The use of the pulse oximetric saturation to fraction of inspired oxygen ratio in an automated acute respiratory distress syndrome screening tool

Abstract COVID-19 affects millions of patients worldwide, with clinical presentation ranging from isolated thrombosis to acute respiratory distress syndrome (ARDS) requiring ventilator support. Neutrophil extracellular traps (NETs) originate from decondensed chromatin released to immobilize pathogens, and they can trigger immunothrombosis. We studied the connection between NETs and COVID-19 severity and progression. We conducted a prospective cohort study of COVID-19 patients (n = 33) and age- and sex-matched controls (n = 17). We measured plasma myeloperoxidase (MPO)-DNA complexes (NETs), platelet factor 4, RANTES, and selected cytokines. Three COVID-19 lung autopsies were examined for NETs and platelet involvement. We assessed NET formation ex vivo in COVID-19 neutrophils and in healthy neutrophils incubated with COVID-19 plasma. We also tested the ability of neonatal NET-inhibitory factor (nNIF) to block NET formation induced by COVID-19 plasma. Plasma MPO-DNA complexes increased in COVID-19, with intubation (P < .0001) and death (P < .0005) as outcome. Illness severity correlated directly with plasma MPO-DNA complexes (P = .0360), whereas Pao2/fraction of inspired oxygen correlated inversely (P = .0340). Soluble and cellular factors triggering NETs were significantly increased in COVID-19, and pulmonary autopsies confirmed NET-containing microthrombi with neutrophil-platelet infiltration. Finally, COVID-19 neutrophils ex vivo displayed excessive NETs at baseline, and COVID-19 plasma triggered NET formation, which was blocked by nNIF. Thus, NETs triggering immunothrombosis may, in part, explain the prothrombotic clinical presentations in COVID-19, and NETs may represent targets for therapeutic intervention.

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Biomarkers of acute respiratory distress syndrome in adults hospitalised for severe SARS-CoV-2 infection in Tenerife Island, Spain

BMC Research Notes ◽

10.1186/s13104-020-05402-w ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Juan Marco Figueira Gonçalves ◽

José María Hernández Pérez ◽

Marco Acosta Sorensen ◽

Aurelio Luis Wangüemert Pérez ◽

Elena Martín Ruiz de la Rosa ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Significant Negative Correlation ◽

Protein Levels ◽

Reactive Protein ◽

Infected Adult ◽

Tenerife Island ◽

Fraction Of Inspired Oxygen

Abstract Objective The dramatic spread of SARS-CoV-2 infections calls for reliable, inexpensive tools to quickly identify patients with a poor prognosis. In this study, acute respiratory distress syndrome (ARDS) was assessed within 72 h after admission of each of 153 consecutive, SARS-CoV-2 infected, adult patients to either of two hospitals in Tenerife, Spain, using suitable routine laboratory tests for lymphocyte counts, as well as ferritin, lactate dehydrogenase (LDH), and C-reactive protein levels. Results were correlated with the patients’ respiratory function, defined through their pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) ratio. Results Within 72 h from admission, criteria matched ARDS (SpO2/FiO2 < 235) in 13.1% of cases. We found a significant, negative correlation between SpO2/FiO2 ratios and d-dimer, ferritin, and LDH levels (− 0.31, − 0.32, and − 0.41; p = 0.004, 0.004, and < 0.0001, respectively). In patients with ARDS, the mean LDH was 373 U/L (CI95%: 300.6–445.3), but only 298 U/L (CI95%: 274.7–323.1) when they did not develop the syndrome (p = 0.015). None of the additionally evaluated biomarkers correlated with the SpO2/FiO2 ratios. Serum LDH levels in patients hospitalised for COVID-19 correlate with ARDS, as defined by their SpO2/FiO2 ratio, and might help to predict said complication.

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Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome

Anesthesiology ◽

10.1097/aln.0000000000002508 ◽

2019 ◽

Vol 130 (2) ◽

pp. 263-283 ◽

Cited By ~ 12

Author(s):

Tài Pham ◽

Ary Serpa Neto ◽

Paolo Pelosi ◽

John Gerard Laffey ◽

Candelaria De Haro ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Peak Inspiratory Pressure ◽

Primary Objective ◽

Oxygen Fraction ◽

Large Observational Study ◽

Fraction Of Inspired Oxygen ◽

Alveolar Oxygen

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: “worsening” if moderate or severe acute respiratory distress syndrome criteria were met, “persisting” if mild acute respiratory distress syndrome criteria were the most severe category, and “improving” if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. Results Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. Conclusions Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.

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Multicenter Trial of Single-Dose Modified Bovine Surfactant Extract (Survanta) for Prevention of Respiratory Distress Syndrome

PEDIATRICS ◽

10.1542/peds.85.6.1092 ◽

1990 ◽

Vol 85 (6) ◽

pp. 1092-1102

Author(s):

Roger F. Soll ◽

Ronald E. Hoekstra ◽

John J. Fangman ◽

Anthony J. Corbet ◽

James M. Adams ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Airway Pressure ◽

Distress Syndrome ◽

Clinical Status ◽

Supplemental Oxygen ◽

Assisted Ventilation ◽

Fraction Of Inspired Oxygen ◽

Alveolar Oxygen ◽

Inspired Oxygen

A multicenter, prospective randomized controlled trial was performed comparing the efficacy of a single intratracheal dose of modified bovine surfactant extract (Survanta, 100 mg/kg, Abbott Laboratory, North Chicago, IL) with air placebo in preventing respiratory distress syndrome. Infants were enrolled if they were estimated to be between 24 and 30 weeks' gestation, weighed between 750 and 1250 g, and were intubated and stabilized within 15 minutes after birth. A total of 160 infants were treated (79 with surfactant, 81 with air placebo) between 4 and 37 minutes after birth (median time 12 minutes). Of these, 5 infants were excluded from the final analysis. The 72-hour average values for the arterial-alveolar oxygen ratio, fraction of inspired oxygen, and mean airway pressure were calculated from the area under the curve of scheduled values measured throughout 72 hours. Clinical status was classified using five ordered categories (no supplemental oxygen or assisted ventilation, supplemental oxygen only, continuous positive airway pressure or assisted ventilation with intermittent mandatory ventilation ≤6 breaths/min, assisted ventilation with intermittent mandatory ventilation >6 breaths/min, death). Chest radiographs at 24 hours were graded for severity of respiratory distress syndrome. Infants receiving Survanta had less severe radiographic changes at 24 hours of age and decreased average fraction of inspired oxygen (31% vs 42%, P = .002) compared with control infants. No differences were noted in the average arterial-alveolar oxygen ratio, mean airway pressure, or clinical status on days 7 and 28. A beneficial effect was noted in the incidence of pneumothorax (P = .057) and an increase was noted in the incidence of necrotizing enterocolitis (P = .052). No differences in incidence of patent ductus arteriosus, intraventricular hemorrhage, sepsis, or bronchopulmonary dysplasia were seen. According to results of a secondary analysis, there was improvement in the fraction of inspired oxygen and a greater number of survivors without bronchopulmonary dysplasia in the subgroup of infants weighing <1000 g who were treated with surfactant. It was concluded that a single dose of Survanta given shortly after birth resulted in decreased severity of chest radiographic findings 24 hours after treatment and improved oxygenation during 72 hours after treatment, but did not improve other acute measures of disease severity or clinical status later in the neonatal period. The group at highest risk for respiratory distress syndrome (infants with birth weights between 750 and 999 g) may benefit the most from preventive therapy.

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Fraction of Inspired Oxygen as a Predictor of CPAP Failure in Preterm Infants with Respiratory Distress Syndrome: A Prospective Multicenter Study

Neonatology ◽

10.1159/000499674 ◽

2019 ◽

Vol 116 (2) ◽

pp. 171-178 ◽

Cited By ~ 8

Author(s):

Ewa Gulczyńska ◽

Tomasz Szczapa ◽

Roman Hożejowski ◽

Maria Katarzyna Borszewska-Kornacka ◽

Magdalena Rutkowska

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Preterm Infants ◽

Multicenter Study ◽

Distress Syndrome ◽

Prospective Multicenter Study ◽

Fraction Of Inspired Oxygen ◽

Inspired Oxygen ◽

Cpap Failure

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A Device for Improving Oxygenation in Patients With Acute Respiratory Distress Syndrome

2018 Design of Medical Devices Conference ◽

10.1115/dmd2018-6838 ◽

2018 ◽

Author(s):

Alex Gordon ◽

Kevin Ai Xin Jue Luo ◽

Rami Saab ◽

Doreen Engelberts ◽

Brian Kavanagh ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Blood Oxygenation ◽

Abdominal Pressure ◽

Healthy Humans ◽

Sensor Module ◽

Lower Lung ◽

Fraction Of Inspired Oxygen

In this paper we present a device for improving blood oxygenation in patients with Acute Respiratory Distress Syndrome (ARDS). ARDS is caused by lung-related illness or injury, and can occur in mechanically ventilated ICU patients due to volutrauma or barotrauma. In ARDS, the lower lung is closed resulting in impaired gas exchange, and the upper lung is easily overstretched resulting in injury. The application of continuous negative abdominal pressure (CNAP) assists in opening the lower lung by pulling the diaphragm towards the abdomen. The device, consisting of a rigid arch, a compliant patient interface, and a pressure sensor module, allows for the application of CNAP to a patient suffering from ARDS. An initial pig trial using the prototype device showed significant improvement in the ratio of oxygen in the blood to the fraction of inspired oxygen, PaO2/FiO2, after five minutes of −5 cmH2O pressure application. Furthermore, preliminary testing on healthy humans indicated the device was comfortable, easy to apply, and formed a consistent airtight seal. Future prototypes will focus on ease of application, rigidity, and adjustability.

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FiO2 Before Surfactant, but Not Time to Surfactant, Affects Outcomes in Infants With Respiratory Distress Syndrome

Frontiers in Pediatrics ◽

10.3389/fped.2021.734696 ◽

2021 ◽

Vol 9 ◽

Author(s):

Piotr Kruczek ◽

Paweł Krajewski ◽

Roman Hożejowski ◽

Tomasz Szczapa

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Daily Practice ◽

Therapy Failure ◽

Fraction Of Inspired Oxygen ◽

Post Hoc ◽

The Impact ◽

Inspired Oxygen ◽

Clinical Characteristic

Aim: To establish the impact of oxygen requirement before surfactant (SF) and time from birth to SF administration on treatment outcomes in neonatal respiratory distress syndrome (RDS).Methods: We conducted a post-hoc analysis of data from a prospective cohort study of 500 premature infants treated with less invasive surfactant administration (LISA). LISA failure was defined as the need for early (<72 h of life) mechanical ventilation (MV). Baseline clinical characteristic parameters, time to SF, and fraction of inspired oxygen (FiO2) prior to SF were all included in the multifactorial logistic regression model that explained LISA failure.Results: LISA failed in 114 of 500 infants (22.8%). The median time to SF was 2.1 h (IQR: 0.8–6.7), and the median FiO2 prior to SF was 0.40 (IQR: 0.35–0.50). Factors significantly associated with LISA failure were FiO2 prior to SF (OR 1.03, 95% CI 1.01–1.04) and gestational age (OR 0.82, 95 CI 0.75–0.89); both p <0.001. Time to SF was not an independent risk factor for therapy failure (p = 0.528) or the need for MV at any time during hospitalization (p = 0.933).Conclusions: The FiO2 before SF, but not time to SF, influences the need for MV in infants with RDS. While our findings support the relevance of FiO2 in SF prescription, better adherence to the recommended FiO2 threshold for SF (0.30) is required in daily practice.

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