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The Journal of International Medical... Aug 2020Spontaneous epistaxis in patients with COVID-19 can represent a clinical challenge with respect to both the risk of contamination and the treatment options. We herein...
Spontaneous epistaxis in patients with COVID-19 can represent a clinical challenge with respect to both the risk of contamination and the treatment options. We herein present the data of 30 patients with COVID-19 who developed spontaneous epistaxis while hospitalized at Eastern Piedmont Hospital during March and April 2020. All patients received low-molecular-weight heparin during their hospital stay and required supplementary oxygen therapy either by a nasal cannula or continuous positive airway pressure. Both conditions can represent risk factors for developing epistaxis. Prevention of crust formation in patients with rhinitis using a nasal lubricant should be recommended. If any treatment is required, appropriate self-protection is mandatory.
Topics: Aged; Betacoronavirus; COVID-19; Cannula; Continuous Positive Airway Pressure; Coronavirus Infections; Epistaxis; Female; Heparin; Humans; Male; Middle Aged; Nasal Mucosa; Oxygen Inhalation Therapy; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32865072
DOI: 10.1177/0300060520951040 -
The European Respiratory Journal Oct 2021Oxygen therapy is frequently prescribed for the palliation of breathlessness, despite lack of evidence for its effectiveness in people who are not hypoxaemic. This study...
Oxygen therapy is frequently prescribed for the palliation of breathlessness, despite lack of evidence for its effectiveness in people who are not hypoxaemic. This study aimed to compare and contrast patients', caregivers' and clinicians' experiences of palliative oxygen use for the relief of chronic breathlessness in people with advanced life-limiting illnesses, and how this shapes prescribing.A systematic review and meta-synthesis of qualitative data was conducted. MEDLINE, CINAHL and PsycINFO were searched for peer-reviewed studies in English (2000-April 2019) reporting perspectives on palliative oxygen use for reducing breathlessness in people with advanced illnesses in any healthcare setting. After data extraction, thematic synthesis used line-by-line coding of raw data (quotes) to generate descriptive and analytical themes.Of 457 articles identified, 22 met the inclusion criteria by reporting perspectives of patients (n=337), caregivers (n=91) or clinicians (n=616). Themes common to these perspectives were: 1) benefits and burdens of palliative oxygen use, 2) knowledge and perceptions of palliative oxygen use beyond the guidelines, and 3) longitudinal trajectories of palliative oxygen use.There are differing perceptions regarding the benefits and burdens of using palliative oxygen. Clinicians should be aware that oxygen use may generate differing goals of therapy for patients and caregivers. These perceptions should be taken into consideration when prescribing oxygen for the symptomatic relief of chronic breathlessness in patients who do not quality for long-term oxygen therapy.
Topics: Caregivers; Dyspnea; Humans; Oxygen; Oxygen Inhalation Therapy; Palliative Care
PubMed: 33653807
DOI: 10.1183/13993003.04613-2020 -
International Journal of Chronic... 2023Devices for Automated Oxygen Administration (AOA) have been developed to optimize the therapeutic benefit of oxygen supplementation. We aimed to investigate the effect... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Devices for Automated Oxygen Administration (AOA) have been developed to optimize the therapeutic benefit of oxygen supplementation. We aimed to investigate the effect of AOA on multidimensional aspects of dyspnea and as-needed consumption of opioids and benzodiazepines, as opposed to conventional oxygen therapy, in hospitalized patients with Acute Exacerbation of COPD (AECOPD).
METHOD AND PATIENTS
A multicenter randomized controlled trial across five respiratory wards in the Capital Region of Denmark. Patients admitted with AECOPD (n=157) were allocated 1:1 to either AOA (O2matic Ltd), a closed loop device automatically delivering oxygen according to the patient's peripheral oxygen saturation (SpO), or conventional nurse-administered oxygen therapy. Oxygen flows and SpO levels were measured by the O2matic device in both groups, while dyspnea, anxiety, depression, and COPD symptoms were accessed by Patient Reported Outcomes.
RESULTS
Of the 157 randomized patients, 127 had complete data for the intervention. The AOA reduced patients' perception of overall unpleasantness significantly on the Multidimensional Dyspnea Profile (MDP) with a difference in medians of -3 (=0.003) between the intervention group (n=64) and the control group (n=63). The AOA also provided a significant between group difference in all single items within the sensory domain of the MDP (all -values≤0.05) as well as in the Visual Analogue Scale - Dyspnea (VAS-D) within the past three days (=0.013). All between group differences exceeded the Minimal Clinical Important Difference of the MDP and VAS-D, respectively. AOA did not seem to have an impact on the emotional response domain of the MDP, the COPD Assessment Test, the Hospital Anxiety and Depression Scale, or use of as-needed opioids and/or benzodiazepines (all -values>0.05).
CONCLUSION
AOA reduces both breathing discomfort and physical perception of dyspnea in patients admitted with AECOPD but did not seem to impact the emotional status or other COPD symptoms.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Oxygen Inhalation Therapy; Dyspnea; Hospitalization; Oxygen
PubMed: 37096159
DOI: 10.2147/COPD.S397782 -
Intensive Care Medicine Dec 2022The effect of high arterial oxygen levels and supplemental oxygen administration on outcomes in traumatic brain injury (TBI) is debated, and data from large cohorts of... (Observational Study)
Observational Study
PURPOSE
The effect of high arterial oxygen levels and supplemental oxygen administration on outcomes in traumatic brain injury (TBI) is debated, and data from large cohorts of TBI patients are limited. We investigated whether exposure to high blood oxygen levels and high oxygen supplementation is independently associated with outcomes in TBI patients admitted to the intensive care unit (ICU) and undergoing mechanical ventilation.
METHODS
This is a secondary analysis of two multicenter, prospective, observational, cohort studies performed in Europe and Australia. In TBI patients admitted to ICU, we describe the arterial partial pressure of oxygen (PaO) and the oxygen inspired fraction (FiO). We explored the association between high PaO and FiO levels within the first week with clinical outcomes. Furthermore, in the CENTER-TBI cohort, we investigate whether PaO and FiO levels may have differential relationships with outcome in the presence of varying levels of brain injury severity (as quantified by levels of glial fibrillary acidic protein (GFAP) in blood samples obtained within 24 h of injury).
RESULTS
The analysis included 1084 patients (11,577 measurements) in the CENTER-TBI cohort, of whom 55% had an unfavorable outcome, and 26% died at a 6-month follow-up. Median PaO ranged from 93 to 166 mmHg. Exposure to higher PaO and FiO in the first seven days after ICU admission was independently associated with a higher mortality rate. A trend of a higher mortality rate was partially confirmed in the OzENTER-TBI cohort (n = 159). GFAP was independently associated with mortality and functional neurologic outcome at follow-up, but it did not modulate the outcome impact of high PaO levels, which remained independently associated with 6-month mortality.
CONCLUSIONS
In two large prospective multicenter cohorts of critically ill patients with TBI, levels of PaO and FiO varied widely across centers during the first seven days after ICU admission. Exposure to high arterial blood oxygen or high supplemental oxygen was independently associated with 6-month mortality in the CENTER-TBI cohort, and the severity of brain injury did not modulate this relationship. Due to the limited sample size, the findings were not wholly validated in the external OzENTER-TBI cohort. We cannot exclude the possibility that the worse outcomes associated with higher PaO were due to use of higher FiO in patients with more severe injury or physiological compromise. Further, these findings may not apply to patients in whom FiO and PaO are titrated to brain tissue oxygen monitoring (PbtO) levels. However, at minimum, these findings support the need for caution with oxygen therapy in TBI, particularly since titration of supplemental oxygen is immediately applicable at the bedside.
Topics: Humans; Oxygen; Prospective Studies; Oxygen Inhalation Therapy; Brain Injuries, Traumatic; Brain Injuries
PubMed: 36264365
DOI: 10.1007/s00134-022-06884-x -
Therapeutic Advances in Respiratory... 2020Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, but safe and effective treatment options remain unavailable. Numerous systematic reviews of varying... (Review)
Review
BACKGROUND
Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, but safe and effective treatment options remain unavailable. Numerous systematic reviews of varying qualities have tried to summarize the evidence on the available therapeutic interventions for COVID-19. This overview of reviews aims to provide a succinct summary of the findings of systematic reviews on different pharmacological and non-pharmacological therapeutic interventions for COVID-19.
METHODS
We searched PubMed, Embase, Google Scholar, Cochrane Database of Systematic Reviews, and WHO database of publications on COVID-19 from 1 December 2019 through to 11 June 2020 for peer-reviewed systematic review studies that reported on potential pharmacological or non-pharmacological therapies for COVID-19. Quality assessment was completed using A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) measure.
RESULTS
Out of 816 non-duplicate studies, 45 were included in the overview. Antiviral and antibiotic agents, corticosteroids, and anti-malarial agents were the most common drug classes used to treat COVID-19; however, there was no direct or strong evidence to support their efficacy. Oxygen therapy and ventilatory support was the most common non-pharmacological supportive care. The quality of most of the included reviews was rated as low or critically low.
CONCLUSION
This overview of reviews demonstrates that although some therapeutic interventions may be beneficial to specific subgroups of COVID-19 patients, the available data are insufficient to strongly recommend any particular treatment option to be used at a population level. Future systematic reviews on COVID-19 treatments should adhere to the recommended systematic review methodologies and ensure that promptness and comprehensiveness are balanced.
Topics: COVID-19; Evidence-Based Medicine; Humans; Oxygen Inhalation Therapy; Respiration, Artificial; Systematic Reviews as Topic; Treatment Outcome; COVID-19 Drug Treatment
PubMed: 33326318
DOI: 10.1177/1753466620976021 -
Minerva Anestesiologica May 2022Procedural sedation for therapeutic and diagnostic procedures can now be achieved through deep sedation techniques that guarantee procedural success. Deep sedation...
Procedural sedation for therapeutic and diagnostic procedures can now be achieved through deep sedation techniques that guarantee procedural success. Deep sedation techniques are delivered in a variety of non-theatre environments where the usual levels of anesthetic equipment are not practical or economical. Hypoxic events are particularly frequent, and challenge sedation providers. Traditional low flow nasal or facial oxygen therapy techniques are often insufficient to maintain acceptable oxygen levels and prevent peri-procedural hypoxia. High flow nasal oxygen delivers warm humidified oxygen up to 70 L/min, at oxygen concentrations between 21-100%, and reduces the incidence of hypoxic events. The provision of deep sedation is a complex process, fraught with risk, which can challenge even the skilled anesthetist. Therefore, regulatory authorities previously stipulated that anesthesia personnel be present during deep sedation. Changing attitudes by regulatory authorities and practical challenges providing anesthesia specialists have led to the acknowledgement that appropriately trained non-anesthetic staff can safely provide deep sedation. Deep sedation services are increasingly applied to subjects with complex co-morbidities, sometimes excluded for safety reasons from surgery under general anesthesia. The development of deep sedation services, delivered by non-anesthesia personnel, to patients with complex co-morbidities requires that services implement appropriate clinical governance tools to prevent deep sedation being the wild west of anesthesia services. Therefore, whilst high flow nasal oxygen may reduce the incidence of peri-procedural hypoxia, the introduction of clinical governance tools and the systematic introduction of initiatives to improve quality, will maintain the safety of deep sedation services.
Topics: Anesthesia, General; Clinical Governance; Conscious Sedation; Deep Sedation; Humans; Hypoxia; Oxygen; Oxygen Inhalation Therapy
PubMed: 34527411
DOI: 10.23736/S0375-9393.21.16078-X -
Respiratory Care Feb 2021
Topics: Humans; Oxygen; Oxygen Inhalation Therapy; Patient Discharge; Pulmonary Disease, Chronic Obstructive
PubMed: 33514661
DOI: 10.4187/respcare.08832 -
Zhongguo Dang Dai Er Ke Za Zhi =... Nov 2022Oxygen reserve index (ORI) is a novel dimensionless index used for noninvasive, real-time, and continuous monitoring of oxygenation, and ORI value ranges from 0 to 1,...
Oxygen reserve index (ORI) is a novel dimensionless index used for noninvasive, real-time, and continuous monitoring of oxygenation, and ORI value ranges from 0 to 1, which reflects the range of 100-200 mmHg for arterial partial pressure of oxygen. ORI combined with pulse oximetry may help to accurately adjust the concentration of inspired oxygen and prevent hyperoxemia and hypoxemia. ORI is suitable for various clinical situations, and the medical staff should master this novel parameter and use it properly to assess the oxygenation of patients. In addition, several limitations of ORI should be noticed during clinical application.
Topics: Humans; Oxygen; Blood Gas Analysis; Oxygen Inhalation Therapy; Oximetry; Hypoxia
PubMed: 36398556
DOI: 10.7499/j.issn.1008-8830.2206112 -
Anaesthesia Jan 2021Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the... (Review)
Review
Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the mid-20th century but has seen renewed interest in the last decade following the demonstration of apnoeic oxygenation with low-flow, and subsequently high-flow, nasal oxygen. This narrative review summarises our understanding of apnoeic oxygenation in the paediatric population. We examine the evidence supporting oxygenation via tracheal tube, modified laryngoscopes and nasal cannulae. The evidence for prolongation of safe apnoea time at induction of anaesthesia is also appraised. We explore the capacity for carbon dioxide clearance, flow rate selection with high-flow nasal oxygen and complications associated with the technique. It remains uncertain whether apnoeic oxygenation in paediatric patients results in a meaningful clinical benefit compared with standard care for outcomes such as the number of tracheal intubation attempts or the incidence of hypoxaemia. In particular, the role of apnoeic oxygenation in paediatric difficult airway management is unclear as this has not been the targeted focus of any published research to date.
Topics: Adolescent; Airway Management; Anesthesia; Apnea; Cannula; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Nasal Cavity; Oxygen Inhalation Therapy; Pediatrics
PubMed: 32592510
DOI: 10.1111/anae.15107 -
PloS One 2022Oxygen (O2) is a mainstay of treatment in acute severe asthma but how it is administered varies widely. The objectives were to examine whether a trial comparing... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Oxygen (O2) is a mainstay of treatment in acute severe asthma but how it is administered varies widely. The objectives were to examine whether a trial comparing humidified O2 to standard O2 in children is feasible, and specifically to obtain data on recruitment, tolerability and outcome measure stability.
METHODS
Heated humidified, cold humidified and standard O2 treatments were compared for children (2-16 years) with acute severe asthma in a multi-centre, open, parallel, pilot randomised controlled trial (RCT). Multiple outcomes were assessed.
RESULTS
Of 258 children screened, 66 were randomised (heated humidified O2 n = 25; cold humidified O2 n = 21; standard O2 n = 20). Median (IQR) length of stay (hours) in hospital was 37.9 (29.1), 52 (35.4) and 49.1 (29.7) for standard, heated humidified and cold humidified respectively and time (hours) on O2 was 15.9 (9.4), 13.6 (14.9) and 13.1 (14.9) for the three groups respectively. The mean (standard deviation) time (hours) taken to step down nebulised to inhaled treatment was 5.6 (14.3), 35.1 (28.2) and 32.7 (20.1). Asthma Severity Score decreased in all three groups similarly, although missing data prevented complete analysis. Humidified O2 was least well tolerated with eight participants discontinuing their randomised treatment early. An important barrier to recruitment was research nurse availability.
CONCLUSION
Although, the results of this pilot study should not be extrapolated beyond the study sample and inferential conclusions should not be drawn from the results, this is the first RCT to compare humidified and standard O2 therapy in acute severe asthmatics of any age. These findings and accompanying screening data show that a large RCT of O2 therapy is feasible. However, challenges associated with randomisation and data collection should be addressed in any future trial design.
Topics: Adolescent; Asthma; Bronchodilator Agents; Child; Child, Preschool; Female; Humans; Male; Nebulizers and Vaporizers; Oxygen; Oxygen Inhalation Therapy; Pilot Projects; Respiratory Therapy
PubMed: 35113903
DOI: 10.1371/journal.pone.0263044