-
Current Opinion in Anaesthesiology Jun 2021Children are at risk of severe hypoxemia in the perioperative period owing to their unique anatomy and physiology. Safe and effective airway management strategies are... (Review)
Review
PURPOSE OF REVIEW
Children are at risk of severe hypoxemia in the perioperative period owing to their unique anatomy and physiology. Safe and effective airway management strategies are therefore key to the practice of pediatric anesthesia. The goal of this review is to highlight recent publications (2019-2021) aimed to advance pediatric airway safety and to highlight a proposed simple, pediatric-specific, universal framework to guide clinical practice.
RECENT FINDINGS
Recent investigations demonstrate that infants with normal and difficult airways experience high incidences of multiple laryngoscopy attempts and resulting hypoxemia. Video laryngoscopy may improve tracheal intubation first attempt success rate in infants with normal airways. In infants with difficult airways, standard blade video laryngoscopy is associated with higher first attempt success rates over non-standard blade video laryngoscopy. Recent studies in children with Pierre Robin sequence and mucopolysaccharidoses help guide airway equipment and technique selection. Department airway leads and hospital difficult airway services are necessary to disseminate knowledge, lead quality improvement initiatives, and promote evidence-based practice guidelines.
SUMMARY
Pediatric airway management morbidity is a common problem in pediatric anesthesia. Improvements in individual practitioner preparation and management strategies as well as systems-based policies are required. A simple, pediatric-specific, universal airway management framework can be adopted for safe pediatric anesthesia practice.
Topics: Airway Management; Child; Humans; Hypoxia; Infant; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy
PubMed: 33935175
DOI: 10.1097/ACO.0000000000000993 -
Respiratory Care Jul 2021Hypoxemia is common in postoperative patients and is associated with prolonged hospital stays, high costs, and increased mortality. This review discusses the... (Review)
Review
Hypoxemia is common in postoperative patients and is associated with prolonged hospital stays, high costs, and increased mortality. This review discusses the postoperative management of hypoxemia in regard to the use of conventional oxygen therapy, high-flow nasal cannula oxygen therapy, CPAP, and noninvasive ventilation. The recommendations made are based on the currently available evidence.
Topics: Cannula; Continuous Positive Airway Pressure; Humans; Hypoxia; Noninvasive Ventilation; Oxygen; Oxygen Inhalation Therapy
PubMed: 34006596
DOI: 10.4187/respcare.08929 -
International Journal of Molecular... Oct 2022Intermittent hypoxia (IH), one of the primary pathologies of sleep apnea syndrome (SAS), exposes cells throughout the body to repeated cycles of hypoxia/normoxia that... (Review)
Review
Intermittent hypoxia (IH), one of the primary pathologies of sleep apnea syndrome (SAS), exposes cells throughout the body to repeated cycles of hypoxia/normoxia that result in oxidative stress and systemic inflammation. Since SAS is epidemiologically strongly correlated with type 2 diabetes/insulin resistance, obesity, hypertension, and dyslipidemia included in metabolic syndrome, the effects of IH on gene expression in the corresponding cells of each organ have been studied intensively to clarify the molecular mechanism of the association between SAS and metabolic syndrome. Dementia has recently been recognized as a serious health problem due to its increasing incidence, and a large body of evidence has shown its strong correlation with SAS and metabolic disorders. In this narrative review, we first outline the effects of IH on the expression of genes related to metabolism in neuronal cells, pancreatic β cells, hepatocytes, adipocytes, myocytes, and renal cells (mainly based on the results of our experiments). Next, we discuss the literature regarding the mechanisms by which metabolic disorders and IH develop dementia to understand how IH directly and indirectly leads to the development of dementia.
Topics: Humans; Diabetes Mellitus, Type 2; Metabolic Syndrome; Hypoxia; Cognition; Dementia
PubMed: 36361741
DOI: 10.3390/ijms232112957 -
Nature Reviews. Drug Discovery Mar 2024Hypoxia-inducible factors (HIFs) are highly conserved transcription factors that are crucial for adaptation of metazoans to limited oxygen availability. Recently, HIF... (Review)
Review
Hypoxia-inducible factors (HIFs) are highly conserved transcription factors that are crucial for adaptation of metazoans to limited oxygen availability. Recently, HIF activation and inhibition have emerged as therapeutic targets in various human diseases. Pharmacologically desirable effects of HIF activation include erythropoiesis stimulation, cellular metabolism optimization during hypoxia and adaptive responses during ischaemia and inflammation. By contrast, HIF inhibition has been explored as a therapy for various cancers, retinal neovascularization and pulmonary hypertension. This Review discusses the biochemical mechanisms that control HIF stabilization and the molecular strategies that can be exploited pharmacologically to activate or inhibit HIFs. In addition, we examine medical conditions that benefit from targeting HIFs, the potential side effects of HIF activation or inhibition and future challenges in this field.
Topics: Humans; Basic Helix-Loop-Helix Transcription Factors; Hypoxia; Transcription Factors; Neoplasms; Oxygen
PubMed: 38123660
DOI: 10.1038/s41573-023-00848-6 -
Experimental Neurology Feb 2022
Topics: Animals; Humans; Hypoxia; Neuronal Plasticity; Reactive Oxygen Species; Time Factors
PubMed: 34955452
DOI: 10.1016/j.expneurol.2021.113951 -
Anesthesia and Analgesia May 2023Critically injured patients who are agitated and delirious on arrival do not allow optimal preoxygenation in the emergency area. We investigated whether the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Critically injured patients who are agitated and delirious on arrival do not allow optimal preoxygenation in the emergency area. We investigated whether the administration of intravenous (IV) ketamine 3 minutes before administration of a muscle relaxant is associated with better oxygen saturation levels while intubating these patients.
METHODS
Two hundred critically injured patients who required definitive airway management on arrival were recruited. The subjects were randomized as delayed sequence intubation (group DSI) or rapid sequence intubation (group RSI). In group DSI, patients received a dissociative dose of ketamine followed by 3 minutes of preoxygenation and paralysis using IV succinylcholine for intubation. In group RSI, a 3-minute preoxygenation was performed before induction and paralysis using the same drugs, as described conventionally. The primary outcome was incidence of peri-intubation hypoxia. Secondary outcomes were first-attempt success rate, use of adjuncts, airway injuries, and hemodynamic parameters.
RESULTS
Peri-intubation hypoxia was significantly lower in group DSI (8 [8%]) compared to group RSI (35 [35%]; P = .001). First-attempt success rate was higher in group DSI (83% vs 69%; P = .02). A significant improvement in mean oxygen saturation levels from baseline values was seen in group DSI only. There was no incidence of hemodynamic instability. There was no statistically significant difference in airway-related adverse events.
CONCLUSIONS
DSI appears promising in critically injured trauma patients who do not allow adequate preoxygenation due to agitation and delirium and require definitive airway on arrival.
Topics: Humans; Ketamine; Rapid Sequence Induction and Intubation; Intubation, Intratracheal; Triage; Hypoxia; Paralysis
PubMed: 37058727
DOI: 10.1213/ANE.0000000000006171 -
Ugeskrift For Laeger Dec 2023Home oxygen therapy is an acknowledged treatment for patients suffering from chronic hypoxaemia, due to pulmonary or cardiac disease, and may have positive effects on... (Review)
Review
Home oxygen therapy is an acknowledged treatment for patients suffering from chronic hypoxaemia, due to pulmonary or cardiac disease, and may have positive effects on survival and quality of life. The risks and side effects of the treatment are usually mild, and the equipment has developed to become relatively affordable, accessible and easy to transport. Adjustments in the oxygen settings can be necessary when travelling by airplane or during physical effort or sleep. Prescription and follow-ups are usually best maintained by hospital departments with expertise in pulmonary medicine, as argued in this review.
Topics: Humans; Quality of Life; Oxygen Inhalation Therapy; Lung; Oxygen; Denmark; Hypoxia
PubMed: 38078470
DOI: No ID Found -
Journal of Applied Physiology... May 2021The word "hypoxia" has recently come to the attention of the general public on two occasions, the Nobel Prize in Medicine or Physiology in 2019 and the recent COVID-19...
The word "hypoxia" has recently come to the attention of the general public on two occasions, the Nobel Prize in Medicine or Physiology in 2019 and the recent COVID-19 pandemic. In the academic environment, hypoxia is a current topic of research in biology, physiology, and medicine: in October 2020, there were more than 150,000 occurrences of "hypoxia" in the PubMed database. However, the first occurrence is dated to 1945, while the interest for the effects of oxygen lack on the living organisms started in the mid-19th century, when scientists explored high altitude regions and mainly used the terms "anoxia" or "anoxemia." I therefore researched online through multiple databases to look for the first appearance of "hypoxia" and related terms "hypoxemia" and "hypoxybiosis" in scientific literature published in English, German, French, Italian, and Spanish. Viault and Jolyet used "Hypohématose" in 1894, but this term has not been used since. Hypoxybiosis first appeared in 1909 in Germany, then hypoxemia in 1923 in Austria, and hypoxia in 1938 in Holland. It was then exported to the United States where it appeared in 1940 in cardiology and anesthesiology. The clinical distinction between anoxia and hypoxia was clearly defined by Carl Wiggers in 1941. Hypoxia (decrease in oxygen), by essence variable in time and in localization in the body, in contrast with anoxia (absence of oxygen), illustrates the concept of homeodynamics that defines a living organism as a complex system in permanent instability, exposed to environmental and internal perturbations.
Topics: COVID-19; Germany; History, 20th Century; Humans; Hypoxia; Inventions; Netherlands; Pandemics; SARS-CoV-2
PubMed: 33703942
DOI: 10.1152/japplphysiol.00936.2020 -
Reproductive Sciences (Thousand Oaks,... Jul 2023Ferroptosis is a recently identified form of programmed cell death which is different from apoptosis, pyroptosis, necrosis, and autophagy. It is uniquely defined by... (Review)
Review
Ferroptosis is a recently identified form of programmed cell death which is different from apoptosis, pyroptosis, necrosis, and autophagy. It is uniquely defined by redox-active iron-dependent hydroxy-peroxidation of polyunsaturated fatty acid (PUFA)-containing phospholipids and a loss of lipid peroxidation repair capacity. Ferroptosis has recently been implicated in multiple human diseases, such as tumors, ischemia-reperfusion injury, acute kidney injury, neurological diseases, and asthma among others. Intriguingly, ferroptosis is associated with placental physiology and trophoblast injury. Circumstances such as accumulation of lipid reactive oxygen species (ROS) due to hypoxia-reperfusion and anoxia-reoxygenation of trophoblast during placental development, the abundance of trophoblastic iron and PUFA, physiological uterine contractions, or pathological placental bed perfusion, cause placental trophoblasts' susceptibility to ferroptosis. Ferroptosis of trophoblast can cause placental dysfunction, which may be involved in the occurrence and development of placenta-related diseases such as gestational diabetes mellitus, preeclampsia, fetal growth restriction, preterm birth, and abortion. The regulatory mechanisms of trophoblastic ferroptosis still need to be explored further. Here, we summarize the latest progress in trophoblastic ferroptosis research on placental-related diseases, provide references for further understanding of its pathogenesis, and propose new strategies for the prevention and treatment of placental-related diseases.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Placenta; Ferroptosis; Premature Birth; Apoptosis; Lipid Peroxidation; Iron; Placenta Diseases; Hypoxia
PubMed: 36930425
DOI: 10.1007/s43032-023-01193-0 -
Ugeskrift For Laeger Nov 2022Oxygen is a standard treatment for patients with chronic lung diseases and hypoxemia. The two main groups of lung diseases leading to oxygen treatment is chronic... (Review)
Review
Oxygen is a standard treatment for patients with chronic lung diseases and hypoxemia. The two main groups of lung diseases leading to oxygen treatment is chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Several guidelines for home oxygen therapy for patients with ILD is, however, based on older observation and extrapolations from studies on COPD. This review focuses on the different oxygen treatment modalities for patients with ILD focusing on present evidence and upcoming trials that might change the oxygen therapy approach for patients with ILD.
Topics: Humans; Oxygen Inhalation Therapy; Lung Diseases, Interstitial; Pulmonary Disease, Chronic Obstructive; Oxygen; Hypoxia
PubMed: 36426814
DOI: No ID Found