Concurrent Heat and Intermittent Hypoxic Training: No Additional Performance Benefit Over Temperate Training

2020 ◽  
Vol 15 (9) ◽  
pp. 1260-1271
Author(s):  
Erin L. McCleave ◽  
Katie M. Slattery ◽  
Rob Duffield ◽  
Stephen Crowcroft ◽  
Chris R. Abbiss ◽  
...  
Keyword(s):  
Relative Humidity ◽  
Interval Training ◽  
Intermittent Hypoxic Training ◽  
Hypoxic Training ◽  
Temperate Environment ◽  
Fraction Of Inspired Oxygen ◽  
Hemoglobin Mass ◽  
C 50 ◽  
Inspired Oxygen ◽  
Independent Heat

Purpose: To examine whether concurrent heat and intermittent hypoxic training can improve endurance performance and physiological responses relative to independent heat or temperate interval training. Methods: Well-trained male cyclists (N = 29) completed 3 weeks of moderate- to high-intensity interval training (4 × 60 min·wk−1) in 1 of 3 conditions: (1) heat (HOT: 32°C, 50% relative humidity, 20.8% fraction of inspired oxygen, (2) heat + hypoxia (H+H: 32°C, 50% relative humidity, 16.2% fraction of inspired oxygen), or (3) temperate environment (CONT: 22°C, 50% relative humidity, 20.8% fraction of inspired oxygen). Performance 20-km time trials (TTs) were conducted in both temperate (TTtemperate) and assigned condition (TTenvironment) before (base), immediately after (mid), and after a 3-week taper (end). Measures of hemoglobin mass, plasma volume, and blood volume were also assessed. Results: There was improved 20-km TT performance to a similar extent across all groups in both TTtemperate (mean ±90% confidence interval HOT, −2.8% ±1.8%; H+H, −2.0% ±1.5%; CONT, −2.0% ±1.8%) and TTenvironment (HOT, −3.3% ±1.7%; H+H, −3.1% ±1.6%; CONT, −3.2% ±1.1%). Plasma volume (HOT, 3.8% ±4.7%; H+H, 3.3% ±4.7%) and blood volume (HOT, 3.0% ±4.1%; H+H, 4.6% ±3.9%) were both increased at mid in HOT and H+H over CONT. Increased hemoglobin mass was observed in H+H only (3.0% ±1.8%). Conclusion: Three weeks of interval training in heat, concurrent heat and hypoxia, or temperate environments improve 20-km TT performance to the same extent. Despite indications of physiological adaptations, the addition of independent heat or concurrent heat and hypoxia provided no greater performance benefits in a temperate environment than temperate training alone.

Pronation Technique in ARDS Patients

ABOUTOPEN ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 21-23
Author(s):  
Raffaele Di Fenza ◽  
Hedwige Gay ◽  
Martina Favarato ◽  
Isabella Fontana ◽  
Roberto Fumagalli
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Distress Syndrome ◽  
Daily Practice ◽  
Volume Distribution ◽  
Intensive Care Unit Staff ◽  
Safe Technique ◽  
Fraction Of Inspired Oxygen ◽  
And Diffusion ◽  
Inspired Oxygen

In severe acute respiratory distress syndrome (ARDS), characterized by the ratio of arterial partial pressure of oxygen over fraction of inspired oxygen (P/F) less than 150 mm Hg, pronation cycles are the only intervention that showed improved survival, in combination with protective ventilation. The physiological advantages of performing pronation cycles, such as the improvement of oxygenation, better tidal volume distribution with increased involvement of dorsal regions, and easier drainage of secretions, overcome the possible complications, that is, endotracheal tube occlusion or misplacement, pressure ulcers, and brachial plexus injury. However, the incidence of complications is dramatically lower in intensive care units with expertise, adopting prone positioning in daily practice. In this video we are proposing step by step an easy and ergonomic technique to perform pronation maneuvers in patients with severe ARDS. Recent literature suggests that a high percentage of these patients are treated without undergoing pronation cycles. The main purpose of this video is to help increase the number of intensive care units worldwide commonly performing pronation cycles in patients that have indications to be pronated, in order to decrease healthcare burden and costs directly caused by ARDS. Proper intensive care unit staff training is fundamental in minimizing the risks associated with the maneuver for both patients and operators; and diffusion of a safe technique encouraging the operators is the second main purpose of this video.

scholarly journals Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: a case series

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Andrew G. Weber ◽  
Alice S. Chau ◽  
Mikala Egeblad ◽  
Betsy J. Barnes ◽  
Tobias Janowitz
Keyword(s):  
Case Series ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Dornase Alfa ◽  
Extracellular Traps ◽  
Dnase 1 ◽  
Fraction Of Inspired Oxygen ◽  
Oxygen Requirements ◽  
Inspired Oxygen ◽  
Ventilated Patients

Abstract Background Mechanically ventilated patients with COVID-19 have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation. DNA from neutrophil extracellular traps (NETs) contribute to the viscosity of mucopurulent secretions and NETs are found in the serum of COVID-19 patients. Dornase alfa is recombinant human DNase 1 and is used to digest DNA in mucoid sputum. Here, we report a single-center case series where dornase alfa was co-administered with albuterol through an in-line nebulizer system. Methods Demographic and clinical data were collected from the electronic medical records of five mechanically ventilated patients with COVID-19—including three requiring veno-venous extracorporeal membrane oxygenation—treated with nebulized in-line endotracheal dornase alfa and albuterol, between March 31 and April 24, 2020. Data on tolerability and response were analyzed. Results The fraction of inspired oxygen requirements was reduced for all five patients after initiating dornase alfa administration. All patients were successfully extubated, discharged from hospital and remain alive. No drug-associated toxicities were identified. Conclusions Results suggest that dornase alfa will be well-tolerated by patients with severe COVID-19. Clinical trials are required to formally test the dosing, safety, and efficacy of dornase alfa in COVID-19, and several have been recently registered.

scholarly journals Inhaled Epoprostenol for Pulmonary Hypertension Treatment in Neonates: A 12-Year Experience

2018 ◽  
Vol 36 (11) ◽  
pp. 1142-1149 ◽  
Author(s):  
Frédérique Berger-Caron ◽  
Bruno Piedboeuf ◽  
Geneviève Morissette ◽  
David Simonyan ◽  
Philippe Chétaille ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Side Effects ◽  
Retrospective Cohort ◽  
Rebound Effect ◽  
Oxygenation Index ◽  
Pediatric Intensive Care ◽  
Primary Objective ◽  
Hypertension Treatment ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

Background Persistent pulmonary hypertension of the newborn (PPHN) occurs in 10% of neonatal respiratory insufficiency. To selectively reduce pulmonary vascular resistance, several treatments have been tried. Inhaled epoprostenol (iPGI2) has been used for 12 years in our institution for the management of refractory PPHN despite the gaps in the literature to support this use. Objectives The primary objective was to evaluate the efficacy of iPGI2 for PPHN. The secondary objectives were to describe its use in neonates and assess side effects. Study Design This retrospective cohort study included infants < 28 days with PPHN treated with iPGI2 in the neonatal or pediatric intensive care units of our institution between 2004 and 2016. Results We reviewed 43 patient' care episodes (mean gestational age of 36 weeks). This was an extremely ill population with 54% mortality rate. Oxygenation index improved significantly after 12-hour treatment (p = 0.047), with a rebound effect when discontinuing nebulization. By the end of the therapy, the fraction of inspired oxygen had significantly dropped (p = 0.0018). Echocardiographic markers tended to normalize during treatment. No potential side effects were reported. Conclusion In these sick newborns, we observed an improvement in PPHN under iPGI2 without significant adverse effects. To our knowledge, this is the largest neonatal cohort reported to have received iPGI2 for PPHN.

scholarly journals Knobmanship: Dialing Up Understanding of VAE Triggers

2021 ◽  
Vol 1 (S1) ◽  
pp. s80-s81
Author(s):  
Kelly Cawcutt ◽  
Mark Rupp ◽  
Lauren Musil
Keyword(s):  
Chart Review ◽  
Clinical Care ◽  
Trigger Points ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Review Period ◽  
Fraction Of Inspired Oxygen ◽  
Provider Bias ◽  
Inspired Oxygen ◽  
Ventilated Patients

Background: Mechanical ventilation is a lifesaving therapy for critically ill patients. Hospitals perform surveillance for the NHSN for ventilator-associated events (VAE) by monitoring mechanically ventilated patients for metrics that are generally thought to be objective and preventable and that lead to poor patient outcomes. The VAE definition is met in a stepwise manner; initially, a ventilator-associated condition (VAC) is triggered with an increase in positive end-expiratory pressure (PEEP, >3 cm H2O) or fraction of inspired oxygen (FIO2, 0.20 or 20 points) after a period of stability or improvement on the ventilator. We believe that many reported VAEs could be avoided by provider and respiratory therapy attention to “knobmanship.” We define knobmanship as knowledge of the VAE definition and trigger points combined with appropriate clinical care for mechanically ventilated patients while avoiding unnecessary triggering of the VAE definition by avoiding small unneeded changes in PEEP or FIO2. Methods: We performed a chart review of 283 patients who had a reported VAE to the NHSN between January 1, 2019, and December 31, 2020. We collected data including type of VAE, VAE triggering criteria, and clinical course. Results: Of the 283 VAEs, 59 were triggered by a PEEP increase from 5 to 8 with stable or decreasing FIO2. Of the 59 VAEs, 33 were VACs, 18 were infection-related ventilator- associated complications (IVACs), and 8 were possible ventilator-associated pneumonia (PVAP). Most of these transient changes in PEEP were deemed clinically unnecessary. A 21% reduction of VAEs reported to the NSHN over the 2-year review period could have been avoided by knobmanship. Conclusions: The VAE definition may often be triggered by provider bias to the ventilator settings rather than what the patient’s clinical-condition requires. Attention to knobmanship may result in substantial decrease in reported VAE.Funding: NoDisclosures: None

scholarly journals Effect of intermittent hypoxic training on orthostatic tolerance in humans before and after simulated microgravity

2020 ◽  
Author(s):  
VP Katuntsev ◽  
TV Sukhostavtseva ◽  
AN Kotov ◽  
MV Baranov
Keyword(s):  
Orthostatic Intolerance ◽  
Bed Rest ◽  
Daily Basis ◽  
Tilt Test ◽  
Control Group ◽  
Orthostatic Tolerance ◽  
Pronounced Increase ◽  
Intermittent Hypoxic Training ◽  
Hypoxic Training ◽  
Before And After

Reduced orthostatic tolerance (OT) is a serious concern facing space medicine. This work sought to evaluate the effects of intermittent hypoxic training (IHT) on OT in humans before and after 3 days of head-down bed rest (HDBR) used to model microgravity. The study was carried out in 16 male volunteers aged 18 to 40 years and included 2 series of experiments with 11-day and 21-day IHT administered on a daily basis. During the first IHT session, the concentration of oxygen in the inspired gas mixture was 10%; for other sessions it was adjusted to 9%. OT was assessed by a 20-minute-long orthostatic tilt test (OTT) conducted before and after HDBR. Before HDBR, orthostatic intolerance was observed in 3 participants, while after HDBR, it was observed in 9 of 16 volunteers (p < 0.05). During OTT conducted after HDBR, the heart rate (HR) exceeded control values by 26.8% (p < 0.01). Preexposure to any of the applied IHT regimens led to a reduction in the number of volunteers with orthostatic intolerance. After the 11-day IHT program, there was a less pronounced increase in HR during OTT before HDBR; with the extended IHT regimen, less pronounced changes were observed for HR, systolic, diastolic and mean blood pressure (BP). The increase in HR during OTT after HDBR was significantly lower in the group that had completed the 11-day IHT program, while BP remained stable. The changes in HR and systolic BP were less pronounced in the group that had completed the 21-day IHT program than in the control group (p < 0.05). Thus, IHT reduced the risk of orthostatic disorders and mitigated changes in cardiovascular parameters during the orthostatic test.

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