Use Of Supplemental Oxygen Research Articles

A quasiexperimental study of targeted normoxia in critically ill trauma patients.

Avoidance of hypoxia and hyperoxia may reduce morbidity and mortality in critically ill civilian and military trauma patients. The objective of this study was to determine if a multimodal quality improvement intervention increases adherence to a consensus-based, targeted normoxia strategy. We hypothesized that this intervention would safely improve compliance with targeted normoxia. This is a pre/postquasiexperimental pilot study to improve adherence to normoxia, defined as a pulse oximetry (SpO2) of 90% to 96% or an arterial partial pressure oxygen (PaO2) of 60 to 100 mm Hg. We used a multimodal informatics and educational intervention guiding clinicians to safely titrate supplemental oxygen to normoxia based on SpO2 monitoring in critically ill trauma patients admitted to the surgical-trauma or neurosurgical intensive care unit within 24 hours of emergency department arrival. The primary outcome was effectiveness in delivering targeted normoxia (i.e., an increase in the probability of being in the targeted normoxia range and/or a reduction in the probability of being on a higher fraction-inspired oxygen concentration [FiO2]). Analysis included 371 preintervention subjects and 201 postintervention subjects. Preintervention and postintervention subjects were of similar age, race/ethnicity, and sex and had similar comorbidities and Acute Physiologic and Chronic Health Evaluation II scores. Overall, the adjusted probability of being hyperoxic while on supplemental oxygen was reduced during the postintervention period (adjusted odds ratio, 0.74; 95% confidence interval, 0.57-0.97). There was a higher probability of being on room air (FiO2, 0.21) in the postintervention period (adjusted odds ratio, 1.38; 95% confidence interval, 0.83-2.30). In addition, there was a decreased amount of patient time spent on higher levels of FiO2 (FiO2, >40%) without a concomitant increase in hypoxia. A multimodal intervention targeting normoxia in critically ill trauma patients increased normoxia and lowered the use of supplemental oxygen. A large clinical trial is needed to validate the impact of this protocol on patient-centered clinical outcomes. Therapeutic/care management, level II.

Obesity and Obesity Hypoventilation, Sleep Hypoventilation, and Postoperative Respiratory Failure.

Obesity hypoventilation syndrome (OHS) is considered as a diagnosis in obese patients (body mass index [BMI] ≥30 kg/m2) who also have sleep-disordered breathing and awake diurnal hypercapnia in the absence of other causes of hypoventilation. Patients with OHS have a higher burden of medical comorbidities as compared to those with obstructive sleep apnea (OSA). This places patients with OHS at higher risk for adverse postoperative events. Obese patients and those with OSA undergoing elective noncardiac surgery are not routinely screened for OHS. Screening for OHS would require additional preoperative evaluation of morbidly obese patients with severe OSA and suspicion of hypoventilation or resting hypoxemia. Cautious selection of the type of anesthesia, use of apneic oxygenation with high-flow nasal cannula during laryngoscopy, better monitoring in the postanesthesia care unit (PACU) can help minimize adverse perioperative events. Among other risk-reduction strategies are proper patient positioning, especially during intubation and extubation, multimodal analgesia, and cautious use of postoperative supplemental oxygen.

Clinical features of parainfluenza infections among young children hospitalized for acute respiratory illness in Amman, Jordan

BackgroundParainfluenza virus (PIV) is a leading cause of acute respiratory illness (ARI) in children. However, few studies have characterized the clinical features and outcomes associated with PIV infections among young children in the Middle East.MethodsWe conducted hospital-based surveillance for ARI among children < 2 years of age in a large referral hospital in Amman, Jordan. We systematically collected clinical data and respiratory specimens for pathogen detection using reverse transcription polymerase chain reaction. We compared clinical features of PIV-associated ARI among individual serotypes 1, 2, 3, and 4 and among PIV infections compared with other viral ARI and ARI with no virus detected. We also compared the odds of supplemental oxygen use using logistic regression.ResultsPIV was detected in 221/3168 (7.0%) children hospitalized with ARI. PIV-3 was the most commonly detected serotype (125/221; 57%). Individual clinical features of PIV infections varied little by individual serotype, although admission diagnosis of ‘croup’ was only associated with PIV-1 and PIV-2. Children with PIV-associated ARI had lower frequency of cough (71% vs 83%; p < 0.001) and wheezing (53% vs 60% p < 0.001) than children with ARI associated with other viruses. We did not find a significant difference in supplemental oxygen use between children with PIV-associated infections (adjusted odds ratio [aOR] 1.12, 95% CI 0.66–1.89, p = 0.68) and infections in which no virus was detected.ConclusionsPIV is frequently associated with ARI requiring hospitalization in young Jordanian children. Substantial overlap in clinical features may preclude distinguishing PIV infections from other viral infections at presentation.

To compare effectiveness of post operative supplemental oxygen on surgical site infection in high risk cases

Introduction: Surgical site infection (SSI) is a common complication after surgery and has a negative impact on clinical outcomes and healthcare costs. The reported incidence of SSI after abdominal surgery ranges from 10-30%. The use of supplemental oxygen to prevent SSI is thought to enhance innate defence mechanisms against surgical pathogens that are neutralised mainly by the neutrophil-mediated oxidative burst. This effect is related to tissue partial pressure of oxygen (PtsO2), which in turn is directly dependent on arterial partial pressure of oxygen (PaO2). Hence, an association between PaO2 and SSI has always been suggested. Hence a comparative study is undertaken to study the effectiveness of supplemental oxygen in the post-operative period in cases which have high risk of developing surgical site infection.Materials and Methods: A prospective Cohort study to evaluate the effectiveness of supplemental oxygen in the post-operative period in high risk abdominal surgeries is performed from Sept 2020- Jan 2021 in R L Jalappa hospital, Kolar. Cases were allocated to study group (Group A) and control group (Group B) by simple random sampling. The results were analysing using SPSS.22VERSION software. Results: There was no significant difference in mean age comparison, duration of procedure, sex distribution and drainage of pus between the two groups. Significant difference was noted in serous discharge, purulent discharge, erythema, separation of tissues distribution between two groups from Day 1 to Day 5. Out of 28 patients in Group A, 16 (57.14%) patients had satisfactory healing, 11 (39.29%) had disturbance of healing and 1 (3.57%) had mild wound infection. Out of 28 patients in Group B, 6 patients (21.42%) had satisfactory healing, 16 (57.14%) had disturbance of healing, 3 (10.71%) had mild wound infection, 2 (7.14%) had moderate wound infection and 1(3.57%) had severe wound infection. SSI was seen more in Group B compared to Group A.Conclusions: Post op supplementation of oxygen in high risk emergency abdominal surgeries reduces the incidence of SSI.

Thalassemia Is Paradoxically Associated with a Reduced Risk of In-Hospital Complications and Mortality in COVID-19: Data from an International Registry

Background: Although numerous patient specific co-factors have been shown to be associated with worse outcomes in COVID-19, the prognostic value of thalasemic syndromes in COVID-19 patients remains poorly understood.Aims: We studied the outcomes of 137 COVID-19 patients with a history of Transfusion Dependent Thalassemia (TDT) and non-Transfusion Dependent Thalassemia (NTDT) extracted from a large international cohort and compared them with the outcomes from a matched cohort of COVID-19 patients with no history of thalasemia.Results: The mean age of thalassemia patients included in our study was 41±16 years (48.9% male). Almost 81% of these patients suffered from TDT requiring blood transfusions on a regular basis. 38.7% of patients were blood group O. Cardiac iron overload was documented in 6.8% of study patients, whereas liver iron overload was documented in 35% of study patients. 25% of thalassemia patients had a history of splenectomy. 27.7% of study patients required hospitalization due to COVID-19 infection. Amongst the hospitalized patients, one patient died (0.7%) and one patient required intubation. Continuous positive airway pressure (CPAP) was required in almost 5% of study patients. After adjustment for age-, sex- and other known risk factors (cardiac disease, kidney disease and pulmonary disease), the rate of in-hospital complications (supplemental oxygen use, admission to the an intensive care unit for CPAP therapy or intubation) and all-cause mortality was significantly lower in the thalassemia group compared to the matched cohort with no history of thalassemia. Amongst thalassemia patients in general, the NTDT group exhibited a higher rate of hospitalization compared to the TDT group (p=0.001). In addition, the rate of complications such as acute kidney injury and need for supplemental oxygen was significantly higher in the NTDT group compared to the TDT group. In the multivariable logistic regression analysis, age and history of heart or kidney disease were all found to be independent risk factors for increased in-hospital, all-cause mortality, whereas the presence of thalassemia (either TDT or NTDT) was found to be independently associated with reduced all-cause mortality.Conclusions: The presence of thalassemia in COVID-19 patients was independently associated with lower in-hospital, all-cause mortality and few in-hospital complications in in our study. The pathophysiology of this is unclear and needs to be studied in vitro and in animal models.Trial Registration for sources of data extraction: NCT: 04334291, 04746066Funding Statement: This study was funded by a non-conditioned grant from FUNDACIÓN INTERHOSPITALARIA PARA LA INVESTIGACIÓN CARDIOVASCULAR, FIC. (Madrid, Spain). This nonprofit institution had no role in the study design, the collection, analysis and interpretation of data, the writing of the report, or the decision to submit the paper for publication.Declaration of Interests: The authors declare no conflicts of interest.Ethics Approval Statement: The study was approved by the Ethics Committees in all of the centers involved (Banjarmasin, Bari, Cagliari, Catania, Ferrara, Gela, Genoa, Getafe, Guadalajara, Legan, Madrid, Mannheim, Milan, Monza, Naples, Olbia, Padua, Pavia, Ragusa, Rome, Salerno, Turin, Valladolid and Verona).

Single-leg exercise training augments in vivo skeletal muscle oxidative flux and vascular content and function in adults with type 2 diabetes.

People with type 2 diabetes (T2D) have impaired skeletal muscle oxidative flux due to limited oxygen delivery. In the current study, this impairment in oxidative flux in people with T2D was abrogated with a single-leg exercise training protocol. Additionally, single-leg exercise training increased skeletal muscle CD31 content, calf blood flow and state 4 mitochondrial respiration in all participants. Cardiorespiratory fitness is impaired in type 2 diabetes (T2D), conferring significant cardiovascular risk in this population; interventions are needed. Previously, we reported that a T2D-associated decrement in skeletal muscle oxidative flux is ameliorated with acute use of supplemental oxygen, suggesting that skeletal muscle oxygenation is rate-limiting to in vivo mitochondrial oxidative flux during exercise in T2D. We hypothesized that single-leg exercise training (SLET) would improve the T2D-specific impairment in in vivo mitochondrial oxidative flux during exercise. Adults with (n=19) and without T2D (n=22) with similar body mass indexes and levels of physical activity participated in two weeks of SLET. Following SLET, in vivo oxidative flux measured by 31 P-MRS increased in participants with T2D, but not people without T2D, measured by the increase in initial phosphocreatine synthesis (P=0.0455 for the group × exercise interaction) and maximum rate of oxidative ATP synthesis (P=0.0286 for the interaction). Additionally, oxidative phosphorylation increased in all participants with SLET (P=0.0209). After SLET, there was no effect of supplemental oxygen on any of the in vivo oxidative flux measurements in either group (P>0.02), consistent with resolution of the T2D-associated oxygen limitation previously observed at baseline in subjects with T2D. State 4 mitochondrial respiration also improved in muscle fibres ex vivo. Skeletal muscle vasculature content and calf blood flow increased in all participants with SLET (P<0.0040); oxygen extraction in the calf increased only in T2D (P=0.0461). SLET resolves the T2D-associated impairment of skeletal muscle in vivo mitochondrial oxidative flux potentially through improved effective blood flow/oxygen delivery.

Oncologic immunomodulatory agents in patients with cancer and COVID-19

Corticosteroids, anti-CD20 agents, immunotherapies, and cytotoxic chemotherapy are commonly used in the treatment of patients with cancer. It is unclear how these agents affect patients with cancer who are infected with SARS-CoV-2. We retrospectively investigated associations between SARS-CoV-2-associated respiratory failure or death with receipt of the aforementioned medications and with pre-COVID-19 neutropenia. The study included all cancer patients diagnosed with SARS-CoV-2 at Memorial Sloan Kettering Cancer Center until June 2, 2020 (N = 820). We controlled for cancer-related characteristics known to predispose to worse COVID-19 as well as level of respiratory support during corticosteroid administration. Corticosteroid administration was associated with worse outcomes prior to use of supplemental oxygen; no statistically significant difference was observed in sicker cohorts. In patients with metastatic thoracic cancer, 9 of 25 (36%) and 10 of 31 (32%) had respiratory failure or death among those who did and did not receive immunotherapy, respectively. Seven of 23 (30%) and 52 of 187 (28%) patients with hematologic cancer had respiratory failure or death among those who did and did not receive anti-CD20 therapy, respectively. Chemotherapy itself was not associated with worse outcomes, but pre-COVID-19 neutropenia was associated with worse COVID-19 course. Relative prevalence of chemotherapy-associated neutropenia in previous studies may account for different conclusions regarding the risks of chemotherapy in patients with COVID-19. In the absence of prospective studies and evidence-based guidelines, our data may aid providers looking to assess the risks and benefits of these agents in caring for cancer patients in the COVID-19 era.

The role of androgen deprivation therapy on the clinical course of COVID-19 infection in men with prostate cancer.

41 Background: TMPRSS2, a cell surface protease which is commonly upregulated in prostate cancer (PC) and regulated by androgens, is a necessary component for SARS-CoV2 cellular entry into respiratory epithelial cells. PC patients receiving ADT were reported to have a lower risk of SARS-CoV-2 infection. However, whether ADT may have an impact on the severity of COVID-19 illness in this population is poorly understood. Methods: In this study performed across 7 US medical centers, we retrospectively evaluated patients with active PC and SARS-COV-2 viral detection by PCR between 03/01/20 and 05/31/20. We collected information on demographics; medical comorbidities; medications; PC Gleason score at initial diagnosis; presence of active disease, metastases, and castration resistance; ADT use as defined by GnRH analog or antagonist within 3 months or castration levels of testosterone &lt; 50 ng/dL within 6 months of COVID-19 diagnosis, or history of bilateral orchiectomy; active non-ADT systemic therapies including, but not limited to, androgen-receptor-targeted therapies and chemotherapy; and COVID-19-related outcomes including hospitalization, supplemental oxygen use, mechanical ventilation requirement, WHO COVID-19 ordinal scale for clinical improvement, follow-up duration, and vital status. Multivariable mixed-effect logistic regression was performed to evaluate any difference in COVID-19 clinical outcomes between patients on and not on ADT. Survival analysis was done using adjusted Cox proportion-hazards regression model. All tests were two-sided at 0.05 significance level. Results: We identified 465 evaluable patients with median age of 71 (61-81) years. Median duration of follow-up was 60 (12-114.2) days. In this follow up period, there were 195 (41.9%) hospitalizations and 111 (23.9%) deaths. When adjusted for age, BMI, and PC clinical disease state, overall survival (HR 1.28 [95%CI 0.79-2.08], P = 0.32), hospitalization status (HR 1.07 [0.61-1.87], P = 0.82), supplemental oxygen use (HR 1.29 [0.77-2.17], P = 0.34), and use of mechanical ventilation (HR 1.07 [0.51-2.23], P = 0.87) were not statistically different between ADT and non-ADT cohorts. Similarly, in subgroup analysis, no statistical difference in overall survival was found between ADT and non-ADT cohorts for hospitalized patients (HR 1.42 [0.82-2.47], P = 0.21) and those receiving supplemental oxygen (HR 1.10 [0.65-1.85], P = 0.73). Conclusions: In this retrospective cohort of PC patients, use of ADT prior to COVID-19 diagnosis does not protect against severe COVID-19 illness as defined by hospitalization, supplemental oxygen use, or death. Further preclinical work in understanding TMPRSS2 expression and androgen regulation in respiratory epithelial cells is needed. As well, longer clinical follow-up and additional clinical studies inclusive of prospective data are warranted to fully address this question.

Respiratory depression in a neonate born to mother on maximum dose sertraline: a case report

BackgroundMood and anxiety disorders are common in women of childbearing age, especially during the peripartum period. As more women seek medical management for these conditions, there is an increasing need for studies to better examine the effects of exposure to selective serotonin reuptake inhibitors (SSRIs), and other antidepressants, on newborns at the time of delivery.Case presentationWe report the case of a term Caucasian infant born to a 17-year-old white female taking 100 mg of sertraline daily for depression and anxiety who exhibited respiratory depression and hypoxia after an uncomplicated vaginal delivery. The neonate was treated with the use of continuous positive airway pressure (CPAP) and supplemental oxygen and subsequently the symptoms resolved without complication.ConclusionsWe present this case with the suspicion of poor neonatal adjustment syndrome as the possible cause of the respiratory depression and hypoxia in this newborn.

The U.S. National Trend for Retinopathy of Prematurity.

The use of supplemental oxygen in premature infants is essential for survival. However, its use has been associated with unintended complications. The restricted use of oxygen is associated with increased mortality and necrotizing enterocolitis (NEC), whereas its liberal use is associated with increased risk for retinopathy of prematurity (ROP). Although there is no clear consensus on the acceptable oxygen saturation range, clinicians have recently become more liberal with the use of oxygen. We aim to assess (1) the national trends for ROP in very low birth weight preterm infants, and (2) the associated trends in mortality, NEC, intraventricular hemorrhage (IVH), and length of hospital stay (LOS). We analyzed deidentified patient data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from 2002 to 2017. All infants with gestational age ≤32 weeks and birth weight <1,500 g were included. Trends in ROP, severe ROP, mortality, NEC, IVH, severe IVH, and LOS were analyzed using Jonckheere-Terpstra test. A total of 818,945 neonates were included in the study. The overall mortality was 16.2% and the prevalence of ROP was 17.5%. There was a significant trend for increased ROP over the years (p < 0.001). Severe ROP was also significantly increased (p < 0.001). This was associated with a significant trend for increased median LOS in survived infants (p < 0.001). Mortality was significantly decreased (p < 0.001), whereas NEC and severe NEC did not change over time (p = 0.222 and p = 0.412, respectively). There is a national trend for increased ROP and severe ROP over the 16 years of the study period. This trend was associated with a significant increase in the LOS in survived infants without change in NEC. · Prevalence of ROP and severe ROP has increased in VLBW infants over the 16-year study period.. · The prevalence of NEC did not change over the same time period.. · Increased ROP and severe ROP were consistent in all three GA and BW subgroups..

Research Highlights.

Research Highlights.

Severity of COVID-19 in hospitalized patients with and without atopic disease

BackgroundData from the 2009 influenza pandemic suggested asthma might protect from severe disease in hospitalized patients. Asthma does not appear to increase risk for hospitalization or mortality with COVID-19. ObjectiveThis study was undertaken to see if atopy actually protected those hospitalized with COVID-19. MethodsRetrospective chart review on all patients testing positive for SARS-CoV-2 over 2 months at a major adult and pediatric tertiary referral center hospital. Charts were evaluated for history of atopic disease, as were the need for ICU admission, requirement for supplemental oxygen and/or intubation, and in hospital mortality. ResultsNo significant differences in outcomes for patients (n = 275) based on atopic disease were noted: ICU admission, 43% versus 44.7% (atopic versus no atopic disease, respectively; p = 0.84); supplemental oxygen use, 79.1% versus 73.6% (p = 0.36); intubation rate, 35.8% versus 36.5% (p = 0.92); and mortality rate, 13.4% versus 20.7% (p = 0.19). More patients with atopic disease had COPD listed as a diagnosis in their chart (38.8% versus 17.3%, p < 0.001). COPD was associated with an increased rate of ICU admission (aOR = 2.22 (1.15, 4.30) p = 0.02) and intubation (aOR = 2.05 (1.07, 3.92) p = 0.03). After adjusting for COPD, patients with atopic disease had a trend for reduced mortality (aOR 0.55 (0.23, 1.28), p = 0.16), but those with asthma did not (p > 0.2). ConclusionSeverity of COVID-19 in hospitalized patients does not differ based on atopic status. However, adjusting for presence of COPD led to a suggestion of possible reduced severity in patients with atopy but not asthma.

513. Viral kinetics of SARS-CoV-2 in patients with COVID-19

BackgroundAs only few studies have analyzed viral kinetics between the incubation and symptomatic periods of COVID-19 patients, we investigated the viral kinetics and compared viral loads between patients with mild and severe COVID-19.MethodsWe determined the viral kinetics of 10 patients diagnosed with COVID-19 at Chosun University Hospital. Six patients were classified into the “mild” group and 4 into the “severe” group according to supplemental oxygen use during admission. Samples were collected via nasopharyngeal swabs and sputum specimens. SARS-CoV-2 was detected using real-time reverse transcription-polymerase chain reaction (RT-PCR). Chest radiograph scores during hospitalization were obtainedResultsCt values of the upper respiratory tract specimens were low during the early stages after symptom onset but gradually increased over time in both groups. The severe group had lower Ct values than the mild group. The Ct values of the RdRP and E genes on day 6 after symptom onset were significantly lower in the severe group than in the mild group (p < 0.05). Three of 6 patients had positive results on RT-PCR even before symptom onset; 2 of them had the lowest Ct values. The chest radiograph scores were higher in the severe group than in the mild group, and the score in the severe group was the highest at approximately 3 weeks after symptom onset.Ct values when the RdRP gene and E gene were targeted to detect SARS-CoV-2 on the basis of the days after symptom onset in all the patients ConclusionViral load and chest radiograph scores were significantly different between the severe and mild groups of COVID-19 patients.Disclosures All Authors: No reported disclosures

Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study.

To examine whether audio-voice guidance application improves adherence to resuscitation sequence and recommended time frames during neonatal resuscitation. A prospective, randomized, pilot study examining the use of an audio-voice application for guiding resuscitation on newborn mannequins, based on the Neonatal Resuscitation Program (NRP) algorithm. Two different scenarios, with and without voice guidance, were presented to 20 medical personnel (2 midwives, 8 nurses, and 10 physicians) in random order, and their performance videotaped. Audio-voice guided resuscitation compared with non-guided resuscitation, resulted in significantly better compliance with NRP order sequence (p<0.01), correct use of oxygen supplementation (p<0.01) and performance of MR SOPA (Mask, reposition, suction, open mouth, pressure, airway) (p<0.01), and shortened the time to "positive pressure ventilation" (p<0.01). In this pilot study, audio-voice guidance application for newborn resuscitation simulation on mannequins, based on the NRP algorithm, improved adherence and performance of NRP guidelines.

Oxygen use in low-resource settings: An intervention still triggered by intuition

BackgroundAlthough hypoxic patients attending low-resource hospitals have a high mortality, many are not given supplemental oxygen. If oximetry is not available, then the decision to provide oxygen must be based on other factors. MethodsThe variables associated with the decision to provide supplemental oxygen made by an emergency department staff, without access to oximetry, in a low resource Ugandan hospital were determined from data collected within 16h of admission to the hospital’s medical and surgical wards. ResultsOf 2,599 patients, 731 (28.1%) had an oxygen saturation <95%, and 164 (6.3%) an oxygen saturation <90%. Of the 731 patients with oxygen levels below 95% 573 (83%) were not given oxygen; oxygen was only given to 63 (38%) of the 164 patients with oxygen saturation <90%. On average, a patient given oxygen was more likely to die than one not given oxygen, regardless of their oxygen saturation (odds ratio 13.4, 95%CI 9.1–19.6). After multivariate analysis weakness, dyspnoea, low oxygen saturation, high heart rate, high respiratory rate, low temperature, alertness, gait, and a medical illness were all significantly associated with the use of supplemental oxygen and in-hospital mortality. Logistic regression modelling of these variables had comparable discrimination for both oxygen use (c statistic 0.88 SE 0.02) and in-hospital mortality (c statistic 0.84 SE 0.02). ConclusionThe intuitive decision to provide oxygen was strongly associated with in-hospital mortality, suggesting that oxygen was given to those considered the sickest patients. In the future, oximetry may guide oxygen therapy more efficiently.

Enhanced recovery after surgery and anesthetic outcomes in pediatric reconstructive urologic surgery.

Enhanced recovery after surgery (ERAS) is a perioperative management strategy to hasten postoperative recovery. We examined the effects of a pilot implementation of ERAS for pediatric patients on anesthetic outcomes. We performed a prospective case-control study utilizing an ERAS protocol in patients aged < 18years undergoing urologic reconstruction that included a bowel anastomosis. Protocol elements included: multimodal analgesia, opioid minimization, and routine nausea/vomiting prophylaxis. ERAS patients were propensity-matched with historical controls. Outcomes of interest included maximum PACU pain score, time to first opioid, opioid-free days, and need for opioids on day of discharge. A total of 13 ERAS patients and 26 historical controls were included, with median ages 9.9years (IQR 9.1-11) and 10.4years (IQR 8.0-12.4), respectively. ERAS increased the percentage of patients who did not receive any intraoperative or postoperative opioids (0% vs 15%, p = 0.046 for both) and reduced maximum PACU pain score (3 vs 0, p < 0.001). The use of postoperative supplemental oxygen was decreased in the ERAS group (85% vs 38%, p = 0.013). The implementation of an ERAS protocol appears to decrease postoperative pain, opioid usage, and positively impact other anesthetic outcomes in children undergoing urologic reconstructive surgery utilizing a bowel anastomosis.

2020 International Consensus on First Aid Science With Treatment Recommendations

This is the summary publication of the International Liaison Committee on Resuscitation’s 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.

2020 International Consensus on First Aid Science With Treatment Recommendations

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.

Peak Inspiratory Pressure During Delivery Room Resuscitation for Infants Born at Less Than 500 Grams.

Introduction: With the advent of technological advancement and better scientific understanding it is possible now to successfully resuscitate and save babies born at less than 500 grams. Stabilization of these infants in the delivery room (DR) is one of the goals of the golden hour management. While some factors, including temperature management and airway care have standards, there is paucity of data on the optimal peak inspiratory pressure (PIP). The Neonatal Resuscitation Program (NRP) recommends using the same inflation pressure of 20 cm to 25 cm H2O for preterm infants as used for term infants. Preterm lungs are not the same as term infants. Due to the smaller lung volume, capacities and dynamic pulmonary mechanics, these preterm infants are prone to pulmonary complications including pneumothorax. Therefore, there is need to use PIP judiciously in the DR. Methods and Results: In this brief report we present two cases of newborn infants that were born at less than 500 grams and were successfully resuscitated with a lower PIP. The success criteria in the DR were heart rate greater than 100 per minute and adequate oxygen saturations minute by minute per NRP guidelines with minimal use of supplemental oxygen. Conclusion: While we need good prospectively designed studies to document the ideal PIP for these extreme preterm infants, we suggest a PIP lower than the currently recommended may be sufficient for some extremely preterm infants.

HAND GRIP STRENGTH IS AN OBJECTIVE CORRELATE TO FUNCTIONAL IMPAIRMENT AND SYMPTOM BURDEN IN PATIENTS WITH COPD

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Hand grip strength (HGS) is a simple to obtain marker of functional status and associated with all-cause mortality in the general population. The value of HGS in the clinical assessment of COPD patients is not well defined. We sought to define the associations of phenotypic features of COPD with hand grip strength. METHODS: We performed interim, cross-sectional analysis of the observational cohort of individuals who participated in COPD phenotyping study at UCLA (Funding: Amgen, Thousand Oaks, CA). One-hundred and seven patients with COPD completed questionnaires, spirometry, imaging, HGS measurement, and laboratory analysis. HGS was obtained from 3 sequential grip tests in each hand and highest single value was used. Values were normalized to previously reported norms for age and sex. The associations between grip strength with lung function, biomarkers, imaging, six-minute walk test (6MWT), symptom scores and quality of life indices were analyzed. 3-month follow-up including the number of reported exacerbations was available for 93 patients. RESULTS: After normalization, HGS was not associated with age, sex, height or BMI. In linear regression models, HGS was directly associated with percent predicted FEV1 (β = 0.24, p = 0.01), distance walked during 6MWT (β = 0.30, p < 0.01) and inversely associated with SGRQ-C score (β = -0.30, p < 0.01). Lower HGS was also associated with higher symptom burden by several other validated COPD-specific scores - CAT, BORG, VSAQ, with a trend towards higher mMRC (p = 0.57). Higher HGS was associated with better perceived health status and better health-related quality of life as quantified by SF-12 health survey. HGS was correlated with the presence of airway thickening by computed tomography but not presence, pattern or degree of emphysema. HGS was correlated with serum c-reactive protein, white blood cell count, eosinophil count but not fibrinogen, erythrocyte sedimentation rate, or neutrophil to lymphocyte ratio. HGS was not correlated with number of exacerbations in the year prior to enrollment or 3-month follow-up, forced vital capacity or use of supplemental oxygen. CONCLUSIONS: Hand grip strength is associated with functional limitation and COPD-specific symptoms but not correlated with number of exacerbations. CLINICAL IMPLICATIONS: Hand grip strength is a simple, objective measure which may aid in identifying those individuals most heavily impacted by COPD in the stable state of the disease. DISCLOSURES: Advisory Committee Member relationship with Astra Zeneca Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Advisory Committee Member relationship with GSK Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Consultant relationship with Grifols Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Theravance and Mylan Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Verona Pharma Please note: $1001 - $5000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Consultant relationship with Boehringer Ingelheim Please note: $1001 - $5000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee Consultant relationship with GE Healthcare Please note: $5001 - $20000 Added 04/15/2020 by Igor Barjaktarevic, source=Web Response, value=Consulting fee no disclosure on file for Marissa Dembek; No relevant relationships by Brett Dolezal, source=Web Response No relevant relationships by Daniel Hoesterey, source=Web Response No relevant relationships by William LeMaster, source=Web Response no disclosure on file for Randy Nguyen