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Respiration; International Review of... 2022Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital...
BACKGROUND
Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed.
METHODS
A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed.
RESULTS
The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort.
CONCLUSION
This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.
Topics: Adult; Critical Care; Humans; Hypercapnia; Hypoxia; Oxygen; Oxygen Inhalation Therapy
PubMed: 34933311
DOI: 10.1159/000520294 -
Biomedica : Revista Del Instituto... Sep 2019Aerobic exercise generates increased cardiorespiratory fitness, which results in a protective factor for cardiovascular disease. High-intensity interval training (HIIT)... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of high-intensity interval training compared to moderate-intensity continuous training on maximal oxygen consumption and blood pressure in healthy men: A randomized controlled trial.
INTRODUCTION
Aerobic exercise generates increased cardiorespiratory fitness, which results in a protective factor for cardiovascular disease. High-intensity interval training (HIIT) might produce higher increases on cardiorespiratory fitness in comparison with moderate-intensity continuous training (MICT); however, current evidence is not conclusive.
OBJECTIVE
To compare the effects of a low-volume HIIT and a MICT on maximal oxygen consumption (VO2max), systolic blood pressure, and diastolic blood pressure during eight weeks in healthy men between 18 and 44 years of age.
MATERIALS AND METHODS
We conducted a randomized controlled trial. Forty-four volunteers were randomized to HIIT (n=22) or MICT (n=22). Both groups performed 24 sessions on a treadmill. The HIIT group completed 15 bouts of 30 seconds (90-95%, maximal heart rate, HRmax), while the MICT group completed 40 minutes of continuous exercise (65-75% HRmax). Results: Intra-group analysis showed an increase in VO2max of 3.5 ml/kg/min [95% confidence interval (CI) 2.02 to 4.93; p=0.0001] in HIIT and 1.9 ml/kg/min (95% CI -0.98 to 4.82; p=0.18) in MICT. However, the difference between the two groups was not statistically significant (1.01 ml/kg/min. 95% CI -2.16 to 4.18, p=0.52). MICT generated a greater reduction in systolic blood pressure compared to HIIT (median 8 mm Hg; p<0.001). No statistically significant differences were found between the groups for DBP.
CONCLUSIONS
Results indicated no significant change in VO2max with a low-volume HIIT protocol versus MICT after 24 sessions. In contrast, MICT provided a greater reduction in systolic blood pressure compared to HIIT. The study is registered as a clinical trial via clinicaltrials.gov with identifier number: NCT02288403.
Topics: Adult; Blood Pressure; Confidence Intervals; Exercise; Healthy Volunteers; Heart Rate; High-Intensity Interval Training; Humans; Male; Oxygen Consumption; Young Adult
PubMed: 31584766
DOI: 10.7705/biomedica.4451 -
Scientific Reports Feb 2021Heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) provide important information on cardiovascular autonomic control.... (Clinical Trial)
Clinical Trial
Heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) provide important information on cardiovascular autonomic control. However, little is known about the reorganization of HRV, BPV, and BRS after aerobic exercise. While there is a positive relationship between heart rate (HR) recovery rate and cardiorespiratory fitness, it is unclear whether there is a relationship between cardiorespiratory fitness and reorganization of cardiovascular autonomic modulation during recovery. Thus, this study aimed to investigate whether cardiorespiratory fitness influences the cardiovascular autonomic modulation recovery, after a cardiopulmonary exercise test. Sixty men were assigned into groups according to their cardiorespiratory fitness: low cardiorespiratory fitness (LCF = VO2: 22-38 mL kg min), moderate (MCF = VO2: 38-48 mL kg min), and high (HCF = VO2 > 48 mL kg min). HRV (linear and non-linear analysis) and BPV (spectral analysis), and BRS (sequence method) were performed before and after a cardiopulmonary exercise test. The groups with higher cardiorespiratory fitness had lower baseline HR values and HR recovery time after the cardiopulmonary exercise test. On comparing rest and recovery periods, the spectral analysis of HRV showed a decrease in low-frequency (LF) oscillations in absolute units and high frequency (HF) in absolute and normalized units. It also showed increases in LF oscillations of blood pressure. Nonlinear analysis showed a reduction in approximate entropy (ApEn) and in Poincare Plot parameters (SD1 and SD2), accompanied by increases in detrended fluctuation analysis (DFA) parameters α1 and α2. However, we did not find differences in cardiovascular autonomic modulation parameters and BRS in relation to cardiorespiratory fitness neither before nor after the cardiopulmonary test. We concluded that cardiorespiratory fitness does not affect cardiovascular autonomic modulations after cardiopulmonary exercise test, unlike HR recovery.
Topics: Adult; Autonomic Nervous System; Exercise; Exercise Test; Healthy Volunteers; Heart Rate; Hemodynamics; Humans; Lactic Acid; Male; Oxygen Consumption; Rest; Supine Position
PubMed: 33574441
DOI: 10.1038/s41598-021-83071-w -
Sensors (Basel, Switzerland) Aug 2020Adequate oxygen delivery to a tissue depends on sufficient oxygen content in arterial blood and blood flow to the tissue. Oximetry is a technique for the assessment of... (Review)
Review
Adequate oxygen delivery to a tissue depends on sufficient oxygen content in arterial blood and blood flow to the tissue. Oximetry is a technique for the assessment of blood oxygenation by measurements of light transmission through the blood, which is based on the different absorption spectra of oxygenated and deoxygenated hemoglobin. Oxygen saturation in arterial blood provides information on the adequacy of respiration and is routinely measured in clinical settings, utilizing pulse oximetry. Oxygen saturation, in venous blood (SvO) and in the entire blood in a tissue (StO), is related to the blood supply to the tissue, and several oximetric techniques have been developed for their assessment. SvO can be measured non-invasively in the fingers, making use of modified pulse oximetry, and in the retina, using the modified Beer-Lambert Law. StO is measured in peripheral muscle and cerebral tissue by means of various modes of near infrared spectroscopy (NIRS), utilizing the relative transparency of infrared light in muscle and cerebral tissue. The primary problem of oximetry is the discrimination between absorption by hemoglobin and scattering by tissue elements in the attenuation measurement, and the various techniques developed for isolating the absorption effect are presented in the current review, with their limitations.
Topics: Humans; Monitoring, Physiologic; Oximetry; Oxygen; Spectroscopy, Near-Infrared
PubMed: 32867184
DOI: 10.3390/s20174844 -
Nigerian Journal of Clinical Practice Nov 2023The physical examination is a key part of a continuum that extends from the history of the present illness to the therapeutic outcome. An understanding of the... (Review)
Review
The physical examination is a key part of a continuum that extends from the history of the present illness to the therapeutic outcome. An understanding of the pathophysiological mechanism behind a physical sign is essential for arriving at the correct diagnosis. Early detection of deteriorating physical/vital signs and their appropriate interpretation is thus the key to achieve correct and timely management. By definition, vital signs are "the signs of life that may be monitored or measured, namely pulse rate, respiratory rate, body temperature, and blood pressure." Vital signs are the simplest, cheapest and probably the most inexpensive information gathered bedside in outpatient or hospitalized patients. The pulse oximeter was introduced in the 1980s. It is an accurate and non-invasive method for the measurement of arterial hemoglobin oxygen saturation (SaO2). Pulse oximetry-based arterial oxygen saturation can be effectively used bedside in in-hospital and ambulatory patients with diagnosed or suspected lung disease. The present pandemic of COVID-19 should be considered as a wake-up call. Articles related to arterial oxygen saturation and its importance as a vital sign in patient care were searched online especially in PubMed. Available studies were studied in full length and data was extracted. Discussion: A. Clinical Utility of Oxygen Saturation Monitoring: There are many studies reporting the clinical applicability and usefulness of pulse oximetry in the early detection of hypoxemic events during intraoperative and postoperative periods. B. Role of clinical expertise accompanied by knowledge of physiology: A diagnostic sign is useful only if it is interpreted accurately and applied appropriately while evaluating a patient. The World Health Organisation also appreciates these facts and published "The WHO Pulse Oximetry Training Manual." Understanding the physiology behind and overcoming limitations of the diagnostic sign by clinical expertise is important. While using pulse oximetry, a clinician needs to keep in mind the sigmoidal nature of the oxygen-Hb dissociation curve. Considering these benefits of SaO2 measurement, there have been several references in the past to consider oxygen saturation as the fifth vital sign. In the present pandemic oxygen saturation i.e., SpO2 (arterial oxygen saturation) measured by pulse oxymeter, has been the single most important warning and prognostic sign be it for households, offices, street vendors, hospitals or governments. Measurement of trends of SaO2 added with respiratory rate will provide clinicians with a holistic overview of respiratory functions and multidimensional conditions associated with hypoxemia.
Topics: Humans; Heart Rate; Hypoxia; Oximetry; Oxygen; Oxygen Saturation
PubMed: 38044759
DOI: 10.4103/njcp.njcp_2026_21 -
Endocrine Journal Feb 2020Recent studies have revealed that decline in cellular nicotinamide adenine dinucleotide (NAD) levels causes aging-related disorders and therapeutic approaches increasing... (Clinical Trial)
Clinical Trial
Recent studies have revealed that decline in cellular nicotinamide adenine dinucleotide (NAD) levels causes aging-related disorders and therapeutic approaches increasing cellular NAD prevent these disorders in animal models. The administration of nicotinamide mononucleotide (NMN) has been shown to mitigate aging-related dysfunctions. However, the safety of NMN in humans have remained unclear. We, therefore, conducted a clinical trial to investigate the safety of single NMN administration in 10 healthy men. A single-arm non-randomized intervention was conducted by single oral administration of 100, 250, and 500 mg NMN. Clinical findings and parameters, and the pharmacokinetics of NMN metabolites were investigated for 5 h after each intervention. Ophthalmic examination and sleep quality assessment were also conducted before and after the intervention. The single oral administrations of NMN did not cause any significant clinical symptoms or changes in heart rate, blood pressure, oxygen saturation, and body temperature. Laboratory analysis results did not show significant changes, except for increases in serum bilirubin levels and decreases in serum creatinine, chloride, and blood glucose levels within the normal ranges, independent of the dose of NMN. Results of ophthalmic examination and sleep quality score showed no differences before and after the intervention. Plasma concentrations of N-methyl-2-pyridone-5-carboxamide and N-methyl-4-pyridone-5-carboxamide were significantly increased dose-dependently by NMN administration. The single oral administration of NMN was safe and effectively metabolized in healthy men without causing any significant deleterious effects. Thus, the oral administration of NMN was found to be feasible, implicating a potential therapeutic strategy to mitigate aging-related disorders in humans.
Topics: Administration, Oral; Adult; Bilirubin; Blood Glucose; Blood Pressure; Body Temperature; Chlorides; Chromatography, Liquid; Creatinine; Diagnostic Techniques, Ophthalmological; Dose-Response Relationship, Drug; Electrocardiography; Healthy Volunteers; Heart Rate; Humans; Intraocular Pressure; Japan; Male; Middle Aged; Niacinamide; Nicotinamide Mononucleotide; Oxygen; Pyridones; Sleep; Tandem Mass Spectrometry; Visual Acuity
PubMed: 31685720
DOI: 10.1507/endocrj.EJ19-0313 -
Journal of Applied Physiology... Oct 2019Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with attenuated vascular function, cardiorespiratory capacity, physical function, and... (Randomized Controlled Trial)
Randomized Controlled Trial
Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with attenuated vascular function, cardiorespiratory capacity, physical function, and muscular strength. It is essential to combat these negative effects on health by incorporating lifestyle interventions to slow disease progression, such as exercise. We sought to examine the effects of aquatic walking exercise on cardiovascular function, cardiorespiratory capacity [maximal volume of oxygen consumption (V̇o)], exercise tolerance [6-min walking distance (6MWD)], physical function, muscular strength, and body composition in patients with PAD. Patients with PAD ( = 72) were recruited and randomly assigned to a 12-wk aquatic walking training group (AQ, = 35) or a control group (CON, = 37). The AQ group performed walking and leg exercises in waist-to-chest-deep water. Leg arterial stiffness [femoral-to-ankle pulse wave velocity (legPWV)], heart rate (HR), blood pressure (BP), ankle-to-brachial index (ABI), V̇o, 6MWD, physical function, muscular strength, body composition, resting metabolic rate (RMR), and flexibility were measured before and after 12 wk. There were significant group × time interactions ( < 0.05) after 12 wk for legPWV and HR, which significantly decreased ( < 0.05) in AQ, and V̇o, 6MWD, physical function, and muscular strength, which significantly increased ( < 0.05) in AQ, compared with no changes in CON. There were no significant differences ( > 0.05) for BP, ABI, RMR, or flexibility after 12 wk. Interestingly, there was relatively high adherence (84%) to the aquatic walking exercise program in this population. These results suggest that aquatic walking exercise is an effective therapy to reduce arterial stiffness and resting HR and improve cardiorespiratory capacity, exercise tolerance, physical function, and muscular strength in patients with PAD. The results of this study reveal for the first time that aquatic walking exercise can decrease arterial stiffness and improve exercise tolerance, cardiorespiratory capacity, and muscular strength in patients with peripheral artery disease (PAD). Aquatic walking exercise training demonstrates relatively high exercise adherence in this population. Aquatic walking exercise training may be a useful therapeutic intervention for improving physical function in patients with PAD.
Topics: Aged; Ankle; Ankle Brachial Index; Blood Pressure; Exercise; Exercise Test; Exercise Therapy; Exercise Tolerance; Female; Heart Rate; Humans; Intermittent Claudication; Lower Extremity; Male; Muscle Strength; Oxygen Consumption; Peripheral Arterial Disease; Pulse Wave Analysis; Vascular Stiffness; Walking
PubMed: 31369328
DOI: 10.1152/japplphysiol.00209.2019 -
Journal of Perinatal Medicine Dec 2019For newly born babies, especially those in need of intervention at birth, actions taken during the first minute after birth, the so-called "Golden Minute", can have... (Review)
Review
For newly born babies, especially those in need of intervention at birth, actions taken during the first minute after birth, the so-called "Golden Minute", can have important implications for long-term outcomes. Both delivery room handling, including identification of maternal and infant risk factors and provision of effective resuscitation interventions, and antenatal care decisions regarding antenatal steroid administration and mode of delivery, are important and can affect outcomes. Anticipating risk factors for neonates at high risk of requiring resuscitation can decrease time to resuscitation and improve the prognosis. Following a review of maternal and fetal risk factors affecting newborn resuscitation, we summarize the current recommendations for delivery room handling of the newborn. This includes recommendations and rationale for the use of delayed cord clamping and cord milking, heart rate assessment [including the use of electrocardiogram (ECG) electrodes in the delivery room], role of suctioning in newborn resuscitation, and the impact of various ventilatory modes. Oxygenation should be monitored by pulse oximetry. Effects of oxygen and surfactant on subsequent pulmonary outcomes, and recommendations for provisions of appropriate thermoregulatory support are discussed. Regular teaching of delivery room handling should be mandatory.
Topics: Body Temperature; Heart Rate; Humans; Infant, Newborn; Neonatal Screening; Resuscitation; Umbilical Cord
PubMed: 31834864
DOI: 10.1515/jpm-2019-0304 -
Neonatology 2021Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery... (Review)
Review
Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery room should therefore be optimized, but knowledge gaps, including initial fraction of oxygen (FiO2) and how FiO2 should be changed to reach an optimal oxygen saturation measured by pulse oximetry (SpO2) target within the first 5-10 min of life, remain. In order to answer this question, we therefore reviewed relevant literature. For newly born infants with gestational age (GA) <32 weeks in need of positive pressure ventilation (PPV) immediately after birth, we identified 2 fundamental issues: (1) the optimal initial FiO2 and (2) the target SpO2 within the first 5-10 min of life. For newly born infants between 29 and 31 weeks of GA, an initial FiO2 of 0.3 hit the target defined by the International Liaison Committee on Resuscitation (ILCOR) best. Newborn infants with GA <29 weeks in need of PPV and supplementary oxygen, we suggest starting with FiO2 0.3 and adjusting the FiO2 to reach SpO2 of 80% within 5 min of life for best outcomes. Prolonged bradycardia (heart rate <100 bpm for >2 min) is associated with increased risk of adverse outcomes, including death. The combination of strict control of development of SpO2 in the first 10 min of life and a heart rate >100 bpm represents the best tool today to achieve the most optimal outcome in the delivery room of very preterm and immature newborn infants.
Topics: Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Oximetry; Oxygen
PubMed: 33902059
DOI: 10.1159/000516261 -
Journal of Forensic and Legal Medicine Oct 2020Law-enforcement often uses forensic restraints to control individuals and often these individuals are placed in positions and with various amounts of weight used to hold... (Review)
Review
Law-enforcement often uses forensic restraints to control individuals and often these individuals are placed in positions and with various amounts of weight used to hold them in place. There has been a moderate amount of research performed on humans in this field of study to assess the physiologic impact of the positions and weight on ventilatory and cardiovascular parameters. This review discusses the scientific medical literature on the use of restraints and restraint position including the use of weight force and aggregates the findings in specific physiologic areas, such as impact on blood pressure, heart rate, and ventilatory parameters.
Topics: Asphyxia; Blood Pressure; Cardiac Output; Forensic Sciences; Heart Rate; Humans; Oxygen Consumption; Prone Position; Respiratory Function Tests; Restraint, Physical
PubMed: 32956928
DOI: 10.1016/j.jflm.2020.102056