Hypoxemia

Acute respiratory distress syndrome (ARDS) is a syndrome, a combination of clinical and physiological observations that describe a pathological state. The pathogenesis of ARDS is not completely clear and there is no gold standard for diagnosis. ARDS is characterized by non-cardiogenic pulmonary edema, inflammation of the lungs, hypoxemia, and decreased lung compliance. Acute is defined as a symptom that occurs within one week of a known risk factor. Early clinical manifestations are shortness of breath (dyspneu and tachypneu) which then quickly develop into respiratory failure. ARDS was first described in 1967 by Asbaugh, et al., then the AECC made a definition that was finally refined by Berlin's criteria. Berlin's criteria divided the degree of hypoxemia into 3, namely mild, moderate, and severe, based on the arterial PO2 / FiO2 ratio and the need for PEEP (5 cm H2O or more) which can be given via endotracheal tube or non-invasive ventilation. Sepsis, aspiration of fluid or gastric contents, and multipe transfusion (>15 units/24 hours) are associated with a high risk of ARDS. Cases of ARDS related to pulmonary sepsis, such as pneumonia, inhalational trauma, and pulmonary contusions are as much as 46% or non-pulmonary sepsis as much as 33%. ARDS management includes oxygen therapy and supportive therapy, such as hemodynamics, pharmacotherapy, and nutrition. Further studies are still needed to get a good outcome for ARDS patients.

Cite this article Kozinn R, Foley L, Feinleib J. SuperNOVA nasal mask ventilation maintains oxygenation during deep sedation in high-risk patients: A case series. Anesthesiol Open With the convergence of two major medical trends, increasing obesity and the expansion of minimally invasive procedures come new challenges for airway management. In this case series we describe the use of a nasal ventilation mask, SuperNO 2 VA TM , in 10 patients at high-risk for sedation-induced airway obstruction and hypoxemia that required procedural sedation. This well tolerated device produced nasal oxygenation and positive airway pressure (PAP) that maintained oxygen saturation (SpO 2) > 97.0% throughout the cases. These encouraging outcomes suggest the utility of pressurized nasal ventilation masks, such as the Super-NO 2 VA TM , in patients at risk for airway obstruction requiring procedural sedation.

Intensivists and respirologists are very likely to encounter patients with OHS and AHRF. A high index of suspicion is needed to avoid misdiagnosis and delayed treatment that can only worsen morbidity and mortality and increase healthcare costs. Despite a lack of relevant RCTS, there is now a consensus that NIV is the first-line treatment for OHS presenting with acute-on-chronic hypercapnic respiratory failure. In this setting, NIV improves alveolar ventilation, hypercapnia, and hypoxemia, avoids invasive ventilation, and probably decreases the frequency of adverse outcomes.

In twelve hypoxemic patients with severe chronic obstructive pulmonary disease (COPD), red cell 2,3-diphosphoglycerate (2,3-DPG) correlated significantly with arterial Po 2 (p 2 . Arterial pH seems to be the best predictor of red cell 2,3-DPG in acute hypoxemia and metabolic acid-base disorders while arterial Po 2 or a related factor is pre-eminent in stable COPD.

Background: Data are lack on predicting features of meningitis in diarrheal children although the great clinical importance. Objective: To evaluate clinical and laboratory features in predicting meningitis in under-fifteen children having diarrheal illnesses. Methods: Children aged 1 month to 15 years, admitted in the ICU of the Dhaka Hospital of icddr, b between March 2011 and February 2012 with fever and seizure or altered consciousness and having LP done were enrolled into this analysis. Those children who had abnormal CSF findings [pleocytosis (normal range of leukocyte, 0 - 10/mm3) and/or elevated protein (normal range, 0.10 - 0.45 mg/dl) and low glucose (normal value, 60% of corresponding blood glucose)] were defined as meningitis. Comparison was made between children with (cases = 17) and without meningitis (controls = 66) from our study children. Data were retrospectively collected from SHEBA, an online database system of the Dhaka Hospital of icddr, b. Results: Death was significantly higher among the cases compared to the controls (29% vs. 3%, p = 0.003). In logistic regression analysis, after adjusting for potential confounders, cases frequently had hypoxemia (95% CI 1.55 - 21.93), absent peripheral pulse (95% CI 1.95 - 27.13) and neutrophilia (95% CI 1.13 - 17.00). Conclusion: Our data suggest that children with meningitis had higher case fatality rate. Simple independent predictors of meningitis such as hypoxemia, absent peripheral pulse, and neutrophilia may help clinicians to initiate early and prompt management in order to curve lifelong sequel due to meningitis and death in such patient population especially those in resource poor settings.

Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 

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