1.
High flow nasal cannulae oxygen therapy in acute-moderate hypercapnic respiratory failure.
Lee, MK, Choi, J, Park, B, Kim, B, Lee, SJ, Kim, SH, Yong, SJ, Choi, EH, Lee, WY
The clinical respiratory journal. 2018;(6):2046-2056
Abstract
INTRODUCTION Severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a significant event that results in substantial mortality. OBJECTIVES We evaluated the effectiveness of the high flow nasal cannulae (HFNC) therapy in severe AECOPD with moderate hypercapnic acute respiratory failure (ARF) compared to non-invasive ventilation (NIV). METHODS The prospective observational trial was performed to compare the effectiveness between the HFNC and NIV in severe AECOPD with moderate hypercapnic ARF. The end point was the intubation rate and 30-day mortality. RESULTS Ninety-two AECOPD patients enrolled during study periods. The median age was 73 (66.5-79) years, and 57 patients (64.8%) were male. Forty-four patients were assigned to HFNC, and 44 patients were assigned to NIV. The intubation rate at day 30 was 25.0% in the HFNC group and 27.3% in the NIV group (P = .857), and the 30-day mortality was 15.9% in the HFNC group and 18.2% in the NIV group (P = .845). The pH (7.38 ± 0.59 vs 7.36 ± 0.10, P = .295), PaO2 (82.2 ± 24.9 vs 81.6 ± 21.7 mm Hg, P = .899) and PaCO2 (46.8 ± 15.2 vs 51.7 ± 17.2 mm Hg, P = .160) after 6 hours and the pH (7.39 ± 0.07 vs 7.39 ± 0.08, P = .743), PaO2 (84.3 ± 18.5 vs 84.7 ± 23.2 mm Hg, P = .934) and PaCO2 (47.0 ± 16.0 vs 49.6 ± 13.7 mm Hg, P = .422) after 24 hours were not significantly different. CONCLUSION There was no difference of the 30-day mortality and intubation rate between HFNC and NIV groups.
2.
Oxygen and parenteral nutrition two main oxidants for extremely preterm infants: 'It all adds up'.
Mohamed, I, Elremaly, W, Rouleau, T, Lavoie, JC
Journal of neonatal-perinatal medicine. 2015;(3):189-97
Abstract
OBJECTIVES To assess the effect of early exposure to O2 and parenteral nutrition (PN) on oxidative stress at 36 weeks post-menstrual age (PMA) and on bronchopulmonary dysplasia (BPD) in extremely preterm infants. STUDY DESIGN A prospective observational study including 116 infants <29 weeks of gestation. Baseline clinical characteristics, FiO2 on day 7, duration of PN and clinical outcomes data were collected. In 39 infants, whole blood glutathione (GSH) and oxidized glutathione (GSSG) at 36 weeks PMA were measured and the redox potential was calculated using Nernst equation. Student's t-test, Chi-square, Spearman correlation, ANOVA, and logistic regression analyses were used as appropriate. P < 0.05 was considered significant. RESULTS FiO2 ≥25% was associated with higher level of GSSG (0.29 ± 0.04 versus 0.18 ± 0.02 nmol/mg of protein), a more oxidized redox potential (-191 ± 2 versus -198 ± 2 mV) and more BPD (90% versus 45%). PN duration >14 days was also associated with higher level of GSSG (0.26 ± 0.03 versus 0.13 ± 0.02 nmol/mg of protein), a more oxidized redox potential (-193 ± 5 versus -203 ± 2 mV) and more BPD (89% versus 24%). In logistic regression model, each 1% increase in FiO2 and each day increase in PN duration resulted in an increase in the OR for BPD by 1.57 (1.09 -2.28) and 1.17 (1.03 -1.33) respectively. CONCLUSION Early O2 supplement and PN have additive effects that were associated with prolonged oxidative stress and increased risk of BPD. Strategies targeting judicious use of O2 and decreasing the duration or developing a safer formulation of PN can be targeted to decrease BPD.