oxygen control Dotaz Zobrazit nápovědu
Thorax, ISSN 0040-6376 Vol. 64, suppl. II, April 2009
26 s. : il., tab. ; 28 cm
- MeSH
- dítě MeSH
- oxygenoterapie klasifikace metody MeSH
- zajištění dýchacích cest metody MeSH
- Check Tag
- dítě MeSH
- Publikační typ
- směrnice MeSH
OBJECTIVE: The objective of this study was to evaluate the efficacy of the automatic oxygen control (A-Fio2) in reducing the percentage of time spent in severe hypoxaemia (Spo2 <80%) in preterm infants for the time period on invasive ventilation and/or nasal continuous positive airway pressure (NCPAP) delivered by AVEA ventilator. DESIGN: A parallel arm randomised controlled trial. SETTING: A level-III neonatal intensive care unit. PATIENTS: Preterm infants (<33 weeks birth gestation) who received invasive ventilation or NCPAP in the first 72 hours of age. INTERVENTIONS: A-Fio2 vs manual (M-Fio2) oxygen control. OUTCOMES: The primary outcome of the study was percentage of time spent in severe hypoxaemia (Spo2 <80%). RESULTS: 44 infants were randomised to either A-Fio2 or M-Fio2 arm and continued in the study for the period of respiratory support (invasive ventilation and/or NCPAP). The total number of study days in A-Fio2 and M-Fio2 arm were 194 and 204 days, respectively. The percentage of time spent in Spo2 <80% was significantly lower with A-Fio2 compared with M-Fio2 (median of 0.1% (IQR: 0.07-0.7) vs 0.6% (0.2-2); p=0.03). The number of prolonged episodes (>60 s) of Spo2 <80% per day was also significantly lower in A-Fio2 (0.3 (0.0-2) vs 2 (0.6-6); p=0.02). CONCLUSION: A-Fio2 was associated with statistically significant reduction in the percentage of time spent in severe hypoxaemia when compared with M-Fio2 in preterm infants receiving respiratory support. TRIAL REGISTRATION NUMBER: NCT04223258.
OBJECTIVE: To evaluate the effect of implementing automated oxygen control as routine care in maintaining oxygen saturation (SpO2) within target range in preterm infants. METHODS: Infants <30 weeks gestation in Leiden University Medical Centre before and after the implementation of automated oxygen control were compared. The percentage of time spent with SpO2 within and outside the target range (90-95%) was calculated. SpO2 values were collected every minute and included for analysis when infants received extra oxygen. RESULTS: In a period of 9 months, 42 preterm infants (21 manual, 21 automated) were studied. In the automated period, the median (IQR) time spent with SpO2 within target range increased (manual vs automated: 48.4 (41.5-56.4)% vs 61.9 (48.5-72.3)%; p<0.01) and time SpO2 >95% decreased (41.9 (30.6-49.4)% vs 19.3 (11.5-24.5)%; p<0.001). The time SpO2<90% increased (8.6 (7.2-11.7)% vs 15.1 (14.0-21.1)%; p<0.0001), while SpO2<80% was similar (1.1 (0.4-1.7)% vs 0.9 (0.5-2.1)%; ns). CONCLUSIONS: During oxygen therapy, preterm infants spent more time within the SpO2 target range after implementation of automated oxygen control, with a significant reduction in hyperoxaemia, but not hypoxaemia.
- MeSH
- intratracheální intubace MeSH
- jednotky intenzivní péče o novorozence MeSH
- kyslík aplikace a dávkování krev MeSH
- lidé MeSH
- monitorování fyziologických funkcí * MeSH
- neinvazivní ventilace MeSH
- novorozenec nedonošený MeSH
- novorozenec MeSH
- oxygenoterapie MeSH
- oxymetrie * MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Manual titration of inspired oxygen necessary to adequately respond to respiratory fluctuations of the neonate is a challenging task. Furthermore exposure to high and low levels of oxygen saturations are associated with significant morbidity and mortality. Ventilators that automatically control inspired oxygen based on pulse oximeter signals are becoming available, and seem to be safe and effective when compared to manual control. However the potential to overshoot in response to a hypoxemic episode, thus causing excess hyperoxemia, has not been carefully studied. We evaluated the response of one automated FiO2-SpO2control system to 9,486 desaturations in 21 infants over 113 days. We found that the sustained response to desaturations resulted primarily in achievement of normoxemia with balance between high and low saturations. We concluded that this closed loop control system was adequately damped. We suggest that this kind of analysis might be helpful is refining control algorithms.
Frekventovanou komplikací diabetes mellitus je výskyt ulcerací a gangrén na dolních končetinách, vedoucích často k vysoké amputaci, a to i přes intenzivní a agresivní léčbu. V krátkém přehledu autor upozorňuje na možnost snížení počtu amputací a dalších komplikací cukrovky pomocí hyperbarické oxygenoterapie. Ta by se měla aplikovat denně na 90-120 minut při tlaku 0,25-0,28 MPa 2-3krát, v torpidních případech vícekrát, jak ukázaly některé klinické studie. Pomocí hyperbarické oxygenoterapie v rámci komplexního léčebného programu lze v mnohých případech zachránit končetinu před amputací, zkrátit dobu hospitalizace, ušetřit značné finanční prostředky, předejít invalidizaci, což se příznivě projeví jak u našich pacientů, tak i v celé společnosti.
Diabetic foot lesions are a major problem with a high morbidity, mortality and financial impact. Amputation rates cause a significant disability of the patients in spite of aggressive therapy. In this short review attention is focused on the possibility to reduce amputations and subsequent complications of diabetes mellitus with hyperbaric oxygen therapy. The patients should be treated twice daily at a pressure of 0.25-0.28 MPa for 90-120 minutes of oxygen breathing, 2-3 treatments, in refractory cases more treatment is required. When the infection in under control and the soft tissue improves treatment once daily is adequate. Hyperbaric oxygen therapy significantly reduces major amputations, the length of hospital stay, reduces economic costs and prevents amputations. This manifests favourably in our patients and our society as a whole.
