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Seminars in Fetal & Neonatal Medicine Apr 2020Premature infants undergo a complex postnatal adaptation at birth. For last two centuries, oxygen has been integral to respiratory support of preterm infants at birth.... (Review)
Review
Premature infants undergo a complex postnatal adaptation at birth. For last two centuries, oxygen has been integral to respiratory support of preterm infants at birth. Excess oxygen can cause oxidative stress and tissue injury. Preterm infants due to lung immaturity may need oxygen for successful transition at birth. Although, considerable progress has been made in the last 3 decades, optimum oxygen therapy for preterm delivery room resuscitation remains unknown. In this review, we discuss the history and physiology behind oxygen therapy in the delivery room, evaluate current literature, provide practice points and point out knowledge gaps of oxygen therapy in preterm infant at birth.
Topics: Calibration; Delivery Rooms; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Oxygen; Oxygen Inhalation Therapy; Parturition; Pregnancy; Resuscitation
PubMed: 32044281
DOI: 10.1016/j.siny.2020.101081 -
The Journal of International Medical... Dec 2016High-flow nasal cannula (HFNC) oxygen therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal... (Review)
Review
High-flow nasal cannula (HFNC) oxygen therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNC in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNC for these patients. This review article summarizes the available published literature on the positive physiological effects, mechanisms of action, and the clinical applications of HFNC, compared with traditional oxygen therapy devices. The available literature suggests that HFNC oxygen therapy is an effective modality for the early treatment of critically adult patients.
Topics: Adult; Cannula; Critical Illness; Humans; Lung; Mucociliary Clearance; Nasopharynx; Oxygen; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Respiratory Insufficiency
PubMed: 27698207
DOI: 10.1177/0300060516664621 -
Respiratory Care Jan 2013Home oxygen therapy equipment options have increased over the past several decades, in response to innovations in technology, economic pressure from third-party payers,... (Review)
Review
Home oxygen therapy equipment options have increased over the past several decades, in response to innovations in technology, economic pressure from third-party payers, and patient demands. The delivery of oxygen in the home has evolved from packaged gas systems containing 99% United States Pharmacopeia oxygen provided by continuous-flow delivery to intermittent-flow delivery, with oxygen concentrators delivering < 99% oxygen purity. The majority of published papers indicating the value of long-term oxygen therapy have been based on continuous-flow delivery of 99% United States Pharmacopeia oxygen. The lack of research on new home oxygen therapy devices requires more clinical involvement from physician and respiratory therapist to evaluate the performance of oxygen devices used in the home to ensure the patient is provided adequate oxygenation at all activity levels. New standards of care are required to address the need to have consistent titration of long-term oxygen therapy to meet the patient's home needs at all activity levels. Consistent labeling of metering devices on home oxygen equipment will need to be developed by professional medical societies to be implemented by standards organizations that direct industrial manufacturers. Home oxygen therapy will need professionally trained respiratory therapists reimbursed for skills and service to ensure that patients receive optimal benefits from home oxygen equipment to improve patient outcomes and prevent complications and associated costs.
Topics: Home Care Services; Humans; Lung Diseases; Oxygen; Oxygen Inhalation Therapy
PubMed: 23271820
DOI: 10.4187/respcare.01932 -
JACC. Heart Failure Oct 2016Supplemental oxygen, a therapy that has been used for more than a century, is recommended in all practice guidelines in the management of hypoxemic (peripheral oxygen... (Review)
Review
Supplemental oxygen, a therapy that has been used for more than a century, is recommended in all practice guidelines in the management of hypoxemic (peripheral oxygen saturation <90% to 94% or partial arterial oxygen pressure <60 mm Hg) patients with acute heart failure, but its use in normoxemic patients is controversial. Several pre-clinical and early clinical studies have shown the detrimental effects of oxygen therapy and subsequent hyperoxia in patients with normal oxygen saturation levels. These effects are suggested to be gauged by the increased production of reactive oxygen species and the related oxidative stress and by the reductions in coronary blood flow and myocardial oxygen consumption resulting from hyperoxia-induced vasoconstriction in the cerebral, coronary, and systemic vasculature. Considering these findings, recent practice guidelines are diverging from the previous consensus that oxygen should be administered routinely in patients with cardiac disease, but this new direction is also based on expert opinions rather than evidence such as well-designed trials. In this review, the authors summarize current evidence regarding the cardiovascular effects of supplemental oxygen therapy, particularly evidence from the field of acute heart failure, and delineate knowledge gaps in the field and future directions in research.
Topics: Acute Disease; Coronary Circulation; Heart Failure; Hemodynamics; Humans; Hyperoxia; Hypoxia; Myocardium; Oxidative Stress; Oxygen Consumption; Oxygen Inhalation Therapy; Reactive Oxygen Species; Vasoconstriction
PubMed: 27289409
DOI: 10.1016/j.jchf.2016.03.026 -
Topics in Companion Animal Medicine 2022Respiratory distress is a common ailment in small animal medicine. Oxygen supplementation is a mainstay of initial therapy. High Flow Nasal Cannula Oxygen Therapy... (Review)
Review
Respiratory distress is a common ailment in small animal medicine. Oxygen supplementation is a mainstay of initial therapy. High Flow Nasal Cannula Oxygen Therapy (HFNCOT) has become increasingly popular as a treatment modality in human medicine, and more recently in canine patients. These devices deliver high flow rates of heated and humidified oxygen at an adjustable fraction of inspired oxygen . This article reviews current literature in human patients on HFNCOT as well as studies that have evaluated its use in veterinary patients. A discussion of the respiratory physiology that is associated with respiratory distress, in addition to an overview of currently available oxygen supplementation modalities is provided. The physiologic benefits of HFNCOT are explained, as are technical aspects associated with its use. Recommendations on initial settings, maintenance therapy, and weaning are also described.
Topics: Animals; Cannula; Dogs; Humans; Oxygen; Oxygen Inhalation Therapy
PubMed: 34757156
DOI: 10.1016/j.tcam.2021.100596 -
Seminars in Fetal & Neonatal Medicine Apr 2020Premature neonates <34 weeks gestation can present with early-onset, late-onset and bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PHT), with... (Review)
Review
Premature neonates <34 weeks gestation can present with early-onset, late-onset and bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PHT), with clinical, echocardiographic, and histological features similar to term infants with PHT. Changes in pulmonary vascular resistance (PVR) in response to oxygen are diminished in preterm infants compared to term. Studies from preterm lambs and human infants with BPD have shown that PaO > 30-55 mm Hg promotes pulmonary vasodilation. Targeting saturations of 80-85% by 5 min, 85-95% by 10 min during resuscitation and 90-95% during the postnatal course are appropriate targets for routine management of preterm infants. Among preterm infants with PHT, avoiding hypoxia/hyperoxia by titrating supplemental oxygen to maintain saturations in low to mid 90s with alarm limits at 90 and 97% seems to be a reasonable approach pending further studies. Further high-quality evidence generated from randomized trials is required to guide oxygen therapy in preterm PHT.
Topics: Administration, Inhalation; Animals; Gestational Age; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Oxygen; Oxygen Inhalation Therapy; Sheep
PubMed: 31836427
DOI: 10.1016/j.siny.2019.101070 -
Pulmonology 2021Thermo-humidified nasal high flow (NHF) oxygen therapy is increasingly used in the management of respiratory failure. This therapy has recently gained attention as an... (Review)
Review
Thermo-humidified nasal high flow (NHF) oxygen therapy is increasingly used in the management of respiratory failure. This therapy has recently gained attention as an alternative non-invasive respiratory support in several clinical scenarios, including acute and chronic settings. NHF enhances the patient's comfort and tolerance when compared with standard oxygen by supplying a heated and humidified mixture of air and oxygen at flows up to 60L/min. It can be delivered through different devices. Although few studies have compared the clinical effects of different NHF systems, the purpose of this paper is to describe the major benefits of NHF and to provide a quick guide on how to implement this therapy in daily practice. We have also included a brief description of the most frequently used NHF systems.
Topics: Acute Disease; Humans; Oxygen Inhalation Therapy; Respiratory Insufficiency
PubMed: 33589403
DOI: 10.1016/j.pulmoe.2021.01.005 -
The Cochrane Database of Systematic... Dec 2016Oxygen (O) is widely used in people with acute myocardial infarction (AMI). Previous systematic reviews concluded that there was insufficient evidence to know whether... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Oxygen (O) is widely used in people with acute myocardial infarction (AMI). Previous systematic reviews concluded that there was insufficient evidence to know whether oxygen reduced, increased or had no effect on heart ischaemia or infarct size. Our first Cochrane review in 2010 also concluded there was insufficient evidence to know whether oxygen should be used. Since 2010, the lack of evidence to support this widely used intervention has attracted considerable attention, prompting further trials of oxygen therapy in myocardial infarction patients. It is thus important to update this Cochrane review.
OBJECTIVES
To assess the effects of routine use of inhaled oxygen for acute myocardial infarction (AMI).
SEARCH METHODS
We searched the following bibliographic databases on 6 June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO) and Web of Science (Thomson Reuters). LILACS (Latin American and Caribbean Health Sciences Literature) was last searched in September 2016. We also contacted experts to identify eligible studies. We applied no language restrictions.
SELECTION CRITERIA
Randomised controlled trials in people with suspected or proven AMI (ST-segment elevation myocardial infarction (STEMI) or non-STEMI) within 24 hours after onset, in which the intervention was inhaled oxygen (at normal pressure) compared to air, regardless of co-therapies provided to participants in both arms of the trial.
DATA COLLECTION AND ANALYSIS
Two authors independently reviewed the titles and abstracts of identified studies to see if they met the inclusion criteria and independently undertook the data extraction. We assessed the quality of studies and the risk of bias according to guidance in the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was death. The measure of effect used was the risk ratio (RR) with a 95% confidence interval (CI). We used the GRADE approach to evaluate the quality of the evidence and the GRADE profiler (GRADEpro) to import data from Review Manager 5 and create 'Summary of findings' tables.
MAIN RESULTS
The updated search yielded one new trial, for a total of five included studies involving 1173 participants, 32 of whom died. The pooled risk ratio (RR) of all-cause mortality in the intention-to-treat analysis was 0.99 (95% CI 0.50 to 1.95; 4 studies, N = 1123; I = 46%; quality of evidence: very low) and 1.02 (95% CI 0.52 to 1.98; 4 studies, N = 871; I = 49%; quality of evidence: very low) when only analysing participants with confirmed AMI. One trial measured pain directly, and two others measured it by opiate usage. The trial showed no effect, with a pooled RR of 0.97 for the use of opiates (95% CI 0.78 to 1.20; 2 studies, N = 250). The result on mortality and pain are inconclusive. There is no clear effect for oxygen on infarct size (the evidence is inconsistent and low quality).
AUTHORS' CONCLUSIONS
There is no evidence from randomised controlled trials to support the routine use of inhaled oxygen in people with AMI, and we cannot rule out a harmful effect. Given the uncertainty surrounding the effect of oxygen therapy on all-cause mortality and on other outcomes critical for clinical decision, well-conducted, high quality randomised controlled trials are urgently required to inform guidelines in order to give definitive recommendations about the routine use of oxygen in AMI.
Topics: Air; Analgesics; Cause of Death; Humans; Intention to Treat Analysis; Myocardial Infarction; Oxygen Inhalation Therapy; Pain Measurement; Randomized Controlled Trials as Topic
PubMed: 27991651
DOI: 10.1002/14651858.CD007160.pub4 -
Canadian Journal of Veterinary Research... Oct 2021Dogs with lower airway pathology that present in respiratory distress often receive oxygen therapy as the first line of treatment regardless of the underlying cause.... (Review)
Review
Dogs with lower airway pathology that present in respiratory distress often receive oxygen therapy as the first line of treatment regardless of the underlying cause. Conventional "low-flow" systems deliver oxygen with a maximum flow rate of 15 L/minute. Traditionally, when an animal's respiratory status does not improve with conventional oxygen therapy and treatments for underlying disease, options might be limited to either intubation and mechanical ventilation or humane euthanasia. High-flow oxygen therapy (HFOT) has been gaining popularity in veterinary medicine as an alternative route of oxygen supplementation for animals that require support beyond conventional therapy. High-flow oxygen therapy can supply a mixture of air and oxygen a heated and humidified circuit. It is user friendly and can be used in an environment in which mechanical ventilation is unavailable. This review article is written for emergency doctors and general practitioners who lack access to mechanical ventilation. This article briefly reviews pertinent respiratory physiology, traditional oxygen supplementation techniques, the physiology of HFOT, and the limited evidence available in veterinary medicine regarding the use of HFOT, its applications, and limitations. Guidelines for the use of HFOT are suggested and HFOT is compared to conventional therapy.
Topics: Animals; Dog Diseases; Dogs; Lung Injury; Oxygen; Oxygen Inhalation Therapy
PubMed: 34602728
DOI: No ID Found -
European Review For Medical and... Oct 2020Hypoxia is one of the primary causes that leads to multiple organ injuries and death in COVID-19 patients. Aggressive oxygen therapy for the treatment of hypoxia is...
Hypoxia is one of the primary causes that leads to multiple organ injuries and death in COVID-19 patients. Aggressive oxygen therapy for the treatment of hypoxia is important in saving these patients. We have summarized the mechanisms, efficacy, and side effects of various oxygen therapy techniques and their status or the potential to treat hypoxia in COVID-19 patients. The benefit to risk ratio of each oxygen therapy technique and strategy to use them in COVID-19 patients are discussed. High flow nasal cannula oxygen (HFNO) should be considered a better choice as an early stage oxygen therapy. Supraglottic jet oxygenation and ventilation (SJOV) is a promising alternative for HFNO with potential benefits.
Topics: COVID-19; Humans; Hypoxia; Oxygen Inhalation Therapy; Pandemics; SARS-CoV-2
PubMed: 33090435
DOI: 10.26355/eurrev_202010_23248