Respiratory Oxygen Research Articles

No Effect of Acute or Chronic New Zealand Blackcurrant Extract on Cycling Performance or Physiological Responses in Trained Cyclists.

Previous research examining the ergogenic benefits of blackcurrant supplementation (BC) on exercise performance is contradictory. The BC supplementation period in many studies has typically been chronic (> 6-days), with a final dose taken hours before testing. Whether any observed performance benefits are from the acute dose or chronic supplementation is unclear. This study aimed to examine the effects on cycling performance of a single-acute dose and 7-day supplementation with BC extract. This study was a placebo-controlled, double-blind, randomised, cross-over trial. Sixteen cyclists (mean±SD: age 37±11years; height 175.8±7.6cm; body mass 73.2±12.5kg; V̇O2peak 3.8±0.7L·min-1) completed a total of six experimental sessions (2×3 treatment blocks). Each treatment block consisted of a no-supplement baseline trial, a single dose (acute) and a 7-day (chronic) supplementation trial. During each trial, subjects completed a maximal incremental test and 4km time trial, separated by 15min of recovery. Respiratory data, heart rate, muscle oxygenation and performance power were measured continuously in each trial, and differences between treatments were determined using RM-ANOVA and effect size analysis. There was no significant difference (p>0.05) in cycling performance between experimental and placebo treatments following acute or chronic supplementation periods. There were no significant effects on measured physiological and metabolic parameters, and any observed differences in performance or physiology were trivial to small. Blackcurrant supplementation delivered either acutely or over a period of 7days had no significant effect on cycling performance or physiology. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry: ACTRN12622001277730.

Treatment effect of head extension by cervical collar on moderate obstructive sleep apnea-A randomized controlled trial.

As available treatments in obstructive sleep apnea are all associated with side-effects or adherence problems, there is a need for alternative treatment options. In this randomized, open, parallel-group intervention study, the effect of head extension by cervical collar was evaluated in patients with moderate obstructive sleep apnea. One-hundred patients with moderate obstructive sleep apnea (apneas and hypopneas per estimated hours asleep = respiratory events index: 15-30) were randomized to either lifestyle intervention, or cervical collar in combination with lifestyle intervention. Both groups received lifestyle advice. In addition, the treatment group was treated with a cervical collar, which allows adjustment of head extension, during sleep. Assessment with questionnaires and polygraphy were performed at baseline and after 6 ± 2 weeks. A linear regression model was used to assess a total effect on respiratory events index, which was the primary endpoint. In the intention-to-treat analysis, the cervical collar in combination with lifestyle intervention group decreased their respiratory events index (p = 0.008) and oxygen desaturation index (p = 0.008) more than the lifestyle intervention group, with a mean difference of -4.5 and -4.3, respectively. In the sub-analysis, there was a clear effect on respiratory events index in the supine position (mean difference between the groups -9.1, p = 0.018) but not on non-supine apnea-hypopnea index (-2.3, p = 0.17). We conclude that head extension by cervical collar during sleep resulted in improved respiratory events index and oxygen desaturation index values in patients with moderate obstructive sleep apnea. Cervical collar can be a second-line treatment option in this group, especially in positional obstructive sleep apnea.

A cytochrome bd repressed by a MarR family regulator confers resistance to metals, nitric oxide, sulfide, and cyanide in Chromobacterium violaceum.

The terminal oxidases of bacterial respiratory chains rely on heme-copper (heme-copper oxidases) or heme (cytochrome bd) to catalyze the reduction of molecular oxygen to water. Chromobacterium violaceum is a facultative anaerobic bacterium that uses oxygen and other electron acceptors for respiration under conditions of varying oxygen availability. The C. violaceum genome encodes multiple respiratory terminal oxidases, but their role and regulation remain unexplored. Here, we demonstrate that CioAB, the single cytochrome bd from C. violaceum, protects this bacterium against multiple stressors that are inhibitors of heme-copper oxidases, including nitric oxide, sulfide, and cyanide. CioAB also confers C. violaceum resistance to iron, zinc, and hydrogen peroxide. This cytochrome bd is encoded by the cioRAB operon, which is under direct repression by the MarR-type regulator CioR. In addition, the cioRAB operon responds to quorum sensing and to cyanide, suggesting a protective mechanism of increasing CioAB in the setting of high endogenous cyanide production.

Retrospective Analysis of the Prevalence and Risk Factors of Retinopathy of Prematurity in a Single-Center Cohort in Romania and Comparison with National and European Data.

Background and Objectives: This study investigated and compared with European literature data the incidence, severity, and perinatal risk factors of retinopathy of prematurity (ROP) in preterm infants admitted to the Premature Department of Mureş County Clinical Hospital over a two-year period (January 2022-December 2023). Materials and Methods: ROP screening was performed in 96 infants (76.8%) according to professional guidelines. A literature review was conducted to compare our findings with national and European data. Significant differences were identified in comparisons with studies from Cluj-Napoca (p = 0.0125), Timișoara, and Bucharest (p < 0.0074), as well as Serbia and Croatia when stratified by gestational age limits. The variations in GA thresholds (32 vs. 34 weeks) between studies required stratified analyses to ensure meaningful comparisons. The included European studies provided data on screening criteria, prevalence, and associated risk factors, offering a comprehensive perspective on screening effectiveness. Results: Among the 149 admitted patients, 125 were preterm (n = 125). Of the screened patients, 20 (20.83%) infants were diagnosed with ROP, including 13 boys (65%) and 7 girls (35%), all requiring prolonged respiratory support, and 55% of them needed blood transfusion. The average birth weight of affected infants was 1030.5 g (550-1700 g ), and the mean gestational age was 28.3 weeks (25-34 weeks). In those found to have stage 2 and 3 ROP in zone II with plus disease (n = 6), intravitreal anti-VEGF injections and/or retinal laser treatments were performed. Notably, no cases of ROP-related blindness were recorded. Conclusions: To our knowledge, this is the first study to compare ROP prevalence and screening outcomes across Romanian national centers. Identified risk factors in this cohort, such as respiratory distress syndrome, oxygen therapy, blood transfusion, and intraventricular hemorrhage, are consistent with the existing literature data. These findings underscore the importance of standardized screening criteria and effective management protocols to prevent ROP-related blindness. The comparative approach of this study highlights the necessity of harmonized internationally applied criteria to facilitate robust comparisons and, more importantly, improve patient care outcomes.

Individualized PEEP titration by lung compliance during one-lung ventilation: a meta-analysis

BackgroundDespite the physiological advantages of positive end-expiratory pressure (PEEP), its optimal utilization during one-lung ventilation (OLV) remains uncertain. We aimed to investigate whether individualized PEEP titration by lung compliance is associated with a reduced risk of postoperative pulmonary complications during OLV.MethodsWe searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials until April 1, 2024, to identify published randomized controlled trials that compared individualized PEEP titration by lung compliance with fixed PEEP during OLV. The primary outcome was a composite of postoperative pulmonary complications. Secondary outcomes included clinical outcomes (pneumonia, atelectasis, ARDS, cardiovascular complications, mortality), respiratory mechanics, gas exchanges, and hemodynamic variables. Subgroup analyses were conducted for the primary outcome according to the PEEP titration method (dynamic compliance vs. driving pressure/static compliance, stepwise decremental vs. incremental strategy).ResultsTen trials involving 3426 patients were included. Compared with fixed PEEP, individualized PEEP titration by lung compliance was associated with reduced risk of a composite of postoperative pulmonary complications (eight trials, 3351 patients, risk ratio [RR] 0.55, 95% CI 0.38–0.78). Subgroup analyses suggested the association was evident in the subgroup with titration by dynamic compliance rather than driving pressure/static compliance and in the subgroup with PEEP titration by stepwise decremental but not stepwise incremental strategy. Individualized PEEP titration by lung compliance was also associated with a reduced risk of pneumonia (RR 0.71, 95% CI 0.52–0.96) and atelectasis (RR 0.63, 95% CI 0.45–0.88), higher dynamic compliance, PaO2, PaO2/FiO2, and lower driving pressure. The individualized and fixed PEEP groups did not differ in ARDS, cardiovascular complications, mortality, peak pressure, plateau pressure, PaCO2, heart rate, and mean arterial pressure.ConclusionsCompared with fixed PEEP, individualized PEEP titration by lung compliance is associated with a reduced risk of postoperative pulmonary complications during OLV, especially in PEEP titration by dynamic compliance or stepwise decremental strategy. It improves respiratory mechanics and oxygenation with no difference in hemodynamic variables.Trial registration number ClinicalTrials.gov (PROSPERO No. CRD42024529980).

Assessment of the ROX index as a predictor of invasive ventilation in patients with community-acquired pneumonia

Aims: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality worldwide, particularly among elderly patients and those with comorbid conditions. CAP can lead to severe respiratory failure, often necessitating invasive mechanical ventilation (IMV). Early identification of patients at high risk for intubation is crucial for optimizing management and improving outcomes. The ROX index, which incorporates respiratory rate, oxygen saturation, and fraction of inspired oxygen, has emerged as a potential tool for predicting the need for IMV in patients with respiratory distress. This study aims to evaluate the effectiveness of the ROX index in predicting IMV in patients hospitalized with CAP. Methods: This retrospective cohort study included patients diagnosed with CAP who were admitted to a tertiary healthcare institution between January 1, 2019, and January 1, 2024. The ROX index was calculated at hospital admission using respiratory rate, oxygen saturation (SpO₂), and fraction of inspired oxygen (FiO₂). Severe pneumonia was defined as pneumonia severity index (PSI) class IV or V, and subgroup analyses were conducted for these patients to evaluate the diagnostic performance of the ROX index. The primary outcome was the requirement for IMV, and the predictive ability of the ROX index was evaluated. Results: A total of 416 patients were included, with 30 (7.2%) requiring invasive mechanical ventilation. The mean ROX index was significantly lower in the intubation group (14.4±4.5) compared to the non-intubation group (23.8±5.4) (p

Predictors of high-flow nasal cannula (HFNC) failure in severe community-acquired pneumonia or COVID-19.

The aim was to identify predictors for early identification of HFNC failure risk in patients with severe community-acquired (CAP) pneumonia or COVID-19. Data from adult critically ill patients admitted with CAP or COVID-19 and the need for ventilatory support were retrospectively analysed. HFNC failure was defined as the need for invasive ventilation or death before intubation. 60 patients with CAP and 185 with COVID-19 were included. 27 (45%) patients with CAP and 69 (37.3%) patients with COVID-19 showed HFNC failure. Lower oxygenation index, lower respiratory oxygenation (ROX) index, and higher respiratory rate at the start of HFNC were significantly associated with HFNC failure. ROC-analysis identified a respiratory rate of 27/min as the optimal cut-off for predicting HFNC failure, with a specificity of 59% and a sensitivity of 75%, and an oxygenation index after HFNC initiation of 99.6 (specificity 81%, sensitivity 74%). In COVID-19, an elevated CRB65-score at hospital admission and at HFNC-initiation was significantly associated with HFNC failure. In CAP and COVID patients an oxygenation index < 99.6, a respiratory rate > 27/min and a ROX index < 4.88 were predictors for HFNC failure whereas a CRB65 score > 3 at hospital admission and > 2 at HFNC start was predictive for HFNC failure in COVID-19.

Respiratory support of patients with pneumonia in the context of the COVID-19 pandemic

The purpose of this study is to evaluate and analyse existing methods of supporting individuals suffering from pneumonia due to the coronavirus infection, as well as to find new ones. The following methods were used in a randomised controlled trial: artificial lung ventilation (ALV), non-invasive ventilation, oxygen therapy using oxygen masks and nasal cannulas, penetrating ventilation with high oxygen flow, high-flow nasal oxygen therapy; advantages and disadvantages of such methods. The analysis of a sample of 200 patients aged 18-80 years, among whom there were both women and men with different levels of severity of the disease, was carried out. The study showed that the use of penetrating ventilation with high oxygen flow significantly improves blood oxygenation and reduces the requirement for lung intubation and ALV. However, minimally invasive respiratory support and oxygen treatment have also proven to be effective methods of respiratory support. When using non-invasive ventilation and penetrating ventilation with high oxygen flow, higher survival rates and shorter hospital stay were observed in patients with pneumonia caused by coronavirus infection, compared with the use of ALV. The study revealed that the use of artificial respiration may result in more severe adverse effects, such as lung barotrauma, so it is recommended to use it only in the absence of other effective methods of respiratory support. Thus, the results of the study emphasise the need for an individual approach when choosing a method of respiratory support in patients with pneumonia caused by coronavirus infection, and also confirm the effectiveness of minimally invasive respiratory aid and high-flow oxygen penetrating ventilation in the treatment of this pathology.

Influence of an inspiratory muscle fatigue protocol on older adults on respiratory muscle strength, muscle oxygen saturation, and functional capacity: a randomized controlled trial

BackgroundThe fatigue of the inspiratory musculature, particularly the diaphragm, has been demonstrated to exert systemic effects on the body, impacting cardiovascular and performance outcomes. This study aimed to evaluate the influence of an inspiratory muscle fatigue protocol on respiratory muscle strength, functionality, and muscle oxygen saturation in older adults.MethodsA single-blinded randomized controlled clinical trial was conducted on twenty-four older adults aged over 60 years, who met inclusion criteria were physically independent in terms of gait and functionality. Participants were randomly assigned to one of three groups: control group, inspiratory muscle fatigue group, or activation group. Diaphragmatic ultrasonography (diaphragmatic thickness, thickening fraction, diaphragm movement curve), maximal inspiratory mouth pressure, muscle oxygen saturation, and functionality (timed up and go test, for five times sit to stand test) were used to measure the study variables at two time points: pre-intervention (T1) and post-intervention (T2).ResultsIn the maximum inspiratory pressure variable in the activation group an increase was found between baseline and post-treatment of 3.00 ± 0.93 cmH2O (P < 0.01), while in the inspiratory muscle fatigue a decrease of -6.75 ± 2.66 cmH2O (P < 0.01) was found. In addition, the inspiratory muscle fatigue group showed lower scores for respiratory and functional variables after performing the diaphragmatic fatigue intervention than the activation and control group (P < 0.05), on the other hand, the activation group showed more positive values for functional and respiratory capacity variables after performing the inspiratory muscle activation training (P < 0.05).ConclusionsFatigue of the inspiratory musculature appears to negatively impact inspiratory muscle strength, peripheral muscle strength, muscular oxygenation, and functionality in older adults. Activation of the inspiratory musculature could contribute to improved respiratory muscle strength and function in these individuals.Trial registrationClinicalTrials.gov ID: NCT06266013.

Nasal High-Flow Therapy Versus Low-Flow Oxygen Therapy Post-Discharge in Infants With Bronchopulmonary Dysplasia: A Retrospective Observational Study.

Low-flow oxygen therapy (LFOT) has been the only option for infants with bronchopulmonary dysplasia (BPD) requiring supplemental oxygen after discharge for years. Nasal high-flow therapy (NHFT) has more recently become available as a home device. We compared the impact of NHFT and LFOT on respiratory morbidity and lung function over the first 4 years in infants with BPD requiring respiratory support post-discharge. We retrospectively analyzed data on respiratory morbidity and lung function assessed by tidal breathing flow-volume loop (TBFVL) analysis available from follow-up visits of infants with BPD discharged home with LFOT or NHFT up to 4 years. We compared long-term respiratory outcomes by applying a mixed model, adjusting for mechanical ventilation, overall respiratory support duration, pulmonary hypertension, oxygen therapy, caffeine therapy, and smoking exposure. We included 26 infants discharged with LFOT and 47 with NHFT. The two groups were homogeneous for baseline demographics and BPD severity. Infants in the NHFT group were weaned from respiratory support earlier compared to the LFOT group (median [IQR] 8.0 [4.0; 12.0] vs 14.5 [6.0; 21.5] months, p 0.046). After applying a mixed model, the NHFT group showed a lower incidence of upper (p = 0.025) and lower respiratory tract infections (p = 0.003), wheezing (p: 0.001), and need for bronchodilator (p = 0.028) and systemic steroids (p < 0.001) during the initial 4 years. Lung function testing did not highlight between-group differences. NHFT as an alternative to LFOT may positively impact long-term clinical outcomes of infants with BPD requiring noninvasive respiratory support post-discharge.

Respiratory support and oxygen therapy at home: Clinical results of the prospective observatory study

Respiratory support and oxygen therapy at home: Clinical results of the prospective observatory study

IRF-1 Regulates Mitochondrial Respiration and Intrinsic Apoptosis Under Metabolic Stress through ATP Synthase Ancillary Factor TMEM70.

Mitochondrial dysfunction, which can be caused by metabolic stressors such as oxidized low-density lipoprotein (oxLDL), sensitizes the endothelium to pathological changes. The transcription factor interferonregulatoryfactor 1 (IRF-1) is a master regulator of inflammation, previously shown to promote oxLDL-induced inflammatory pyroptosis in human aortic endothelial cells (HAEC). However, a presumed role for IRF-1 in regulating the intrinsic apoptotic pathway in response to metabolic stress has not been demonstrated. Here targeted deletion of IRF-1 by siRNA in HAEC aggravated oxLDL-induced, mitochondria-mediatedintrinsicapoptosis, as evidenced by increased Caspase-3 and Caspase-9 activation, and chromosomal DNA breakage. The increased apoptosis was concomitant with accumulation of mitochondrial ROS, decrease in intracellular ATP production and respiratory oxygen consumption, and abnormal mitochondrial structure. RNA profiling of endothelial cells isolated from wild type and Irf1 knockout mice, followed by quantitative PCR, luciferase activity assay and chromatin immunoprecipitation (ChIP), revealed that IRF-1 directly regulated the expression of transmembrane protein 70 (TMEM70), an ancillary factor required for the assembly of ATP synthase and conversion of an electrochemical gradient to ATP synthesis. Mirroring the effect of IRF1 knockdown, depletion of TMEM70 in HAEC resulted in impaired mitochondrial function and enhanced cell apoptosis. In contrast, overexpression of TMEM70 rescued ATP biosynthesis and suppressed apoptosis in oxLDL-treated, IRF-1-deficient HAEC. These results reveal a novel homeostatic role for IRF-1 in the regulation of mitochondrial function and associated stress-induced apoptosis.

Effect of extra corporeal reducing pre-load on pulmonary mechanical power in patients with acute respiratory distress syndrome

To explore the effects of veno-venous extra corporeal carbon dioxide removal (V-V ECCO2R) on local mechanical power and gas distribution in the lungs of patients with mild to moderate acute respiratory distress syndrome (ARDS) receiving non-invasive ventilation. Retrospective research methods were conducted. Sixty patients with mild to moderate ARDS complicated with renal insufficiency who were transferred to the respiratory intensive care unit (RICU) through the 96195 platform critical care transport green channel from January 2018 to January 2020 at the collaborative hospitals of Henan Provincial People's Hospital were enrolled. According to different treatment methods, they were divided into a conventional treatment group and an ECCO2R group, with 30 patients in each group. Both groups received standard treatments including primary disease treatment, airway management, and non-invasive ventilation. The conventional treatment group received bedside continuous renal replacement therapy (CRRT), and the ECCO2R group received V-V ECCO2R treatment. General information of patient such as gender, age, cause of disease, and acute physiology and chronic health evaluation II (APACHE II) were recorded; arterial blood gas analysis was performed before treatment and at 12 hours and 24 hours during treatment, recording arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and oxygenation index (PaO2/FiO2). Respiratory mechanics parameters [tidal volume, respiratory rate, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP)] were recorded, and the rapid shallow breathing index (RSBI) was calculated; electrical impedance tomography (EIT) was used to measure regional of interest (ROI) values in different lung areas at 12 hours and 24 hours of treatment, and the pulmonary mechanical energy was calculated. The arterial blood gas analysis indicators, respiratory mechanics parameters, and pulmonary mechanical energy of patients in the conventional treatment group and ECCO2R group improved significantly after 24 hours of treatment compared to 12 hours of treatment (all P < 0.05). The levels of PaCO2, RSBI, total mechanical power, and non-dependent zone mechanical power in the ECCO2R group were significantly lower than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [PaCO2 (mmHg, 1 mmHg ≈ 0.133 kPa): 44.03±2.96 vs. 49.96±2.50 at 12 hours, 41.65±3.21 vs. 48.53±2.33 at 24 hours; RSBI (times×min-1×L-1): 88.67±4.05 vs. 92.35±4.03 at 12 hours, 77.66±4.64 vs. 90.98±4.21 at 24 hours; total mechanical power (mJ): 10.40±1.15 vs. 12.93±1.68 at 12 hours, 11.13±1.18 vs. 14.05±1.69 at 24 hours; non-dependent zone mechanical power (mJ): 7.15±0.84 vs. 7.98±0.75 at 12 hours, 7.77±0.93 vs. 9.13±1.10 at 24 hours], and MEP and MIP in the ECCO2R group were significantly higher than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [MEP (cmH2O, 1 cmH2O ≈ 0.098 kPa): 89.88±5.04 vs. 86.09±5.57 at 12 hours, 96.57±2.59 vs. 88.66±2.98 at 24 hours; MIP (cmH2O): 47.64±2.82 vs. 41.93±2.44 at 12 hours, 60.11±6.53 vs. 43.63±2.80 at 24 hours], the differences were statistically significant (all P < 0.05). V-V ECCO2R combined with non-invasive ventilation can effectively reduce the regional tidal volume, mechanical power, and respiratory rate in the non-gravitational dependent zones of patients with mild to moderate ARDS, and improve respiratory distress and oxygenation status.

Continuous characterisation of exacerbation pathophysiology using wearable technologies in free-living outpatients with COPD: a prospective observational cohort study

The most recent exacerbation of COPD (ECOPD) classification criteria relies in part on changes in respiratory rate (RR), heart rate (HR) and oxygen saturation (SpO2). Despite this paradigm shift, a thorough understanding of exacerbation patterns is still lacking, as is the identification of physiological exacerbation biomarkers. Using a convenience sampling approach, this prospective observational cohort study was conducted between February 2023 and January 2024. Continuous measurements of daytime/overnight respiratory (primary outcome), cardiovascular, autonomic, activity and sleep-related parameters were collected by a wearable biometric wristband and ring over 21 consecutive days in free-living outpatients experiencing and receiving treatment (≤3 days) for a current exacerbation from the home environment. The EXACT-PRO questionnaire served as the validated reference for daily symptom burden and to identify 'recovered' versus 'persistent worsening' participants. Unadjusted and adjusted (for age, sex, FEV1) linear mixed-effects models were fitted to estimate associations between each physiological parameter with daily EXACT-PRO score (points, pts), in all, 'recovered', and 'persistent worsening' participants. Results are presented as point estimates with 95% CIs. In 21 participants with COPD (43% female, mean age 66.8, BMI 27.7kg/m2, FEV1 36.3% predicted; 85.7% with GOLD 3-4 disease), significant associations in unadjusted models with daily EXACT-PRO score included RR variability (-1.45 [-2.84,-0.073] pts/breath/min) but not RR, daily step count (-0.56 [-0.82,-0.31] pts/1000 steps), and sleep efficiency (-0.12 [-0.20,-0.037] pts/%asleep). In 'recovered' participants (n=10), significant associations included nighttime HR, movement intensity and nightly SpO2. In 'persistent worsening' participants (n=11), significant associations included HR variability, nightly RR variability, nightly SpO2, sleep efficiency, and skin temperature. Similar results were found in adjusted models. This study provides a prospective continuous characterisation of exacerbations of COPD using remotely collected, ambulatory/free-living data. The physiological patterns presented may contribute to the understanding of exacerbations and may enhance the development of effective remote monitoring solutions. University hospital (MUHC-CAS) grant.

Impact of Fluid Balance on the Development of Lung Injury.

The pathophysiological relationship between fluid administration, fluid balance, and mechanical ventilation in the development of lung injury is unclear. To quantify the relative contribution of mechanical power and fluid balance in the development of lung injury. Thirty-nine healthy female pigs, divided into four groups, were ventilated for 48 hours with high (~18J/min) or low (~6J/min) mechanical power; and high (~4L) or low (~1L) targeted fluid balance. We measured physiological variables e.g., end-expiratory lung gas volume, respiratory-system mechanics, gas-exchange and hemodynamics, and pathological variables, i.e., lung weight, wet-to-dry ratio, and histology score of lung injury. End-expiratory lung gas volume, respiratory system elastance, strain and oxygenation significantly worsened in the two groups assigned to receive high fluid balance, irrespective of the mechanical power received. All four groups had similar lung weight (i.e., lung edema), lung wet-to-dry ratio and pathological variables. Animals with higher fluid balance developed more ascites, which was associated with a decrease in end-expiratory lung gas volume. In conclusion, our study did not detect a significant difference in lung injury between high and low mechanical power. Some damage is directly attributable to mechanical power, while additional injury appears to result indirectly from high fluid balance, which reduces end-expiratory lung gas volume, with ascites playing an important role in this process.

Predicting ICU Admission for Hospitalized COVID-19 Patients by Artificial Neural Network Combined with Elastic Net

Background: Machine learning models could assist physicians in identifying high-risk COVID-19 patients. This study aimed to predict the Intensive Care Unit (ICU) admission in COVID-19 hospitalized patients by the Artificial Neural Network (ANN) model combined with Elastic Net algorithm. Methods: In this prospective study, the data of 139 COVID-19 patients admitted to Imam Reza Hospital in Tabriz between 20 March and 5 April 2020, were analyzed. The Elastic Net method was used to choose features with high importance. The chosen variables were standardized and ANN was fitted to the data with one hidden layer based on the descending gradient algorithm. To validate the model, the training and test group method with a ratio of 70 to 30 was used. The model’s predictive power was reported by calculating the overall accuracy, sensitivity, specificity, and Area Under the ROC curve (AUC). Results: According to the results of the Elastic Net, the ANN model was constructed based on age, sex, body mass index, diabetes mellitus status, history of heart disease, and vital signs including systolic and diastolic blood pressure, saturated oxygen level, pulse rate, respiration rate, and body temperature. The overall accuracy of this model was 93.15%, sensitivity 80%, specificity 95.8%, and AUC 0.90. Saturated oxygen level, pulse rate, and age were the most important and predictive variables. Conclusion: In the investigated sample of patients admitted with COVID-19, the fitted ANN model had acceptable performance to predict the ICU admission. This finding could be useful for physicians and policy makers.

Effect of Self-Proning on Respiratory Functions, Pneumonia Severity, and Mortality Risk Among Patients Diagnosed With Community-Acquired Pneumonia: A Nursing-Based Quasi-Experimental Study.

Assessing and monitoring respiratory parameters, such as respiratory rate, oxygen saturation, and lung sounds, is crucial for the management and prognosis of pneumonia patients. Prone positioning has been shown to improve oxygenation in patients with respiratory disorders, including pneumonia, by reducing ventilation/perfusion mismatch. However, there is a lack of evidence supporting the benefits of self-proning in spontaneously breathing pneumonia patients. This study aims to evaluate the effect of self-proning on respiratory functions, pneumonia, and mortality risk among patients diagnosed with community-acquired pneumonia. The study used a pre- and post-test quasi-experimental design with a control group, adhering to the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines. It was conducted in the Medical Respiratory Department inpatient wards at the Respiratory Diseases Hospital in Alexandria, Egypt. The study recruited 128 patients with community-acquired pneumonia, conveniently assigned to an intervention group (n = 64) and a control group (n = 64). Data were collected using socio-demographic and historical data sheets, respiratory parameters assessment sheets, the confusion uremia respiratory rate and blood pressure (CURB-65) severity of pneumonia score, and the Pneumonia Severity Index. Prone positioning significantly positively impacted respiratory parameters in the intervention group compared to the control group. Specifically, the intervention group exhibited improvements in respiratory rate, oxygen saturation, reduced need for supplemental oxygen, and cough (p < .05). Furthermore, the intervention group exhibited fewer changes in findings from chest inspection, palpation, and auscultation. In addition, the severity of pneumonia was reduced in the intervention group compared to the control group, as indicated by lower CURB-65 (p = .014) and pneumonia severity index scores (p = .005). The study demonstrated that self-proning interventions significantly improved respiratory functions and reduced the risk of death among participants with community-acquired pneumonia. These findings suggest that self-proning is a beneficial technique for managing respiratory distress, particularly in non-intubated patients, and can be an effective strategy to improve patient outcomes in clinical settings.

“Challenging acquired pulmonary interstitial emphysema in an extreme preterm infant: A case report and review of literature”

Background Pulmonary interstitial emphysema (PIE) can occur in the immature lungs of preterm infants due to overdistension from mechanical ventilation. Case Report Preterm female infant (26 weeks of gestational age, 950 grams) born via urgent cesarean section, APGAR 1/3/6. Invasive mechanical ventilation during the first day of life transitioned to noninvasive positive pressure ventilation (NIPPV), afterward initially stable. Apnea and bradycardia noted at 20 days of life, requiring endotracheal intubation, with complementary studies showing right PIE. Progressive emphysema deterioration, air trapping, and left lung atelectasis, with hemodynamic repercussion despite positioning, high-frequency oscillatory ventilation, and hemodynamic support with dopamine and dobutamine. Selective left intubation attempted positioning the infant, unsuccessful. Due to failure of conventional therapies and impossibility to achieve selective intubation, pediatric surgery performed endobronchial balloon occlusion with angioplasty balloon inflated with contrast with fluoroscopy control. Progressive improvement, weaning ventilatory settings with acceptable oxygenation. Balloon was retired after 5 days. Mechanical ventilation was discontinued at 52 days of life. Infant was discharged without respiratory support nor oxygen at 100 days of life. Conclusions PIE treatment is based in conventional measures (respiratory support and positioning) but eventually might require alternative techniques when the first fail, with limited work in pediatric population and further technical limitations in the preterm infants.

Morphological, physiological, and biochemical responses of rice (Oryza sativa L.) varieties to drought stress via regulating respiration and ROS metabolism during germination

Morphological, physiological, and biochemical responses of rice (Oryza sativa L.) varieties to drought stress via regulating respiration and ROS metabolism during germination

Saline nebulizers in treatment of bronchiolitis.

This study was conducted to assess the response to treatment and compare the effects of nebulized normal saline 0.9% and hypertonic saline 3% in the management of acute bronchiolitis, a condition associated with multiple complications in pediatric patients. In this clinical trial, a total of 60 children diagnosed with viral bronchiolitis in the autumn and winter of 2018 at Ali Asghar Children's Hospital's emergency department were enrolled. The cohort consisted of 30 children in the control group treated with normal saline 0.9% nebulization and 30 in the treatment group treated with 3% hypertonic saline nebulization. Demographic variables, symptom onset duration, and initial heart and respiratory rates were recorded. Disease severity was assessed using the Respiratory Distress Assessment Index (RDAI). Data were analyzed using SPSS software. Following treatment, both groups exhibited significant improvements in vital signs (respiratory rate, heart rate, and oxygen saturation) and RDAI scores (P value < 0.001). However, there was no statistically significant difference in the degree of improvement in vital signs and RDAI scores between the two treatment groups (P value > 0.05). The mean hospital stay duration did not significantly differ between the groups (P value = 0.16). Nebulized hypertonic saline and normal saline both effectively ameliorated symptoms in children with bronchiolitis. The absence of a significant difference between these treatments suggests that either can be recommended for use in the pediatric population experiencing acute bronchiolitis symptoms.