of hypoxia-induced damage to the mechanical property in human erythrocytes-band 3 phosphorylation and sulfhydryl oxidation of membrane proteins.

Introduction: The integrity of the erythrocyte membrane cytoskeletal network controls the morphology, specific surface area, material exchange, and state of erythrocytes in the blood circulation. The antioxidant properties of resveratrol have been reported, but studies on the effect of resveratrol on the hypoxia-induced mechanical properties of erythrocytes are rare. Methods: In this study, the effects of different concentrations of resveratrol on the protection of red blood cell mor-phology and changes in intracellular redox levels were examined to select an appropriate concentration for further study. The Young's modulus and surface roughness of the red blood cells and blood viscosity were measured via atomic force microsco-py and a blood rheometer, respectively. Flow cytometry, free hemoglobin levels, and membrane lipid peroxidation levels were used to characterize cell membrane damage in the presence and absence of resveratrol after hypoxia. The effects of oxida-tive stress on the erythrocyte membrane proteins band 3 and spectrin were further investigated by immunofluorescent label-ing and Western blotting. Results and discussion: Resveratrol changed the surface roughness and Young's modulus of the erythrocyte mem-brane, reduced the rate of eryptosis in erythrocytes after hypoxia, and stabilized the intracellular redox level. Further data showed that resveratrol protected the erythrocyte membrane proteins band 3 and spectrin. Moreover, resistance to band 3 pro-tein tyrosine phosphorylation and sulfhydryl oxidation can protect the stability of the erythrocyte membrane skeleton net-work, thereby protecting erythrocyte deformability under hypoxia. The results of the present study may provide new insights into the roles of resveratrol in the prevention of hypoxia and as an antioxidant.

Protective Effect of Modified Hemoglobin on Rabbits and Goats in High-AltitudeSickness.

The prevalence and severity of high-altitude sickness increases with increasing altitude. Prevention of hypoxia caused by high-altitude sickness is an urgent problem. As a novel oxygen-carrying fluid, modified hemoglobin can carry oxygen in a full oxygen partial pressure environment and release oxygen in a low oxygen partial pressure environment. It is unclear whether modified hemoglobin can improve hypoxic injury on a plateau. Using hypobaric chamber rabbit (5000 m) and plateau goat (3600 m) models, general behavioral scores and vital signs, hemodynamic, vital organ functions, and blood gas are measured. The results show that the general behavioral scores and vital signs decrease significantly in the hypobaric chamber or plateau, and the modified hemoglobin can effectively improve the general behavioral scores and vital signs in rabbits and goats, and reduce the degree of damage to vital organs. Further studies reveal that arterial partial pressure of oxygen (PaO2 ) and arterial oxygen saturation (SaO2 ) on the plateau decrease rapidly, and the modified hemoglobin could increase PaO2 and SaO2 ; thus, increasing the oxygen-carrying capacity. Moreover, modified hemoglobin has few side effects on hemodynamics and kidney injury. These results indicate that modified hemoglobin has a protective effect against high-altitude sickness.

Predicting Coastal Dissolved Oxygen Values with the Use of Artificial Neural Networks: A Case Study for Cyprus

Coastal hypoxia is a serious environmental problem that needs to be addressed at a global level. The phenomenon of hypoxia is characterized by low Dissolved Oxygen (DO) levels in the water column that causes detrimental effects on aquatic organisms. Anthropogenic activities such as intensive agriculture practices and point-source nutrient loading are considered the main causes of coastal hypoxia. This study utilizes data-driven modelling based on Artificial Neural Networks (ANNs), and specifically Feed-Forward ANNs, to predict surface DO levels. Several surface water quality parameters such as water temperature, nitrogen species (ammonium, nitrite and nitrate), phosphorus, pH, salinity, electrical conductivity, and chlorophyll-a served as the ANN’s input parameters. These parameters were measured at several sampling sites in the coastal waters of Cyprus and some of the sites were located near areas with anthropogenic activities, during the period 2000-2021. An ANN with a 9-5-1 topology was developed and ANN managed to predict with good accuracy the DO levels, with the Coefficient of determination (r 2) as high as r 2=0.991 for the test set. Additionally, sensitivity analysis was performed to measure the impact of each input parameter on the DO level, and it was estimated that the water temperature is the most influential factor. The “Weights” sensitivity analysis algorithm was used for this purpose. The ANN-based method proposed can be used as a management tool for predicting the DO levels and prevention of hypoxia. Therefore, this work has a positive impact on marine sciences and marine information technology.

Variations on Ernsting's Post-Decompression Hypoxia Prevention Model.

INTRODUCTION: In the event of decompression using an isobaric differential cockpit pressurization system, oxygen concentration breathed pre-decompression must be greater than required for the given cockpit altitude in order to prevent hypoxia. The model for determining oxygen concentration requirements advanced by Dr. John Ernsting, when graphed against cockpit altitude, creates a hypoxia safety "notch" which has become a standard requirement for aircraft oxygen systems. Although variables in the Ernsting notch model are not fixed, they are often presented as such.METHODS: Model equations are presented to evaluate the effects of different cockpit pressurization, oxygen regulator PBA schedules, and changes to the physiological state of the aircrew.RESULTS: Increased cockpit differential pressure, regulator breathing pressure, and aircrew respiratory quotient decreased pre-decompression oxygen concentration requirements by up to 6%, eliminating the hypoxia safety "notch." Although effects were small, reducing alveolar carbon dioxide pressure decreased oxygen concentration requirements while reducing respiratory quotient increased oxygen concentration requirements. A 10-mmHg increase in the minimal oxygen hypoxia threshold increased the pre-decompression oxygen concentration requirement 8 to 12% depending on cockpit altitude.CONCLUSION: Variation in cockpit and regulator pressure schedules which stray outside the parameters used by Ernsting need to be independently calculated. During flight, an individual's physiological "notch" will be dynamic, wavering in response to changes in metabolic load, respiratory dynamics, and environmental conditions. Consideration of aircrew activity should be factored in when considering minimal oxygen concentration for pre-decompression hypoxia protection in the design of aircrew life support systems.Dart TS, Morse BG. Variations on Ernsting's post-decompression hypoxia prevention model. Aerosp Med Hum Perform. 2022; 93(2):99-105.

Strategic Airway Management in an Independent Anaesthetic Practice – Hurdles and Possible Solutions

Airway management in an independent anaesthetic practice, often with limited resources, is always challenging. Comprehensive situational awareness, detailed airway evaluation, strategic planning and efficient execution of the plan are essential components of care. Equally important is the willingness to back out if the situation demands. Although the placement of a definitive airway device is necessary for the safe conduct of anaesthesia, prevention of hypoxia and secondary insults takes priority at times of crisis and all attempts should be channelled to achieve this at all costs. The practicing anaesthesiologist must always be prepared with an airway kit for dealing with emergencies and also train support staff in managing a difficult or failed airway.

Features of the provision of inpatient medical care to patients with Alzheimer's disease during the SARS‐COVID‐19 pandemic

BackgroundWith Alzheimer's disease, the patient is not only unable to help himself, but he cannot even ask for such help. This is especially dangerous for a patient during the SARS‐COVID‐19 pandemic. Since the deadly complications of SARS‐COVID‐19 are observed in the age group in which Alzheimer's disease manifests itself.MethodWe observed 26 women aged 71‐84 with Alzheimer's disease. All patients received treatment according to Alzheimer's disease treatment standards. Both amyloid‐beta and tau were found in their cerebrospinal fluid. They also showed neurodegeneration in the areas classic for Alzheimer's disease on MRI of the brain.During a pandemic, sickness departments must wear masks and change them every 4 hours to prevent SARS‐COVID‐19 disease. In patients with Alzheimer's disease, the fulfillment of these requirements on their own is impracticable, since they have memory disorders for current events, changes in mood (apathy). Therefore, constant monitoring of medical personnel for compliance with these requirements is required.These patients in all inpatient care periods were given masks with a built‐in 4‐hour timer and a sensor that responded to opening contacts when the mask was removed. The end of 4 hours of wearing the mask and the removal of the mask as indicated by sound and light alarms installed in the mask.ResultThis greatly facilitated the monitoring of compliance with quarantine SARS‐COVID‐19 measures in patients with Alzheimer's disease. Also, the timely change of the mask was the prevention of hypoxia that develops as a result of wetting the mask with prolonged wearing.ConclusionPrevention of hypoxia with the prolonged wearing of a wet mask alleviates the symptoms of Alzheimer's disease, allows the patient to convey their thoughts and feelings, and significantly improves the quality of life of patients.

Impact of High-Flow Nasal Cannula Oxygenation on the Prevention of Hypoxia During Endoscopic Retrograde Cholangiopancreatography in Elderly Patients: A Randomized Clinical Trial.

Hypoxia is the most frequently occurring adverse effect during endoscopic retrograde cholangiopancreatography (ERCP) under sedation; thus, oxygen must be properly supplied to prevent a reduction of oxygen saturation. In this study, we intend to verify the preventive effect for hypoxia during ERCP, using a high-flow nasal cannula (HFNC), in elderly patients. As a multicenter prospective randomized trial, patients who underwent ERCP with propofol-based sedation were randomly assigned into two groups: Patients in the HFNC group were supplied with oxygen via an HFNC, and those in the standard nasal cannula group were supplied with oxygen via a low-flow nasal cannula. The co-primary end points were the lowest oxygen saturation rate and hypoxia during the overall procedure. A total of 187 patients (HFNC group: 95; standard nasal cannula group: 92) were included in the analysis. Unexpected hypoxia events were more frequently observed among patients in the standard nasal cannula group than among patients in the HFNC group (13% vs. 4%, odds ratio 3.41, 95% confidence interval 1.06-11.00, p = 0.031). The mean of the lowest oxygen saturation rate during ERCP was significantly lower in the standard nasal cannula group than in the HFNC group (95% vs. 97%, p = 0.002). Oxygen supplementation with an HFNC can prevent oxygen desaturation and hypoxia events in patients undergoing ERCP under sedation. Trial registration Clinical Research Information Service (CRIS; KCT0004960).

Complex protocol of cardiopulmonary bypass

Complex protocol of cardiopulmonary bypass

Коклюш: мета терапії та можливості профілактики

Статтю присвячено питанням раціональної терапії та імунопрофілактики коклюшу. Показано, що антибіотики можуть придушити кашель тільки в інкубаційному періоді та на стадії продроми за рахунок ерадикації B.pertussis. У спазматичній стадії коклюшу головною метою є боротьба з гіпоксією, а не придушення кашлю або ерадикація збудника. Зроблено акцент на значенні гіперлейкоцитозу в периферичній крові як однієї з цілей терапії тяжкого коклюшу в дітей раннього віку за допомогою лейкоферезу або замінного переливання крові. Одним із способів зниження захворюваності на коклюш є введення в календар імунопрофілактики обов’язкової ревакцинації старших дітей і дорослих.

Prevention of Hypoxia During Electroconvulsive Therapy: Use of Modified Bite Block Combined With Laryngeal Mask Airway.

Hardy, Morgan MD, MPH∗; Faber, Raymond MD∗,†; Vazquez, Jennifer RN†; Klinger, Jonathan E. MD‡Author Information

Regulated hypothermia in response to endotoxin in birds

The costs associated with immune and thermal responses may exceed the benefits to the host during severe inflammation. In this case, regulated hypothermia instead of fever can occur in rodents as a beneficial strategy to conserve energy for vital functions with consequent tissue protection and hypoxia prevention. We tested the hypothesis that this phenomenon is not exclusive to mammals, but extends to the other endothermic group, birds. A decrease in metabolic rate without any failure in mitochondrial respiration, nor oxygen delivery, is the main evidence supporting the regulated nature of endotoxin-induced hypothermia in chicks. Thermolytic mechanisms such as tachypnea and cutaneous vasodilatation can also be recruited to facilitate body temperature decrease under lipopolysaccharide treatment, especially in the cold. Our findings bring a new perspective for evolutionary medicine studies on energy trade-off in host defence because regulated hypothermia may be a phenomenon spread among vertebrates facing a severe immune challenge. A switch from fever to regulated hypothermia can occur in mammals under circumstances of reduced physiological fitness (e.g. sepsis) to direct energy to defend vital systems. Birds in which the cost to resist a pathogen is additive to the highest metabolic rate and body temperature (Tb ) among vertebrates may also benefit from regulated hypothermia during systemic inflammation. Here, we show that the decrease in Tb observed during an immune challenge in birds is a regulated hypothermia, and not a result of metabolic failure. We investigated O2 consumption (thermogenesis index), ventilation (respiratory heat loss), skin temperature (sensible heat loss) and muscle mitochondrial respiration (thermogenic tissue) during Tb fall in chicken chicks challenged with endotoxin [lipopolysaccharide (LPS)]. Chicks injected with LPS were also tested regarding the capacity to raise O2 consumption to meet an increased demand driven by 2,4-dinitrophenol. LPS decreased Tb and the metabolic rate of chicks without affecting muscle uncoupled, coupled and non-coupled mitochondrial respiration. LPS-challenged chicks were indeed capable of increasing metabolic rate in response to 2,4-dinitrophenol, indicating no O2 delivery limitation. Additionally, chicks did not attempt to prevent Tb from falling during hypothermia but, instead, activated cutaneous and respiratory thermolytic mechanisms, providing an additional cooling force. These data provide the first evidence of the regulated nature of the hypothermic response to endotoxin in birds. Therefore, it changes the current understanding of bird's thermoregulation during severe inflammation, indicating that regulated hypothermia is either a convergent trait for endotherms or a conserved response among vertebrates, which adds a new perspective for evolutionary medicine research.

Precision Dosing of Doxapram in Preterm Infants Using Continuous Pharmacodynamic Data and Model-Based Pharmacokinetics: An Illustrative Case Series.

IntroductionCurrent drug dosing in preterm infants is standardized, mostly based on bodyweight. Still, covariates such as gestational and postnatal age may importantly alter pharmacokinetics and pharmacodynamics. Evaluation of drug therapy in these patients is very difficult because objective pharmacodynamic parameters are generally lacking. By integrating continuous physiological data with model-based drug exposure and data on adverse drug reactions (ADRs), we aimed to show the potential benefit for optimized individual pharmacotherapy.Materials and MethodsContinuous data on oxygen saturation (SpO2), fraction of inspired oxygen (FiO2) and composite parameters, including the SpO2/FiO2 ratio and the cumulative oxygen shortage under the 89% SpO2 limit, served as indicators for doxapram effectiveness. We analyzed these continuous effect data, integrated with doxapram exposure and ADR parameters, obtained in preterm infants around the start of doxapram therapy. The exposures to doxapram and the active metabolite keto-doxapram were simulated using a population pharmacokinetic model. Infants were selected and retrospectively compared on the indication to start doxapram, the first response to doxapram, a potential dose-response relationship, and the administered dosage over time. Recommendations were made for individual improvements of therapy.ResultsWe provide eight cases of continuous doxapram administration that illustrate a correct and incorrect indication to start doxapram, responders and non-responders to therapy, and unnecessary over-exposure with ADRs. Recommendations for improvement of therapy include: objective evaluation of added effect of doxapram after start, prevention of overdosing by earlier down-titration or termination of therapy, and the prevention of hypoxia and agitation by measuring specific parameters at strategical time-points.ConclusionReal-time and non-invasive effect monitoring of drug therapy combined with model-based exposure provides relevant information to clinicians and can importantly improve therapy. The variability between and within patients emphasizes the importance of individual, objective evaluation of pharmacotherapy. These measurements, together with data on ADRs, allow for precision medicine in neonatology that should be brought to the bedside.

Hypoxia Suppresses Cysteine Deprivation-induced Cell Death Via ATF4 Regulation in MDA-MB-231 Breast Cancer Cells

Cancer cells are frequently exposed to microenvironmental stresses, including amino acid deprivation and hypoxia, which are often targeted for cancer therapy. Here, we examined the effect of hypoxia in cysteine-deprived breast cancer cells and the mechanism to counteract the hypoxia effect. Cell death was determined by annexin V-FITC and propidium iodide staining. Expression of mRNAs and proteins was determined by reverse transcription polymerase chain reaction and western blot analysis, respectively. Cysteine deprivation or sulfasalazine, a potent inhibitor of cysteine/glutamate transporter, induced cell death by activating transcription factor 4 (ATF4) up-regulation. Hypoxia significantly suppressed cell death and ATF4 up-regulation induced by cysteine deprived conditions. In addition, tumor necrosis factor-related apoptosis-inducing ligand reversed the effect of hypoxia on cysteine deprived conditions. Prevention of hypoxia may be a means for augmenting the effect of amino acid deprivation as a strategy for cancer therapy.

In Response.

We thank Weenink et al1 for their comments about our Open Mind article.2 We agree with their remarks and conclusion that it should be avoided that patients are exposed to 1.0 inspiratory oxygen fraction (Fio2) during anesthesia. While Weenink et al1 refers to the quantity of Fio2 in the intraoperative phase, our article and the statements made in it exclusively focused on the extubation period, which we felt is not covered in the literature so far. Clearly, improving oxygen therapy in acute-illness (IOTA) meta-analysis does not cover exactly the perioperative patient population. However, at least in tertiary (university) hospitals, a substantial number of patients during anesthesia are critically ill (American Society of Anesthesiologists [ASA] physical status ≥4) and are thus likely to resemble the IOTA population. We are convinced that focusing on evidence gathered (only) in surgical patients—as suggested by Weenink et al1—is not suitable to generate high-quality information about the effects of hyperoxia. Negative effects of hyperoxia rarely occur in healthy myocardium but in predamaged tissue—preferably in connection with coronary artery disease—as shown by our group.3 Likewise, the way oxygen is delivered to the patient could play a role in the assessment of hyperoxia and its effects. We cautiously expressed this fact2 in connection with the study of de Jonge3: while in their meta-analysis perioperative hyperoxia applied via tracheal intubation showed a positive effect on surgical site infections (SSI), in anesthetized patients with spontaneous ventilation, no such effect was seen, underlining a lack of convincing beneficial effect. We read with great interest the study of hemodiluted pigs—mentioned by Weenink et al1—where ischemic electrocardiogram (ECG) changes recover after administration of 1.0 Fio2. Our explanation is that a healthy pig with hemodilution has another reaction when exposed to high oxygen concentrations (eg, via a higher flow reserve) than a pig with stenotic coronary arteries, as demonstrated in the study by Guensch et al.4 There might be a considerable variation in response to hyperoxia, as another study with hemodiluted pigs showed improved intestinal tissue oxygenation but no improvement in portal venous base excess and lactate levels with high Fio2. While absence of harm of high perioperative Fio2 in the study of Mattishent is an important finding, other investigators as Staehr-Rye et al5 found increased respiratory complications with higher oxygen levels. Even in the absence of harm, we do believe that our interventions should be guided by clear indication and not by the absence of contraindication. The indication for perioperative oxygen therapy is prevention of hypoxia. If oxygen proves effective against SSIs, this indication has to be extended. However, available data are conflicting yet—the meta-analysis of de Jonge3 shows benefit, while a Cochrane systematic review of Wetterslev et al6 does not show benefit. What to believe now? Above considerations and the strong precautions against high oxygen levels in emergency medicine lead us to our opinion that, rather than producing ubiquitous hyperoxia, perioperative oxygen therapy needs to be tailored to the individual patient’s need. Daniel Gerber, MDDominik P. Guensch, MDGabor Erdoes, MD, PhDDepartment of Anesthesiology and Pain MedicineInselspital, Bern University HospitalUniversity of BernBern, Switzerland[email protected]

Pulmonary hemosiderosis in children with Down syndrome: a national experience

BackgroundPulmonary hemosiderosis is a rare and complex disease in children. A previous study from the French RespiRare® network led to two important findings: 20% of the children presented with both pulmonary hemosiderosis and Down syndrome (DS), and at least one tested autoantibody was found positive in 50%. This study investigates the relationships between pulmonary hemosiderosis and DS.MethodsPatients younger than 20 years old and followed for pulmonary hemosiderosis were retrieved from the RespiRare® database. Clinical, biological, functional, and radiological findings were collected, and DS and non-DS patients’ data were compared.ResultsA total of 34 patients (22 girls and 12 boys) were included, among whom nine (26%) presented with DS. The mean age at diagnosis was 4.1 ± 3.27 years old for non-DS and 2.9 ± 3.45 years old for DS patients. DS patients tended to present a more severe form of the disease with an earlier onset, more dyspnoea at diagnosis, more frequent secondary pulmonary hypertension, and an increased risk of fatal evolution.ConclusionsDS patients have a higher risk of developing pulmonary hemosiderosis, and the disease seems to be more severe in this population. This could be due to the combination of an abnormal lung capillary bed with fragile vessels, a higher susceptibility to autoimmune lesions, and a higher risk of evolution toward pulmonary hypertension. A better screening for pulmonary hemosiderosis and a better prevention of hypoxia in DS paediatric patients may prevent a severe evolution of the disease.

The spleen

The spleen

Soluble Curcumin in the Prevention of Diabetic Retinopathy via Modulation of Anti-Oxidant Activity and Genetic Pathways – In Vivo Model

The aim of the present study was to investigate the protective effects of curcuminoids from regular curcumin Powder (95% curcuminoids), and UltraSOL™ Nutrient System with curcumin (CurcuWIN™ Turmeric Extract, 20% curcuminoids) in dry powder forms on retina and metabolic markers in streptozotocin-induced (STZ) diabetic rats. Male Wistar strain (WNIN) rats (2 months old; 213±14 g BW) were randomly assigned into 4 groups: control group (C), diabetic group (STZ-diabetic rats, D), STZ DM+ Soluble curcumin (SC, CurcuWIN™) and STZ DM +regular curcumin (RC). Daily food intake, weekly body weights, fasting glucose levels and HbA1C were assessed. Electroretinogram, immunohistochemistry and Immunofluorescence were performed in all treatment groups. At the end of 12 weeks, rats were euthanized and retinas harvested for histological and molecular analysis. In streptozotocin (STZ) diabetic rats (D) amplitude of oscillatory potentials (Ops) were reduced (334.2 µV) compared to normal control (C) animals. Curcumin resulted in significant changes in OP amplitudes suggested by sum of OPs, RC (445.7) and SC (455.3). Treatment with curcumin prevented gross morphological changes to a significant extent in diabetic retina. Treatment with RC and SC prevented loss of Rhodopsin (Rho) protein expression and nerve growth factor (NGF) protein expression in diabetic retina indicated by intense fluorescence. Treatment with RC and SC showed decreased protein expression in diabetic retina indicated by lower Hypoxia-inducible factor 1-alpha (HIF- 1-α) positive fluorescence indicating the prevention of hypoxia in the retinas. Treatment with RC did not affect the vascular endothelial growth factor (VEGF) over expression in diabetic retina but the SC reduced the VEGF expression. In STZDM the mRNA levels of Glial fibrillary acidic protein (GFAP), are up regulated drastically, while treatment with SC significantly prevented its increase but there is no significant effect of RC treatment. Therefore, soluble curcumin may have therapeutic potential in the treatment of diabetic retinopathy (DR) and appears to be more effective than regular curcumin.

Airway and ventilator management in trauma patients.

Securing the airway to provide sufficient oxygenation and ventilation is of paramount importance in the management of all types of emergency patients. Particularly in severely injured patients, strategies should be adapted according to useful recent literature findings. The role of out-of-hospital endotracheal intubation in patients with severe traumatic brain injury as prevention of hypoxia still persists, and the ideal neuromuscular blocking agent will be a target of research. Standardized monitoring, including capnography and the use of standardized medication protocols without etomidate, can reduce further complications. Prophylactic noninvasive ventilation may be useful for patients with blunt chest trauma without respiratory insufficiency. An algorithm-based approach to airway management can prevent complications due to inadequate oxygenation or procedural difficulties in trauma patients; therefore, advanced equipment for handling a difficult airway is needed. After securing the airway, ventilation must be monitored by capnography, and normoventilation involving the early use of protective ventilation with low-tidal volume and moderate positive end-expiratory pressure must be the target. After early identification of patients with blunt chest trauma at risk for respiratory failure, noninvasive ventilation might be a treatment strategy, which should be evaluated in future research.

Advantages of Porcine Blood Plasma as a Component of Functional Drinks

The composition and properties of blood plasma obtained from slaughtered farm animals and intended for use in the manufacturing of foods for the prevention of oxygen deficiency (hypoxia) are analyzed in the present paper. The use of aerated functional products (oxygen cocktails) is an efficient approach to hypoxia prevention. Protein-based foaming agents are known to form the most stable foams. Porcine blood plasma is a rich source of high molecular weight proteins. A method of processing of the blood of farm animals using a centrifuge with the separation factor (Fr) of 2000 or lower is described in the present article. Fractional composition of blood proteins from farm animals is reported, the choice of porcine blood plasma as a foaming agent is justified, and data on the content and amino acid compositionof high molecular weight proteins from porcine blood plasma is presented.

Outcomes following prehospital airway management in severe traumatic brain injury

Prevention of hypoxia and thus secondary brain injury in traumatic brain injury (TBI) is critical. However there is controversy regarding the role of endotracheal intubation in the prehospital management of TBI. To describe the outcome of TBI with various airway management methods employed in the prehospital setting in the Cape Town Metropole. The study was a cohort descriptive observational analysis of 124 consecutively injured adult patients who were admitted for severe TBI (Glasgow Coma Score ≤8) to Groote Schuur and Tygerberg hospitals between 1 January 2009 and 31 August 2011. Patients were categorised by their method of airway management: rapid sequence intubation (RSI), sedation-assisted intubation, failed intubation, basic airway management, and intubated without drugs. Good outcomes were defined by a Glasgow Outcome Score of 4 - 5. There was a statistically significant association between airway management and outcome (p=0.013). Patients who underwent basic airway management had a higher proportion of a good outcome (72.9%) than patients who were intubated in the prehospital setting. A good outcome was observed with 61.8% and 38.4% of patients who experienced sedation-assisted intubation and RSI, respectively. Patients intubated without drugs had the poorest outcome (88%), followed by rapid sequence intubation (61.5%) and by the sedation assisted group (38.2%). Prehospital intubation did not demonstrate improved outcomes over basic airway management in patients with severe TBI. A large prospective, randomised trial is warranted to yield some insight into how these airway interventions influence outcome in severe TBI.